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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.
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A patient is asking advice about which over-the-counter antacid is considered the most safe to use for heartburn. The nurse explains that the reason that calcium antacids are not used as frequently as other antacids is for which of these reasons?
- A. Their use may result in kidney stones.
- B. They cause decreased gastric acid production.
- C. They cause severe diarrhea.
- D. Their use may result in fluid retention and edema.
Correct Answer: A
Rationale: Calcium antacids are not used as frequently as other antacids because their use may lead to the development of kidney stones; they also cause increased gastric acid production.
The nurse is providing patient teaching about antacids. Which statements about antacids are accurate? (Select all that apply.)
- A. Antacids reduce the production of acid in the stomach.
- B. Antacids neutralize acid in the stomach.
- C. Rebound hyperacidity may occur with calcium-based antacids.
- D. Aluminum-based antacids cause diarrhea.
- E. Magnesium-based antacids cause diarrhea.
Correct Answer: B,C,E
Rationale: Antacids neutralize acid in the stomach. Magnesium-based antacids cause diarrhea, and aluminum-based antacids cause constipation. Calcium-based antacids often cause rebound hyperacidity.
At 0900, the nurse is about to give morning medications, and the patient has asked for a dose of antacid for severe heartburn. Which schedule for the antacid and medications is correct?
- A. Give both the antacid and medications at 0900.
- B. Give the antacid at 0900, and then the medications at 0900.
- C. Give the medications at 0900, and then the antacid at 1900.
- D. Give the medications at 0900, and then the antacid at 0915.
Correct Answer: C
Rationale: Medications are not to be taken, unless prescribed, within 1 to 2 hours of taking an antacid because of the impact on the absorption of many medications in the stomach.
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 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.