# A nurse counsels a client on long-term omeprazole therapy about adverse effects with prolonged use. Which group of risks should the nurse emphasize?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391802&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A nurse counsels a client on long-term omeprazole therapy about adverse effects with prolonged use. Which group of risks should the nurse emphasize?

## Option

1. Improved bone density
2. Hypomagnesemia, vitamin B12 deficiency, increased risk of C. difficile infection, hip and spine fractures, and CKD risk **✔ Correct answer**
3. Lower hemoglobin A1c
4. Decreased risk of pneumonia

**Correct answer: 2**

## Explanation

Correct (2): Long-term PPI use (>1 year) is associated with hypomagnesemia, B12 deficiency, increased C. difficile infection, community-acquired pneumonia, osteoporotic fractures (hip/spine), interstitial nephritis, and CKD. Use the lowest effective dose and consider de-escalation when indication resolves. (1,3,4) Wrong direction.

## In-depth explanation

Memory Tip Long-term PPI = "M.B.C. (Magnesium·B12·C.diff·CKD)·Fractures·Pneumonia." Yearly Mg, B12 check; reassess indication annually.

## Clinical scenario

Scenario 62-year-old female on omeprazole 20 mg PO daily × 5 years for GERD. Provider requests counseling about long-term PPI risks.

## Key concepts

- **Proton pump inhibitor (PPI)** — Irreversibly inhibits H+/K+ ATPase in parietal cells; omeprazole, pantoprazole, esomeprazole, lansoprazole.
- **Hypomagnesemia** — Reduced Mg absorption with long-term PPI; can cause tetany, seizures, arrhythmias.
- **PPI deprescribing** — Annual reassessment of indication; step down to H2 blocker or PRN dosing when possible.

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