The nurse is caring for a patient with rheumatoid arthritis who is on high doses of nonsteroidal anti-inflammatory drugs (NSAIDs) for joint pain relief.

The patient expresses concerns about gastric irritation.

What medication could the nurse suggest to the physician to alleviate gastric irritation?

Choice A rationale
Hypermagnesemia, or high levels of magnesium in the blood, is not a common side effect of proton pump inhibitors. These medications do not contain magnesium and do not cause the body to produce more magnesium.
Choice B rationale
Long-term use of proton pump inhibitors may contribute to osteoporosis. Some studies have suggested that these medications can interfere with calcium absorption, potentially leading to bone loss and an increased risk of fractures.
Choice C rationale
While some people may experience diarrhea as a side effect of proton pump inhibitors, it is not one of the most common side effects.
Choice D rationale
Drowsiness is not a typical side effect of proton pump inhibitors. These medications work by reducing the amount of acid produced in the stomach, but they do not typically affect alertness or energy levels.

Choice A rationale
This choice is correct. Calcium carbonate, which is used to treat GERD, can lead to hypercalcemia, or high levels of calcium in the blood, if taken in excess or if the client has impaired kidney function. Hypercalcemia can cause various symptoms, including nausea, vomiting, constipation, and abdominal pain. It can also affect the nervous system, leading to confusion, lethargy, and fatigue. In severe cases, it can cause cardiac arrhythmias.
Choice B rationale
Metabolic alkalosis is a condition characterized by a high level of bicarbonate in the blood, leading to an increase in blood pH. While antacids like calcium carbonate can potentially cause metabolic alkalosis if taken in large amounts, it is less likely to occur in patients taking the medication for GERD, as the medication is used to neutralize stomach acid. Therefore, while it’s a potential risk, it’s less likely than hypercalcemia.
Choice C rationale
Hepatotoxicity, or liver damage, is not typically associated with the use of calcium carbonate. This medication does not have a direct effect on the liver, so it’s unlikely to cause hepatotoxicity unless the client has an underlying liver condition or is taking other medications that can cause liver damage.
Choice D rationale
Hyperphosphatemia, or high levels of phosphate in the blood, is not typically a risk associated with the use of calcium carbonate. In fact, calcium carbonate can bind to phosphate in the gut and reduce phosphate absorption, which can help manage high phosphate levels in certain conditions. Therefore, this choice is not the most likely risk for the client.