Ch 17 GI System

A patient with a body mass index (BMI) of 28 has recently been diagnosed with gastroesophageal reflux disease (GERD), and omeprazole has been prescribed. Which advice would the APN give this patient regarding lifestyle changes? 1. "You should eat meals high in carbohydrates." 2. "Small amounts of alcohol are OK." 3. "Attaining a healthy weight will help reduce symptoms of GERD." 4. "Drinking peppermint tea before bed will help."

3. "Attaining a healthy weight will help reduce symptoms of GERD."

A 25-year-old female patient is about to embark on a 2-week cruise for her honeymoon, and she is worried because she experiences seasickness. She asks about using a scopolamine patch. Which advice would the APN provide the patient about this medication? 1. "Apply the patch behind your ear 4 hours before getting on the ship." 2. "Change the patch every morning while on the ship." 3. "When you change the patch, put it behind the same ear." 4. "Only apply the patch to your arm if you experience seasickness."

1. "Apply the patch behind your ear 4 hours before getting on the ship."

Prior to initiating therapy with misoprostol for a 30-year-old woman, which question is essential for the APN to ask? 1. "Is there any possibility that you might be pregnant?" 2. "Do you take any other pain medication?" 3. "Are you taking any antacids or [histamine-2] H2 blockers right now?" 4. "How long have you been suffering from arthritis?"

1. "Is there any possibility that you might be pregnant?"

A patient in the emergency room (ER) has been prescribed prochlorperazine for nausea. By which mechanism of action does this medication work? 1. Blocking dopamine receptors in the chemoreceptor trigger zone (CTZ) 2. Blocking histamine1 receptors in the gastrointestinal (GI) tract 3. Blocking serotonin on vagal nerve terminals 4. Stimulating gastric emptying and peristalsis

1. Blocking dopamine receptors in the chemoreceptor trigger zone (CTZ)

Considering eradication rates, adverse effects, antimicrobial resistance, and patient compliance, which regimen is most appropriate for treatment of H. pylori-induced peptic ulcer disease (PUD)? 1. Clarithromycin, amoxicillin, and a proton pump inhibitor (PPI) 2. Tetracycline, metronidazole, and a proton pump inhibitor (PPI) 3. Clarithromycin, tetracycline, and a histamine-2 (H2) blocker 4. Metronidazole, amoxicillin, and a histamine-2 (H2) blocker

1. Clarithromycin, amoxicillin, and a proton pump inhibitor (PPI)

An elderly person has been prescribed lactulose for treatment of chronic constipation. Monitoring with long-term treatment would include: 1. Electrolytes, including potassium and chloride 2. Bone mineral density for osteoporosis 3. Magnesium level 4. Liver function

1. Electrolytes, including potassium and chloride

Patients who are on chronic long-term proton pump inhibitor therapy require monitoring for: 1. Iron deficiency anemia, vitamin B12 and calcium deficiency 2. Folate and magnesium deficiency 3. Elevated uric acid levels leading to gout 4. Hypokalemia and hypocalcemia

1. Iron deficiency anemia, vitamin B12 and calcium deficiency

A 72-year-old patient takes omeprazole for their chronic GERD. Chronic long-term omeprazole use places them at increased risk for: 1. Megaloblastic anemia 1. Loperamide four times a day throughout the trip 3. Hypertension 4. Strokes

1. Megaloblastic anemia

Older adults taking ranitidine should be monitored carefully for which of these? 1. Mental status changes 2. Asymptomatic ventricular tachycardia 3. Community-acquired pneumonia (CAP) 4. Bone fractures

1. Mental status changes

A 56-year-old male patient with diabetes has been taking a proton pump inhibitor (PPI) daily as prescribed for gastroesophageal reflux disease (GERD) but still experiences significant acid reflux. Which medication could be prescribed to increase gastric emptying and help improve his symptoms? 1. Metoclopramide 2. Famotidine 3. Prochlorperazine 4. Sucralfate

1. Metoclopramide

Which medication has a Black Box Warning because of the risk of developing tardive dyskinesia and can cause or exacerbate depression? 1. Metoclopramide 2. Pantoprazole 3. Misoprostol 4. Prochlorperazine

1. Metoclopramide

The APN is assessing a 6-year-old boy who has Down syndrome. His mother states that he is starting to get over a severe bout of flu but now has diarrhea. She asks what can be prescribed to stop the diarrhea. Which regimen would the APN order? 1. Oral rehydration therapy (ORT) 2. Loperamide orally after each loose stool 3. Diphenoxylate with atropine orally once daily 4. Bismuth subsalicylate orally after each loose stool

1. Oral rehydration therapy (ORT)

Many patients self-medicate with antacids. Which patients should be counseled to not take calcium carbonate antacids without discussing it with their provider or a pharmacist first? 1. Patients with kidney stones 2. Pregnant patients 3. Patients with heartburn 4. Postmenopausal women

1. Patients with kidney stones

The APN is writing orders for a patient who is scheduled to have a colonoscopy 3 days from now. Which medication should be prescribed to cleanse the entire gastrointestinal (GI) tract prior to this procedure? 1. Polyethylene glycol 2. Methylcellulose 3. Lactulose 4. Docusate calcium

1. Polyethylene glycol

Patients with uncomplicated peptic ulcer disease or mild gastroesophageal reflux disease (GERD) may benefit from taking antacids daily. Which instruction should the APN give the patient regarding an antacid suspension? 1. Take the antacid suspension 1 to 3 hours after meals and at bedtime. 2. Take the suspension immediately before eating. 3. Take the antacid once a day just before going to bed. 4. Take the antacid suspension along with morning medications.

1. Take the antacid suspension 1 to 3 hours after meals and at bedtime.

A 70-year-old male patient on the medical floor tells the APN that he has frequent heartburn but that his wife has brought in Alka-Seltzer from home. Which fact about the patient would be a contraindication for this over-the-counter (OTC) medication? 1. The patient has been admitted for an exacerbation of congestive heart failure. 2. The patient was diagnosed with benign prostatic hypertrophy (BPH) 3 years ago. 3. The patient has experienced intermittent episodes of asthma over the past 20 years. 4. The patient has occasional constipation and takes bisacodyl once or twice a week.

1. The patient has been admitted for an exacerbation of congestive heart failure.

When initiating long-term drug therapy with proton pump inhibitors (PPIs) for patients with severe gastroesophageal reflux disease (GERD), which of these is one of the four goals of treatment? 1. To reduce symptoms of reflux 2. To remove barriers to adherence 3. To prevent the development of vitamin B12 deficiency 4. To cure the disorder

1. To reduce symptoms of reflux

A patient with gastroesophageal reflux disease (GERD) has been self-medicating with various antacids at home. The APN is reviewing the patient's prescription medications with him. Which medication decreases lower esophageal sphincter (LES) tone and could potentially exacerbate GERD? 1. Verapamil 2. Metoclopramide 3. Prochlorperazine 4. Cisapride

1. Verapamil

Loperamide is available over the counter (OTC) and is commonly used to treat acute diarrhea. Which dose is initially recommended for an adult? 1. 2 mg orally 2. 4 mg orally 3. 6 mg orally 4. 8 mg orally

2. 4 mg orally

A 10-year-old patient presents with uncomfortable constipation. Along with diet changes, a laxative is ordered to provide more rapid relief of constipation. An appropriate choice of medication for a 10-year-old child would be: 1. PEG 3350 (Miralax) 2. Bisacodyl (Dulcolax) suppository 3. Docusate (Colace) suppository 4. Methylnaltrexone

2. Bisacodyl (Dulcolax) suppository

A young adult will be traveling to Mexico with her church group over spring break to build houses. She is concerned she may develop traveler's diarrhea. Advice includes following normal food and water precautions as well as taking: 1. Loperamide four times a day throughout the trip 2. Bismuth subsalicylate before each meal and at bedtime 3. Prescription diphenoxylate with atropine if she gets diarrhea 4. Calcium carbonate (Tums) four times a day for stomach upset

2. Bismuth subsalicylate before each meal and at bedtime

The APN understands that loperamide works by which mechanism? 1. Supplying missing bacteria to the gastrointestinal (GI) tract 2. Decreasing gastric and bowel motility 3. Coating the walls of the gastrointestinal (GI) tract and binding to toxins 4. Stimulating peristalsis and gastric motility

2. Decreasing gastric and bowel motility

When treating a patient with a duodenal ulcer, the APN should consider which action to be the priority? 1. Advise the patient to stop smoking. 2. Eradicate infection of H. pylori. 3. Advise the patient to avoid spicy foods. 4. Evaluate the patient for infection with methicillin-resistant S. aureus (MRSA).

2. Eradicate infection of H. pylori.

Many patients, particularly older adults, take over-the-counter (OTC) laxatives regularly. Which statement about laxative use is accurate? 1. Patients cannot become dependent on laxatives. 2. Fluid and electrolyte imbalances can occur. 3. Persons with Crohn's disease often abuse laxatives and take too many. 4. Castor oil is good choice of laxative for a pregnant woman.

2. Fluid and electrolyte imbalances can occur.

Many patients are prescribed opioid analgesics for the amelioration of chronic pain. Chronic constipation often results from taking these medications long term. Which medication is the best choice for the APN to prescribe to help with the constipation? 1. Lubiprostone 2. Methylnaltrexone 3. Docusate 4. Psyllium

2. Methylnaltrexone

Which of the following medications places a patient at increased risk of developing chronic kidney disease? 1. Ranitidine 2. Omeprazole 3. Loperamide 4. Ondansetron

2. Omeprazole

Pernicious anemia can develop in patients having long-term treatment with which class of drugs? 1. Histamine2 receptor antagonists (H2RAs) 2. Proton pump inhibitors (PPIs) 3. Antacids 4. Prokinetic agents

2. Proton pump inhibitors (PPIs)

A patient presents with complaints of heartburn that is minimally relieved with Tums (calcium carbonate) and is diagnosed as gastroesophageal reflux disease (GERD). An appropriate on-demand therapy would be: 1. Omeprazole (Prilosec) twice a day 2. Ranitidine (Zantac) twice a day 3. Famotidine (Pepcid) once a day 4. Metoclopramide (Reglan) four times a day

2. Ranitidine (Zantac) twice a day

A patient has diarrhea and is wondering if they can take loperamide (Imodium). Loperamide: 1. Can be given to patients of all ages, including infants and children, for viral gastroenteritis 2. Slows gastric motility and reduces fluid and electrolyte loss from diarrhea 3. Is the treatment of choice for the diarrhea associated with E. coli 0157 4. May be used in pregnancy and by lactating women

2. Slows gastric motility and reduces fluid and electrolyte loss from diarrhea

A 70-year-old patient complains of recurrent constipation and tells the APN that he has been self-medicating with over-the-counter (OTC) bisacodyl. The APN understands that bisacodyl works by which mechanism? 1. Drawing water into the intestinal lumen 2. Stimulating the myenteric plexus 3. Increasing the bulk and water content of feces 4. Lubricating the intestine and softening feces

2. Stimulating the myenteric plexus

Which medication works by binding to the base of ulcers and gastric erosions, thus forming a protective barrier? 1. Metoclopramide 2. Sucralfate 3. Aluminum carbonate 4. Bismuth subsalicylate

2. Sucralfate

A patient is to start taking esomeprazole for the treatment of gastroesophageal reflux disease (GERD). Which instruction must the APN give the patient regarding this medication? 1. Take this medication with every meal. 2. Take the medication at least 1 hour before a meal. 3. Take the medication 1 to 3 hours after meals. 4. Take the medication every time you experience heartburn.

2. Take the medication at least 1 hour before a meal.

The APN is considering treatment options for a patient with diabetic gastroparesis. Which clinical fact about this patient would cause the APN to prescribe half the normal dose of metoclopramide? 1. The patient's serum creatinine is 1.1. 2. The patient's creatinine clearance is 32 mL/minute. 3. The patient has diabetic neuropathy in both feet. 4. The patient experiences abdominal bloating and nausea after eating.

2. The patient's creatinine clearance is 32 mL/minute.

The APN is reviewing a patient's current medications, including over-the-counter (OTC) medications, with him. The patient suffers from dyspepsia and takes Tums (calcium carbonate). Which statement by the patient indicates that the patient understands how best to take this medication? 1. "I take it when I have my spinach salad for lunch." 2. "I take it with a glass of orange juice." 3. "I take it just before I eat my breakfast cereal." 4. "I take it along with my regular medications in the morning."

3. "I take it just before I eat my breakfast cereal."

A student APN is giving a presentation to her classmates about gastroesophageal reflux disease (GERD). Which piece of information should be included? 1. "GERD is uncomfortable for the patient but will not cause lasting damage." 2. "Most patients complain of retrosternal pain radiating downwards to the abdomen." 3. "Older adults may have few symptoms, despite having significant disease." 4. "Dysphagia with GERD indicates that the patient has esophageal cancer."

3. "Older adults may have few symptoms, despite having significant disease."

A 65-year-old female patient in generally good health requests information regarding the amount of calcium she should take daily as a supplement to prevent osteoporosis. Which amount would the APN recommend? 1. 500 mg/day 2. 1,000 mg/day 3. 1,500 mg/day 4. 2,500 mg/day

3. 1,500 mg/day

The capacity of an antacid to neutralize hydrochloric acid (HCl) varies between products. To be effective, antacids must neutralize at least how much HCl per dose? 1. 1 mEq HCl per dose 2. 2 mEq HCl per dose 3. 5 mEq HCl per dose 4. 10 mEq HCl per dose

3. 5 mEq HCl per dose

A patient in the emergency room (ER) has been prescribed ondansetron for nausea. The APN understands that this medication works by which mechanism? 1. Blocking dopamine receptors in the chemoreceptor trigger zone 2. Blocking histamine1 receptors in the gastrointestinal (GI) tract 3. Blocking serotonin on vagal nerve terminals 4. Stimulating gastric emptying and peristalsis

3. Blocking serotonin on vagal nerve terminals

The APN must be sure to educate the patient about ways to avoid constipation when they are taking which drug? 1. Psyllium 2. Magnesium hydroxide 3. Calcium carbonate 4. Metoclopramide

3. Calcium carbonate

Which medication gives short-term relief of dyspepsia by directly increasing the pH of the gastric contents? 1. Pantoprazole 2. Sucralfate 3. Calcium carbonate 4. Diphenoxylate with atropine

3. Calcium carbonate

The APN is assessing a patient who is complaining of frequent and debilitating diarrhea. The APN notes that the patient was diagnosed HIV-positive 6 months ago and is taking a combination of antiretroviral medications. Which medication would be most appropriate for the APN to prescribe? 1. Loperamide 2. Kaolin-pectin 3. Crofelemer 4. Bismuth subsalicylate

3. Crofelemer

A 22-year-old female patient suffering from irritable bowel syndrome (IBS) with constipation is seen at the clinic. Which medication would be most appropriate for this patient? 1. Lactulose 2. Mineral oil 3. Lubiprostone 4. Polycarbophil

3. Lubiprostone

A 26-year-old female patient, who is 30 weeks pregnant, comes to the clinic complaining of constipation and asking which over-the-counter (OTC) medication from the many choices available is safe for her to take. Which medication would be recommended? 1. Castor oil 2. Mineral oil 3. Psyllium 4. Glycerin suppository

3. Psyllium

A 62-year-old male patient in the clinic tells the APN that he often experiences motion sickness when traveling but that his wife has bought over-the-counter (OTC) scopolamine patches for him to use on their upcoming trip. Which fact about the patient would be a contraindication for this medication? 1. The patient has Parkinson's disease (PD). 2. The patient has a history of emphysema. 3. The patient has narrow-angle glaucoma. 4. The patient has a history of seizures.

3. The patient has narrow-angle glaucoma.

Four weeks after completing treatment for an H. pylori-induced duodenal ulcer, which test would the APN order to confirm eradication of the bacterium? 1. Barium swallow 2. Abdominal x-ray 3. Urea breath test 4. Fecal occult blood test

3. Urea breath test

Most infants experience gastroesophageal reflux to some degree. The APN would start to be concerned if the child had not outgrown reflux by which age? 1. 3 months 2. 6 months 3. 9 months 4. 12 months

4. 12 months

For which patient is docusate contraindicated? 1. A female patient with an 8-week-old baby who is breastfeeding 2. A female patient who is 16 weeks pregnant 3. A male patient who has just undergone a thoracotomy 4. A male patient complaining of nausea and abdominal pain

4. A male patient complaining of nausea and abdominal pain

Patients taking antacids should be educated regarding these drugs, including letting them know that: 1. They may cause constipation or diarrhea. 2. Many are high in sodium. 3. They should separate antacids from other medications by one hour. 4. All of the above

4. All of the above

A patient with chronic renal failure is on dialysis three times a week. He frequently complains of dyspepsia and has been receiving aluminum hydroxide orally several times a day for the past 2 years. Why would this be of grave concern to the APN? 1. Aluminum hydroxide can worsen renal failure. 2. Aluminum hydroxide frequently causes diarrhea. 3. Prolonged use of aluminum hydroxide can cause metabolic acidosis. 4. Aluminum hydroxide can cause dialysis osteomalacia.

4. Aluminum hydroxide can cause dialysis osteomalacia.

Traveler's diarrhea is common in people who journey to high-risk areas such as Central and South America. Which medications are specifically indicated for traveler's diarrhea? 1. Bismuth subsalicylate and alosetron 2. Loperamide and kaolin-pectin 3. Crofelemer and bismuth subsalicylate 4. Bismuth subsalicylate and loperamide

4. Bismuth subsalicylate and loperamide

A patient underwent sternotomy and coronary artery bypass surgery yesterday. It is important to avoid straining for a bowel movement postoperatively. Which laxative would be the best choice for this type of patient? 1. Psyllium 2. Lubiprostone 3. Methylnaltrexone 4. Docusate

4. Docusate

A patient comes to the clinic complaining of a 2-day history of diarrhea. He receives two tablets of diphenoxylate HCl with atropine sulfate to take orally as needed for each loose stool. The APN should inform him that he may experience which symptom(s)? 1. A slower heart rate than normal 2. The need to urinate frequently 3. An increase in appetite 4. Drowsiness and dizziness

4. Drowsiness and dizziness

hen comparing the histamine2 antagonists with each other, the APN recognizes that cimetidine is more likely to cause which adverse effect in male patients? 1. Drowsiness 2. Dizziness 3. Tardive dyskinesia 4. Gynecomastia

4. Gynecomastia

Bismuth subsalicylate (Pepto-Bismol) is a common over-the-counter (OTC) remedy for gastrointestinal complaints. Bismuth subsalicylate: 1. May lead to toxicity if taken with ibuprofen 2. Is contraindicated in children with flu-like illness 3. Has no antimicrobial effects against bacterial and viral enteropathogens 4. May cause stools to turn reddish color

4. May cause stools to turn reddish color

A 53-year-old female patient has been diagnosed with vertigo, which occurs intermittently throughout the day. She asks if there is a medication to help with the symptoms. Which medication would be most appropriate for this patient? 1. Prochlorperazine 2. Scopolamine 3. Dronabinol 4. Meclizine

4. Meclizine

A 15-year-old patient presents to the clinic with a 48-hour history of nausea, vomiting, and some diarrhea. She is unable to keep fluids down and her weight is four pounds less than her last recorded weight. Besides intravenous (IV) fluids, the exam warrants the use of an antinausea medication. Which of the following would be the appropriate drug to order? 1. Prochlorperazine (Compazine) 2. Meclizine (Antivert) 3. Promethazine (Phenergan) 4. Ondansetron (Zofran)

4. Ondansetron (Zofran)

Methylnaltrexone is used to treat constipation in: 1. Patients with functional constipation 2. Patients with irritable bowel syndrome-associated constipation 3. Children with encopresis 4. Patients with opioid-associated constipation

4. Patients with opioid-associated constipation

Which is the standard first-line therapy for the treatment of gastroesophageal reflux disease (GERD)? 1. Histamine2 receptor antagonists (H2RAs) 2. Antacids 3. Histamine1 receptor antagonists (H1RAs) 4. Proton pump inhibitors (PPIs)

4. Proton pump inhibitors (PPIs)

A 50-year-old male patient is complaining of recurrent heartburn. He has been taking over-the-counter (OTC) famotidine as per the directions on the box but has had little relief. Which situation could influence the efficacy of the medication? 1. The patient sleeps on four pillows. 2. The patient takes the medication with meals. 3. The patient feels sleepy after taking famotidine. 4. The patient smokes 5 to 10 cigarettes per day.

4. The patient smokes 5 to 10 cigarettes per day.