PHARM - GI/GU practice questions

A nurse is planning teaching for a client who has been prescribed loperamide to treat diarrhea. Which of the following statements should the nurse plan to include?

"Avoid driving or activities requiring alertness" Loperamide can cause drowsiness and dizziness. The client should avoid driving or activities requiring alertness while taking the drug.

Which client statement indicates the need for further teaching about antiemetic medications?

"I will apply the scopolamine patch to my right or left arm and rotate sites of application." Transdermal scopolamine patches should be applied to nonirritated areas behind the ear, not on the arms.

Which client statement demonstrates understanding of teaching by the nurse regarding the use of histamine2-receptor antagonists?

"Smoking decreases the effects of this medication, so I should look into cessation programs." Clients taking histamine2-receptor-blocking drugs should avoid spicy foods, extremes in temperatures, alcohol, and smoking. Diarrhea, not constipation, is a GI adverse effect. Whereas cimetidine should be taken with meals, famotidine can be taken without regard to meals.

A patient asks the nurse about using potassium supplements while taking spironolactone (Aldactone). What is the nurse's best response?

"This diuretic is potassium sparing, so there is no need for extra potassium." Spironolactone is a potassium-sparing diuretic, and thus the patient does not need potassium supplementation. Intake of excess potassium may lead to hyperkalemia.

Antidopaminergic drugs are useful to treat not only nausea and vomiting but also which other conditions? (Select all that apply)

- Anxiety - Schizophrenia - Intractable hiccups Antidopaminergic drugs are used to treat psychotic disorders (mania, schizophrenia, anxiety), intractable hiccups, nausea, and vomiting.

A patient prescribed spironolactone (Aldactone) asks the nurse to assist with food choices that are low in potassium. The nurse would recommend which food choices? (Select all that apply)

- Apples - Pineapple - Lean meat Spironolactone is a potassium-sparing diuretic that could potentially cause hyperkalemia. Bananas and winter (not summer) squash are high in potassium and should be avoided in patients taking spironolactone.

Potassium-sparing diuretics may cause which common adverse reactions? (Select all that apply)

- Dizziness - Headache - Hyperkalemia Hyperkalemia, dizziness, and headache are common adverse effects associated with potassium-sparing diuretics.

Acetazolamide (Diamox) is used to treat which conditions? (Select all that apply)

- High-altitude sickness - Open-angle glaucoma - Edema associated with heart failure Acetazolamide causes excretion of bicarbonate, which would worsen metabolic acidosis. It is used to treat high-altitude sickness, edema secondary to heart failure, open-angle glaucoma, and rarely as an antiepileptic drug. It is not used for treatment of dry eye syndrome or cardiac dysrhythmias.

When diarrhea occurs in a pediatric client, the nurse will advise the parents to seek emergency medical treatment if which symptoms occur? (Select all that apply)

- Malaise or lethargic - Severe abdominal pain - Bloody diarrhea - Firm or rigid abdomen If diarrhea is accompanied by fever, malaise, or abdominal pain, the parents should contact the health care provider immediately because of the possibility of excessive fluid and electrolyte loss. Dehydration and electrolyte loss occur very rapidly in pediatric clients because of the clients' size and sensitivity to loss of fluid volume and electrolytes through the stool. Immediately report to the health care provider any abdominal distention, firm abdomen, painful abdomen, or worsening of or lack of improvement in diarrhea 24 to 48 hours after medication administration. If symptoms persist or dehydration occurs (e.g., no tears and decreased urine output in the child), contact the health care provider. If the client is sluggish, lethargic, or confused or the diarrhea is bloody, contact the prescriber immediately or go to the closest emergency facility.

A nurse is planning care for a client who is receiving chemotherapy and has a new prescription for ondansetron. Which of the following actions should the nurse plan to take? (Select all that apply)

- infuse the drug 30 minutes prior to chemotherapy - infuse the drugs slowly over 15 minutes - repeat the dose four hours after chemotherapy

A nurse is administering sulfasalazine to a client. Which of the following data should the nurse collect to help identify an adverse drug reaction? (select all that apply)

- skin integrity - temperature - CBC

A nurse is providing teaching to a client who has a new prescription for dimenhydrinate to prevent motion sickness. Which of the following instructions should the nurse include? (select all that apply)

- take a drug 30 to 60 minutes before activities not trigger nausea - avoid activities that require alertness - increase fluid and fiber intake

A nurse is providing teaching to a client who is about to start taking psyllium to treat constipation. Which of the following instructions should the nurse include? (select all that apply)

- take the drug with at least 8 ounces of fluid - increase fluid & fiber intake

A pediatric client with a weight of 20 kg is prescribed diphenoxylate with atropine (Lomotil) for diarrhea. The dosage is 0.3 mg/kg/day in four divided doses. How many milligrams will the nurse administer for each dose?

1.5 mg 20 kg × 0.3 mg/kg = 6 mg ÷ 4 doses = 1.5 mg per dose

When preparing to administer intravenous furosemide (Lasix) to a patient with renal dysfunction, the nurse will administer the medication no faster than which rate?

4 mg/min Furosemide controlled infusion rate should not exceed at a rate of 4 mg/min in patients with renal failure.

To avoid fecal impaction, psyllium (Metamucil) should be administered with at least how many ounces of fluid?

8 oz Bulk-forming laxatives such as psyllium must be given with at least 8 oz of liquid plus additional liquid each day to prevent esophageal obstruction and fecal impaction.

The nurse should recognize that misoprostol is contraindicated for a client who has which of the following conditions?

A + pregnancy test Misoprostol, a prostaglandin E1 analog, is a teratogenic drug. It can cause uterine contractions and induce spontaneous abortion; therefore, providers must confirm that clients are not pregnant before prescribing the drug; and clients who take misoprostol must use contraception.

The nurse will question an order for misoprostol (Cytotec) in which patient?

A 32-year-old pregnant woman with a urinary tract infection Misoprostol (Cytotec) is a prostaglandin E analogue and is believed to inhibit gastric acid secretion and protect the gastric mucosa from injury by enhancing the local production of mucus. However, it is also an abortifacient and therefore is contraindicated in pregnancy. The drug may be useful in treating patients with Zollinger-Ellison syndrome (a hypersecretory syndrome) and GERD. Hypertension is not a contraindication for its use.

A nurse is caring for a client who has a new prescription for alosetron to treat irritable bowel syndrome. The nurse should instruct the client to report which of the following adverse affects of the drug?

Abdominal pain Alosetron, a serotonin 5-HT3 receptor antagonist, can cause ischemic colitis. The nurse should tell the client to report abdominal pain, bloody diarrhea, or rectal bleeding, and to stop taking the drug if these manifestations occur.

PPIs have the ability to almost totally inhibit gastric acid secretion. Because of this possibility, the use of the medication can lead to what condition?

Achlorhydria Because PPIs stop the final step of acid secretion, they can block up to 90% of acid secretion, leading to achlorhydria (without acid).

A nurse is caring for a client who is taking allopurinol to treat gout and has a new prescription for Azathioprine to treat ulcerative colitis. For which of the following reasons should the nurse clarify these prescriptions with the provider?

Allopurinol delays the conversion of azathioprine and can lead to toxicity Allopurinol delays the conversion of azathioprine to an inactive form and can lead to toxicity. If used concurrently, the dose of azathioprine must be reduced.

Which of the following drugs has protocols that require clients to meet specific risk management criteria and sign a treatment agreement before the nurse can administer the drug?

Alosetron Clients who take alosetron, a serotonin 5-HT3 receptor antagonist, can develop severe constipation that can lead to impaction, bowel obstruction, perforation, and potentially fatal ischemic colitis. Because of these risks, nurses must inform clients of the benefits and risks of the drug therapy, and clients must sign a treatment agreement.

A nurse is caring for a client who has peptic ulcer disease. The nurse should monitor the clients phosphorus levels when administering which of the following drugs?

Aluminum hydroxide Antacids that contain aluminum, such as aluminum hydroxide, can cause hypophosphatemia because of aluminum's ability to bind with phosphate and decrease its absorption. The nurse should monitor the client's phosphorus levels while administering this drug.

A nurse is caring for a client who has a new prescription for ranitidine to treat GERD. The nurse should instruct the client to wait at least one hour between taking ranitidine and which of the following over the counter drugs?

Antacids Antacids can decrease the absorption of ranitidine, a histamine2-receptor antagonist. The nurse should instruct the client to wait at least 1 hr between taking ranitidine and taking an antacid.

The nurse would question the use of mannitol (Osmitrol) for which patient condition?

Anuria related to end-stage kidney disease Mannitol does not influence urine production; it only increases existing urine output. It is not metabolized but excreted unchanged in the urine by the kidneys. Thus, if no urine is produced (anuria), mannitol is not excreted, which increases.

The nurse should recognize that sulfasalazine is contraindicated for clients who have which of the following conditions?

Aspirin sensitivity Any sensitivity to salicylates, sulfonamides, or trimethoprim is a contraindication for the use of sulfasalazine, a 5-aminosalicylate. This is because intestinal bacteria metabolize the drug into 5-aminosalicylic acid, a salicylate. Aspirin is also a salicylate.

A nurse is providing teaching to a client who has a new prescription for loperamide. Which of the following instruction should the nurse include?

Avoid activities that require alertness Loperamide, an opioid agonist, can cause sedation and dizziness. The nurse should instruct the client to avoid taking it before activities that require alertness.

Bismuth subsalicylate (Pepto-Bismol), as an adsorbent, has which mechanism of action?

Binds to diarrhea-causing bacteria for excretion Adsorbent antidiarrheal medications bind to diarrhea-causing bacteria to form a nonabsorbable complex, which is then excreted in the stool.

How does sucralfate (Carafate) achieve a therapeutic effect?

By forming a protective barrier over the gastric mucosa Sucralfate has a local effect only on the gastric mucosa. It forms a protective barrier that can be thought of as a liquid bandage in the stomach. This liquid bandage adheres to the gastric lining, protecting against adverse effects related to gastric acid. It also stimulates healing of any ulcerated areas of the gastric mucosa.

The nurse would teach a client prescribed simethicone (Mylicon) to avoid which substance?

Carbonated beverages Simethicone is used to decrease gas and belching, both of which can be aggravated or caused by ingesting carbonated beverages. It may be given in combination with other medications used to decrease acidity.

Magnesium hydroxide (Milk of Magnesia) alleviates constipation by which action?

Causes water absorption into the colon Milk of magnesia is a saline laxative that increases osmotic pressure to draw water into the colon, producing a watery stool, usually within 3 to 6 hours of ingestion.

The nurse will monitor a client taking an aluminum-containing antacid, such as aluminum hydroxide (Amphojel), for which adverse effect?

Constipation Aluminum- and calcium-containing antacids cause constipation, magnesium-containing antacids cause diarrhea, and sodium-containing antacids cause sodium and fluid retention.

To evaluate the therapeutic effects of mannitol (Osmitrol), the nurse should monitor the patient for which clinical finding?

Decrease in intracranial pressure Mannitol is an osmotic diuretic that pulls fluid from extravascular spaces into the bloodstream to be excreted in urine. This decreases intracranial pressure and cerebral blood volume, increases excretion of medications, decreases urine osmolality, and increases serum osmolality.

In developing a plan of care for a client receiving an antihistamine antiemetic drug, which nursing diagnosis would be the highest priority?

Deficient fluid volume related to nausea and vomiting Although all of the options are appropriate nursing diagnoses, fluid volume deficit is the highest priority because it has the highest associated mortality rate. Although a fall or injury could also prove fatal, this diagnosis is a risk; actual nursing diagnoses have priority over potential diagnoses.

When planning administration of antiemetic medications to a client, the nurse is aware that combination therapy is preferred because of which drug effect?

Different vomiting pathways are blocked Combining antiemetic drugs from various categories allows the blocking of the vomiting center and chemoreceptor trigger zone (CTZ) through different pathways, thus enhancing the antiemetic effect.

A nurse is assessing a client who has administered ondansetron IV one hour ago. Which of the following findings should the nurse recognize as an adverse effect of this drug?

Dizziness Dizziness and lightheadedness are the most common adverse effects of ondansetron.

A client receiving an anticholinergic drug to treat nausea and vomiting should be taught to expect which adverse effect?

Dry mouth Anticholinergic drugs block the parasympathetic nervous system, which causes the body to "rest and digest." Blocking of these effects leads to constipation, urinary retention, and decreased secretions (dry mouth).

To treat a patient with pulmonary edema, the nurse prepares to administer which diuretic to this patient?

Furosemide (Lasix) Furosemide is a potent, rapid-acting diuretic that would be the drug of choice to treat pulmonary edema. The other medications are not potent enough to cause the diuresis necessary to treat this condition.

Why does the health care provider prescribe furosemide (Lasix) 40 mg twice a day by mouth for a patient with a history of renal insufficiency?

Furosemide is effective in treating patients with impaired kidney function. Furosemide effectiveness continues in impaired renal function. When creatinine clearance decreases below 25 L/min (normal is 125 L/min), the loop diuretics can still work.

Before administering the anticholinergic drug scopolamine (Transderm-Scōp), the nurse should carefully assess the client for a history of which condition?

Glaucoma Anticholinergic drugs are contraindicated in clients with glaucoma. These drugs can cause pupillary dilation, which can obstruct the flow of aqueous humor and increase intraocular pressure.

For a patient prescribed hydrochlorothiazide (HydroDIURIL), the nurse should closely monitor which laboratory test value?

Glucose Thiazide and thiazide-like diuretics are associated with adverse metabolic effects of hyperglycemia; therefore, close monitoring of blood glucose levels are needed. Other metabolic disturbances include hyperlipidemia and hyperuricemia.

A nurse is teaching a client who has a new prescription for methotrexate. The nurse should instruct the client to monitor for manifestations of which of the following conditions?

Gout An adverse effect of methotrexate is hyperuricemia, which causes gout. The nurse should instruct the client to drink plenty of fluids to minimize this effect, and to report edema or pain in the joints.

When assessing a patient taking triamterene (Dyrenium), the nurse would monitor for which possible adverse effect?

Hyperkalemia Triamterene is a potassium-sparing diuretic, and therefore hyperkalemia is a possible adverse effect.

Which laboratory test result is a common adverse effect of furosemide (Lasix)?

Hypokalemia Furosemide is a potent loop diuretic, and the most common adverse effect of loop diuretics is electrolyte imbalances. This results in major electrolyte losses of potassium and sodium and, to a lesser extent, calcium.

The nurse should recognize that diphenoxylate/atropine should be used with caution for a client who has which of the following conditions?

IBD Diphenoxylate is an opioid, which can cause the severe complication of toxic megacolon in clients who have inflammatory bowel disease. The nurse should have the client monitor the consistency and frequency of stools throughout therapy.

The nurse would question the prescription of bismuth subsalicylate (Pepto-Bismol) as an antidiarrheal medication for a client prescribed aspirin daily because of which potential adverse effect?

Increased bleeding The adsorbent bismuth subsalicylate is a form of aspirin, or acetylsalicylic acid, and therefore it also has many of the same drug adverse effects as aspirin. Bismuth subsalicylate can lead to increased bleeding times and bruising when administered with warfarin as well as aspirin and other nonsteroidal antiinflammatory drugs.

What is the mechanism of action for Famotidine (Pepcid)?

It competes with histamine for binding sites on the parietal cells Histamine receptor-blocking drugs decrease gastric acid by competing with histamine for binding sites on the parietal cells.

What is the mechanism of action of diphenoxylate (Lomotil)?

It decreases peristalsis in the intestinal wall. Diphenoxylate is an opiate antidiarrheal medication that acts on the smooth muscle of the intestinal tract to inhibit gastrointestinal (GI) motility and excessive propulsion of the GI tract (peristalsis).

The nurse recognizes that metoclopramide (Reglan) is useful in treating postoperative nausea and vomiting because of what action?

It promotes motility in the small intestine. Metoclopramide works by increasing gastrointestinal (GI) motility in the small intestine, thus minimizing gastric distention and accompanying stimulation of the vomiting center.

A nurse is reviewing the medical record of a client who has a new prescription for ranitidine. The nurse should recognize that which of the following drugs interact with ranitidine?

Ketoconazole Ranitidine reduces the absorption of ketoconazole.

A nurse is caring for an older adult client who has renal impairment and a new prescription for cimetidine. The nurse should instruct the client to report which of the following?

Lethargy Cimetidine, a histamine2 receptor antagonist, can cause CNS effects, such as lethargy, depression, confusion, and seizures, especially in older adults. The nurse should instruct the client to report these manifestations. If they persist, the provider may prefer to prescribe ranitidine for the client.

For a client with chronic renal failure, the nurse MOST likely will question a prescription for which type of antacid?

Magnesium-containing antacids Magnesium-containing antacids can cause hypermagnesemia in clients with chronic renal failure. Aluminum-containing antacids may be used as a phosphate binder in clients with chronic renal failure. Sodium- and aluminum-containing antacids are chemically more easily excreted in clients with renal compromise. Although calcium-containing antacids may accumulate in the bloodstream of clients with renal failure, they may also be appropriate because these patients may be hypocalcemic.

What condition will the nurse monitor for with a client using sodium bicarbonate to treat gastric hyperacidity?

Metabolic alkalosis Solutions containing sodium bicarbonate (a base) can cause metabolic alkalosis. Serum potassium and serum calcium would decrease, not increase, with alkalosis.

When teaching a patient about symptoms of hypokalemia, the nurse will instruct the patient to notify the health care provider if which symptom occurs?

Muscle weakness Muscle weakness is a common symptom of hypokalemia.

A nurse is caring for a client who is taking lubiprostone. The nurse should tell the client that lubiprostone can cause which of the following adverse drug reactions?

Nausea Lubiprostone, a chloride channel activator, can cause nausea. Clients who develop this effect do not need to discontinue the drug but should take it with food and water to minimize GI upset.

The nurse will teach clients that antacids are effective in the treatment of hyperacidity based on which mechanism of action?

Neutralizes gastric acid Antacids work by neutralizing gastric acid, which would cause an increase in pH. They do not affect gastric motility.

Which drug works by blocking serotonin receptors in the GI tract, vomiting center, and CTZ?

Ondansetron (Zofran) Ondansetron is a serotonin blocker.Metoclopramide is a prokinetic drug,meclizine is an antihistamine,droperidol is an antidopaminergic drug.

A nurse is caring for a client who has a prescription for alosetron. The nurse should recognize that alosetron therapy is effective when the client reports which of the following?

One formed stool per day Alosetron, a serotonin 5-HT3 receptor antagonist, treats the diarrhea and pain of severe irritable bowel syndrome. One formed stool per day indicates effective therapy.

A nurse is teaching a client who recently had a myocardial infarction and has a new prescription for docusate sodium. The nurse should inform the client that docusate sodium has which of the following therapeutic effects?

Prevents straining Docusate sodium, a stool softener, prevents straining during defecation and prevents the elevation in blood pressure that can result from straining. It also helps relieve constipation and reduces the painful elimination of hard stools.

Related to its mechanism of action, what is an additive effect of lactulose (Enulose)?

Reducing ammonia levels Lactulose draws water into the colon and produces a laxative effect. This drug-induced acidic environment also reduces blood ammonia levels by forcing ammonia from the blood into the colon. This effect is useful in treating clients with hepatic encephalopathy.

A client is prescribed the over-the-counter laxative of magnesium hydroxide (Milk of Magnesia). Which condition in the client's history would alert the nurse to discuss this medication with the client and the health care provider?

Renal insufficiency The magnesium saline laxatives are to be used with caution in clients with renal insufficiency, because they can be absorbed enough to cause hypermagnesemia. They are most commonly used for bowel preparation for diagnostic and surgical procedures.

Which nursing diagnosis is appropriate for a patient receiving famotidine (Pepcid)?

Risk for injury related to thrombocytopenia A serious side effect of famotidine is thrombocytopenia, which is manifested by a decrease in platelet count and an increased risk of bleeding. The patient receiving famotidine may experience hypotension as an adverse effect, not hypertension. Famotidine does not cause immunosuppression or urinary retention.

The nurse should teach a client about which antiemetic commonly used to prevent motion sickness?

Scopolamine (Transderm-Scōp) Scopolamine has potent effects on the vestibular nuclei, which are located in the area of the brain that controls balance. These effects make scopolamine one of the most commonly used drugs for the treatment and prevention of nausea and vomiting associated with motion sickness.

To treat a patient diagnosed with primary hyperaldosteronism, the nurse would expect to administer which diuretic?

Spironolactone (Aldactone) Spironolactone is the direct antagonist for aldosterone.

A nurse is caring for a client who is taking phenytoin for a seizure disorder and has a new prescription for sucralfate to treat a duodenal ulcer. The nurse should instruct the client to take the drugs at least two hours apart for which of the following reasons?

Sucralfate interferes with the absorption of phenytoin. Sucralfate decreases the absorption of phenytoin. The nurse should instruct the client to allow at least 2 hr between taking the two drugs and should monitor the client's phenytoin levels.

A nurse is providing teaching to a client who has a new prescription for omeprazole to treat a duodenal ulcer. Which of the following instruction should the nurse include?

Swallow the capsules whole Omeprazole, a proton pump inhibitor, is unstable in stomach acid. The nurse should tell the client to swallow the capsules or tablets whole and not chew the delayed-release tablets.

When planning to administer metoclopramide (Reglan), the nurse is aware that this drug must be given in regards to which fluid or food consideration?

Take 30 minutes before meals and at bedtime Metoclopramide should be administered 30 minutes before meals and at bedtime. Administering the medication before meals allows time for onset to increase GI motility before food ingestion, thus decreasing stomach distention and resulting nausea and vomiting.

A nurse is caring for a male client asked the nurse about taking alosetron for irritable bowel syndrome with diarrhea (IBS-D) lasting three months. Which of the following information should the nurse provide the clients about alosetron?

The drug is prescribed to female clients who have IBS-D lasting more than six months Alosetron is approved only to be prescribed to females who have IBS-D lasting 6 months or longer that has not been controlled by conventional treatment.

How will the nurse describe the action of proton pump inhibitors (PPIs)?

They irreversibly bind to the hydrogen-potassium-ATPase pump. PPIs work to block the final step in the acid-secreting mechanisms of the proton pump. They do this by irreversibly binding to the ATPase pump, H+/K+ ATPase, the enzyme for this step.

The nurse is providing education to a patient prescribed spironolactone (Aldactone) and furosemide (Lasix). What information does the nurse explain to the patient?

This combination promotes diuresis but decreases the risk of low levels of potassium. Spironolactone is a potassium-sparing diuretic; furosemide is a potassium-losing diuretic. Giving these together minimizes potassium loss.

The nurse plans to administer 50 mg of diphenhydramine (Benadryl) intravenously. How will the nurse administer this medication?

Undiluted over 2 minutes Diphenhydramine should be administered undiluted at a rate of 25 mg/min.

A nurse is teaching a client who has a new prescription for sulfasalazine. Which of the following statements should the nurse make?

Use sunscreen and protective clothing while taking sulfasalazine to prevent sunburn. Photosensitivity is a possible adverse effect of sulfasalazine that makes the skin sensitive to light. The nurse should instruct the client to wear sunscreen and protective clothing when outdoors to prevent burning.