Chapter 77: Drugs for Peptic Ulcer Disease

Chapter 77: Drugs for Peptic Ulcer Disease

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

1. The nurse is discussing the mechanism of action of omeprazole (Prilosec) with a group of nursing students. Which statement by a student would best indicate understanding of the mechanism of action of omeprazole?

a.	“The duration of action is short, because the drug has a short half-life.”
b.	“Absorption occurs in the stomach when the pH is greater than 5.”
c.	“It irreversibly inhibits the enzyme needed to produce stomach acid.”
d.	“The complete return of acid production occurs 24 hours after discontinuation.”

 

 

ANS:   C

The mechanism of action of omeprazole is that it irreversibly inhibits the enzyme needed to produce stomach acid. Effects persist until new enzyme is synthesized, with partial recovery in 3 to 5 days.

Although the half-life of the drug is short, the effects persist long after the drug has been cleared from the body.

Absorption does not take place in the stomach. The medication is acid labile and would be destroyed in the gut without protection. It is enteric coated and designed to become activated in the alkaline environment of the duodenum.

Partial return of acid production occurs 3 to 5 days after the medication is stopped. Full recovery may take weeks.

 

DIF:    Cognitive Level: Application             REF:    p. 921

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

2. The nurse has provided education on factors that contribute to ulcer formation to her patient diagnosed with peptic ulcer disease (PUD). Which of the following statements by the patient indicates a need for further teaching?

a.	“I guess I’ll have to avoid coffee and cola from now on.”
b.	“I am surprised to learn that Helicobacter pylori infection can lead to ulcers.”
c.	“Instead of ibuprofen, I’ll take acetaminophen for my arthritis.”
d.	“I’m going to ask my doctor to order a nicotine patch to help me quit smoking.”

 

 

ANS:   A

No convincing evidence shows that beverages containing caffeine (eg, coffee, tea, and cola) promote ulcer formation or interfere with recovery; this statement indicates a need for further teaching.

The most common cause of PUD is infection with H. pylori; no further teaching is necessary.

The second most common cause of PUD is the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Ibuprofen is an NSAID, but acetaminophen is not; no further teaching is necessary.

Smoking delays ulcer healing and increases the risk of recurrence; no further teaching is necessary.

 

DIF:    Cognitive Level: Application             REF:    p. 918

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Physiological Adaptation

 

3. The health care provider is treating a patient with complaints of severe abdominal pain and confirmed infection with H. pylori. Which of the following medication combinations would the nurse expect the health care provider to order?

a.	cimetidine (Tagamet) and metronidazole (Flagyl)
b.	cimetidine (Tagamet), tetracycline, and cefuroxime (Ceftin)
c.	clarithromycin (Biaxin), amoxicillin (Amoxil), and esomeprazole (Nexium)
d.	amphotericin B, cimetidine (Tagamet), and bismuth (Pepto-Bismol)

 

 

ANS:   C

The antibiotics administered most often are amoxicillin, clarithromycin, bismuth, metronidazole, and tetracycline. None is effective alone, hence the combination of clarithromycin and amoxicillin. The antibacterial activity of amoxicillin is highest at a neutral pH and can be enhanced by reducing gastric acidity with an antisecretory agent, such as esomeprazole. This combination is an appropriate treatment plan.

Metronidazole is very effective against sensitive strains; however, more than 40% of strains are now resistant. One antibiotic alone is not effective in treating H. pylori. Cimetidine promotes healing of ulcers, therefore it would be an important drug to include in the treatment plan.

Although two antibiotics are included, only tetracycline is effective against H. pylori. Cimetidine promotes healing of ulcers, therefore it would be an important drug to include in the treatment plan.

Although cimetidine and bismuth are appropriate in the treatment plan, amphotericin B is an antifungal agent and would have no effect on H. pylori.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 918 | p. 922-923

TOP:    Nursing Process: Planning

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

4. A patient is placed on a multidrug regimen that includes bismuth for treatment of peptic ulcer disease (PUD). The nurse should include which of the following points when providing patient education?

a.	One week of therapy should heal ulcers, relieve symptoms, and eradicate H. pylori.
b.	Resolution of pain indicates that the ulcer has healed.
c.	The tongue and stool may turn black.
d.	A single-antibiotic regimen is preferable to a multi-antibiotic regimen whenever possible.

 

 

ANS:   C

Bismuth can impart a harmless black color to the tongue and stool. Patients should be forewarned of this effect.

One week of therapy does not heal ulcers. Eradication rates for H. pylori are consistently higher with a 2-week course of treatment.

Instructing the patient that when symptoms resolve, the ulcer will be healed is incorrect. The cessation of pain and disappearance of the ulcer rarely coincide.

Guidelines recommend that, to minimize the emergence of resistance, at least two antibiotics, and preferably three, should be used to eradicate H. pylori.

 

DIF:    Cognitive Level: Application             REF:    p. 918

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies