Nokea
A patient who has been taking cimetidine for hyperacidity calls the clinic to say that the medication has not been effective. The nurse reviews his history and notes that which factor may be influencing the effectiveness of this drug?
- A. He takes the cimetidine with meals.
- B. He smokes two packs of cigarettes a day.
- C. He drinks a glass of water with each dose.
- D. He takes an antacid 3 hours after the cimetidine dose.
Correct Answer: B
Rationale: Smoking may impair the absorption of H2 antagonists.
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An older adult patient had gastric surgery due to a gastrointestinal bleed 3 days ago, and he has been stable since the surgery. This evening, his daughter tells the nurse, 'He seems to be more confused this afternoon. He's never been like this.' What could be the problem? The nurse reviews the patient's medication record and suspects that which drug could be the cause of the patient's confusion?
- A. Cimetidine
- B. Pantoprazole
- C. Clarithromycin
- D. Sucralfate
Correct Answer: A
Rationale: Sometimes H2 receptor antagonists such as cimetidine may cause adverse effects related to the central nervous system in the older adult, including confusion and disorientation.
The nurse is teaching a patient who will be taking a proton pump inhibitor as long-term therapy about potential adverse effects. Which statement is correct?
- A. Proton pump inhibitors can cause diarrhea.
- B. These drugs can cause nausea and anorexia.
- C. Proton pump inhibitors cause drowsiness.
- D. Long-term use of these drugs may contribute to osteoporosis.
Correct Answer: D
Rationale: New concerns have arisen over the potential for long-term users of proton pump inhibitors (PPIs) to develop osteoporosis. This is thought to be due to the inhibition of stomach acid, and it is speculated that PPIs speed up bone mineral loss.
During an admission assessment, the patient tells the nurse that he has been self-treating his heartburn for 1 year with over-the-counter Prilosec OTC (omeprazole, a proton pump inhibitor). The nurse is aware that this self-treatment may have which result?
- A. No serious consequences
- B. Prevention of more serious problems, such as an ulcer
- C. Chronic constipation
- D. Masked symptoms of serious underlying diseases
Correct Answer: D
Rationale: Long-term self-medication with antacids may mask symptoms of serious underlying diseases, such as bleeding ulcer or malignancy. Patients with ongoing symptoms need to undergo regular medical evaluations, because additional medications or other interventions may be needed.
A patient has excessive and painful gas. The nurse checks the patient's medication orders and prepares to administer which drug for this problem?
- A. Famotidine
- B. Aluminum hydroxide and magnesium hydroxide
- C. Calcium carbonate
- D. Simethicone
Correct Answer: D
Rationale: Simethicone alters the elasticity of mucus-coated bubbles, causing them to break, and is an over-the-counter antiflatulent.
A patient in the intensive care unit has a nasogastric tube and is also receiving a proton pump inhibitor (PPI). The nurse recognizes that the purpose of the PPI is which effect?
- A. Prevent stress ulcers.
- B. Reduce bacteria levels in the stomach.
- C. Reduce gastric gas formation (flatulence).
- D. Promote gastric motility.
Correct Answer: A
Rationale: Stress-related mucosal damage is an important issue for critically ill patients. Stress ulcer prophylaxis (or therapy to prevent severe gastrointestinal [GI] damage) is undertaken in almost every critically ill patient in an intensive care unit and for many patients on general medical surgical units. Guidelines suggest that all such patients receive either a histamine receptor-blocking drug or a proton pump inhibitor.