NCLEX Prep II Gastrointestinal Medications

The nurse administers ondansetron to a client. Which statement by the client indicates that this medication has been effective? 1."My headache is gone." 2."I no longer feel nauseous." 3."The dizziness has stopped." 4."The pain at my incision has decreased."

"I no longer feel nauseous." Rationale: Ondansetron is an antiemetic used in the treatment of nausea and vomiting. All of the other options are incorrect. Headache and dizziness are side effects of ondansetron. It is not used to treat pain.

A client is taking lansoprazole. The nurse anticipates that the health care provider will advise the client to take which product if needed for a headache? 1.Naproxen 2.Ibuprofen 3.Acetaminophen 4.Acetylsalicylic acid

Acetaminophen Rationale: Lansoprazole is a proton pump inhibitor and is commonly used to treat a gastrointestinal disorder. The client with gastrointestinal disease should avoid taking medications that are irritating to the stomach lining. Irritants would include aspirin and nonsteroidal antiinflammatory drugs (NSAIDs), which include naproxen and ibuprofen. The client should be advised to take acetaminophen for a headache.

A client has just taken a dose of trimethobenzamide hydrochloride. Which finding indicates that this client has had a therapeutic response to the medication? 1.Relief of constipation 2.Decrease in heartburn 3.Absence of abdominal pain 4.Relief of nausea and vomiting

Relief of nausea and vomiting Rationale: Trimethobenzamide hydrochloride is an antiemetic agent used to treat nausea and vomiting. The other options are not related effects of the medication.

A client has an as needed prescription for loperamide hydrochloride. For which condition should the nurse administer this medication? 1.Constipation 2.Abdominal pain 3.An episode of diarrhea 4.Hematest-positive nasogastric tube drainage

An episode of diarrhea Rationale: Loperamide is an antidiarrheal agent. It is used to manage acute and chronic diarrhea in conditions such as inflammatory bowel disease. Loperamide also can be used to reduce the volume of drainage from an ileostomy. It is not used for the conditions in options 1, 2, and 4.

A health care provider has written a prescription for ranitidine 300 mg once daily. The client indicates understanding of use of this medication by stating that the prescribed dose is best taken at what time? 1.At bedtime 2.After lunch 3.With supper 4.Before breakfast

At bedtime Rationale: Ranitidine is a histamine H2-receptor antagonist and should be taken at bedtime, when it is given as a single daily dose. This allows for prolonged effect and provides the greatest protection of the gastric mucosa both during sleep and around the clock.

The nurse has administered a dose of docusate. The nurse evaluates that the medication has been effective if the client experiences which finding? 1.Decreased heartburn 2.Decrease in fatty stools 3.Relief of sharp abdominal pain 4.Bowel movement with soft, formed stool

Bowel movement with soft, formed stool Rationale: Docusate is a stool softener that relieves constipation because it promotes absorption of water into the stool, producing a softer consistency of stool. The other options are not effects of this medication.

A client with Crohn's disease is scheduled to receive an infusion of infliximab. What intervention by the nurse will determine the effectiveness of treatment? 1.Monitoring the leukocyte count for 2 days after the infusion 2.Checking the frequency and consistency of bowel movements 3.Checking serum liver enzyme levels before and after the infusion 4.Carrying out a Hematest on gastric fluids after the infusion is completed

Checking the frequency and consistency of bowel movements Rationale: The principal manifestations of Crohn's disease are diarrhea and abdominal pain. Infliximab is an immunomodulator that reduces the degree of inflammation in the colon, thereby reducing the diarrhea. Options 1, 3, and 4 are unrelated to this medication.

A client is experiencing diarrhea. The nurse reviews the client's "as needed" (PRN) medication prescription sheet and should plan to administer which medication for this problem? 1.Psyllium 2.Bisacodyl 3.Sennosides 4.Loperamide

Loperamide Rationale: Loperamide is an antidiarrheal agent. It inhibits peristalsis in the intestinal wall and inhibits intestinal secretion so that the number of stools and water content are decreased. Psyllium, bisacodyl, and sennosides are laxatives.

Lactulose is prescribed for a client with a diagnosis of hepatic encephalopathy. The nurse should determine that this medication is effective if serum diagnostics reveal which finding? 1. Increased protein level 2. Increased red blood cell count 3. Decreased serum ammonia level 4. Decreased white blood cell count

Decreased serum ammonia level Rationale: Lactulose is prescribed for the client with hepatic encephalopathy to reduce bacterial breakdown of protein in the bowel. The medication creates an acidic environment in the bowel and causes the ammonia to leave the bloodstream and enter the colon. Ammonia then becomes trapped in the bowel. Lactulose also has a laxative effect that allows for the elimination of the ammonia.

A calcium carbonate antacid has been prescribed for a client, and the nurse provides instructions to the client about the medication. The nurse should tell the client that it is best to take the antacid with which item? 1.Milk 2.Water 3.Yogurt 4.Cheese

Water Rationale:Calcium carbonate antacids should not be taken with milk, milk products, or foods or supplements high in vitamin D because milk-alkali syndrome (headache, urinary frequency, anorexia, nausea, vomiting, and fatigue) can occur. The best item to consume when taking calcium carbonate is water.

The nurse notes that a client is taking lansoprazole. Which question by the nurse helps to determine that this medication is effective? 1."Has your appetite increased?" 2."Are you experiencing any heartburn?" 3."Do you have any problems with vision?" 4."Do you experience any leg pain when walking?"

"Are you experiencing any heartburn?" Rationale: Lansoprazole is a gastric acid proton pump inhibitor that is used to treat gastric and duodenal ulcers, erosive esophagitis, and hypersecretory conditions. It also is used to treat gastroesophageal reflux disease (GERD). It is not used to treat problems with appetite, visual problems, or leg pain.

A client who is in the postanesthesia care unit (PACU) has received a dose of ondansetron. The nurse evaluates that an adverse effect is occurring if which problem arises? 1.Headache 2.Incisional pain 3.Urinary retention 4.Nausea and vomiting

Headache Rationale: Ondansetron is an antiemetic used for relief of postoperative nausea and vomiting and nausea and vomiting associated with chemotherapy. Adverse effects include headache, dizziness, intravenous site irritation, dysrhythmias, dysphoria, dystonia, dry mouth, and sedation. Options 2 and 3 are not related to this medication, and option 4 is the indication for this medication.

A client has been taking omeprazole for 4 weeks. The ambulatory care nurse evaluates medication effectiveness by asking the client if relief was obtained from which symptom? 1.Diarrhea 2.Heartburn 3.Flatulence 4.Constipation

Heartburn Rationale: Omeprazole is a proton pump inhibitor and is classified as an antiulcer agent. The medication relieves pain from gastric irritation, which often is experienced as "heartburn" by clients. The medication does not relieve the symptoms identified in the remaining options.

A client has an "as needed" (PRN) prescription for trimethobenzamide. The nurse should assess the client for which sign or symptom to determine whether the client needs a dose of this medication? 1.Heartburn 2.Constipation 3.Abdominal pain 4.Nausea and vomiting

Nausea and vomiting Rationale: Trimethobenzamide is an antiemetic agent used for relief of nausea and vomiting. The medication is not used to treat heartburn, constipation, or abdominal pain.

A client has begun medication therapy with pancrelipase. The nurse evaluates that the medication is having the optimal intended benefit if which effect is observed? 1.Weight loss 2.Relief of heartburn 3.Reduction of steatorrhea 4.Absence of abdominal pain

Reduction of steatorrhea Rationale: Pancrelipase is a pancreatic enzyme used in clients with pancreatitis as a digestive aid. The medication should reduce the amount of fatty stools (steatorrhea). Another intended effect could be improved nutritional status. It is not used to treat abdominal pain or heartburn. Its use could result in weight gain but should not result in weight loss if it is aiding in digestion.

A client who is taking a stimulant laxative develops abdominal cramps. The nurse interprets that this clinical manifestation most likely indicates the presence of which problem? 1. The client has peptic ulcer disease. 2. The client is experiencing a case of influenza. 3. This is a common side effect of this medication. 4. The client may have a partial bowel obstruction.

This is a common side effect of this medication Rationale: Stimulant laxatives commonly cause abdominal cramps as a side effect. The health problems noted in the other options are not determined based on a single symptom.

A client has a new prescription for metoclopramide. On review of the chart, the nurse identifies that this medication can be safely administered with which condition? 1. Intestinal obstruction 2. Peptic ulcer with melena 3. Diverticulitis with perforation 4. Vomiting following cancer chemotherapy

Vomiting following cancer chemotherapy Rationale: Metoclopramide is a gastrointestinal stimulant and antiemetic. Because it is a gastrointestinal stimulant, it is contraindicated with gastrointestinal obstruction, hemorrhage, or perforation. It is used in the treatment of vomiting after surgery, chemotherapy, or radiation.

An older client recently has been taking cimetidine. The nurse monitors the client for which most frequent central nervous system side effect of this medication? 1.Tremors 2.Dizziness 3.Confusion 4.Hallucinations

confusion Rationale: Cimetidine is a histamine (H2)-receptor antagonist. Older clients are especially susceptible to central nervous system side effects of cimetidine. The most frequent of these is confusion. Less common central nervous system side effects include headache, dizziness, drowsiness, and hallucinations.

The nurse instructs a client taking aluminum hydroxide that a common side or adverse effect associated with administration of this medication is which effect? 1.Cramping 2.Headache 3.Constipation 4.Muscle weakness

constipation Rationale:Aluminum-containing antacids are constipating, so the client should be instructed to take a stool softener or additional bulk-type laxatives to relieve this uncomfortable side effect. Cramping, headache, and muscle weakness are not side or adverse effects of this medication.

The nurse is preparing to give a client directions for proper use of aluminum hydroxide tablets. Which instruction should the nurse provide to the client? 1."Take the tablet at the same time as an antacid." 2."Swallow the tablet whole with a full glass of water." 3."Take each dose with a laxative to prevent constipation." 4."Chew the tablet thoroughly and then drink 8 ounces of water."

"Chew the tablet thoroughly and then drink 8 ounces of water." Rationale: Aluminum hydroxide tablets are an antacid and should be chewed thoroughly before swallowing to prevent them from entering the small intestine undissolved. An antacid should not be taken with the medication to prevent additive and interactive effects. Constipation is a side or adverse effect of the use of aluminum products, but the client should not take a laxative with each dose. This would promote laxative abuse and should be avoided if less habit-forming means can be used.

A client with peptic ulcer disease asks the nurse what medications they might be prescribed for this problem. The nurse tells the client that which medications will be prescribed? Select all that apply. 1.Antacids 2.Antibiotics 3.Proton pump inhibitors 4.Cytoprotective therapy 5.Histamine H2-receptor blockers 6.Nonsteroidal anti-inflammatory drugs (NSAIDs)

1.Antacids 2.Antibiotics 3.Proton pump inhibitors 4.Cytoprotective therapy 5.Histamine H2-receptor blockers Rationale:Medications to treat peptic ulcer disease include antacids, antibiotics, proton pump inhibitors, cytoprotective therapy, and histamine H2-receptor blockers. NSAIDs are contraindicated in peptic ulcer disease because of the risk of bleeding.

A client admitted to the medical nursing unit has a diagnosis of gastroesophageal reflux disease (GERD). Metoclopramide has been prescribed 4 times a day. When should the nurse schedule administration of the medication? 1.Every 8 hours 2.With meals and at bedtime 3.Right after meals and at bedtime 4.30 minutes before meals and at bedtime

30 minutes before meals and at bedtime Rationale: Metoclopramide is a gastrointestinal stimulant. Administration should be scheduled 30 minutes before meals and at bedtime to allow the medication time to begin working before food intake and digestion. The other options are incorrect.

A client reports frequent use of sodium bicarbonate to relieve heartburn after meals. The nurse should monitor the client for which condition that the client is at risk for with long-term frequent use of this medication? 1.Urinary calculi 2.Chronic bronchitis 3.Metabolic alkalosis 4.Respiratory acidosis

Metabolic alkalosis Rationale:Sodium bicarbonate is an electrolyte modifier and antacid. With large doses or long-term use, it can cause metabolic alkalosis. The other options are incorrect.

The client with peptic ulcer disease is prescribed medication therapy. The nurse explains the medications to the client and explains that sucralfate will help to heal the ulcer by doing what? 1. Eradicate Helicobacter pylori. 2. Reduce gastric acidity. 3. Treat bacterial infection. 4. Enhance mucosal defenses.

Enhance mucosal defenses. Rationale: Medication therapy is used to treat peptic ulcer disease by 3 mechanisms: eradicating H. pylori (or other bacterial infections), reducing gastric acidity, and enhancing mucosal defenses. Sucralfate works by enhancing mucosal defenses. Antibiotics treat infection and eradicate H. pylori. Antisecretory agents, misoprostol, and antacids work by reducing gastric acidity.

A client with a history of duodenal ulcer is taking calcium carbonate chewable tablets. Which finding indicates that the client is experiencing optimal effects of the medication? 1. Heartburn is relieved. 2. Muscle twitching stops. 3. The serum calcium level increases. 4. The serum phosphorus level decreases.

Heartburn is relieved Rationale: Calcium carbonate can be used as an antacid for the relief of heartburn and indigestion. Calcium carbonate also can be used as a calcium supplement (serum calcium level increases) or to bind phosphorus in the gastrointestinal tract with chronic kidney disease (serum phosphorus level decreases). Although adequate calcium levels are needed for proper neurological function, a reduction in muscle twitching is not an expected outcome when taking the medication for duodenal ulcer.

A client is taking docusate sodium. Which finding by the nurse indicates that treatment has been effective? 1.Reduction in steatorrhea 2.Hematest-negative stools 3.Regular bowel movements 4.Absence of abdominal pain

Regular bowel movements Rationale: Docusate sodium is a stool softener that promotes absorption of water into the stool, producing a softer consistency of stool. The intended effect is relief or prevention of constipation. The medication does not decrease the amount of fat in the stools, stop gastrointestinal bleeding, or relieve abdominal pain.

A client rings the call bell and asks for medication to relieve postoperative gas pains. The nurse selects which medication to be given as prescribed on the medication sheet? 1.Droperidol 2.Simethicone 3.Acetaminophen 4.Magnesium hydroxide

Simethicone Rationale: Simethicone is an antiflatulent used in the relief of pain caused by excessive gas in the gastrointestinal tract. Droperidol relieves postoperative nausea and vomiting. Acetaminophen is a nonopioid analgesic. Magnesium hydroxide is an antacid and laxative.

The client has begun taking misoprostol. Which statement by the client indicates that the misoprostol is effective? 1."I have fewer joint aches." 2."My joint mobility has improved." 3."I no longer have pain above my stomach." 4."I am no longer experiencing constipation."

"I no longer have pain above my stomach." Rationale: Misoprostol is a gastric protectant and is given specifically to prevent gastric mucosal injury. Constipation is not associated with the use of this medication. Fewer joint aches and improved joint mobility are incorrect and are not intended effects of the medication.

Dicyclomine hydrochloride has been prescribed for a client with irritable bowel syndrome, and the nurse provides instructions to the client about how to take this medication. Which statement, if made by the client, indicates an understanding of how to take this medication? 1."I should take the pill with food and at mealtimes." 2."I should take the pill 30 minutes before each meal." 3."I should take the pill after I have finished eating my meal." 4."I should take the pill when I first wake up in the morning and right before I go to bed."

"I should take the pill 30 minutes before each meal." Rationale: Dicyclomine hydrochloride is an anticholinergic, antispasmodic agent often used to treat irritable bowel syndrome that is unresponsive to diet therapy. To be effective in decreasing bowel motility, antispasmodic medication should be administered 30 minutes before meals. The other options are incorrect.

Mineral oil has been prescribed for constipation, and the nurse teaches about administration of the mineral oil. Which statement by the mother indicates that teaching was effective? 1."I will administer the mineral oil before each meal." 2."I will administer the mineral oil followed by a glass of warm water." 3."I will mix the mineral oil with a chilled drink before administration." 4."I will mix the mineral oil with 8 ounces of warm juice before administration."

"I will mix the mineral oil with a chilled drink before administration." Rationale: Mineral oil is best tolerated when it is given chilled or mixed with cold drinks. Mixing the oil with chocolate milk, blending it with ice cubes and fruit juice, or chilling it helps to disguise the taste. Administering mineral oil before meals would affect appetite.

A client with constipation has been directed to take oral bisacodyl. The nurse instructs the client on how to receive the most rapid effect from the medication. The client demonstrates understanding of use of this medication by stating that which method will produce the most rapid effect? 1."I should take it at bedtime." 2."I will take it with a large meal." 3."I will take it on an empty stomach." 4."I will drink 2 glasses of milk when I take it."

"I will take it on an empty stomach." Rationale: The most rapid results from bisacodyl occur when it is taken on an empty stomach. If it is taken at bedtime, the client will have a bowel movement in the morning. It will not have a rapid effect if taken with a large meal or with 2 glasses of milk.

The nurse provides medication instructions to a client who has a prescription for sucralfate to be taken four times daily. Which statement by the client indicates teaching was effective? 1."I can stop the medication if my pain is relieved." 2."I may get terrible diarrhea from the medication, and if I do I need to stop taking it." 3."Side effects are minimal and I need to take it an hour before meals and at bedtime." 4."I need to take the medication halfway between meals and at bedtime on an empty stomach."

"Side effects are minimal and I need to take it an hour before meals and at bedtime." Rationale: Sucralfate is a gastric protectant. The medication should be scheduled for administration 1 hour before meals and at bedtime. The medication is scheduled so that it has time to bind to the base of ulcers and erosions and form a protective coating before food intake stimulates chemical and mechanical irritation in the stomach. Medication should not be stopped. Side effects are minimal, and diarrhea is not associated with the medication.

A client with a peptic ulcer is diagnosed with a Helicobacter pylori infection. The nurse is teaching the client about the medications prescribed, including clarithromycin, esomeprazole, and amoxicillin. Which statement by the client indicates the best understanding of the medication regimen? 1."My ulcer will heal because these medications will kill the bacteria." 2."These medications are only taken when I have pain from my ulcer." 3."The medications will kill the bacteria and decrease the acid production." 4."These medications will coat the ulcer and decrease the acid production in my stomach."

"The medications will kill the bacteria and decrease the acid production." Rationale: Triple therapy for H. pylori infection usually includes 2 antibacterial medications and a proton pump inhibitor. Clarithromycin and amoxicillin are antibacterials. Esomeprazole is a proton pump inhibitor. These medications will kill the bacteria and decrease acid production.

A client has just been given a prescription for diphenoxylate with atropine. The nurse determines that the client understands important information about this medication if the client makes what statement? 1."It's best to take this medication with a laxative." 2."This medication contains a habit-forming ingredient." 3."I might drool frequently from taking this medication." 4."I will probably become irritable from taking this medication."

"This medication contains a habit-forming ingredient." Rationale: The client should understand that an adverse effect of this medication is that it may be habit forming, so careful adherence to proper dose is important. The medication is an antidiarrheal and therefore should not be taken with a laxative. Side effects of the medication include dry mouth and drowsiness. Drooling and irritability are not associated with the use of this medication.

The nurse has given instructions to a client who has just been prescribed cholestyramine. Which statement by the client indicates a need for further instruction? 1."I will continue taking vitamin supplements." 2."This medication will help to lower my cholesterol." 3."This medication should only be taken with water." 4."A high-fiber diet is important while taking this medication."

"This medication should only be taken with water." Rationale: Cholestyramine is a bile acid sequestrant used to lower the cholesterol level, and client compliance is a problem because of its taste and palatability. The use of flavored products or fruit juices can improve the taste. Some side effects of bile acid sequestrants include constipation and decreased vitamin absorption.

A client diagnosed with peptic ulcer disease is prescribed an over-the counter antacid suspension containing aluminum hydroxide, magnesium hydroxide, and simethicone. What should the nurse include in the client instructions for time of administration of this medication? 1. Just before each meal 2. An hour before breakfast 3. Immediately after each meal 4. 1 and 3 hours after meals

1 and 3 hours after meals Rationale: Antacids are alkaline compounds that neutralize stomach acid. The objective of peptic ulcer therapy is to promote healing in addition to relieving pain. Consequently, antacids should be taken on a regular schedule, not just in response to discomfort. In the usual dosing schedule, antacids are administered 7 times a day: 1 and 3 hours after each meal and at bedtime. Thus, option 4 is the correct option. Options 1, 2, and 3 are incorrect because they are either not the correct timing or not often enough as recommended.

A client has a prescription for sucralfate, orally 4 times daily. The nurse writes which schedule for this medication on the medication administration record? 1.Every 6 hours 2.With meals and at bedtime 3.1 hour after meals and at bedtime 4.1 hour before meals and at bedtime

1 hour before meals and at bedtime Rationale: Sucralfate is prescribed to treat gastric ulcers. It should be scheduled for administration 1 hour before meals and at bedtime to allow it to form a protective coating over the gastric ulcer to prevent irritation by food, gastric acid, and mechanical movement of the stomach. The other options are incorrect.

The nurse determines the client needs further instruction on cimetidine if which statements were made? Select all that apply. 1."I will take the cimetidine with my meals." 2."I'll know the medication is working if my diarrhea stops." 3."My episodes of heartburn will decrease if the medication is effective." 4."Taking the cimetidine with an antacid will increase its effectiveness." 5."I will notify my health care provider if I become depressed or anxious." 6."Some of my blood levels will need to be monitored closely since I also take warfarin for atrial fibrillation."

1. "I will take the cimetidine with my meals." 2. "I'll know the medication is working if my diarrhea stops." 4. "Taking the cimetidine with an antacid will increase its effectiveness." Rationale: Cimetidine, a histamine (H2)-receptor antagonist, helps to alleviate the symptom of heartburn, not diarrhea. Because cimetidine crosses the blood-brain barrier, central nervous system side and adverse effects, such as mental confusion, agitation, depression, and anxiety, can occur. Food reduces the rate of absorption, so if cimetidine is taken with meals, absorption will be slowed. Antacids decrease the absorption of cimetidine and should be taken at least 1 hour apart. If cimetidine is concomitantly administered with warfarin therapy, warfarin doses may need to be reduced, so prothrombin and international normalized ratio results must be followed.

The adult client with hepatic encephalopathy has a serum ammonia level of 200 mcg/dL (120 mcmol/L) and receives treatment with lactulose. The nurse determines that the client had the best and most realistic response if the serum ammonia level changed to which value after medication administration? 1.5 mcg/dL (3 mcmol/L) 2.10 mcg/dL (6 mcmol/L) 3.15 mcg/dL (9 mcmol/L) 4.90 mcg/dL (54 mcmol/L)

90 mcg/dL (54 mcmol/L) Rationale: The normal serum ammonia level is 10 to 80 mcg/dL (6 to 47 mcmol/L). In the client with hepatic encephalopathy, the ammonia level is not likely to drop below normal, nor is it likely to drop into the low-normal range. A level of 90 mcg/dL (54 mcmol/L) is slightly above normal and represents the most realistic response of the medication. The nurse should also monitor the client for signs and symptoms that indicate improvement in the condition.

A client has begun medication therapy with pancrelipase. Which finding indicates that the medication has been effective? 1.Relief of heartburn 2.Elimination of abdominal pain 3.Stabilization of blood glucose levels 4.A decrease in the amount of fat in the stools

A decrease in the amount of fat in the stools Rationale: Pancrelipase is a pancreatic enzyme used as a digestive aid for clients with pancreatitis. It should reduce the amount of fatty stools (steatorrhea). Another recognized beneficial effect is improved nutritional status. It is not used to treat heartburn or abdominal pain and does not regulate blood glucose.

A client has been told by a health care provider to take psyllium daily. The nurse should tell the client to take the medication with which item? 1.A dose of antacid 2.A total of 2 glasses of liquid 3.Gelatin, applesauce, or pudding 4.A multivitamin and mineral supplement

A total of 2 glasses of liquid Rationale: Psyllium is a bulk-forming laxative that should be taken with a full glass of water or juice, followed by another glass of liquid. This will help prevent impaction of the medication in the stomach or small intestine. The other options are incorrect.

A client has begun taking a stimulant laxative. In monitoring the client for medication side and adverse effects, the nurse is likely to note which finding? 1.Abdominal cramps 2.Peptic ulcer disease 3.Gastrointestinal bleeding 4.Partial bowel obstruction

Abdominal cramps Rationale: A stimulant laxative causes nausea and abdominal cramps as the most frequent side effects. The incorrect options represent health problems that are not caused by this medication.

A client has been given lansoprazole for the chronic management of Zollinger-Ellison syndrome. The nurse instructs the client to take which product for pain while taking this medication? 1.Ibuprofen 2.Acetaminophen 3.Naproxen sodium 4.Acetylsalicylic acid

Acetaminophen Rationale: Lansoprazole is a proton pump inhibitor. Zollinger-Ellison syndrome is a hypersecretory condition of the stomach, associated with increased risk of problems from irritation of the stomach lining. The client should take acetaminophen for pain relief. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen sodium, should be avoided, as should aspirin, because they are potential stomach irritants.

A client has a prescription for magnesium citrate to prevent constipation after undergoing barium studies of the gastrointestinal tract. How should the nurse administer the magnesium citrate? 1.With fruit juice only 2.At room temperature 3.With a full glass of water 4.After it is chilled in the refrigerator

After it is chilled in the refrigerator Rationale: Magnesium citrate is available as an oral solution and should be served chilled to make it more palatable. The other options are incorrect.

A client with portosystemic encephalopathy is receiving oral lactulose daily. The nurse should check which item to determine that this medication has been effective? 1.Lung sounds 2.Blood pressure 3.Blood ammonia level 4.Serum potassium level

Blood ammonia level Rationale: Lactulose is a hyperosmotic laxative and ammonia detoxicant. It is used to prevent or treat portosystemic encephalopathy, including hepatic precoma and coma. It also is used to treat constipation. The medication retains ammonia in the colon (decreases the blood ammonia concentration), producing an osmotic effect. It promotes increased peristalsis and bowel evacuation, expelling ammonia from the colon. This medication has no effect on lung sounds, blood pressure, or serum potassium level.

The nurse has administered prochlorperazine to a client for relief of nausea and vomiting. The nurse should then assess the client for which frequent side or adverse effect of this medication? 1.Diarrhea 2.Drooling 3.Blurred vision 4.Excessive tearing

Blurred vision Rationale: Prochlorperazine is a phenothiazine-type antiemetic and antipsychotic agent. A frequent side or adverse effect is blurred vision. Other frequent side and adverse effects of this medication are constipation, dry mouth, and dry eyes.

The nurse is providing instructions to the client who is taking antacid tablets. How should the nurse instruct the client to take this medication? 1.Chew the tablet thoroughly. 2.Swallow the tablet with water. 3.Place the tablet under the tongue. 4.Place the tablet between the gum and the cheek.

Chew the tablet thoroughly. Rationale: Antacid tablets should be chewed thoroughly and followed by a full glass of water or milk. Options 2, 3, and 4 are incorrect.

The nurse is giving the client directions for proper use of aluminum hydroxide tablets. What should the nurse tell the client? 1. Swallow the tablets whole with a full glass of water. 2. Take the tablets at the same time as other medications. 3. Take each dose with a laxative to prevent constipation. 4. Chew the tablets thoroughly and follow with 4 oz of water.

Chew the tablets thoroughly and follow with 4 oz of water. Rationale: Aluminum hydroxide tablets should be chewed thoroughly before swallowing. This prevents them from entering the small intestine undissolved. They should not be swallowed whole. Antacids should be taken at least 1 hour apart from other medications to prevent interactive effects. Constipation is a side effect of the use of aluminum products, but it is not correct for the client to take a laxative with each dose. This promotes laxative abuse. The client should first try other means to prevent constipation.

The nurse is reviewing a client's medication reconciliation form in the medical record and notes that the client is taking tamsulosin at home. Which medication, if started in the hospital, should the nurse question? 1.Lisinopril 2.Valsartan 3.Metoprolol 4.Cimetidine

Cimetidine Rationale: Tamsulosin is used most commonly for the treatment of benign prostatic hyperplasia. This medication should not be used concurrently with cimetidine because of the risk of tamsulosin toxicity. The other medications noted do not cause interactions with this medication.

Which finding suggests to the nurse that a client with bleeding esophageal varices is experiencing a side or adverse effect of vasopressin therapy? 1.Complaints of chest pain 2.Bounding peripheral pulses 3.Temperature of 102°F (39.8°C) 4.Blood urea nitrogen (BUN) of 20 mg/dL (7.1 mmol/L)

Complaints of chest pain Rationale: Vasopressin therapy causes vasoconstriction, and side and adverse effects include myocardial ischemia, which may be evident by the client's complaints of chest pain. Elevated temperature, bounding peripheral pulses, and a BUN of 20 mg/dL (7.1 mmol/L) are not adverse effects. Vasopressin therapy can cause hypothermia. Because vasopressin has potent vasoconstrictive effects on the peripheral arterioles, weak versus bounding pulses may be found. The normal BUN is 10 to 20 mg/dL (3.6 to 7.1 mmol/L).

A client is told by the health care provider to take aluminum hydroxide as needed for heartburn. The nurse advises the client to watch for which common side effect of this medication? 1.Dizziness 2.Excitability 3.Restlessness 4.Constipation

Constipation Rationale: Because of the antacid's aluminum base, aluminum hydroxide causes constipation as a side effect. The other side effect is hypophosphatemia, which is noted by monitoring serum laboratory studies. The other options are not side effects of this medication.

Oral rifaximin has been prescribed for a client with portosystemic encephalopathy. The nurse reviews the health care provider's prescription and determines that this medication has been prescribed for which purpose? 1.Prevent infection. 2.Prevent restlessness in the client. 3.Prevent fluid retention and ascites. 4.Destroy normal bacteria found in the bowel.

Destroy normal bacteria found in the bowel. Rationale: Rifaximin may be prescribed for the client with portosystemic encephalopathy. It is a broad-spectrum antibiotic that destroys normal bacteria found in the bowel, thereby decreasing protein breakdown and ammonia production. The remaining options are not accurate rationales for administration of this medication to this client.

The nurse has just given a client a dose of an "as needed" (PRN) medication called loperamide. The nurse documents in the client's record that the client received this medication for complaints of what symptom? 1.Diarrhea 2.Tarry stools 3.Constipation 4.Abdominal pain

Diarrhea Rationale: Loperamide is an antidiarrheal agent commonly administered after the client experiences loose stools. It is used to treat both acute diarrhea and chronic diarrhea from disorders such as inflammatory bowel disease. It also can be used to reduce the volume of drainage from an ileostomy.

A client receives a dose of scopolamine. The nurse determines that which sign or symptom later displayed by the client is a result of medication side and adverse effects? 1. Dry mouth 2. Diaphoresis 3. Excessive urination 4. Pupillary constriction

Dry Mouth Rationale: Side and adverse effects of scopolamine, an anticholinergic medication, are dry mouth, urinary retention, decreased sweating, and dilation of the pupils. Each of the incorrect options states the opposite of a side effect of this medication.

A client who has been chronically taking acetylsalicylic acid (aspirin) for arthritis has been given a prescription for misoprostol. The nurse determines that the new medication is effective if the client states relief from which problem? 1.Diarrhea 2.Bleeding 3.Joint aches 4.Epigastric pain

Epigastric pain Rationale: A client who chronically uses aspirin is prone to gastric mucosal injury, which causes epigastric pain as a symptom. Misoprostol is a gastric protectant specifically given to prevent this occurrence. Diarrhea can be a side effect of the medication, but it is not an intended effect. Bleeding and joint aches are not relieved by misoprostol.

The nurse reads that metoclopramide is prescribed for a client. Based on this prescription, the nurse expects to note that which diagnosis is documented? 1.Asthma 2.Gastroparesis 3.Allergic rhinitis 4.Chronic kidney disease

Gastroparesis Rationale: Metoclopramide stimulates motility of the upper gastrointestinal tract. It is used to stimulate gastric emptying, for the treatment of gastroparesis, and to treat gastroesophageal reflux disease. It may also be prescribed to relieve nausea and vomiting. It is not a respiratory medication or a renal/urinary medication and is not used to treat the conditions noted in the incorrect options.

A client has been taking omeprazole for 4 weeks. The ambulatory care nurse evaluates that the client is receiving the optimal intended effect of the medication if the client reports the absence of which symptom? 1.Diarrhea 2.Heartburn 3.Flatulence 4.Constipation

Heartburn Rationale: Omeprazole is a proton pump inhibitor classified as an antiulcer agent. The intended effect of the medication is relief of pain from gastric irritation, often called heartburn by clients. Omeprazole is not used to treat the conditions identified in options 1, 3, and 4.

The nurse notes in the medication record that a client is taking calcium carbonate chewable tablets. Based on these data, the nurse should ask the client about a history of which symptom? 1.Flatus 2.Heartburn 3.Rectal pain 4.Muscle twitching

Heartburn Rationale:Calcium carbonate can be used as an antacid for the relief of heartburn and indigestion. It also can be used as a calcium supplement or to bind phosphorus in the gastrointestinal tract in clients with chronic kidney disease. The other options are incorrect and are not indications for the use of calcium carbonate.

An older client takes a stimulant laxative for ongoing management of chronic constipation. Which findings should the nurse expect to note when reviewing the client's laboratory results? 1.Hypokalemia 2.Hyperkalemia 3.Hyponatremia 4.Hypernatremia

Hypokalemia Rationale: Hypokalemia can result from long-term use of a stimulant laxative. The medication stimulates peristalsis and alters fluid and electrolyte transport, thus helping fluid to accumulate in the colon. The remaining options are not specifically associated with the use of this medication.

The nurse is administering senna to an older client. What is the expected result of this medication? 1. It increases peristalsis. 2. It lines the wall of the bowel. 3. It adds fiber and bulk to the stool. 4. It stimulates the vagus nerve to improve bowel tone.

It increases peristalsis. Rationale:Senna works by altering the transport of water and electrolytes in the large intestine, which causes accumulation of water in the mass of stool and increased peristalsis. The other options are incorrect actions for this medication.

The nurse is reviewing the prescriptions for a newly admitted client. The nurse sees a prescription for intravenous pantoprazole but does not see any gastrointestinal conditions in the medical record. How should the nurse interpret this prescription? 1.It is used as a prophylactic measure. 2.It is inaccurate and should be questioned. 3.It is likely that the client has a new gastrointestinal disorder. 4.It is used before surgery, so the client will probably require surgery.

It is used as a prophylactic measure. Rationale: Pantoprazole is a proton pump inhibitor and is commonly used as a gastrointestinal prophylactic measure to prevent stress ulcers. The other options are incorrect.

The nurse is preparing to administer prescribed medications to a client with hepatic encephalopathy. The nurse anticipates that the health care provider's prescriptions will include which medication? 1.Bisacodyl 2.Lactulose 3.Magnesium hydroxide 4.Psyllium hydrophilic mucilloid

Lactulose Rationale: Lactulose is a hyperosmotic laxative agent that has the adjunct benefit of lowering serum ammonia levels. This occurs because the medication lowers bowel pH and aids in the conversion of ammonia in the gut to the ammonium ion, which is poorly absorbed. Bisacodyl is a stimulant laxative. Magnesium hydroxide is a saline laxative. Psyllium hydrophilic mucilloid is a bulk laxative.

A client who has had a myocardial infarction has a prescription to take a powdered form of psyllium after discharge. The nurse should plan to include which information when teaching the client about this medication? 1.Mix the medication with applesauce. 2.Mix the medication with a full glass of water or juice. 3.Decrease fluid intake following administration of the medication. 4.Decrease the amount of fiber in the diet when taking this medication.

Mix the medication with a full glass of water or juice. Rationale: Psyllium is a bulk-forming laxative that should be taken with a full glass of water or juice (not applesauce), followed by another glass of liquid. This will help prevent impaction of the medication in the stomach or small intestine. Fiber in the diet and fluid intake should not be decreased unless specifically prescribed by the health care provider.

A client with recurrent constipation has been prescribed psyllium. Teaching provided by the nurse should include which instruction? 1.Take the powder with food. 2.Sprinkle the powder on top of a hot beverage. 3.Mix the powder with warm applesauce. 4.Mix the powder with a full glass of water or juice followed by drinking an additional glass of liquid.

Mix the powder with a full glass of water or juice followed by drinking an additional glass of liquid. Rationale: Metamucil is a bulk-forming laxative. It should be mixed with 8 oz of water or juice, followed by drinking another 8 oz of liquid. This will help prevent impaction of the medication in the stomach or small intestine. The other options are incorrect methods of administration.

A client with gastrointestinal hypermotility has a prescription to receive atropine sulfate. The nurse should withhold the medication and question the prescription if the client has a history of which disease process? 1.Biliary colic 2.Sinus bradycardia 3.Peptic ulcer disease 4.Narrow-angle glaucoma

Narrow-angle glaucoma Rationale: Atropine sulfate can cause a blockade of muscarinic receptors on the iris sphincter, producing mydriasis (dilation of the pupils). It also produces cycloplegia (relaxation of the ciliary muscles). It is contraindicated in clients with narrow-angle glaucoma. The other options are therapeutic reasons for using the medication.

A client in the postanesthesia care unit (PACU) has a prescription for droperidol. The nurse determines that this medication has been prescribed to treat which condition? 1.Pain 2.Nausea 3.Headache 4.Confusion

Nausea Rationale: Droperidol is an antiemetic and is used to treat nausea. It is not used to treat the conditions in the other options.

A client has received a dose of dimenhydrinate. The nurse should observe relief of what sign or symptom to evaluate that the medication has been effective? 1.Chills 2.Headache 3.Nausea and vomiting 4.Buzzing sound in the ears

Nausea and vomiting Rationale: Dimenhydrinate is used to prevent and treat the symptoms of dizziness, vertigo, nausea, and vomiting that accompany motion sickness. The other options are incorrect reasons for administering the medication.

A client has an as needed prescription for ondansetron. For which condition(s) should the nurse administer this medication? 1.Paralytic ileus 2.Incisional pain 3.Urinary retention 4.Nausea and vomiting

Nausea and vomiting Rationale: Ondansetron is an antiemetic used to treat postoperative nausea and vomiting, as well as nausea and vomiting associated with chemotherapy. The other options are incorrect reasons for administering this medication.

A client taking an oral laxative wants to obtain a rapid effect from the medication. How should the nurse instruct the client to take the medication? 1.At bedtime 2.With breakfast 3.With the noon meal 4.On an empty stomach

On an empty stomach Rationale: Most rapid results from an oral laxative occur when it is taken on an empty stomach. If taken at bedtime, the client will have a bowel movement in the morning. It will not have a rapid effect if taken with a meal.

Sucralfate is prescribed for a client. The nurse determines that the client understands the instructions for medication administration if the client states to take the medication at what time? 1.At bedtime 2.One hour after meals 3.At noontime with a meal 4.One hour before meals and again at bedtime

One hour before meals and again at bedtime Rationale: Sucralfate is an antiulcer medication that forms a barrier over the ulcer and protects against acid and pepsin. The medication should be taken 1 hour before meals and at bedtime to allow it to form a protective coating over the ulcer to prevent irritation from food, gastric acid, and mechanical movement. The other time frames are incorrect.

A client with a gastric ulcer has a prescription for sucralfate 1 gram by mouth 4 times daily. The nurse should schedule the medication for which times? 1.With meals and at bedtime 2.Every 6 hours around the clock 3.One hour after meals and at bedtime 4.One hour before meals and at bedtime

One hour before meals and at bedtime Rationale: Sucralfate is a gastric protectant. The medication should be scheduled for administration 1 hour before meals and at bedtime. The medication is timed to allow it to form a protective coating over the ulcer before food intake stimulates gastric acid production and mechanical irritation. The other options are incorrect.

The nurse is caring for a client who has been prescribed intravenous metoclopramide. The nurse determines that the client likely is being treated for which condition? 1.Paralytic ileus 2.Diabetic gastroparesis 3.Gastroesophageal reflux disease 4.Postoperative nausea and vomiting

Postoperative nausea and vomiting Rationale: Metoclopramide is given either orally or intravenously. Indications for intravenous metoclopramide include postoperative nausea and vomiting, facilitation of small bowel intubation, and facilitation of radiological exams of the gastrointestinal tract. Oral metoclopramide is given for paralytic ileus, diabetic gastroparesis, and gastroesophageal reflux disease.

The client in the preoperative holding area has been given a dose of scopolamine. Which intended effect is this medication likely being used for with this client? 1.Obstetric amnesia 2.Suppression of emesis 3.Preanesthetic amnesia 4.Production of cycloplegia

Preanesthetic amnesia Rationale: Scopolamine is an anticholinergic medication that can be used preoperatively. While all options are indications and therapeutic effects of this medication, preanesthetic amnesia is the intended effect in this situation.

A client who uses nonsteroidal anti-inflammatory drugs (NSAIDs) has been taking misoprostol. The nurse determines that the misoprostol is having the intended therapeutic effect if which finding is noted? 1.Resolved diarrhea 2.Relief of epigastric pain 3.Decreased platelet count 4.Decreased white blood cell count

Relief of epigastric pain Rationale: The client who uses NSAIDs is prone to gastric mucosal injury. Misoprostol is a gastric protectant and is given specifically to prevent this occurrence in clients taking NSAIDs frequently. Diarrhea can be a side effect of the medication but is not an intended effect. Options 3 and 4 are unrelated to the purpose of misoprostol.

A hospitalized client asks the nurse for sodium bicarbonate to relieve heartburn after a meal. The nurse reviews the client's medical record, knowing that the medication is contraindicated in which condition? 1.Atelectasis on chest x-ray 2.Hydronephrosis on renal ultrasound 3.Serum pH 7.52 (7.52), bicarbonate 30 mEq/L (30 mmol/L) 4.Serum pH 7.22 (7.22), bicarbonate 29 mEq/L (29 mmol/L)

Serum pH 7.52 (7.52), bicarbonate 30 mEq/L (30 mmol/L) Rationale:Sodium bicarbonate is an electrolyte modifier and antacid, and it would aggravate metabolic alkalosis, which is a difficult acid-base imbalance to correct. Atelectasis, hydronephrosis, and metabolic acidosis are the other conditions noted. The medication is not contraindicated with these conditions.

The client with gastroesophageal reflux disease (GERD) has a new prescription for pantoprazole. Which instruction should the nurse provide to the client? 1.Chew the pill thoroughly. 2.Swallow the tablet whole. 3.Headache is expected to occur. 4.Crush the pill if it is difficult to swallow.

Swallow the tablet whole. Rationale: Pantoprazole, a proton pump inhibitor, is a delayed-release medication and should be swallowed whole. It should not be chewed or crushed. Headache is a potential side effect of the medication and should be reported to the health care provider if it is troublesome.

A client with a history of gastroesophageal reflux disease (GERD) is diagnosed with peptic ulcer disease (PUD). The health care provider prescribes sucralfate in addition to the client's other medications. What teaching should the nurse include in this client's instructions? 1.Take the sucralfate once a day at bedtime with food. 2.Take the sucralfate daily with the proton pump inhibitor. 3.Take the sucralfate before meals and at bedtime on an empty stomach. 4.Take the sucralfate immediately after eating and within 30 minutes of an antacid.

Take the sucralfate before meals and at bedtime on an empty stomach. Rationale: Sucralfate is an antiulcer medication that promotes ulcer healing by creating a protective barrier against acid and pepsin. It should be taken on an empty stomach. The usual recommended adult dosage is 1 gram 4 times a day, taken 1 hour before meals and at bedtime. Options 1, 2, and 4 are incorrect, as sucralfate should be taken on an empty stomach, at least twice a day, and at least 30 minutes apart from an antacid.