Chapter 43 - Pharm: Antiulcer Drugs (NSG 210 - Exam 3)

1. A patient who has been instructed to use a liquid antacid medication to treat gastrointestinal upset asks the nurse
about how to take this medication. What information will the nurse include when teaching this patient?
A) Take a laxative if constipation occurs.
B) Take 60 minutes after meals and at bedtime.
C) Take with at least 8 ounces of water to improve
absorption.
D) Take with milk to improve effectiveness.
ANS: B
Since maximum acid secretion occurs after eating and at bedtime, antacids should be taken 1 to 3 hours after
eating and at bedtime. Taking antacids before meals slows gastric emptying time and causes increased
gastrointestinal (GI) secretions. Patients should not self-treat constipation or diarrhea. Patients should use 2 to 4
ounces of water when taking to ensure that the drug enters the stomach; more than that will increase GI
secretions. Antacids should not be taken with milk or foods high in vitamin D.
2. A patient who has symptoms of peptic ulcer disease will undergo a test that requires drinking a liquid containing
13C urea and breathing into a container. The nurse will explain to the patient that this test is performed to
A) Assess the level of hydrochloric acid.
B) Detect H. pylori antibodies.
C) Measure the pH of gastric secretions.
D) Test for the presence of 13CO2.
ANS: D
When H. pylori is suspected, a noninvasive test is performed by administering 13C urea which, in the presence of
H. pylori, will release 13CO2. The test does not measure the amount of HCl acid or the pH and does not detect H.
pylori antibodies.
3. A patient is taking esomeprazole (Nexium) 15 mg per day to treat a duodenal ulcer. After 10 days of treatment, the
patient reports that the pain has subsided. The nurse will counsel the patient to
A) Continue the medication for 4 more weeks.
B) Reduce the medication dose by half.
C) Stop taking the medication.
D) Take the medication every other day.
ANS: A
With treatment, ulcer pain may subside in 10 days, but the healing process may take 1 to 2 months. Patients
should be counseled to take the drug for the length of time prescribed. Reducing the dose or taking less
frequently is not indicated.
4. A patient with a peptic ulcer has been diagnosed with H. pylori. The provider has ordered lansoprazole (Prevacid),
clarithromycin (Biaxin), and metronidazole (Flagyl). The patient asks the nurse why two antibiotics are needed. The
nurse will explain that two antibiotics
A) Allow for less toxic dosing.
B) Combat bacterial resistance.
C) Have synergistic effects.
D) Improve acid suppression.
ANS: B
The use of two antibiotics when treating H. pylori peptic ulcer disease helps to combat bacterial resistance
because H. pylori develops resistance rapidly. Giving two antibiotics, in this case, is not to reduce the dose or to
cause synergistic effects. Antibiotics do not affect acid production.
5. A patient who takes propantheline bromine (Pro-Banthine) and omeprazole (Prilosec) for an ulcer will begin taking
an antacid. The nurse will give which instruction to the patient regarding how to take the antacid?

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 A) Take the antacid 2 hours after taking the propantheline.
B) Take the antacid along with a meal.
C) Take the antacid with milk.
D) Take the antacid with the propantheline bromine.
ANS: A
Antacids can slow the absorption of anticholinergics and should be taken 2 hours after anticholinergic
administration. Antacids should be given 1 to 3 hours after a meal and should not be given with dairy products.
6. Which antacid is likely to cause acid rebound?
A) Aluminum hydroxide
B) Calcium carbonate
C) Magnesium hydroxide
D) Magnesium trisilicate
ANS: B
While calcium carbonate is most effective in neutralizing acid, a significant amount can be systemically absorbed
and can cause acid rebound. The other antacids do not have significant systemic absorption.
7. An elderly patient reports using Maalox frequently to treat acid reflux. The nurse should notify the patient's provider
to request an order for which laboratory tests?
A) Liver enzymes and serum calcium
B) Liver enzymes and serum magnesium
C) Renal function tests and serum calcium
D) Renal function tests and serum magnesium
ANS: D
Maalox contains magnesium and carries a risk of hypermagnesemia, especially with decreased renal function.
Older patients have an increased risk of poor renal function, so this patient should especially be evaluated for
hypermagnesemia.
8. The nurse is caring for a patient who has Zollinger-Ellison syndrome. Which medication order would the nurse
question for this patient?
A) Cimetadine (Tagamet)
B) Pantoprazole (Protonix)
C) Rabeprazole (Aciphex)
D) Ranitidine (Zantac)
ANS: A
Cimetidine is not effective for treating Zollinger-Ellison syndrome. The other medications are used to treat
Zollinger-Ellison syndrome.
9. A patient who is diagnosed with peptic ulcer disease has been started on a regimen that includes ranitidine (Zantac)
300 mg daily at bedtime. The patient calls the clinic 1 week later to report no relief from discomfort. What action will
the nurse take?
A) Contact the provider to discuss changing to cimetidine (Tagamet).
B) Notify the provider to discuss increasing the dose.
C) Reassure the patient that the drug may take 1 to 2 weeks to be effective.
D) Suggest that the patient split the medication into twice daily dosing.
ANS: C
Patients taking histamine2 blockers can expect abdominal pain to decrease after 1 to 2 weeks of drug therapy.
Cimetidine is not as potent as ranitidine and interacts with many medications through the cytochrome P450
system. Three hundred milligrams is the maximum dose.
10. A male patient who has been taking a histamine2 blocker for several months reports decreased libido and breast
swelling. What will the nurse do?
A) Contact the provider to report possible drug toxicity.
B) Reassure the patient that these symptoms will stop when the drug is discontinued.

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 C) Request an order for serum hormone levels.
D) Suggest that the patient see an endocrinologist.
ANS: B
Drug-induced impotence and gynecomastia are reversible drug side effects. These signs do not indicate drug
toxicity. Serum hormone levels and endocrinology evaluation are not indicated.
11. A patient who has been taking ranitidine (Zantac) continues to have pain associated with peptic ulcer. A noninvasive
breath test is negative. Which treatment does the nurse expect the provider to order for this patient?
A) Adding an over-the-counter antacid to the patient's drug regimen
B) A dual drug therapy regimen
C) Amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec)
D) Lansoprazole (Prevacid) instead of ranitidine
ANS: D
This patient does not have H. pylori ulcer disease, so dual and triple drug therapy with antibiotics is not indicated.
Patients who fail treatment with a histamine2 blocker should be changed to a proton pump inhibitor (PPI) such
as lansoprazole. PPIs tend to inhibit gastric acid secretion up to 90% greater than the histamine antagonists.
12. A patient has been taking famotidine (Pepcid) 20 mg bid to treat an ulcer but continues to have pain. The provider
has ordered lansoprazole (Prevacid) 15 mg per day. The patient asks why the new drug is necessary, since it is more
expensive. The nurse will explain that lansoprazole
A) Can be used for long-term therapy.
B) Does not interact with other drugs.
C) Has fewer medication side effects.
D) Is more potent than famotidine.
ANS: D
Famotidine is a histamine2 (H2) blocker. When patients fail therapy with these agents, proton pump inhibitors,
which can inhibit gastric acid secretion up to 90% greater than the H2 blockers, are used. Lansoprazole is not for
long-term treatment and has drug interactions and drug side effects as do all other medications.
13. The nurse is caring for a patient who will begin taking omeprazole (Prevacid) 20 mg per day for 4 to 8 weeks to
treat gastroesophageal reflux disease esophagitis. The nurse learns that the patient takes digoxin. The nurse will
contact the provider for orders to
A) Decrease the dose of omeprazole.
B) Increase the dose of digoxin.
C) Increase the omeprazole to 60 mg per day.
D) Monitor for digoxin toxicity.
ANS: D
Proton pump inhibitors can enhance the effects of digoxin, so patients should be monitored for digoxin toxicity.
Changing the dose of either medication is not indicated prior to obtaining lab results that are positive for digoxin
toxicity.
14. A patient reports experiencing flatulence and abdominal distension to the nurse. Which over-the-counter
medication will the nurse recommend?
A) Alka-Seltzer
B) Maalox
C) Mylicon
D) Tums
ANS: C
Mylicon is a brand-name simethicone, which is an anti-gas agent. Maalox Gas contains simethicone, while regular
Maalox does not. The other products do not contain simethicone.
15. A patient who recently began having mild symptoms of GERD is reluctant to take medication. What measures will
the nurse recommend to minimize this patient's symptoms? (Select all that apply.)
A) Avoiding hot, spicy foods

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 B) Avoiding tobacco products
C) Drinking a glass of red wine with dinner
D) Eating a snack before bedtime
E) Taking ibuprofen with food
F) Using a small pillow for sleeping
G) Wearing well-fitted clothing
ANS: A, B, E
Hot, spicy foods aggravate gastric upset, tobacco increases gastric secretions, and ibuprofen on an empty
stomach increases gastric secretions, so patients should be taught to avoid these actions. Alcohol should be
avoided since it increases gastric secretions. Eating at bedtime increases reflux, as does laying relatively flat to
sleep, or wearing fitted clothing.