NURS 615 Exam 4 Questions Answered Correctly Already Passed

NURS 615 Exam 4 Questions Answered Correctly Already Passed PPI long term consequences - Answers osteoporosis, B 12 and iron deficiency How would you treat peptic ulcer disease and H-pylori (H-pylori being the leading cause of peptic ulcer with NSAIDS and aspirin being second leading causes) - Answers Triple therapy: PPI twice a day Amoxicillin 1gm BID or metronidazole Clarithromycin 500mg daily for 7-14 days (10 days to 2 weeks recommended) Then continue with PPI for 8-12 weeks Step down with GERD - Answers Standard dose PPI x 8 weeks. If not resolved, double PPI dose for 4-8 weeks. After 4 weeks a lower dose of PPI is tried, if no relief after 8 weeks daily PPI then refer to GI. Step down to lowest PPI dose or transition to H2RA blocker if symptoms are not relieved. If first line GERD therapy fails (triple therapy), what is second line therapy? - Answers quadruple therapy. PPI bid, metronidazole, tetracycline, bismuth subsalicylate x 14 days Step up therapy for GERD? - Answers Lifestyle changes antacids H2RA PPI If GERD patient is already on a PPI, what is the next step? - Answers If the pt is already on a once daily PPI, you increase to BID. If no improvement, referral to GI for endoscopy. What would you recommend for travelers diarrhea? - Answers bismuth salisalate After a patient is treated for H. Pylori, what is next? - Answers Take PPI for 8-12 weeks What are monitoring parameters for chronic long term proton pump therapy? - Answers Anemia, osteoporosis, iron, B12, calcium, magnesium How does metoclopramide improve GERD symptoms? - Answers It increases lower esophageal tone due to it's antagonist activity at the D2 receptors and the chemoreceptor trigger zone in the CNS. If you have a GERD patient and they are taking TUMS (calcium carbonate) but their symptoms are minimally relieved, what is the next step for therapy? - Answers H2RA & PPI What is the action of loperamide (immodium) when treating diarrhea? - Answers Loperamide acts on the opioid receptors in the myenteric plexus in the large intestine, decreasing the activity and decreasing the tone of the longitudinal and circular smooth muscles of the intestinal wall. This increases the time that the material stays in the intestines, allowing more water to be absorbed from the fecal matter. It also decreases colonic mass movements in the presence of the gastric colonic reflex (the movement of food out as new food comes in stretching the stomach). What are important counseling points when administering antacids? - Answers Antacids can cause constipation when aluminum based or diarrhea when magnesium based. If a loop diuretic like furosemide is added to a patients heart failure regimen when they are already taking a cardiac glycoside like digoxin, what are important monitoring parameters? - Answers potassium, magnesium, and digitalis toxicity What are important considerations in your choice of diuretics when treating hypertension? - Answers Kidney function: Check BUN/creatinine. Also, if on thiazide, make sure GFR is higher than mid 40s. What is the primary use of tiotropium? - Answers COPD When should phenylepherine be avoided? - Answers If the patient is 4 years old or younger or has hypertension or BPH How do you treat a 3 year old with an upper respiratory infection and a cough? - Answers supportive therapy: fluids and rest