Report new confusion or agitation in elderly patients, especially on cimetidine.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A client with GERD is taking ranitidine. The nurse explains that this medication relieves symptoms by which mechanism?
Answer: B. Ranitidine is a histamine-2 (H2) receptor antagonist that decreases gastric acid secretion by blocking histamine at the parietal cell H2 receptors. It does not neutralize existing acid (that is what antacids do), coat the ulcer (sucralfate), or increase lower esophageal sphincter tone (metoclopramide). Understanding that H2 blockers reduce acid production guides correct timing and teaching.
Question 2 of 5
A client newly prescribed lisinopril for hypertension reports a persistent dry cough. Which action by the nurse is most appropriate?
Answer: C. A dry, nonproductive cough is a classic ACE inhibitor side effect caused by accumulation of bradykinin. The nurse should notify the prescriber, who will likely switch the client to an angiotensin II receptor blocker (ARB), which does not cause this effect. The cough is not a sign of allergy and does not warrant emergency care, but it is a common reason for discontinuation. Encouraging fluids will not resolve a bradykinin-mediated cough.
Question 3 of 5
A client takes a GLP-1 receptor agonist (for example liraglutide) by subcutaneous injection. Which expected effect should the nurse explain?
Answer: A. GLP-1 receptor agonists enhance glucose-dependent insulin secretion, suppress glucagon, slow gastric emptying, and promote satiety, which often leads to reduced appetite and weight loss. Nausea is a common early side effect. They are not insulin replacements and rarely cause hypoglycemia alone.
Question 4 of 5
A client is started on metoprolol for atrial fibrillation with a rapid ventricular response. Which assessment finding would cause the nurse to withhold the dose?
Answer: B. Beta blockers such as metoprolol slow heart rate and lower blood pressure by blocking beta-1 receptors. A heart rate of 48 beats per minute and a systolic pressure of 88 mmHg indicate bradycardia and hypotension, so the nurse should hold the dose and notify the provider. A heart rate of 88 with a normal pressure, mild fatigue, or a blood glucose of 110 do not require withholding.
Question 5 of 5
A client newly started on prazosin, an alpha-1 blocker, for hypertension should be cautioned about which effect, especially after the first dose?
Answer: A. Alpha-1 blockers such as prazosin can cause a pronounced drop in blood pressure with the first dose, known as the first-dose effect or first-dose syncope. The nurse cautions the client about orthostatic hypotension and dizziness and advises taking the first dose at bedtime and rising slowly. These drugs do not cause hypertension, do not increase the heart rate as a desired effect, and are not associated with a chronic cough.
Keep the streak going with more questions like these, each with a full rationale.
What is h2 receptor blockers?
They act faster than PPIs but suppress acid less completely. Memory aid: the -tidine suffix (famotidine, cimetidine, nizatidine); ranitidine was withdrawn for NDMA contamination.
Key points to remember
- Decrease acid secretion by blocking the histamine pathway, providing partial acid suppression.
- Best taken with or just after meals and at bedtime to control nocturnal acid.
- Cimetidine inhibits hepatic enzymes (CYP450), raising levels of warfarin, phenytoin, theophylline, and many other drugs.
- Cimetidine can cause antiandrogen effects such as gynecomastia, impotence, and confusion in older adults.
- Separate from antacids by about 1 hour because antacids reduce absorption.
- Generally fewer long-term risks than PPIs but provide less acid control.
Signs & symptoms
- Cimetidine: confusion in elderly
- Cimetidine → many drug interactions
Nursing priorities
- Give with meals and/or at bedtime as ordered.
- Screen for drug interactions, especially with cimetidine before administration.
- Assess older adults on cimetidine for confusion, agitation, or disorientation.
- Evaluate for relief of heartburn and epigastric pain and monitor stools for blood.
- Space dosing at least 1 hour apart from antacids.
Patient teaching
- Prefer famotidine over cimetidine when many other medications are taken.
- Take at bedtime to control overnight acid and reflux.
- Avoid alcohol, NSAIDs, smoking, and caffeine.
- Notify your provider if heartburn lasts more than 2 weeks with OTC use.
Red flags: report now
- Report new confusion or agitation in elderly patients, especially on cimetidine.
- Report black tarry stools or coffee-ground emesis suggesting GI bleeding.
- Never give cimetidine without checking for interacting drugs like warfarin or phenytoin.
References
Clinical references for this topic
