A patient with heart failure who follows a salt-restricted diet asks which over-the-counter antacid adds the largest salt load. Which antacid does the nurse name?
Sodium bicarbonate
✓
Calcium carbonate
Aluminum hydroxide
Magnesium hydroxide
Correct Answer
Sodium bicarbonate
Sodium bicarbonate is absorbed and delivers a substantial sodium load, which can worsen fluid retention in heart failure, hypertension or kidney disease. Calcium carbonate supplies calcium, not sodium, and its concerns are constipation and hypercalcemia. Aluminum hydroxide mainly causes constipation and can lower phosphate. Magnesium hydroxide mainly causes diarrhea and can accumulate in kidney impairment.
Category: Antacids
Question 2
Why are aluminum hydroxide and magnesium hydroxide often combined in one antacid product?
Aluminum keeps magnesium out of the bloodstream
Their opposite effects on the bowel offset each other
✓
Magnesium stops aluminum from binding phosphate
Together they no longer bind other oral drugs
Correct Answer
Their opposite effects on the bowel offset each other
Aluminum salts tend to cause constipation and magnesium salts tend to cause diarrhea, so pairing them balances bowel effects. Aluminum keeps magnesium out of the bloodstream is incorrect; some magnesium is still absorbed, which matters in kidney disease. Magnesium stops aluminum from binding phosphate is false; aluminum still binds phosphate. Together they no longer bind other oral drugs is false; combination antacids still interfere with absorption of many drugs.
Category: Antacids
Question 3
A patient has been taking large amounts of calcium carbonate antacid tablets along with plenty of milk. Labs now show hypercalcemia, metabolic alkalosis and reduced kidney function. Which condition does this pattern suggest?
Zollinger-Ellison syndrome
Refeeding syndrome
Milk-alkali syndrome
✓
Serotonin syndrome
Correct Answer
Milk-alkali syndrome
Milk-alkali syndrome results from heavy intake of calcium together with an absorbable alkali, producing the triad of hypercalcemia, metabolic alkalosis and kidney injury. Zollinger-Ellison syndrome is acid hypersecretion caused by a gastrin-secreting tumor. Refeeding syndrome is a drop in phosphate, potassium and magnesium when nutrition restarts after starvation. Serotonin syndrome is excess serotonergic activity from drugs such as SSRIs.
Category: Antacids
Question 4
Long-term use of aluminum hydroxide antacids can lead to which electrolyte imbalance?
Hyperkalemia
Hypernatremia
Hypercalcemia
Hypophosphatemia
✓
Correct Answer
Hypophosphatemia
Aluminum binds phosphate in the gut and carries it out in the stool, so prolonged use can lower serum phosphate; this same action is why aluminum compounds have been used as phosphate binders. Hyperkalemia is not an effect of aluminum antacids. Hypernatremia is linked to sodium bicarbonate. Hypercalcemia is linked to calcium carbonate.
Category: Antacids
Question 5
A man who has taken cimetidine for months reports tender enlargement of his breasts. Which property of cimetidine explains this finding?
Weak antiandrogen activity
✓
Blockade of H1 receptors
Irreversible proton pump inhibition
Stimulation of thyroid hormone release
Correct Answer
Weak antiandrogen activity
Cimetidine has weak antiandrogenic effects and can raise prolactin, which can cause gynecomastia and, less often, impotence; famotidine does not share this effect to a meaningful degree. Blockade of H1 receptors is the action of antihistamines for allergy, not cimetidine. Irreversible proton pump inhibition is how PPIs such as omeprazole work. Stimulation of thyroid hormone release is not an action of H2 blockers.
Category: H2 Receptor Blockers
Question 6
An older adult with reduced kidney function who takes famotidine becomes newly confused and agitated. What should the nurse do?
Give the next dose with an antacid to slow its absorption
Report the change, since the drug can accumulate and cause CNS effects
✓
Record it as an expected sign that the ulcer is healing
Hold all fluids until the confusion clears on its own
Correct Answer
Report the change, since the drug can accumulate and cause CNS effects
Famotidine is cleared by the kidneys, so it can accumulate when kidney function is reduced, and confusion, agitation and other CNS effects are reported most often in older adults and people with kidney impairment; the provider may lower the dose or change the drug. Giving the next dose with an antacid to slow its absorption does not address accumulation. Recording it as an expected sign that the ulcer is healing is wrong because confusion is not part of healing. Holding all fluids until the confusion clears on its own is unsafe and could worsen kidney function.
Category: H2 Receptor Blockers
Question 7
When should a patient take a delayed-release omeprazole capsule ordered once daily?
With a bedtime snack
After the evening meal
Before breakfast
✓
Together with an antacid at lunch
Correct Answer
Before breakfast
PPIs block only proton pumps that are actively secreting, and pumps are activated when a meal is eaten, so taking the dose before the first meal of the day gives the best acid control. With a bedtime snack is not the recommended timing for once-daily PPI dosing. After the evening meal misses the morning pump activation. Together with an antacid at lunch is not needed and is not the labeled timing.
Category: Proton Pump Inhibitors
Question 8
Long-term proton pump inhibitor therapy can cause which electrolyte disturbance that may present with tremor, muscle cramps or dysrhythmias?
Hypernatremia
Hypercalcemia
Hyperkalemia
Hypomagnesemia
✓
Correct Answer
Hypomagnesemia
Prolonged PPI use can lower serum magnesium, which can cause tetany, tremor, seizures and dysrhythmias, so the provider may check magnesium in patients on long-term therapy or taking drugs such as digoxin or diuretics. Hypernatremia is not a recognized PPI effect. Hypercalcemia is not caused by PPIs; low magnesium can instead lower calcium. Hyperkalemia is not a typical PPI effect.
Category: Proton Pump Inhibitors
Question 9
A patient who has taken pantoprazole for a long time develops frequent, watery stools and abdominal cramping that persist. Which complication should the nurse suspect?
Clostridioides difficile infection
✓
Rebound acid hypersecretion
Aluminum toxicity
Lactose intolerance
Correct Answer
Clostridioides difficile infection
Reduced stomach acid lets more organisms survive passage through the stomach, and PPI use is linked to a higher risk of C. difficile diarrhea, so persistent watery diarrhea needs prompt evaluation. Rebound acid hypersecretion happens after stopping a PPI and causes heartburn, not diarrhea. Aluminum toxicity is a concern with aluminum-containing products in kidney failure. Lactose intolerance is a lactase deficiency, not a PPI complication.
Category: Proton Pump Inhibitors
Question 10
Omeprazole and esomeprazole can weaken the effect of which antiplatelet drug by reducing its conversion to the active form?
Aspirin
Clopidogrel
✓
Ticagrelor
Dipyridamole
Correct Answer
Clopidogrel
Clopidogrel is a prodrug activated mainly by CYP2C19, and omeprazole and esomeprazole inhibit that enzyme, so US labeling advises avoiding these two PPIs with clopidogrel. Aspirin acts directly and does not need CYP2C19 activation. Ticagrelor is active without conversion by CYP2C19. Dipyridamole is not activated by CYP2C19.
Category: Proton Pump Inhibitors
Question 11
A patient takes sucralfate and an aluminum-magnesium antacid for ulcer pain. Why should the two be taken at separate times?
The antacid destroys sucralfate in the bloodstream
Sucralfate causes the antacid to be absorbed too quickly
Sucralfate needs an acidic stomach to form its protective coating
✓
Together they cause severe metabolic acidosis
Correct Answer
Sucralfate needs an acidic stomach to form its protective coating
Sucralfate becomes a sticky, protective gel only in an acidic environment, so an antacid taken at the same time can reduce its ability to coat the ulcer; antacids are given apart from sucralfate. The antacid destroys sucralfate in the bloodstream is wrong because sucralfate acts locally and is minimally absorbed. Sucralfate causes the antacid to be absorbed too quickly is not a recognized interaction. Together they cause severe metabolic acidosis is not an effect of this combination.
Category: Sucralfate
Question 12
A patient with chronic kidney disease on dialysis is prescribed sucralfate. Which risk is the nurse especially alert for?
Sodium overload
Severe hypokalemia
Calcium kidney stones
Aluminum accumulation
✓
Correct Answer
Aluminum accumulation
Sucralfate is a complex of sucrose sulfate and aluminum hydroxide, and the small amount of aluminum absorbed is normally excreted by the kidneys, so it can build up in chronic kidney failure or dialysis. Sodium overload is a concern with sodium bicarbonate. Severe hypokalemia is not a recognized sucralfate effect. Calcium kidney stones are linked to excess calcium carbonate.
Category: Sucralfate
Question 13
A patient who takes digoxin is started on sucralfate. What should the nurse teach?
Take digoxin at a separate time from sucralfate
✓
Take both drugs together with milk
Stop digoxin while taking sucralfate
Crush both tablets and mix them in food
Correct Answer
Take digoxin at a separate time from sucralfate
Sucralfate can bind other oral drugs in the gut, reducing absorption of digoxin, phenytoin, levothyroxine, fluoroquinolones and others, so those drugs are taken well apart from sucralfate. Taking both drugs together with milk would not prevent binding. Stopping digoxin while taking sucralfate is not appropriate without a provider order. Crushing both tablets and mixing them in food would increase contact and binding.
Category: Sucralfate
Question 14
Which adverse effect is most common with misoprostol and is usually mild and self-limiting?
Hypertension
Diarrhea
✓
Bradycardia
Hyperkalemia
Correct Answer
Diarrhea
Diarrhea, often with abdominal pain, is the most frequent dose-related adverse effect of misoprostol; taking it with food helps, and it usually resolves without stopping the drug. Hypertension is not a typical effect of misoprostol. Bradycardia is not a recognized misoprostol effect. Hyperkalemia is not caused by misoprostol.
Category: Misoprostol
Question 15
A patient who takes misoprostol along with a long-term NSAID wants something for occasional heartburn. What should the nurse teach?
Take any heartburn remedy together with each misoprostol dose
Stop misoprostol on days a heartburn remedy is needed
Avoid magnesium-containing antacids, which can worsen diarrhea
✓
Take the NSAID on an empty stomach to reduce heartburn
Correct Answer
Avoid magnesium-containing antacids, which can worsen diarrhea
Misoprostol commonly causes diarrhea, and magnesium-containing antacids have a laxative effect that adds to it, so labeling advises avoiding that combination; an antacid without magnesium can be used if one is needed. Taking any heartburn remedy together with each misoprostol dose ignores this interaction. Stopping misoprostol on days a heartburn remedy is needed removes the ulcer protection an NSAID user needs. Taking the NSAID on an empty stomach increases gastric irritation rather than reducing it.
Category: Misoprostol
Question 16
A patient taking misoprostol to prevent NSAID ulcers should report which symptom right away?
Mild loose stools early in therapy
Occasional gas after meals
A mild headache after a dose
Uterine cramping with abnormal vaginal bleeding
✓
Correct Answer
Uterine cramping with abnormal vaginal bleeding
Misoprostol stimulates the uterus and can cause cramping, spotting and heavy bleeding, and in pregnancy it can cause miscarriage, so these symptoms need prompt reporting. Mild loose stools early in therapy are common and usually resolve. Occasional gas after meals is a minor effect. A mild headache after a dose can occur and is not usually urgent.
Category: Misoprostol
Question 17
Why is a proton pump inhibitor given together with antibiotics to treat Helicobacter pylori infection?
Raising stomach pH helps the antibiotics work and the ulcer heal
✓
It prevents the diarrhea caused by the antibiotics
It removes the need to finish the antibiotic course
It coats the ulcer so bacteria cannot reach it
Correct Answer
Raising stomach pH helps the antibiotics work and the ulcer heal
Antibiotics such as amoxicillin and clarithromycin are more stable and effective at a higher gastric pH, and acid suppression also lets the ulcer heal while the infection is cleared. It prevents the diarrhea caused by the antibiotics is wrong; PPIs can actually add to diarrhea risk. It removes the need to finish the antibiotic course is wrong; the full regimen must be completed. It coats the ulcer so bacteria cannot reach it describes no action of a PPI.
Category: H. pylori Treatment
Question 18
Why do proton pump inhibitors suppress gastric acid more completely than H2 receptor blockers?
They neutralize acid after it is secreted
They block the final step of acid secretion
✓
They block only histamine-driven secretion
They form a barrier over the gastric mucosa
Correct Answer
They block the final step of acid secretion
Parietal cells can be stimulated by histamine, gastrin and acetylcholine, but every pathway ends at the hydrogen-potassium ATPase pump, so blocking the pump stops acid secretion regardless of the stimulus. They neutralize acid after it is secreted describes antacids. They block only histamine-driven secretion describes H2 blockers and is why those drugs are less complete. They form a barrier over the gastric mucosa describes sucralfate.
Category: Proton Pump Inhibitors
Question 19
A patient being treated for H. pylori infection feels better after a few days and asks to stop the antibiotics. What should the nurse explain?
Stopping is fine once the pain is gone
Only the acid suppressant needs to continue
Every dose of the full regimen should be taken
✓
The antibiotics can be saved for future flare-ups
Correct Answer
Every dose of the full regimen should be taken
H. pylori is eradicated only when the whole regimen is completed, and stopping early leads to treatment failure, ulcer recurrence and antibiotic resistance, which makes the infection harder to cure. Stopping is fine once the pain is gone is wrong because symptoms ease well before the organism is cleared. Only the acid suppressant needs to continue is wrong because acid suppression alone does not cure the infection. The antibiotics can be saved for future flare-ups is unsafe and encourages resistance.
Category: H. pylori Treatment
Question 20
Which patient is a typical candidate for stress ulcer prophylaxis with an acid-suppressing drug?
A healthy adult with occasional heartburn
An outpatient taking acetaminophen for arthritis
A patient with constipation from an opioid
A patient on mechanical ventilation in the ICU
✓
Correct Answer
A patient on mechanical ventilation in the ICU
Critically ill patients, especially those on mechanical ventilation or with coagulopathy, are at risk for stress-related mucosal bleeding, so a PPI or H2 blocker is often given to prevent it. A healthy adult with occasional heartburn may use an antacid as needed but does not need prophylaxis. An outpatient taking acetaminophen for arthritis is not at risk the way an NSAID user is. A patient with constipation from an opioid needs a bowel regimen, not ulcer prophylaxis.
Category: Stress Ulcer Prevention