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
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: NPH insulin is not mixed with insulin glargine, as glargine’s pH and formulation cause precipitation or altered pharmacokinetics when combined. NPH can be mixed with regular insulin, as they are compatible, making this choice incorrect for the patient’s reported practice.
Choice B reason: NPH and regular insulin are compatible and routinely mixed in one syringe to provide both intermediate and short-acting coverage. They don’t react chemically or lose efficacy when combined properly, making this choice incorrect, as mixing is a standard practice in diabetes management.
Choice C reason: Mixing NPH and regular insulin does not increase potency; it combines their pharmacokinetics for basal and prandial glucose control. The mixture delivers the additive effects of each insulin’s profile without enhancing overall potency, making this choice inaccurate for their combined action.
Choice D reason: Mixing NPH (intermediate-acting) and regular insulin (short-acting) is an accepted practice to manage type 1 diabetes with one injection, covering basal and prandial needs. Proper technique (drawing regular insulin first) ensures stability, making this the correct choice for the patient’s reported insulin administration.
Correct Answer is D
Explanation
Choice A reason: Nighttime awakenings more than twice weekly indicate step 2, requiring maintenance therapy. Step 1 uses albuterol as needed, so this is incorrect.
Choice B reason: Twice-daily glucocorticoids are for step 2 or higher, not step 1, where albuterol is used as needed. This is incorrect for step 1 management.
Choice C reason: LABAs are used in step 3 or higher, not step 1, where albuterol alone is sufficient as needed. This is incorrect for the asthma step.
Choice D reason: At step 1, albuterol is used as a rescue inhaler for acute asthma symptoms. This is the standard approach, making it the correct choice.
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