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 B
Explanation
Choice A reason: Telmisartan is an angiotensin II receptor blocker (ARB), which prevents angiotensin II from binding to its receptors but does not inhibit its formation. ARBs are less likely to cause a dry cough because they do not increase bradykinin levels.
Choice B reason: Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor. It blocks the conversion of angiotensin I to angiotensin II, reducing vasoconstriction and aldosterone secretion. A common side effect is a persistent dry cough due to increased bradykinin levels, making it the correct answer.
Choice C reason: Amlodipine is a calcium channel blocker that works by relaxing vascular smooth muscle to lower blood pressure. It does not affect the renin-angiotensin system and is not associated with dry cough.
Choice D reason: Furosemide is a loop diuretic that inhibits sodium and chloride reabsorption in the loop of Henle. It is used to manage fluid overload in heart failure and hypertension but does not act on the renin-angiotensin system or cause dry cough.
Correct Answer is D
Explanation
Choice A reason: Hypersomnolence disorder is characterized by excessive sleepiness despite a main sleep period lasting at least seven hours. It typically involves prolonged sleep episodes or recurrent daytime naps that are not refreshing. However, it does not include sudden muscle weakness or episodes of “zoning out” with preserved awareness. The presence of cataplexy-like symptoms in this case makes hypersomnolence less likely.
Choice B reason: Sleep inertia refers to the transitional state of grogginess and impaired performance immediately after waking. It does not involve sudden sleep episodes during the day or muscle weakness triggered by emotions. The student’s symptoms are not limited to waking periods but occur throughout the day, making sleep inertia an incorrect diagnosis.
Choice C reason: Circadian rhythm sleep-wake disorders involve misalignment between the internal circadian clock and the external environment, leading to insomnia or excessive sleepiness at inappropriate times. However, these disorders do not typically include cataplexy-like symptoms or sudden sleep attacks. The episodic muscle weakness and daytime sleep episodes described here are not consistent with circadian rhythm disorders.
Choice D reason: Narcolepsy is a chronic neurological disorder characterized by excessive daytime sleepiness, sudden sleep attacks, and cataplexy—brief episodes of muscle weakness triggered by strong emotions. The student’s symptoms of falling asleep in class, zoning out, and experiencing muscle weakness without sleep are classic signs of narcolepsy, particularly type 1, which includes cataplexy. This diagnosis best fits the clinical picture.
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