adams4e tif ch40

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/EChapter 40Question 1Type: MCSA

The nursing instructor teaches the student nurses about intrinsic factor. The instructor evaluates that learning has occurred when the students make which response?

1. "Intrinsic factor is secreted by the chief cells of the stomach."

2. "Intrinsic factor is necessary for absorption of vitamin B6."

3. "Intrinsic factor aids in the secretion of mucus to protect the stomach."

4. "Intrinsic factor is necessary for absorption of vitamin B12."

Correct Answer: 4

Rationale 1: Chief cells secrete pepsinogen and rennin, not intrinsic factor.

Rationale 2: Intrinsic factor is necessary for the absorption of vitamin B12, not B6.

Rationale 3: Intrinsic factor does not aid in the secretion of mucus in the stomach.

Rationale 4: Parietal cells secrete intrinsic factor, which is essential for the absorption of vitamin B12.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 40-1

Question 2Type: MCMA

The physician has ordered bismuth (Pepto-Bismol) for the client with a peptic ulcer who is colonized with H. Pylori. The client asks the nurse why he is receiving this drug. What is the best response by the nurse?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

1. "Bismuth (Pepto-Bismol) increases stomach acid to help kill bacteria."

2. "Bismuth (Pepto-Bismol) helps prevent the side effects of antibiotics."

3. "Bismuth (Pepto-Bismol) is effective for inhibiting bacterial growth."

4. "Bismuth (Pepto-Bismol) keeps bacteria from sticking in your stomach."

5. "Bismuth (Pepto-Bismol) helps relieve ulcer-related constipation."

Correct Answer: 3,4

Rationale 1: Bismuth (Pepto-Bismol) does not increase stomach acid.

Rationale 2: Bismuth (Pepto-Bismol) does not prevent the side effects of antibiotics.

Rationale 3: Bismuth compounds (Pepto-Bismol) are added to the antibiotic regimen to inhibit bacterial growth.

Rationale 4: Bismuth compounds (Pepto-Bismol) prevent H. Pylori from adhering to the gastric mucosa.

Rationale 5: Bismuth (Pepto-Bismol) is used to relieve diarrhea, not constipation.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 40-6

Question 3Type: MCSA

The physician orders misoprostol (Cytotec) for the female client with peptic ulcer disease (PUD). What is a priority question for the nurse to ask the client prior to administration of this medication?

1. "Do you plan on becoming pregnant?"

2. "Are you sexually active?"

3. "Are you pregnant?"

4. "Are your menstrual cycles irregular?"

Correct Answer: 3

Rationale 1: Misoprostol (Cytotec) is safe as long as the client is not currently pregnant.Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Rationale 2: Asking if a client is sexually active could be appropriate, but the nurse would also ask if the client is using birth control.

Rationale 3: Misoprostol (Cytotec) is contraindicated during pregnancy; it is sometimes used to terminate pregnancies.

Rationale 4: There is no contraindication for misoprostol (Cytotec) in a client with irregular menstrual cycles.

Global Rationale:



The client receives esomeprazole (Nexium). He asks the nurse why that little purple pill is better than his cimetidine (Tagamet). What is the best response by the nurse?

1. "It is about the same, but a lot cheaper than your cimetidine (Tagamet)."

2. "It decreases acid in your stomach, better than cimetidine (Tagamet)."

3. "It is about the same, but has fewer side effects than your cimetidine (Tagamet)."

4. "It is not as effective as cimetidine (Tagamet), but kills bacteria better."

Correct Answer: 2

Rationale 1: Esomeprazole (Nexium) is not cheaper than cimetidine (Tagamet).

Rationale 2: Proton-pump inhibitors reduce acid secretion to a greater extent than H2-receptor antagonists, and have a longer duration of action.

Rationale 3: Esomeprazole (Nexium) does not have fewer side effects than cimetidine (Tagamet).

Rationale 4: Esomeprazole (Nexium) is more effective than cimetidine (Tagamet), but will not kill bacteria.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationAdams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Learning Outcome: 40-7


A client is admitted for treatment of a duodenal ulcer. What will the nurse’s admission assessment likely reveal?

1. Nausea and lower right quadrant abdominal pain

2. Burning pain several hours after eating a meal

3. Anorexia and weight loss

4. Low back pain radiating down the left leg

Correct Answer: 2

Rationale 1: Nausea and lower right quadrant abdominal pain are more likely associated with appendicitis.

Rationale 2: Duodenal ulcers are associated with burning upper abdominal pain after a meal.

Rationale 3: Anorexia and weight loss are more common with gastric, not duodenal, ulcers.

Rationale 4: Duodenal ulcers do not cause low back pain radiating down the left leg.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 40-3


The nurse has completed education about peptic ulcer disease (PUD) with the client. The nurse evaluates that learning has occurred when the client makes which statement?

1. "I will limit my intake of caffeine products."

2. "I will take ibuprofen (Motrin) for my headaches."

3. "I will drink more milk and limit spicy foods."

4. "I will join a gym and increase my exercise."


Correct Answer: 1

Rationale 1: Caffeine is a risk factor for peptic ulcer disease (PUD), so limiting caffeine will be beneficial in the treatment of peptic ulcer disease (PUD).

Rationale 2: Nonsteroidal anti-inflammatory drugs (NSAIDS) are a primary cause of peptic ulcer disease (PUD).

Rationale 3: Milk can increase acid production and spicy foods are not an issue with peptic ulcer disease (PUD).

Rationale 4: There is no correlation between exercise and the management of peptic ulcer disease (PUD).

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 40-2


An elderly client comes to the emergency department with his wife. He has a history of peptic ulcer disease (PUD), and is currently experiencing confusion and severe headaches. What does the best plan by the nurse include?

1. Ask the client if he has experienced any head injuries recently.

2. Obtain a complete blood count (CBC), chemistry profile, and urine drug screen.

3. Ask the client's wife for a list of medications that the client has taken.

4. Obtain a magnetic resonance imaging (MRI) exam to assess if the client has experienced a stroke.

Correct Answer: 3

Rationale 1: Since the client has PUD, it would be logical to ask about medication prior to asking about injury.

Rationale 2: A complete blood count (CBC), chemistry profile, and urine drug screen are worthwhile tests, but the first priority for a client with a history of peptic ulcer disease (PUD) should be to find out what medications he has been taking.

Rationale 3: There is a known correlation between H2-receptor antagonists and confusion and headaches in the elderly population; the nurse should ascertain what medications the client is taking.

Rationale 4: It is premature to obtain a magnetic resonance imaging (MRI) exam until other causes have been ruled out. Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 40-9


The client has gastroesophageal reflux disease (GERD) and has been receiving medication treatment for many years. What priority assessment findings associated with the medication must the nurse report to the physician?

1. Vomiting and mild upper mid-epigastric pain

2. Anemia, fatigue, and weakness

3. Hypotension and tachycardia

4. Diarrhea and soft stools

Correct Answer: 2

Rationale 1: Vomiting and mild upper mid-epigastric pain are not signs of pernicious anemia or vitamin B12 deficiency that may result from chronic suppression of stomach acid from medications.

Rationale 2: Anemia, fatigue, and weakness are common signs of pernicious anemia or vitamin B12 deficiency. With chronic suppression of stomach acid by medications used for gastroesophageal reflux disease (GERD), the stomach may not be able to absorb vitamin B12, and there is the possibility of pernicious anemia.

Rationale 3: Hypotension and tachycardia are not signs of pernicious anemia or vitamin B12 deficiency that may result from chronic suppression of stomach acid from medications.

Rationale 4: Diarrhea and soft stools are not signs of pernicious anemia or vitamin B12 deficiency that may result from chronic suppression of stomach acid from medications.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 40-2

Question 9


Type: MCSA

The physician has ordered combination therapy for the client with peptic ulcer disease (PUD). The nurse plans to do medication education. What will the best plan by the nurse include?

1. Combination therapy has the best outcomes when antibiotics are used with antacids.

2. Combination therapy has the best outcomes when antibiotics are used with proton-pump inhibitors.

3. The use of sucralfate (Carafate) along with antibiotics is the best combination therapy for peptic ulcer disease (PUD).

4. Various antibiotics are used to eradicate the bacteria that are responsible for the development of peptic ulcer disease (PUD).

Correct Answer: 2

Rationale 1: Combination therapy has the best outcomes when antibiotics are used with proton-pump inhibitors, not with antacids.

Rationale 2: Combination therapy has the best outcomes when antibiotics are used with proton-pump inhibitors.

Rationale 3: Combination therapy has the best outcomes when antibiotics are used with proton-pump inhibitors, not with sucralfate (Carafate).

Rationale 4: Combination therapy has the best outcomes when antibiotics are combined with proton-pump inhibitors, rather than when used alone.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 40-7


The nurse designs a plan of care for the client with peptic ulcer disease (PUD) who is taking omeprazole (Prilosec) for the management of his illness. What will the best plan by the nurse include?




1. Omeprazole (Prilosec) should not be crushed or chewed.

2. Omeprazole (Prilosec) is best taken with yogurt.

3. Omeprazole (Prilosec) is recommended for long-term treatment of peptic ulcer disease (PUD).

4. Omeprazole (Prilosec) should be administered before meals.

5. Omeprazole (Prilosec) should be administered after meals.

Correct Answer: 1,4

Rationale 1: Omeprazole (Prilosec) is enteric-coated and needs to dissolve in the intestine; it should not be crushed or chewed.

Rationale 2: Yogurt may help replace beneficial bacteria, but should not be taken at the same time.

Rationale 3: Omeprazole (Prilosec) is recommended for short-term, not long-term, use.

Rationale 4: Omeprazole (Prilosec) should be administered before meals.

Rationale 5: Omeprazole (Prilosec) should be administered before, not after, meals in order to be most effective.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 40-8


The nurse planning medication administration instruction for a client receiving antacids should consider including which information?

1. Antacids can be safely administered with H2-receptor medications.

2. Antacids can be safely administered with antibiotics.

3. Administer antacids at least 2 hours before other oral medications.

4. Lay down for 30 minutes after taking antacids.

Correct Answer: 3


Rationale 1: Administering antacids with H2-receptor antagonists will decrease their absorption.

Rationale 2: Administering antacids with antibiotics will decrease their absorption.

Rationale 3: Administering antacids with other oral medications can affect the absorption of the other medications; they should be taken 2 hours before other oral medications.

Rationale 4: There is no need for the client to lay down after taking antacids.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 40-9


The client receives H2-receptor antagonists for treatment of peptic ulcer disease (PUD). Which assessment finding should be reported immediately to the physician?

1. The client reports he is constipated.

2. The client reports pain after 24 hours of treatment.

3. The client reports episodes of melana.

4. The client reports he took the antacid Tums with his H2-receptor antagonist.

Correct Answer: 3

Rationale 1: Constipation is a common side effect that does not need to be immediately reported to the physician.

Rationale 2: The client may still experience pain for several days with this type of medication.

Rationale 3: Melana could indicate GI bleeding and should be reported to the physician immediately.

Rationale 4: Taking Tums with an H2-receptor antagonist will cause deceased absorption of the H2-receptor antagonist, but this does not need to be reported to the physician; the nurse should educate the client.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesAdams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 40-7


The nurse completes medication education for the client receiving sucralfate (Carafate). The nurse evaluates that learning has occurred when the client makes which statement?

1. "This works by inhibiting bacterial growth in my stomach."

2. "This works by dissolving into a jelly and sticking to my ulcer."

3. "This works by decreasing the amount of acid in my stomach."

4. "This works by neutralizing the acid in my stomach."

Correct Answer: 2

Rationale 1: Sucralfate (Carafate) does not inhibit bacterial growth.

Rationale 2: Sucralfate (Carafate) works by dissolving into a gel and adhering to the site of the ulcer.

Rationale 3: Sucralfate (Carafate) does not decrease the amount of acid in the stomach.

Rationale 4: Sucralfate (Carafate) does not neutralize stomach acid.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 40-7


What is the correct administration technique for sucralfate (Carafate)?

1. Administer it after meals.

2. Administer it prior to meals.

3. Administer the drug once daily.


4. Administer it with milk.

Correct Answer: 2

Rationale 1: Administering sucralfate (Carafate) after meals will inhibit its ability to adhere to the ulcer.

Rationale 2: Sucralfate (Carafate) provides a protective coating and should be administered before meals in order to be effective.

Rationale 3: Sucralfate (Carafate) must be taken 4 times a day.

Rationale 4: Administering sucralfate (Carafate) with milk will inhibit its action.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 40-7


The client receives misoprostol (Cytotec) for treatment of peptic ulcer disease (PUD). The client asks the nurse why he is receiving this medication. What is the best response by the nurse?

1. "It dissolves into a gel and sticks to your ulcer."

2. "It increases mucus production in your stomach."

3. "It inhibits bacterial growth."

4. "It neutralizes stomach acid."

Correct Answer: 2

Rationale 1: Sucralfate (Carafate), not misoprostol (Cytotec), dissolves into a gel and adheres to the ulcer site.

Rationale 2: Misoprostol (Cytotec) inhibits gastric secretion and stimulates the production of protective mucus.

Rationale 3: Bismuth (Pepto-Bismol), not misoprostol (Cytotec), inhibits bacterial growth.

Rationale 4: Antacids, not misoprostol (Cytotec), neutralize stomach acid.

Global Rationale:




The pyloric sphincter regulates flow of food into the

1. small intestine.

2. stomach.

3. esophagus.

4. rectum.

Correct Answer: 1

Rationale 1: The pyloric sphincter regulates food out of the stomach into the small intestine.

Rationale 2: The pyloric sphincter moves food out of the stomach.

Rationale 3: The cardiac sphincter keeps food from moving back into the esophagus.

Rationale 4: The pyloric sphincter regulates food out of the stomach, not the rectum.

Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 40-1


An erosion of the mucosal layer of the stomach or duodenum describes a

1. diverticulum.

2. Crohn's lesion.


3. hiatal hernia.

4. Peptic ulcer.

Correct Answer: 4

Rationale 1: Diverticulum occurs in the large intestine.

Rationale 2: Crohn's lesion can occur anyway in the gastrointestinal tract.

Rationale 3: Hiatal hernias are an outpouching in the esophagus.

Rationale 4: A peptic ulcer is erosion of the mucosal layer of the stomach or duodenum.

Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 40-3


The primary goal in treatment of gastroesophageal reflux disease is to

1. promote ulcer healing.

2. prevent infection.

3. reduce gastric acid secretions.

4. decrease stomach pain.

Correct Answer: 3

Rationale 1: Promoting ulcer healing is not the goal.

Rationale 2: Preventing infection is not the goal.

Rationale 3: The primary goal is to reduce gastric secretions, which produce the reflux.

Rationale 4: Heartburn occurs, but not pain in the stomach.

Global Rationale:


Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 40-4


Peptic ulcer disease is treated primarily with

1. pharmacotherapy.

2. exercise.

3. a combination of lifestyle changes and pharmacotherapy.

4. diet.

Correct Answer: 3

Rationale 1: A combination of lifestyle changes and pharmacotherapy is the best and most effective way to treat peptic ulcer disease.




Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 40-9


The nurse is aware that antacids containing magnesium and aluminum can cause


1. diarrhea.

2. abdominal pain.

3. constipation.

4. indigestion.

Correct Answer: 1

Rationale 1: Magnesium and aluminum, such as in Maalox, can cause diarrhea.

Rationale 2: Antacids do not cause abdominal pain.

Rationale 3: Calcium-based products, such as Tums, cause constipation.

Rationale 4: Antacid would help the indigestion.

Global Rationale:

Cognitive Level: UnderstandingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 40-9


The mechanism of action of proton pump inhibitors is to

1. neutralize acid.

2. reduce acid secretion in the stomach.

3. block H2 receptors in the stomach.

4. decrease infection.

Correct Answer: 2

Rationale 1: The mechanism of action of proton pump inhibitors is to reduce acid secretion in the stomach.





Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 40-5


A client comes to the clinic with report of intermittent epigastric pain that is associated with meals. The nurse would review the client’s medical record and assess for the presence of which risk factors for peptic ulcer disease (PUD)?



1. The client reports that his mother and grandfather both had ulcers.

2. The client has type AB blood.

3. The client reports drinking several cups of coffee every morning.

4. The client reports mild to moderate job and family stress.

5. The client tested positive for influenza A.

Correct Answer: 1,3

Rationale 1: A close family history of PUD increases the client’s risk for developing the disease.

Rationale 2: The risk for developing PUD is higher in those with type O.

Rationale 3: Consumption of beverages that contain caffeine increases the risk for PUD.

Rationale 4: The presence of excessive psychological stress increases the risk for PUD.

Rationale 5: Infection with hylicobacter pylori increases the risk for PUD. Influenza A is not associated with increased risk.

Global Rationale:


Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: LO #2


It is suspected that a client has developed peptic ulcer disease (PUD). Which information should the nurse provide this client regarding projected course of treatment?



1. You will be started on an antibiotic.

2. You will be tested for the presence of H. pylori.

3. You may be directed to take Pepto-Bismol along with your other medications.

4. You should plan on taking medication for 4 to 8 weeks.

5. There are some lifestyle changes you can take to make therapy more successful.

Correct Answer: 2,3,4,5

Rationale 1: The client may or may not be started on an antibiotic.

Rationale 2: The client should be tested for the presence of H. pylori before antibiotic therapy is started.

Rationale 3: If the client is positive for H. pylori, bismuth-containing medications are sometimes prescribed for concurrent use.

Rationale 4: It takes time to heal a peptic ulcer, so therapy may continue for several weeks.

Rationale 5: Some lifestyle changes such as changing dietary habits and smoking cessation can help therapy be more successful.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: Implementation


Learning Outcome: 40.6


A client has been prescribed ranitidine (Zantac). The nurse plans to include which information in the teaching plan for this client?



1. You should experience symptom relief in 10 to 15 minutes after taking this drug.

2. Take this medication after your meal.

3. Take this medication first thing in the morning, before breakfast.

4. This drug will not work as well if you continue smoking.

5. If you experience confusion, discontinue the drug and call for an appointment.

Correct Answer: 2,4

Rationale 1: Onset of action is 30 to 60 minutes.

Rationale 2: This medication should be administered after a meal.

Rationale 3: This medication should be taken with food at bedtime.

Rationale 4: Smoking decreases the effectiveness of ranitidine.

Rationale 5: Ranitidine does not cause the confusion and CNS depression observed with cimetidine.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 40.8



A client has been prescribed aluminum hydroxide (AlternaGEL) for the treatment of heartburn. Which information should the nurse plan to teach this client?



1. You should expect this medication to take up to two days to start taking effect.

2. Take this medication with a glass of milk.

3. You may notice constipation as an effect of this drug.

4. Take this medication at least 2 hours before or after any other medication you are taking.

5. This medication will reduce the acid your stomach produces.

Correct Answer: 3,4

Rationale 1: This medication’s onset of action is within 20–40 minutes.

Rationale 2: There is no reason for the client to drink milk with this medication.

Rationale 3: Constipation may be a side effect of this antacid.

Rationale 4: Absorption may be affected if taken within 2 hours of any other drug.

Rationale 5: This medication acts to neutralize acid, not to reduce its production.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: LO #8


adams4e tif ch40

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