Which of the following is correct about pharmacologic management of gastroesophageal reflux disease (GERD)?
Therapy with histamine (H2) receptor antagonists should be considered first-line due to efficacy and safety.
For the treatment of GERD, American College of Gastroenterology guidelines recommend proton pump inhibitor (PPI) therapy initiated at once-a-day dosing before the first meal of the day.
Multiple PPIs have been recalled from the market due to safety issues.
Of the available medical options, H2 receptor agonist therapy is considered the most effective for both erosive and nonerosive GERD, based on multiple large-scale studies.
The Correct Answer is B
Choice A reason: H2 receptor antagonists such as ranitidine and famotidine are effective for mild GERD symptoms, but they are not considered first-line for moderate to severe GERD. PPIs are preferred due to their superior acid suppression and healing rates for erosive esophagitis.
Choice B reason: The American College of Gastroenterology recommends initiating PPI therapy once daily before the first meal of the day for GERD management. PPIs reduce gastric acid secretion by inhibiting the H+/K+ ATPase pump in parietal cells, providing effective symptom relief and mucosal healing.
Choice C reason: While some PPIs have undergone scrutiny for long-term safety concerns (e.g., risk of kidney disease, osteoporosis, and infections), they have not been widely recalled. Most remain approved and in use under proper clinical guidance.
Choice D reason: H2 receptor agonists do not exist; the correct term is H2 receptor antagonists. Moreover, they are less effective than PPIs for healing erosive GERD and maintaining remission, especially in severe cases.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Acanthosis nigricans is characterized by hyperpigmented, velvety plaques typically found on the neck, axillae, and other skin folds. It is strongly associated with insulin resistance and is common in individuals with obesity and type 2 diabetes.
Choice B reason: Diabetic dermopathy presents as small, round or oval, brownish atrophic patches usually on the shins. It does not involve the neck or axilla and lacks the velvety texture seen in acanthosis nigricans.
Choice C reason: Scleroderma diabeticorum involves thickening and hardening of the skin, usually on the upper back and neck, but it is less common and lacks the characteristic velvety hyperpigmentation.
Choice D reason: Necrobiosis lipoidica typically affects the lower legs and presents as yellow-brown plaques with telangiectasia and central atrophy. It is not associated with the axilla or neck and does not have a velvety appearance.
Correct Answer is C
Explanation
Choice A reason: Psoriasis vulgaris is the most common form of psoriasis and typically affects the scalp, elbows, knees, and lower back. While it can affect the trunk, it is more chronic and less likely to be triggered by a recent infection.
Choice B reason: Generalized pustular psoriasis is a severe and rare form of psoriasis that presents with widespread pustules and systemic symptoms such as fever and malaise. The boy’s presentation lacks pustules and systemic toxicity.
Choice C reason: Guttate psoriasis is characterized by small, drop-like erythematous plaques that often appear suddenly on the trunk and proximal extremities. It is commonly triggered by a recent group A Streptococcal infection, such as tonsillitis. This matches the boy’s history and clinical findings.
Choice D reason: Inverse psoriasis affects intertriginous areas such as the axillae, groin, and under the breasts. It presents with smooth, shiny lesions and is not typically triggered by streptococcal infections. The trunk distribution and recent tonsillitis make this diagnosis unlikely.
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