A patient who has severe arthritis and who takes nonsteroidal antiinflammatory drugs (NSAIDs)daily develops a duodenal ulcer.The patient has tried a cyclooxygenase-2 selective NSAID in the past and states that it is not as effective as the current NSAID.The primary care nurse practitioner (NP)should:

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Patients with NSAID-induced ulcer should discontinue the NSAID if possible and use an acid suppressant.This patient has severe arthritis and so cannot discontinue the NSAID.In a situation such as this,a PPI is indicated.Cimetidine is a histamine-2 blocker,which would be a second-line choice,but cimetidine has many serious side effects.Bland diets are not effective in treating ulcers.Corticosteroids are not indicated.

A Patient Who Has Severe Arthritis and Who Takes Nonsteroidal