Which are potentially worrisome adverse effects associated with proton pump inhibitor use in older patients? (Select all that apply)

Gastric cancer

Osteoporosis

Vitamin and mineral deficiencies

Headaches

Medication interactions

Answer and Explanation

Correct Answer : B,C,E

Choice A reason: Long-term proton pump inhibitor (PPI) use has a weak, controversial association with gastric cancer due to hypergastrinemia, but evidence is inconclusive. In older patients, risks like osteoporosis and nutrient deficiencies are more established and immediate concerns, making this choice less consistently worrisome compared to others.

Choice B reason: PPIs reduce gastric acid, impairing calcium absorption, which increases osteoporosis risk in older patients. Chronic use is linked to decreased bone density and higher fracture risk, particularly in the elderly, due to disrupted mineral homeostasis, making this a significant and correct adverse effect to monitor.

Choice C reason: PPIs inhibit acid production, reducing absorption of vitamin B12, magnesium, and iron, leading to deficiencies in older patients. These can cause anemia, neurological issues, or hypomagnesemia, which are particularly concerning in the elderly due to comorbidities, making this a correct and critical adverse effect.

Choice D reason: Headaches are a possible PPI side effect but are less common and less severe in older patients compared to osteoporosis, nutrient deficiencies, or drug interactions. They don’t pose a significant long-term risk or require specific monitoring, making this choice incorrect for major concerns.

Choice E reason: PPIs interact with drugs like clopidogrel, reducing its efficacy by inhibiting CYP2C19, and affect absorption of drugs requiring acidic environments. In older patients with polypharmacy, these interactions increase risks of adverse outcomes, making this a significant and correct concern for PPI use.

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Correct Answer is ["A","C","D"]

Explanation

Choice A reason: Benzonatate suppresses cough by anesthetizing stretch receptors in the respiratory tract, reducing the cough reflex. It acts locally on nerve endings in the lungs and pleura, effectively decreasing cough frequency without systemic opioid effects, making it an appropriate choice for cough suppression.

Choice B reason: Guaifenesin is an expectorant, promoting mucus clearance by thinning secretions, not suppressing the cough reflex. It facilitates productive coughing rather than inhibiting it, making it ineffective for cough suppression and an incorrect choice for this indication in managing cough symptoms.

Choice C reason: Dextromethorphan suppresses cough by acting on the medulla’s cough center, reducing the urge to cough. As a non-opioid antitussive, it effectively controls non-productive cough without significant respiratory depression, making it a suitable and correct choice for cough suppression in various conditions.

Choice D reason: Codeine, an opioid, suppresses cough by acting on the central nervous system’s cough center, reducing reflex activity. It’s effective for non-productive cough but carries risks of sedation and dependency, making it a correct but cautiously used choice for cough suppression.

A. “Beta blockers decrease the release of renin.” B. “Beta blockers decrease peripheral vascular resistance.” C. “Beta blockers decrease heart rate and contractility.” D. “Beta blockers block the actions of angiotensin II.”

Correct Answer is B

Explanation

Choice A reason: Beta blockers decrease renin release, reducing angiotensin II and aldosterone, which lowers blood pressure. This statement is accurate, reflecting correct understanding, so it does not indicate a need for further teaching.

Choice B reason: Beta blockers do not primarily decrease peripheral vascular resistance; they reduce heart rate and contractility. Peripheral resistance is more affected by alpha blockers or vasodilators, so this incorrect statement indicates a need for further teaching.

Choice C reason: Beta blockers reduce heart rate and myocardial contractility, decreasing cardiac output and blood pressure. This statement is correct, showing proper understanding, so it does not require additional teaching.

Choice D reason: While beta blockers do not directly block angiotensin II, they reduce its production by decreasing renin. The statement is imprecise but not entirely wrong, making it less indicative of a teaching need than choice B.

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Which are potentially worrisome adverse effects associated with proton pump inhibitor use in older patients? (Select all that apply)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which medication is indicated for suppression of cough? (Select all that apply)

Correct Answer is ["A","C","D"]

Explanation

A nurse is discussing how beta blockers work to decrease blood pressure with a nursing student. Which statement by the student indicates a need for further teaching?

Correct Answer is B

Explanation

A patient is to receive a beta agonist. Before administration of this medication, which assessment finding would most concern the nurse?

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