LP7 Review

Has the greatest noncompliance

Aluminum/Magnesium hydroxide

High dose and frequency stimulate release of gastrin

Aluminum/Magnesium hydroxide

10. Which adverse reaction is common and usually dose-related in patients taking misoprostol? a. Diarrhea b. Nausea c. Vomiting d. Bloating

Diarrhea Rationale: Misoprostol commonly causes diarrhea. This reaction is usually dose-related.

Covers the ulcer, protecting it from erosion by acids

Sucralfate (Carafate)

6. An elderly client with diverticulosis is instructed to take the bulk laxative psyllium (Metamucil). Which question is most important for the nurse to assess the client? a. "When was your last bowel movement?" b. "Do you have difficulty swallowing?" c. "How much fiber do you eat daily?" d. "Do you ever notice any of abdominal tenderness?"

"Do you have difficulty swallowing?"

1. A nurse is teaching a client with PUD how to properly self-administer ranitidine (Zantac). Which of the following client statements indicates effective teaching by the nurse? a. "I should call my doctor if my stools look black and sticky." b. "I will take Zantac regularly until my burning symptoms disappear." c. "I need to take Zantac on an empty stomach." d. "I can take ibuprofen if I have minor aches and pains."

"I should call my doctor if my stools look black and sticky." Rationale: Clients need to notify the provider if signs of GI bleeding develop. Symptom relief is not indicative of ulcer healing. Ranitidine can be taken without regard to food, and NSAIDs, such as ibuprofen should be avoided for clients with PUD due to the risk of bleeding.

4. For which of the following clients with peptic ulcer disease is misoprostol (Cytotec) contraindicated? a. 27-year-old client who is pregnant b. 75-year-old client with osteoarthritis c. 37-year-old client with a kidney stone d. 46-year-old client with a urinary tract infection

27-year-old client who is pregnant Rationale: Misoprostol can induce labor, and therefore is contraindicated in pregnancy. There are no contraindications for use in clients with osteoarthritis, kidney stones, or urinary tract infection.

5. For which of the following clients is a laxative indicated? (Select all that apply.) ____ A young female who is postpartum following a vaginal delivery with an episiotomy ____ A young adult male with constipation and periumbilical pain ____ A young adult client affected by IBS ____ An older adult client with limited mobility and minor bowel incontinence ____ An older adult client preparing for a colonoscopy

A young female who is postpartum following a vaginal delivery with an episiotomy A young adult client affected by IBS An older adult client preparing for a colonoscopy Rationale: Laxatives will prevent straining until the episiotomy heals. Bulk-forming laxatives provide relief of diarrhea for clients with IBS. Laxatives are used for bowel cleansing prior to diagnostic procedures of the GI tract. Appendicitis can begin in the periumbilical area before progressing to the right lower quadrant. The older adult may be experiencing fecal impaction and a laxative could cause perforation.

12. A patient is admitted to the emergency department with salicylate poisoning. Which drug should the nurse anticipate giving the patient? a. Chlorpromazine b. Activated charcoal c. Magnesium citrate d. Docusate

Activated charcoal Rationale: Activated charcoal is a general-purpose antidote that's used for various types of acute oral poisoning.

3. A client taking sucralfate (Carafate) PO for peptic ulcer disease has been started on phenytoin (Dilantin) to control seizures. Which of the following should be included in the client's teaching? a. Take both of these medications at the same time b. Take sucralfate with a glass of milk c. Allow a 2-hour interval between these medications d. Chew the sucralfate thoroughly before swallowing

Allow a 2-hour interval between these medications Rationale: Sucralfate can interfere with the absorption of phenytoin, so the client should allow a 2-hour interval between the sucralfate and phenytoin. Sucralfate should be taken on an empty stomach and it should be swallowed whole.

13. Which drug is used to treat IBS in women whose primary bowel symptom is diarrhea? a. Alosetron b. Bisacodyl c. Famotadine d. Docusate

Alosetron Rationale: Alosetron is a selective 5-HT3-receptor antagonist that's used for the short-term treatment of IBS in women whose primary bowel symptom is severe diarrhea.

Prevents conversion of pepsinogen to pepsin

Aluminum/Magnesium hydroxide

Used in patients with verified H. pylori

Amoxicillin/clarithromycin/omeprazole

Decrease HCl acid secretion and gastric motility

Anticholinergics

High incidence of side effects and contraindications

Anticholinergics

2. A nurse is caring for a client who is starting omeprazole (Prilosec) PO for management of GERD. The nurse should recognize that this medication works by a. Improving gastric motility b. Decreasing the production of gastric acid c. Neutralizing gastric acid d. Antagonizing serotonin receptors

Decreasing the production of gastric acid Rationale: Omeprazole reduces gastric acid secretion by irreversibly inhibiting the enzyme that produces gastric acid. Gastric motility is improved by metoclopramide (Reglan), a prokinetic agent. Gastric acid is neutralized by aluminum hydroxide, an antacid. Ondansetron (Zofran), an antiemetic, antagonizes serotonin receptors, decreasing nausea and vomiting.

7. Which information should the nurse discuss with a 75-year-old client diagnosed with diverticulosis who is prescribed Citrucel, a bulk laxative? a. Notify the healthcare provider if abdominal cramping occurs. b. Explain that results should be evident within 24 hours. c. Encourage the client to increase the intake of fluids, especially water. d. Instruct the client to decrease fiber intake while taking this medication.

Encourage the client to increase the intake of fluids, especially water.

6. Children and older adults are usually not administered prochlorperzine (Compazine) for nausea and vomiting due to the increased risk for _____________.

Extrapyramidal symptoms such as restlessness, anxiety, and spasms of the face and neck are more common in children and older adults.

Reduce HCl acid secretion by blocking action of histamine

Famotidine (Pepcid)

4. The female client diagnosed with low back pain has been self-medicating with ibuprofen, an NSAID. The client called the clinic and tells the nurse she has been getting dizzy and lightheaded. Which intervention should the nurse implement? a. Tell the client to get up from the sitting or lying position slowly. b. Have a client come to the clinic for lab work immediately. c. Suggest the client to take ibuprofen with food or an anti-acid. d. Discussed changing to a different nonsteroidal anti-inflammatory medication.

Have a client come to the clinic for lab work immediately.

9. A patient is taking calcium carbonate for peptic ulcer disease. You should monitor the patient for: a. Hypercalcemia b. Hypocalcemia c. Hyperkalemia d. Hypokalemia

Hypercalcemia Rationale: Watch for signs of hypercalcemia in the patient receiving calcium carbonate. (Signs would be lack of coordination, anorexia, N/V, decreased level of consciousness)

7. Laxatives containing sodium are contraindicated for which of the following client conditions? a. Hypertension b. Arthritis c. Depression d. Seizure disorder

Hypertension Rationale: Laxatives containing sodium can lead to sodium and water retention, which could exacerbate hypertension. Laxatives with sodium are not contraindicated for arthritis, depression, or seizure disorders.

Antisecretory effects in patients using antiprostaglandin drugs

Misoprostol (Cytotec) mixture

3. The nurse is discharging a client diagnosed with gastroesophageal reflux disease (Gerd). Which information should the nurse include in the teaching? a. There are no complications of Gerd as long as the client takes the medication. b. Notify the healthcare provider if the medication does not resolve the symptoms. c. Immediately after a meal, lie down for at least 45 minutes. d. If any discomfort is noted, take the NSAID for the pain.

Notify the healthcare provider if the medication does not resolve the symptoms.

Decreases gastric acid secretion by blocking adenosine triphosphatase (ATPase) enzyme

Omeprazole (Prilosec)

11. Which drug or drug type may interact with the H2-receptor antagonist cimetidine? a. Hormonal contraceptives b. Antilipemic agents c. Digoxin d. Oral anticoagulants

Oral anticoagulants Rationale: Cimetidine may increase the blood levels of oral anticoagulants by reducing their metabolism in the liver and excretion.

2. Which statement is the scientific rationale for administering a proton pump inhibitor (PPI) to a client diagnosed with gastroesophagel reflux disease (Gerd)? a. PPI medications neutralize the gastric secretions. b. PPI medications block H2 receptors in the parietal cells c. PPI medications inhibit the enzymes that generate gastric acid. d. PPI medications for my protective barrier against acid and pepsin

PPI medications inhibit the enzymes that generate gastric acid.

5. The male client diagnosed with peptic ulcer disease (PUD) has been taking magnesium hydroxide (Milk of Magnesia) for indigestion. The client complains that he has been having diarrhea. Which intervention should the nurse implement? a. Suggest that the client use magnesium hydroxide with aluminum hydroxide (Mylanta). b. Encourage the client to discuss the problem with the healthcare provider. c. Tell the client to take loperamide (Imodium) over the counter. d. Discuss why the client is concerned about experiencing diarrhea.

Suggest that the client use magnesium hydroxide with aluminum hydroxide (Mylanta).

8. The 80-year-old client with diverticulosis is prescribed a stool surfactant, docusate sodium (Colace). Which assessment data indicates the medication is effective? a. The client has a bowel movement within eight hours. b. The client has soft, brown stools. c. The client has a soft, nontender abdomen. d. The client has bowel sounds in all four quadrants.

The client has soft, brown stools.

1. The client complaining of "acid" when lying down at night asked some nurse if there is any medication that might help. Which statement is the nurse's best response? a. There are no medications to treat this problem, but losing weight will sometimes help the symptoms. b. There are several over-the-counter prescription medications available to treat this. You should discuss this with your healthcare provider. c. Have you had any x-rays or other test to determine if you have cancer or some other serious illness? d. Acid reflex at night can lead to serious complications. You need to have test done to determine the cause.

There are several over-the-counter prescription medications available to treat this. You should discuss this with your healthcare provider.

8. A nurse is taking a history for a client who has irritable bowel syndrome with constipation. Which of the following in the client's history is a contraindication to lubiprostone (Amitiza)? a. Myocardial infarction b. Ulcerative colitis c. Diabetes mellitus d. Rheumatoid arthritis

Ulcerative colitis Rationale: A client with ulcerative colitis should not be prescribed lubiprostone. Myocardial infarction, diabetes mellitus, and rheumatoid arthritis are not contraindications to lubiprostone.