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8 Cards in this Set
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A patient who has severe arthritis and will take some non-steroidal anti-inflammatory drugs (NSAIDs)!daily develops a duodenal ulcer. The patient has tried a cyclooxygenase-2 selective NSAID in the past and says states that it is not as effective as a current NSAID. The primary care nurse practitioner should: |
Prescribe omeprazole (Prilosec) Patient with NSAID- induced should discontinue the NSAID if possible. This patient and has severe arthritis and so cannot discontinue the NSAID. In a situation such as this, a PPI is indicated. Cimetidine Is a histamine-2 blocker, which would be a second line choice, but cimetidine has many serious side effects. Bland diet so not effective in treating ulcers . Corticosteroids are not indicated. |
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A patient is given a diagnosis of peptic ulcer disease. A laboratory test confirms the presence of Helicobacter pylori. The primary care NP orders a proton pump inhibitor (PPI) before meals twice daily, clarithromycia and amoxicillin. After 14 days of treatment. H. Pylori is still present. The nurse practitioner should order: |
A PPI, amoxicillin and metronidazole for 14 days A PPI, along with amoxicillin and metronidazole is used as first line treatment in macro life-allergic patient ms and for re-treatment for 14 days if first- line treatment of choice failed because of occasional resistance to clarithromycin |
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A patient with a diagnosis of peptic also disease asked the nurse practitioner about nonpharmacologic treatment. Which statement by the NP is correct |
“You should consume a diet that is high in fiber” Balanced meals consumed at a regular time that are high in fiber are encouraged. Caffeine increases acid secretion and should be avoided. Patient may consume alcohol in moderation. Although lifestyle changes on proper diet are an integral part of treatment for peptic ulcer disease, they do not eliminate the need for medications. |
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A patient has inside and used all sir and has started taking him rantidine (Zantac). At a follow up appointment three days after, the patient reports no alleviation of symptoms. The primary care nurse practitioner should: |
Change from ranitidine to omeprazole (Prilosec). If the patient does not start to see improvement within a few days after initiation of treatment with a histamine -2 blocker, the provider either should increase the dose of the medication or should change to a PPI. Cimetidine is a histamine-2 blocker and has many serious side effects. Metronidazole is used only when h.pylori is known to be present. Patient should start to get relief within a few days |
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An 18-year-old patient has a history of renal disease and develops duodenal ulcer. The primary care NP should order a: |
Normal dose of a PPI. No adjustment of doses necessary for older patients taking PPIs. Patients with a history of renal disease may have decreased elimination of histamine -2 blockers, so the nurse practitioner should avoidavoid these if possible |
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A patient with peptic ulcer disease is taking a histamine-2 blocker and tells her primary care nurse practitioner that over-the-counter ant acid tablets help with discomfort. The nurse practitioner should tell this patient to: |
Take the histamine-2 blocker two hours before taking the ant acid Histamine-2 blockers should not be taken within two hours of ant acid ingestion because acid decreases the action of histamine-2 blockers. |
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A patient with erosive esophagitis is taking lansoprazole ( Prevacid). The primary care nurse practitioner performs a medication history and learns that the patient also takes digoxin. The NP should recommend: |
Obtaining a serum digoxin level Because PPIs decrease gastric acid, they may interfere with the absorption of the drugs that require absorption in an acid stomach, including digoxin. It may be necessary to increase the dose of digoxin but not before obtaining a serum digoxin level. All PPIs have this effect, so changing to another PPI would not solve the problem. Increasing the dose of the lansoprazole would decrease the absorption of digoxin |
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A post menopausal woman develops NSAID-induced ulcer. The primary care nurse practitioner should prescribe |
Ranitidine (Zantac) PPIs carry a possible increased risk of fractures in menopausal woman. The nurse practitioner should begin therapy with a histamine-2 blocker, such as a Ranitidine. |
