NURS 615 EXAM 3 FINAL PAPER TESTED
QUESTIONS WITH COMPLETE ANSWER
KEY
●● Peptic ulcer disease and H-pylori treatment
Answer: 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
Answer: 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.
●● Second line therapy for GERD if first line fails
Answer: quadruple therapy: PPI bid, metronidazole, tetracycline,
bismuth subsalicylate x 14 days
●● Step up therapy for GERD
Answer: Lifestyle changes, antacids, H2RA, PPI
●● Next step if GERD patient is on PPI
,Answer: If the patient is already on a once daily PPI, increase to BID. If
no improvement, referral to GI for endoscopy.
●● Recommendation for travelers diarrhea
Answer: bismuth salicylate
●● Next step after treating H. Pylori
Answer: Take PPI for 8-12 weeks
●● Monitoring parameters for chronic long term proton pump therapy
Answer: Anemia, osteoporosis, iron, B12, calcium, magnesium
●● How metoclopramide improves GERD symptoms
Answer: It increases lower esophageal tone due to its antagonist activity
at the D2 receptors and the chemoreceptor trigger zone in the CNS.
●● Next step if GERD patient taking TUMS
Answer: H2RA & PPI
●● Action of loperamide (immodium) when treating diarrhea
Answer: 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.
●● Important counseling points when administering antacids
Answer: Antacids can cause constipation when aluminum based or
diarrhea when magnesium based.
●● Monitoring parameters when adding loop diuretic to heart failure
regimen
Answer: Important monitoring parameters when a loop diuretic like
furosemide is added to a patient's heart failure regimen when they are
already taking a cardiac glycoside like digoxin.
●● Potassium, magnesium, and digitalis toxicity
Answer: Conditions that require careful monitoring when using
diuretics.
●● Kidney function
Answer: Check BUN/creatinine; if on thiazide, ensure GFR is higher
than mid 40s.
●● Tiotropium
QUESTIONS WITH COMPLETE ANSWER
KEY
●● Peptic ulcer disease and H-pylori treatment
Answer: 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
Answer: 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.
●● Second line therapy for GERD if first line fails
Answer: quadruple therapy: PPI bid, metronidazole, tetracycline,
bismuth subsalicylate x 14 days
●● Step up therapy for GERD
Answer: Lifestyle changes, antacids, H2RA, PPI
●● Next step if GERD patient is on PPI
,Answer: If the patient is already on a once daily PPI, increase to BID. If
no improvement, referral to GI for endoscopy.
●● Recommendation for travelers diarrhea
Answer: bismuth salicylate
●● Next step after treating H. Pylori
Answer: Take PPI for 8-12 weeks
●● Monitoring parameters for chronic long term proton pump therapy
Answer: Anemia, osteoporosis, iron, B12, calcium, magnesium
●● How metoclopramide improves GERD symptoms
Answer: It increases lower esophageal tone due to its antagonist activity
at the D2 receptors and the chemoreceptor trigger zone in the CNS.
●● Next step if GERD patient taking TUMS
Answer: H2RA & PPI
●● Action of loperamide (immodium) when treating diarrhea
Answer: 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.
●● Important counseling points when administering antacids
Answer: Antacids can cause constipation when aluminum based or
diarrhea when magnesium based.
●● Monitoring parameters when adding loop diuretic to heart failure
regimen
Answer: Important monitoring parameters when a loop diuretic like
furosemide is added to a patient's heart failure regimen when they are
already taking a cardiac glycoside like digoxin.
●● Potassium, magnesium, and digitalis toxicity
Answer: Conditions that require careful monitoring when using
diuretics.
●● Kidney function
Answer: Check BUN/creatinine; if on thiazide, ensure GFR is higher
than mid 40s.
●● Tiotropium
