Week 1 EAQs
A patient is prescribed lorazepam and a glucocorticoid during chemotherapy treatments. What is the nurse's best action?
Administer the medications and assess the patient for relief. Rationale Drug combination therapy is commonly used to manage chemotherapy-induced nausea and vomiting. Both lorazepam and the glucocorticoids have been found to be effective medications to assist in preventing and managing chemotherapyinduced nausea and vomiting. The nurse should not question the order. The lorazepam is not being administered for anxiety, and the two medications do not have to be given 12 hours apart.
A nurse is planning care for a patient undergoing chemotherapy. The care plan includes medications to reduce chemotherapy-induced nausea and vomiting (CINV). Which regimen should the nurse anticipate the provider to prescribe?
Aprepitant and ondansetron Rationale Regimens for preventing CINV may include medications such as a serotonin receptor antagonist (ondansetron), the substance P/neurokinin antagonist aprepitant, and a benzodiazepine (lorazepam). Scopolamine and dimenhydrinate are indicated for motion sickness, not CINV; diphenhydramine is an antihistamine indicated for allergic reactions.
How do H receptor antagonists reduce the secretion of acids?
By blocking the H 2 receptors Rationale H receptor antagonists block H receptors and stop the secretion of acids by parietal cells. H receptor antagonists do not block acetylcholine receptors. They make parietal cells unresponsive to the stimulation of acetylcholine and gastrin receptors. H receptor antagonists do not directly affect gastrin and acetylcholine receptors.
A patient is prescribed an aluminum-containing antacid for hyperacidity. The nurse should inform the patient about which possible adverse effect?
Constipation Rationale Formulations containing aluminum or calcium cause constipation. Aluminum, used to reduce gastric acid, binds to phosphate and may lead to hypercalcemia. Early hypercalcemia is characterized by constipation. Diarrhea is an adverse effect of magnesium-containing antacids. Flatulence is due to the accumulation of gas in the intestine and is not related to the intake of aluminum-containing antacids. Muscle twitching is due to metabolic alkalosis resulting from the excessive use of sodium bicarbonate antacids.
Which factor would the nurse include in a list of risk factors for peptic ulcer disease?
Daily cigarette smoking Rationale Cigarette smoking destroys the inherent mucosal defenses of the upper gastrointestinal tract and places the patient at risk for peptic ulcer disease. Age, caffeine use, and a sedentary lifestyle are not specifically associated with peptic ulcer disease
Which outcome assessment is essential to monitor for in the patient taking diphenoxylate with atropine?
Decrease in gastric motility Rationale Diphenoxylate with atropine acts on the smooth muscle of the intestinal tract to inhibit gastrointestinal motility and excessive propulsion of the gastrointestinal tract (peristalsis). A decrease in the gastric motility results in a decrease in the number of bowel movements. Bowel movements should not increase, bowel sounds should not increase, and there should be no change in urination.
A nurse is planning care for a patient who has peptic ulcer disease and is taking amoxicillin. The nurse is aware that amoxicillin has which mechanism of action?
Disruption of the bacterial cell wall, causing lysis and death Rationale Amoxicillin disrupts the cell wall of H. pylori, which causes lysis and death. Inhibition of an enzyme to block acid secretion is a function of the proton pump inhibitors. Coating of the ulcer crater as a barrier to acid is an action of sucralfate. Selective blockade of parietal cell histamine receptors is an action of the histamine receptor antagonists cimetidine, ranitidine, famotidine, and nizatidine.
The nurse is caring for a patient with anorexia due to acquired immunodeficiency syndrome (AIDS). The nurse should request the healthcare provider to prescribe which medication to help with this patient's anorexia?
Dronabinol Rationale Dronabinol is used to stimulate the appetite in patients with AIDS. It is administered before lunch and dinner. Aprepitant, ondansetron, and metoclopramide are used to prevent and treat emesis.
A patient going on a vacation cruise is prescribed a scopolamine transdermal patch for motion sickness. The nurse teaches the patient to recognize which side effect?
Dry mouth Rationale Scopolamine blocks the binding of acetylcholine with cholinergic receptors in the inner ear, an imbalance that is a common cause of motion sickness. The most common side effects are dry mouth, blurred vision, and drowsiness. Urinary retention occurs less frequently. An increased heart rate and irritability are not associated effects.
A nurse monitors a patient who has peptic ulcer disease and is taking antibacterial medications. If the treatment has been effective, the patient's breath test result should reveal the absence of what?
H. pylori Rationale Antibacterial medications should be given to patients who have confirmed infection with H. pylori, a cause of ulcers. A breath test is a noninvasive means of measuring H. pylori levels. The patient is given radiolabeled urea, which converts to carbon dioxide and ammonia if H. pylori is present. Radiolabeled carbon dioxide then can be detected in the breath. Bicarbonate, histamine , and prostaglandins are not affected by the actions of antibacterial medications for peptic ulcers.
Which increases the concentration of gastric acids?
Hypersecretion of parietal cells Rationale Hydrochloric acid, which is necessary for digestion, is secreted by the parietal cells lining the stomach. Hypersecretion of these cells causes acidity or more severe disorders. Inhibition of the proton pump reduces the hypersecretion of acid. Proteolytic enzymes such as pepsinogen, which is activated by hydrochloric acid, are secreted by the chief cells of the stomach and are responsible for the cleaving of proteins. Acetylcholine receptors also mediate the proton pump, and inhibition of these receptors helps to prevent the effects caused by a highly acidic environment.
A patient is having high-volume output from a new ileostomy. A nurse develops a plan that includes teaching the patient to take which antidiarrheal agent?
Loperamide Rationale Opioids are the most effective antidiarrheal agents because they activate opioid receptors in the gastrointestinal tract, thus slowing intestinal transit. This action allows more time for fluid and electrolyte absorption in the colon. Loperamide, a structural analog of meperidine, is used to reduce the volume of discharge from ileostomies. Alosetron is a dangerous medication that is approved only for diarrheapredominant irritable bowel syndrome. Paregoric is not appropriate as an antidiarrheal for long-term use because it has a moderate potential for abuse. Bismuth subsalicylate is effective only for mild diarrhea.
A patient has been taking aluminum hydroxide to treat gastric hyperacidity for a few days. The patient reports being constipated. Which drug will the provider likely order in addition to aluminum hydroxide?
Magnesium hydroxide Rationale The constipation caused by the aluminum-based antacid is neutralized when taken in combination with a magnesium-based antacid such as magnesium hydroxide, which acts as a laxative. Administration of aluminum carbonate and aluminum hydroxide would aggravate constipation. Sodium-based antacids such as sodium citrate along with aluminum hydroxide have no effect in relieving the effects of the latter. Calcium-based antacids such as calcium carbonate also cause constipation, and hence their use will not alleviate the patient's discomfort.
Instruction by the nurse regarding alcohol abstinence is essential when a patient will be discharged taking which medication?
Metronidazole Rationale A disulfiram-like reaction can occur if metronidazole is used with alcohol; therefore, alcohol must be avoided during treatment with this drug. Although the use of alcohol is not promoted in patients who take tetracycline, clarithromycin, or bismuth subsalicylate, it does not create an adverse reaction.
A patient who has gastroesophageal reflux disease (GERD) is taking magnesium hydroxide (milk of magnesia). Which outcome should a nurse expect if the medication is achieving the desired therapeutic effect?
Neutralized gastric acid Rationale Antacids work by neutralizing, absorbing, or buffering gastric acid, which raises the gastric pH above 5. For patients with GERD, antacids can produce symptomatic relief. An increased barrier to pepsin is an effect of sucralfate. Reduced stomach motility is not an effect of milk of magnesia. A reduced duodenal pH would result in a more acidic environment.
A patient who has had a pancreatectomy is taking pancrelipase. Which finding would the nurse use to evaluate the effectiveness of this drug?
Reduction in fatty stools Rationale A deficiency of pancreatic enzymes through pancreatectomy or pancreatitis may compromise digestion, especially the digestion of fats. Fatty stools are characteristic of the deficiency. Replacement of pancreatic enzymes with pancrelipase results in a reduction of fat excretion through the stools. An increase in flatulence, resolution of jaundice, and a decrease in abdominal distention are not therapeutic effects of pancrelipase.
A patient is prescribed ranitidine for the treatment of peptic ulcers. To ensure drug safety, what should the nurse assess before administering the drug?
Serum creatinine levels Rationale Assessment of serum creatinine levels is useful for determining the kidney function that is required to prescribe H receptor antagonist drugs such as ranitidine. Monitoring blood glucose and blood pressure gives a general idea about the patient's well-being. Serum antibody levels detect possible infections in the patient.
Which is the mechanism of action of a proton pump inhibitor?
Suppresses acid secretion by inhibiting the enzyme that makes gastric acid Rationale Proton pump inhibitors are antisecretory agents which suppress acid secretion by inhibiting the enzyme that makes gastric acid. Antacids react with gastric acid to form neutral salts. A mucosal protectant is prescribed to form a barrier over the ulcer crater to protect it from acid and pepsin. An antibacterial drug is prescribed to eradicate H. pylori.
Why are proton pump inhibitors (PPIs) used in the treatment of patients with bleeding due to erosive esophagitis?
They act directly on the proton pump. Rationale Erosive esophagitis is a condition in which irritation is caused by acid in the esophagus. PPIs directly inhibit the hydrogen-potassium-ATPase pump, thus reducing the release of hydrogen ions that form acid. Food digestion and absorption are unaltered by these drugs. About 90% of acid secretion is stopped within 24 hours of administration, bringing relief to the patient. PPIs inhibit only the proton pump of parietal cells and reduce only gastric acids.
Which clinical findings are associated with a diagnosis of erosive gastroesophageal reflux disease (GERD)? Select all that apply.
Ulcers Anemia Vomiting Painful swallowing Rationale GERD is a common disorder characterized by heartburn and acid regurgitation. Complications of erosive GERD include ulcers, anemia, vomiting, and painful swallowing. Difficulty chewing is not a clinical finding associated with erosive GERD.