Chapter 20: Drugs for Gastric Ulcers and Reflux Nursing School Test Banks

Workman: Understanding Pharmacology

Chapter 20: Drugs for Gastric Ulcers and Reflux

Test Bank

MULTIPLE CHOICE

1. Which protective mechanism by the stomach protects it from stomach acids and the formation of gastric ulcers?
a. Buffers such as bicarbonate neutralize stomach acids.
b. The stomach secretes a thick gel-like mucus to coat itself.
c. Acid secretion is decreased when food is not present in the stomach.
d. Stomach secretions such as lipase digest foods and protect the stomach.
ANS: B
The stomach secretes a thick gel-like mucus that coats and protects it from contact with stomach acids. Acid production is usually balanced by mucous secretion. When acid production exceeds mucous production, the risk for tissue damage and ulcer formation increases.

PTS: 0 DIF: Cognitive Level: Remembering (Knowledge)
REF: p. 358 TOP: Nursing Process Step: N/A MSC: Client Needs Category: N/A

2. Why does the backward flow of stomach contents into the esophagus cause tissue damage?
a. No digestive processes occur in the esophagus.
b. The esophagus does not have the thick gel-like mucus to protect it from acid.
c. The esophagus secretes only bicarbonate, which is not strong enough to neutralize stomach acids.
d. The esophagus cannot expand with extra volume, and the excessive stretching damages the muscle layer.
ANS: B
The stomach is the site where protein digestion begins. Acid is secreted in the stomach to enhance this process. Because the acids can damage the stomach lining, the stomach secretes a thick, gel-like mucus to protect it. Neither the esophagus nor the duodenum has this protection. Stomach contents that reflux up into the esophagus are highly acidic and cause inflammatory damage with ulcer formation to the lining.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 358 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

3. Which factor is the cause of most peptic ulcers?
a. Excessive production of stomach acids
b. Lifestyle factors such as stress and spicy foods
c. Infection with Helicobacter pylori bacteria
d. Excessive use of drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs)
ANS: C
Historically the cause of peptic ulcers was thought to be excessive acid formation. Research has shown that 80% to 90% of gastric ulcers are caused by H. pylori infections. Lifestyle changes including stress and diet as well as acid secretion are causes, but H. pylori is the major cause of peptic ulcers.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF: p. 359 TOP: Nursing Process Step: N/A MSC: Client Needs Category: N/A

4. Which symptoms are associated with gastric ulcers?
a. Constant bloating and diarrhea
b. Shortness of breath in any position
c. Burning pain that is relieved by eating
d. Burning pain that is relieved by abstaining from food
ANS: C
The most common symptom of a peptic ulcer is burning, gnawing pain caused by stomach acid coming into contact with the open wound (ulcer). It often occurs when the stomach is empty and can be relieved by eating foods that buffer stomach acids or taking a drug that reduces stomach acid such as an antacid.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF: p. 359 TOP: Nursing Process Step: N/A MSC: Client Needs Category: N/A

5. A patient with a history of GI ulcers reports feeling new onset burning, gnawing stomach pain. What is the nurses best action?
a. Assess the patients abdomen for the presence of active bowel sounds.
b. Administer the already ordered as-needed dose of liquid antacid.
c. Offer the patient food to buffer excess stomach acid.
d. Notify the prescriber immediately.
ANS: D
The most common symptom of peptic ulcer is burning, gnawing pain caused by stomach acid coming into contact with an open wound (ulcer). The pain usually occurs somewhere between the navel and breastbone and may last from a few minutes to many hours. Even though foods and antacids may relieve the pain, the fact that this is new onset pain indicates that the nurse should notify the prescriber immediately.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Assessment MSC: Client Needs Category: Physiological Integrity

6. A patient who is prescribed sucralfate asks the nurse how this drug will help treat his gastric ulcer. What is the nurses best response?
a. Sucralfate decreases secretion of gastric acids to help your ulcer heal.
b. Sucralfate completely blocks the secretion of gastric acids so your ulcer can heal.
c. Sucralfate treats the infection with H. pylori that is the major cause of gastric ulcers.
d. Sucralfate forms a thick coating to cover the ulcer, protect from further damage, and allow healing.
ANS: D
Sucralfate is a cryoprotective drug. These drugs form a thick coating that covers an ulcer to protect the open sore from further damage and allow healing to occur. Histamine blockers decrease secretion of gastric acids. Proton pump inhibitors block secretion of gastric acids. Antibiotics are used to treat H. pylori infections.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

7. How do histamine (H2) blockers help heal gastric ulcers?
a. They promote cell division.
b. They neutralize acids that are present in the stomach.
c. They decrease the amount of acid secreted by stomach cells.
d. They increase the rate that stomach contents move into the intestinal tract.
ANS: C
Ulcers do not heal in an acidic environment. Histamine increases acid production by stimulating the stomachs parietal cells to secrete hydrochloric acid. Histamine (H2) blockers reduce the amount of histamine that is present, which then results in less stimulation of the parietal cells.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: pp. 363-364 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

8. The nurse is preparing an older adult patient who has been prescribed famotidine (Pepcid) for discharge. Which common side effect should the nurse instruct the patients family to watch for?
a. Confusion
b. Anxiety
c. Depression
d. Psychosis
ANS: A
Famotidine is a histamine H2 blocker. The most common side effect of these drugs is confusion. The nurse must teach the patients family to monitor for changes in level of consciousness and confusion and to notify the prescriber if this occurs.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 365 TOP: Nursing Process Step: Planning
MSC: Client Needs Category: Health Promotion and Maintenance

9. A patient who has been taking nizatidine (Axid) for the last month has all of the following blood laboratory results. Which result does the nurse report to the prescriber as soon as possible?
a. International normalized ratio (INR) of 0.9
b. Red blood cell count of 2 million/mm3
c. White blood cell count of 8000/mm3
d. Platelet count of 150,000/mm3
ANS: B
Nizatidine is a histamine H2 blocker. This class of drugs can cause anemia. The patients red blood cell count is more than 50% below normal.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Physiological Integrity

10. A patient with gastroesophageal reflux disease is prescribed ranitidine (Zantac). Which statement by the patient indicates to the nurse a need for additional teaching?
a. If I need to use ranitidine for more than 2 weeks, I will notify my prescriber.
b. I will look into a smoking cessation program when I go home.
c. I will take the ranitidine first thing in the morning so that its effect will last all day and night.
d. I will not drive until I know how the ranitidine affects me.
ANS: C
To prolong the effects of histamine H2 blockers like ranitidine, they should be taken with meals. If a patient takes this drug once a day, giving it at bedtime prolongs the effects when there is no food in the stomach and reflux may be worse.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation
MSC: Client Needs Category: Health Promotion and Maintenance

11. A patient who has been prescribed ranitidine (Zantac) reports darkened stools. What is the nurses best action?
a. Hold the dose and notify the prescriber.
b. Document the report as the only action.
c. Reassure the patient that this is a common and harmless side effect.
d. Ask the patient if he or she has been using aspirin or any other nonsteroidal anti-inflammatory drug (NSAID).
ANS: C
Ranitidine contains a substance that darkens the tongue and the stools. This is a harmless side effect and does not indicate a health problem. It is not a reason to stop the drug.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Psychosocial Integrity

12. A patient who has been taking cimetidine (Tagamet) for a year has all of the following symptoms. Which symptom does the nurse report immediately to the prescriber?
a. Darkened urine and white stool
b. Altered food taste and dry mouth
c. Weekly constipation with bloating
d. Reduced interest in sexual activity
ANS: A
Cimetidine can cause drug-induced hepatitis. Dark urine and white stool are symptoms of liver problems and should be investigated immediately before any damage becomes permanent. It is likely the drug will need to be discontinued.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Physiological Integrity

13. The nurse is instructing a pregnant patient about how to manage reflux. Which point about histamine H2 blockers does the nurse include in the teaching plan?
a. They are safe for use during pregnancy.
b. They may be used while breastfeeding.
c. They should only be taken with a prescribers approval.
d. They can be prescribed instead of lifestyle changes to control reflux.
ANS: C
The use of histamine H2 blockers has not been studied in pregnant women and safe use has not been established. These drugs pass into breast milk so should be avoided while breastfeeding. During pregnancy, lifestyle changes (e.g., eating more slowly, eating smaller meals) should be tried first to control reflux. Pregnant women must consult with their prescriber before taking any drug for reflux.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

14. Which precaution is most important for the nurse to teach an older patient who is starting histamine H2 blockers for gastroesophageal reflux disease (GERD)?
a. Do not drink caffeine while taking this drug.
b. Elevate the head of your bed by 6 to 10 inches.
c. Take this drug with meals and before going to bed.
d. Avoid driving until you know how this drug affects you.
ANS: D
Older adults are more likely to experience drowsiness and acute confusion when taking these drugs. They should avoid driving or operating dangerous equipment until they know how the drug affects them. Although the drug should be taken with a meal or before bedtime, the safety issue with the confusion and drowsiness has the highest priority. Avoiding caffeine and elevating the head of the bed are helpful for GERD but are not related to drug therapy.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

15. A patient who is prescribed omeprazole (Prilosec) asks the nurse why the drug should be taken before breakfast. What is the nurses best response?
a. The intended action of this drug is best achieved when given before meals, preferably in the morning.
b. It is best to take this drug in the morning so that antacids taken later in the day do not interfere with absorption.
c. This drug should always be taken on an empty stomach for maximal action and for better absorption.
d. Taking this drug early in the morning helps to minimize the occurrence of side effects or adverse effects.
ANS: A
Omeprazole is a proton pump inhibitor. These drugs work best when given before meals, preferably in the morning. Proton pump inhibitors can be given with antacids, with food, or without food.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

16. Which precaution is most important for the nurse to teach a patient who is prescribed raberprazole (Aciphex)?
a. Wear a hat and sunscreen outdoors to prevent sunburn.
b. Take this drug one hour before or two hours after a meal.
c. Drink at least 3 liters of fluid daily to prevent constipation.
d. Avoid eating raw fruits and vegetables while taking this drug.
ANS: A
Raberprazole increases sun sensitivity and patients can develop a severe sunburn if precautions are not taken. This effect also can occur in people who have very dark skin and have never before experienced a sunburn. Increased sun sensitivity is present during drug therapy and for many weeks after therapy is completed.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

17. A patient who has been prescribed rabeprazole (Aciphex) develops black, tarry stools. What is the nurses best first action?
a. Check the patients medication list for prescribed iron supplements.
b. Teach the patient that this is an expected side effect of proton pump inhibitors.
c. Send a stool sample to the lab for analysis.
d. Notify the prescriber immediately.
ANS: D
Black and tarry stools are never normal; they indicate bleeding and should be reported to the prescriber at once. Sending a stool sample to the laboratory to test for blood helps to confirm the presence of blood in the stool, but an order from the prescriber is needed to perform this action.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

18. To prevent a common risk among older adults who are prescribed proton pump inhibitors, which safety precaution does the nurse recommend?
a. Be sure to take a daily multivitamin.
b. Use handrails when going up or down stairs.
c. Take this drug with food or a full glass of fluid.
d. Notify your prescriber if you develop belching or gas.
ANS: B
Proton pump inhibitors have been associated with increased hip fracture in older adults because of decreased calcium absorption. Teach patients to use side rails when going up or down stairs.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

19. Why are older patients who are prescribed proton pump inhibitors more at risk for drug-induced hip fracture?
a. Induced drowsiness increases the risk for falling.
b. Inhibited calcium absorption makes bones more fragile.
c. Excessive potassium loss reduces muscle strength and balance.
d. Anemia and fatigue prevent participation in exercise and reduce mobility.
ANS: B
The change in acidity of stomach contents reduces the absorption of calcium through the intestinal tract. As calcium is lost from bones, it is not replaced and the bones become more fragile. More bone density is lost from the hip, making hip fractures more likely, even without a fall or other trauma.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 367 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

20. A patient with indigestion is prescribed aluminum hydroxide (Amphogel). To prevent the most common side effect of this drug, what does the nurse teach the patient?
a. Take this drug 30 minutes before each meal.
b. Do not drink fluids for at least 30 minutes after taking this drug.
c. Be sure to consume a diet with lots of vegetables and other foods with fiber.
d. Report any episodes of diarrhea immediately to your prescriber.
ANS: C
Aluminum hydroxide is an aluminum-based antacid. The most common side effect of these drugs is constipation. Patients should be taught to consume a diet rich in fiber-containing foods to prevent this side effect.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

21. Which precaution is most important for the nurse to teach a patient who is prescribed an antacid?
a. Avoid using extra pepper on your food while taking this drug.
b. If you become constipated, stop taking the antacid completely.
c. Take this drug at least 2 hours before or after taking any other drug.
d. Notify your prescriber if heartburn continues after you have taken the drug for 3 days.
ANS: C
Antacids interfere with the absorption of other drugs. This can render other drugs completely ineffective. Patients should be taught to never take other drugs with antacids and to separate taking antacids from taking other drugs by 2 hours.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

22. Why should parents be taught not to give bismuth subsalicylate (Pepto-Bismol) to a child?
a. It contains aspirin that can cause Reyes syndrome.
b. It changes stool color making the identification of GI bleeding more difficult.
c. It has such powerful antidiarrheal effects that toxic megacolon can occur.
d. It produces a paradoxical reaction in children that results in worsening of the symptoms.
ANS: A
Children should not be given bismuth subsalicylate (Pepto-Bismol) because it contains aspirin and can cause Reyes syndrome, a life-threatening condition that affects the liver and central nervous system.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 370 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

23. The spouse of an older adult with Alzheimers disease tells the nurse that he has been giving the patient Amphogel (aluminum hydroxide) for heartburn. What is the nurses best action?
a. Ask the spouse how often the patient is taking the Amphogel.
b. Suggest that the patient be given AlternaGEL instead.
c. Teach the spouse that taking this drug can worsen the patients condition.
d. Remind the spouse that giving this drug often can interfere with bowel function.
ANS: C
Amphogel is an aluminum-based antacid. Older adults with Alzheimers disease should not take aluminum-based antacids because these drugs can worsen the patients condition. AlternaGEL is not a good alternative because it is also aluminum-based.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

24. The nurse is instructing a patient who has been prescribed sucralfate (Carafate) for peptic ulcer disease. Which statement by the patient indicates the need for additional teaching?
a. This drug coats my ulcer and protects it so that healing can occur.
b. I should eat foods with lots of fiber while Im taking this drug.
c. If I feel dizzy, I will be sure to get up from bed slowly.
d. Once I am feeling better I can stop taking the drug.
ANS: D
Patients prescribed sucralfate should take the drug exactly as directed by their prescriber. The nurse must teach the patient that this drug is usually prescribed for 4 to 8 weeks and the patient should continue to take it even if feeling better.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

25. A patient with gastroesophageal reflux disease (GERD) asks the nurse why metoclopramide (Reglan) has been prescribed. What is the nurses best response?
a. This purpose of this drug for GERD is to prevent nausea.
b. This drug has been prescribed to help move food along through your GI tract.
c. Metoclopramide will prevent vomiting and the risk for aspiration.
d. This drug causes growth of new cells to heal your esophagus.
ANS: B
Metoclopramide increases stomach and small intestine contractions (peristalsis), helping to move food through the GI system. Moving food quickly into the intestinal system decreases the likelihood of backup into the esophagus.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

MULTIPLE RESPONSE

1. Which foods, activities, and drugs does the nurse teach the patient with peptic ulcer disease to avoid? (Select all that apply.)
a. Alcohol
b. Caffeine
c. Dairy products
d. Exercising
e. Smoking
f. Spicy food
g. Nonsteroidal anti-inflammatory drugs (NSAIDs)
ANS: A, B, E, F, G
Alcohol, caffeine, and spicy foods irritate an existing ulcer and promote inflammation. Smoking slows cell division and can delay healing. In addition, smoking promotes acid secretion. NSAIDs inhibit prostaglandin synthesis, which reduces the amount of gel-like mucus in the stomach and increases the likelihood that ulcers will continue to form. Neither dairy products nor exercise promote ulcer formation or delay or reduce healing.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

2. What should the nurse plan to teach a patient about smoking and peptic ulcer disease? (Select all that apply.)
a. Smoking increases acid secretion.
b. Smoking is not a cause of ulcer formation.
c. Smoking slows ulcer healing.
d. Smoking is related to the reoccurrence of ulcers.
e. Smoking decreases stomach mucus production.
ANS: A, C, D, E
When a patient has peptic ulcer disease, not smoking is highly recommended because smoking slows ulcer healing; is related to ulcer recurrence; increases acid secretion; reduces prostaglandin, mucus, and bicarbonate production; and decreases mucosal blood flow.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 360 TOP: Nursing Process Step: Planning
MSC: Client Needs Category: Health Promotion and Maintenance

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