GI

A client reports to the nurse about needing to strain to defecate. The client adds that defecating is very painful. What laxative will the nurse suggest to the prescriber based on the painful defecation? a - Docusate b - Fiber c - Sorbitol d - Psyllium

(A)

A nurse should screen a client for signs of which of the following medical conditions as the use of laxatives in these clients is contraindicated? Select all that apply: a - Acute appendicitis b - Type 1 diabetes c - Chronic hepatitis d - Intestinal obstruction e - Fecal impaction

A, D, E - Laxatives are contraindicated in clients with known hypersensitivity and those with persistent abdominal pain, nausea, vomiting, or unknown cause or signs of acute appendicitis, fecal impaction, intestinal obstruction, or acute hepatitis.

The parent of a school-age client reports that the child frequently fights the urge to defecate because of a fear of using public restrooms. The nurse should inform the parent that this behavior can result in what problem? a - weakened defecation reflex b - strengthened gastrocolic reflex c - chronic diarrhea d - bowel incontinence

a - In people who often inhibit the defecation reflex or fail to respond to the urge to defecate, constipation develops as the reflex weakens. None of the other options result from this lack of response.

A group of students are reviewing the actions of laxatives on the GI tract. The students demonstrate understanding when they state what about bulk stimulants? a - Increase the fluid in the intestinal contents b - Directly stimulate the nerve plexus in the intestinal wall c - Selectively antagonize opioid binding d - Allow formation of a slippery coat on the intestinal contents

(A)

A student asks the physiology instructor what failure to respond to the defecation reflex will cause. What would the instructor answer? a - Decreased sensory stimulation of reflex b - Diarrhea c - Increased sensory stimulation of reflex d - Involuntary evacuation

(A)

Psyllium (Metamucil) is a bulk-forming laxative available over-the-counter and frequently used. The nurse knows that which of these statements regarding use of psyllium is correct? a - Psyllium is useful in critically ill patients who experience constipation. b - Laxatives are the preferred method for bowel management in older adults. c - Psyllium can be used freely in children. d - Home care nurses should not become involved in their patients' bowel management.

(A)

The nurse is assisting a client with chronic constipation to establish a successful bowel routine. The nurse instructs the client that what is the best time to use the bathroom for establishment of a routine for bowel elimination? a - Immediately after eating breakfast b - Immediately upon arising from bed in the morning c - Immediately after eating dinner d - Immediately after eating lunch

(A)

The nurse understands that the drug docusate sodium (Colace) would be most appropriate for what client? a - A 66-year-old client who is recovering from a heart attack b - A 46-year-old client who has not had a bowel movement in 4 days c - A 74-year-old client who takes bisacodyl daily at home d - A 52-year-old client who is preparing for a colonoscopy

(A)

The nurse is reviewing a new prescription for promethazine. The nurse will immediately contact the health care provider if the prescription is for which client? a - an 18th month old child b - a client in the first trimester of pregnancy c - an adult client with type 1 diabetes d - an adult client taking a tricyclic antidepressant

(A) A black box warning alerts nurses that promethazine is contraindicated in children younger than 2 years of age because of the risk of potentially fatal respiratory depression. The drug is not absolutely contraindicated in pregnancy (category C), in clients who have diabetes, or in clients taking tricyclic antidepressants.

Which would be most important for the nurse to do when administering a phenothiazine antiemetic to a patient? a - institute safety precautions b - maintain NPO status c - assessing respiratory status d - insert an indwelling urinary catheter

(A) Adverse effects associated with phenothiazines are linked to their interference with normal CNS stimulation. The patient's risk for injury is high. Withholding food and fluids would not be necessary unless the patient's vomiting was not controlled and food or fluid intake exacerbated his vomiting. Respiratory adverse effects are not associated with the use of phenothiazines. Although urinary retention may occur, catheterization would be a last resort.

For which client would the use of prochlorperazine require the greatest caution? a - a client who is pregnant b - a client who is 6 hours postoperative c - a client receiving chemotherapy d - a 4 year old client

(A) Caution should be used during pregnancy and lactation. The drug is approved for pediatric use and can be used safely and effectively in the treatment of nausea associated with anesthesia or chemotherapy.

The nurse provides drug teaching to the client who will begin taking polycarbophil. What is the nurse's priority teaching point? a - Drink lots of water when taking the drug. b - The drug can be taken up to 6 times per day. c - Do not eat or drink anything for 2 hours after taking the medication. d - Take at night before bedtime.

(A) Clients must take plenty of water with polycarbophil. If only a little water is consumed, the medication may absorb enough fluid in the esophagus to swell the food into a gelatin-like mass that can cause obstruction and other severe problems. The drug should be taken no more than four times a day and should not be taken at night.

The nurse recognizes that a client needs additional instruction if the client makes which comment about treatment for occasional constipation? a - "I will make sure that I have a bowel movement every day." b - "I will choose more foods with fiber." c - "I will make sure to drink an adequate amount of fluid every day." d - "I will obey the urge to have a bowel movement when it occurs."

(A) Clients who believe that a daily bowel movement is necessary need further instruction.

The home health nurse is caring for an 82-year-old client who reports almost daily diarrhea. The nurse should assess for what common cause of diarrhea in older adults? a - Laxative overuse b - Inactivity c - Antihypertensive medications d - Inadequate fluid intake

(A) Diarrhea in older adults may result from laxative overuse, so the nurse should assess what over-the-counter (OTC) products the client is using. Antihypertensives would not be likely to cause this adverse effect. Inactivity and low fluid intake are risk factors for constipation, not diarrhea.

A nurse administers dronabinol to a patient just prior to starting an infusion of chemotherapy drugs. Before allowing the patient to leave the facility, what should the nurse instruct the patient to avoid? a - Driving b - Fluids c - Sleeping d - All the above

(A) Dronabinol, which may be administered prior to chemotherapy drugs to control nausea and vomiting, can cause dizziness, drowsiness, mood changes, and other mind-altering effects. Patients receiving dronabinol should not drive or perform hazardous tasks requiring alertness, coordination, or physical dexterity, to decrease risks of injury. Additionally, patients should avoid alcohol and other drugs that cause drowsiness.

When administering an emollient laxative such as mineral oil, which of the following is an important consideration? a - When administering to the elderly, be alert for aspiration into the lungs. b - This type of laxative should be avoided in clients with constipation. c - It is unsafe to be administered to children and should be avoided. d - Monitor the client for dehydration after administration.

(A) Elderly clients, very young clients, and debilitated clients are at greatest risk for aspiration of mineral oil into the lungs when it is taken orally for constipation. Aspiration of mineral oil can lead to a lipid pneumonitis. Mineral oil can be used with older children and with clients suffering from constipation. Because the action of this laxative does not cause dehydration, this is not a consideration at this time.

When would the nurse recommend that a traveler take an oral antiemetic to prevent motion sickness? a - 30 minutes prior to trip b - 3 hours prior to trip c - when symptoms first begin d - 10 minutes prior to trip

(A) For prevention of motion sickness, give antiemetics 30 minutes before travel and every 4 to 6 hours, if necessary. The nurse would not recommend taking them with the first symptoms, 10 minutes before the trip, or 3 hours prior to the trip.

When administering a bulk laxative to a client, which action is important for the nurse to take? a - administer the laxative with a full glass of water or juice b - other than standard safety measures, no additional actions are needed c - immediately place the client on a bedpan or commode. d - administer an anti-diarrheal medication simultaneously

(A) Give bulk-producing or stool-softening laxatives with a full glass of water or juice. The administration of a bulk-producing laxative is followed by an additional full glass of water. Administration of an anti-diarrheal is contraindicated because it would reduce the effect of the laxative. The onset of action of the laxative does not necessitate placement on a commode or bed pan at the time of medication administration.

The nurse is caring for a client who has been experiencing severe motion sickness. Which response will the nurse make when the client asks, "Why does this occur?" a - Changes in body motion stimulate receptors in the ear, and nerve impulses are transmitted to the vomiting center b - It occurs because drugs you are taking stimulate the release of serotonin to initiate the vomiting reflex c - Vomiting with motion is mediated by afferent signals from the higher centers of the cerebral cortex to the vomiting center d - Neurons in the fourth ventricle of the cerebral cortex are stimulated by emetic substances in the blood

(A) In motion sickness, rapid changes in body motion stimulate receptors in the inner ear, and nerve impulses are transmitted to the vomiting center via the vestibular branch of the auditory nerve, which is concerned with equilibrium. Although the other statements accurately describe mechanisms that lead to vomiting, none are associated with motion sickness. Drugs that have the ability to cause vomiting (emetogenic) are thought to do so by stimulating the release of serotonin from the enterochromaffin cells of the small intestine; the serotonin activates receptors located on vagal afferent nerves in the chemoreceptor trigger zone (CTZ) to initiate the vomiting reflex. The CTZ, composed of neurons in the fourth ventricle, can also be activated by the presence of emetic substances in the blood. Anticipatory nausea and vomiting triggered by memories and fear of nausea and vomiting is mediated by afferent signals from the higher centers of the cerebral cortex to the vomiting center.

What is the correct rationale for why the nurse would administer a laxative at a separate time from the client's other medications? a - Laxatives may reduce absorption of other drugs present in the GI tract. b - They often taste bad and clients are less likely to take other medications. c - Often laxatives make the client nauseated, which interferes with the ability to take medications. d - Because a laxative may stimulate a bowel movement, it can interfere with medication administration.

(A) Laxatives may reduce absorption of other drugs present in the GI tract by combining with them chemically, or hastening their passage through the intestinal tract. Nausea, taste, and onset of action have no bearing on administration of laxatives.

Which intervention has priority when caring for an older adult client who has been prescribed a phenothiazine for reported nausea? a - client is identified as a possible falls risk b - frequent oral care to manage oral dryness c - monitoring the client for signs of anorexia d - assessing the client for pink tinged urine

(A) Older adults are more likely to develop adverse effects associated with the use of these drugs. Safety measures may be needed if these effects occur and interfere with the patient's mobility and balance increasing their risk for falls. While the other options present possible side effects, none have the priority of falls management.

You are preparing to administer a saline cathartic when the patient mentions that they have CHF. You know that saline cathartics are contraindicated for clients with congestive heart failure due to what adverse effect? a - Hypernatremia b - Hyperphosphatemia c - Hypomagnesemia d - Hypochloremia

(A) Patients with congestive heart failure are at risk of fluid retention and edema with sodium-containing laxatives.

What is the therapeutic action of the phenothiazines in reducing nausea? a - Change responsiveness of the chemoreceptor trigger zone (CTZ) b - Producing sedation c - Increasing gastric motility d - Blocking histamine receptors

(A) Phenothiazines are centrally acting antiemetics, which change the responsiveness or stimulation of the CTZ in the medulla. They do not change gastric motility or block histamine receptors. Sedation would be an adverse effect, not a therapeutic effect.

A male client has been receiving promethazine for nausea that occurred following chemotherapy. Recently it has been discovered that this client has developed liver dysfunction. The nurse anticipates that the health care provider will do what to treat this client's nausea? a - use an alternative medication b - increase the dose of the medication c - maintain the current dose of the medication d - decrease the dose of the medication

(A) Phenothiazines are metabolized in the liver and eliminated in urine. In the presence of liver disease (e.g., cirrhosis, hepatitis), metabolism may be slowed and drug elimination half-lives prolonged, with resultant accumulation and increased risk of adverse effects. Therefore, the drugs should be used cautiously in clients with hepatic impairment. Cholestatic jaundice has been reported with promethazine.

A client is scheduled for a colonoscopy in the morning. What laxative would the nurse expect to be prescribed the evening before the procedure? a - polyethylene glycol-electrolyte solution b - psyllium c - castor oil d - lactulose

(A) Saline or stimulant cathartics are acceptable as used for occasional bowel preparations for endoscopic or radiologic examinations.

A female client is going on a cruise to Nova Scotia with her husband to celebrate their 15th wedding anniversary. She is concerned because she has experienced severe, debilitating seasickness in the past. What would the nurse expect the health care provider to order? a - scopolamine b - palonosetron c - dexamethasone d - ondansetron

(A) Scopolamine is an anticholinergic drug that is effective in relieving nausea and vomiting associated with motion sickness and radiation therapy for cancer.

A client with constipation from irritable bowel syndrome is prescribed linaclotide. At which time will the nurse provide the client with a dose of this medication? a - immediately after dinner b - 30 minutes before breakfast c - at bedtime d - 2 hours after lunch

(B) Linaclotide is a guanylate cyclase-C (GC-C) agonist that works to increase the secretion of chloride and water in the intestines by binding to GC-C on the surface of intestinal epithelium. This action softens stools and stimulates bowel movements. It should be given on an empty stomach at least 30 minutes before the first meal. Linaclotide is not given at bedtime, 2 hours after lunch, or immediately after dinner.

It is determined that a client in a hepatic coma needs a laxative. Lactulose is prescribed. What should the nurse monitor to assess the efficacy of the lactulose therapy? a - Blood ammonia levels b - Oncotic pressure in the colon c - Water levels in the colon d - Relief from symptoms

(A) Similar to the saline laxative magnesium hydroxide, lactulose pulls water into the colon. Unlike magnesium hydroxide, lactulose is a synthetic disaccharide of lactose. In the colon, bacteria metabolize lactulose into acids and carbon dioxide, increasing the oncotic pressure in the colon and drawing water into the stool. The acids formed also draw ammonia into the stool. Therefore, lactulose is used not only to treat constipation but also to decrease blood ammonia levels in clients in hepatic coma and those with hepatic encephalopathy. The other factors, although significant, would not indicate the efficacy of the lactulose therapy as accurately as blood ammonia levels.

A 75-year-old client is prescribed magnesium hydroxide for constipation. The nurse's assessment reveals that the client is being treated for rheumatoid arthritis and hypertension. The client is in assisted living and is on a low-sodium diet. Before the magnesium hydroxide therapy begins, it will be most important for the nurse to assess the client's: a - diet. b - medication history. c - activity level. d - home environment.

(B)

A client who has suffered a myocardial infarction is prescribed a laxative to help prevent straining during defecation. Which medication would the nurse expect to administer? a - psyllium b - docusate c - lactulose d - lubiprostone

(B)

A client with a history of constipation has been taking over-the-counter laxatives with good success. The client tells the nurse that he or her is relieved to have found a solution to his or her constipation. When providing health education, the nurse should prioritize what topic? a - Preventive strategies against nausea and vomiting b - Strategies for preventing dependence on laxatives c - Appropriate use of antidiarrheals in case of laxative overdose d - Optimal timing of food intake, fluid intake and laxative use

(B)

Constipation is a frequent problem. The nurse knows that which of these statements regarding constipation is correct? a - Constipation is defined as the absence of daily bowel movements. b - Constipation is characterized by hard, dry stools. c - Opioid drugs relieve constipation. d - Dietary fiber causes constipation.

(B)

The nurse is caring for a new mother who had to have an episiotomy during the birth of her baby. Two days after delivery the client is in need of a laxative. What will the nurse administer? a - Bisacodyl b - Docusate c - Magnesium citrate d - Castor oil

(B)

You are caring for four clients. Which client would you know is at highest risk for constipation? a - Client on antihypertensive medications b - Paraplegic c - Triathlete d - Diabetic

(B)

A woman who is 7 weeks pregnant is experiencing morning sickness but does not want to use any medications to treat the nausea. What nonpharmacologic therapy would be helpful to this client? a - drink a cup of milk every morning before you eat your breakfast b - wear acupressure wristbands c - take phosphorated carbohydrate solution d - eat a sweet roll before getting out of bed in the morning

(B) 0 A nonpharmacologic therapy that is helpful to women who are experiencing morning sickness is the use of acupressure wristbands. Other measures include eating dry crackers before getting out of bed. Phosphorated carbohydrate solution is a medication called Emetrol that may be purchased OTC.

The nurse is providing care to a client with hepatic encephalopathy. Which would the nurse anticipate administering to assist in lowering the client's blood ammonia level? a - psyllium b - lactulose c - mineral oil d - lubiprostone

(B) A client with hepatic encephalopathy may have high levels of ammonia in his blood; lactulose can be used to lower the level of ammonia in the client's blood. Lubiprostone is a hyperosmotic agent that is used to relieve constipation. Psyllium is a bulk-forming laxative. Mineral oil is an emollient that lubricates the intestinal walls and softens the stool, thereby enhancing passage of fecal material.

A hospitalized toddler has been prescribed an antiemetic. The nurse will implement which intervention based on the child's unique needs? a - monitoring for liver dysfunction b - monitoring for electrolyte imbalances. c - encouraging a family member to stay with the child. d - providing the child with developmental appropriate activities

(B) Antiemetics should be used with caution in children who are at higher risk for adverse effects, including CNS effects, as well as fluid and electrolyte disturbances. The older adult is at risk for liver related issues when prescribed an antiemetic. Both of the remaining options would be appropriate for any hospitalized child.

A client taking a chemical stimulant laxative and medications for heart failure and osteoarthritis calls the clinic and reports, "I'm just not feeling right." What is the priorityquestion the nurse should ask this client? a - Previous effectiveness of laxatives b - Timing of medication administration c - Amount of fluid intake d - The amount of fiber intake

(B) Because laxatives increase the motility of the gastrointestinal (GI) tract and some laxatives interfere with the timing or process of absorption, it is not advisable to take laxatives with other prescribed medications. The administration of laxatives and other medications should be separated by at least 30 minutes, so the nurse should question when the client is taking the laxatives and other medications. The other options may be questions the nurse would eventually ask, but the priority is timing of medication administration.

The nurse is seeing a 69-year-old client who is highly physically active and consumes a balanced diet that includes adequate fluid intake. Despite this, the client states experiencing occasional constipation in recent months. What remedy should be the nurse's first suggestion? a - A stimulant laxative b - A bulk-forming (fiber) laxative c - A hyperosmotic laxative d - Bismuth subsalicylate

(B) Bulk-forming (fiber) laxatives are considered the safest and most physiologic of the laxatives. As such, they are normally preferable to stimulant and hyperosmotic laxatives for occasional relief of constipation. Bismuth subsalicylate does not relieve constipation.

A client receiving cancer chemotherapy has been prescribed aprepitant for nausea. The nurse should instruct the client to avoid which liquid? a - coffee b - grapefruit juice c - orange juice d - whole milk

(B) Foods and herbs are known to affect aprepitant concentration. Grapefruit juice decreases the metabolism of aprepitant, and this effect can last up to 24 hours. Therefore, grapefruit juice consumption can result in a cumulative increase in the serum level of aprepitant. Orange juice, coffee, and whole milk do not affect aprepitant metabolism.

The nurse has administered a prescribed dose of ondansetron IV to a client. What assessment finding best indicates therapeutic effect? a - client participates in activities b - client denies nausea c - client's vital signs are within reference ranges d - client requests food

(B) Nausea is a subjective symptom. The client telling the nurse about a decrease in nausea would be the best indication the drug is working, even though all the listed assessment findings are beneficial.

Which part of the brain is responsible for autonomic functioning such as ventilation, cardiac conduction, and vomiting? a - hypothalamus b - medulla oblongata c - pineal gland d - pituitary gland e - tegmentum

(B) The medulla oblongata is the vomiting center as well as the center for other autonomic functioning. It is located in the hindbrain. The pineal gland and the pituitary gland are glands located in the forebrain and are responsible for endocrine functioning. The hypothalamus is a part of the limbic system.

The nurse is working in the medical station at a local amusement park. An adult is reporting dizziness and feelings of "seasickness" after going on several rides. This patient may benefit from: a - a histamine H2 blocker b - an anticholinergic c - cannabis d - substance p/neurokinin 1 receptor antagonist

(B) The nausea and vomiting associated with motion sickness is best treated with an anticholinergic that acts as an antihistamine. Histamine H2 blockers affect gastric acid production. Substance p/neurokinin 1 receptor antagonist and cannabis are strictly prescribed as adjuncts to cancer chemotherapy drugs or therapy.

A nurse is caring for a patient with intestinal stenosis who has been prescribed psyllium. During the course of the treatment, the patient shows the signs of colon obstruction. What intervention should the nurse perform to avoid the occurrence of colon obstruction? a - provide foods high in bulk or roughage b - administer the drug with adequate fluid intake c - administer the drug after chilling it d - give mineral oil to the patient after meals

(B) The nurse should administer the drug with adequate fluid intake to avoid obstruction of the esophagus, stomach, small intestine, and colon in a patient with intestinal stenosis. Mineral oil is given to the patient as a laxative on an empty stomach in the evening. The nurse should provide foods high in bulk or roughage to avoid constipation in a patient receiving laxatives. The nurse administers a laxative with an unpleasant or salty taste after chilling it to disguise its taste.

Vomiting occurs when signals from the chemoreceptor trigger zone reach the vomiting center. Where is the vomiting center located? a - inner ear b - medulla oblongata c - cerebral cortex d - stomach

(B) The vomiting center is a nucleus of cells in the medulla oblongata.

A client is receiving meclizine. The nurse would caution the client to avoid: a - chocolate b -alcohol c - aged cheese d - caffeine

(B) There is an increased risk of sedation if meclizine is combined with other CNS depressants such as alcohol. The client should be instructed to avoid this combination. Meclizine does not interact with caffeine or chocolate. Aged cheese should be avoided by clients taking monoamine oxidase inhibitors.

In pharmacology class the students are learning about the mechanism of action of different laxatives. What would the students learn about the mechanism of action of psyllium hydrophilic mucilloid? a - irritation of the intestinal mucosa b - increasing mass and water content of stool c - creating a barrier between the colon wall and feces d - reducing the surface tension of bowel contents

(B) When water is added, the laxative substance swells and becomes gel-like. The added bulk or size of the fecal mass stimulates peristalsis and defecation. The other options are not the mechanism of action of psyllium.

The nurse is performing an admission assessment of a teenage client who has been experiencing nausea and vomiting. What question would be most important for the nurse to ask this client? a - "when did you last urinate?" b - "have you also had diarrhea?" c - "what was the date of your last period?" d - "what makes your nausea worse?"

(C) - Most antiemetics are not appropriate for use by clients who are pregnant or lactating; therefore, it is most important for the nurse to determine whether the client could be pregnant. The other listed options are not safety risks.

The use of an antiemetic is not clinically safe for which client reporting nausea and vomiting? a - A postoperative client who underwent a an internal fixation of the femur b - A client experiencing exacerbation of chronic intractable hiccups c - A client seen in the emergency room for injuries associated with alcohol intoxication d - A client receiving intensive chemotherapy of metastatic cancer

(C) Additive CNS depression can be seen with any of the antiemetics if they are combined with other CNS depressants, including alcohol. None of the other client's have an obvious contraindication for this form of medication.

The nurse receives a call from a client who is taking lactulose. The client reports having two to three soft stools every day and the client is afraid of developing diarrhea. What is the nurse's best response to this client? a - "Stop taking the medication immediately." b - "You should be having six to ten stools today, double the dose of medication." c - "That is exactly what the medication is supposed to do." d - "Only take half of your usual dose today and take your regular dose tomorrow."

(C) Clients taking lactulose should have two to three soft stools per day.

A client has responded poorly to conservative treatment for nausea and vomiting as has subsequently been prescribed dronabinol. In addition to monitoring the client's nausea, the nurse should prioritize what assessment after administering the drug? a - blood pressure b - apical heart rate c - mental status d - skin integrity

(C) Dronabinol contains the active ingredient of cannabis. As such, there is a high possibility of altered mental status. Effects on heart rate, blood pressure, and skin integrity are less likely.

A pregnant woman in her first trimester is experiencing mild to moderate nausea and vomiting. She does not want to take any pharmacologic medication because she is concerned about the effects on the baby. What could the nurse recommend as an alternative therapy? a - lemon water with honey b - high doses of vitamin C c - ginger d - garlic

(C) Ginger has been proven to be effective in the treatment of nausea and vomiting caused by motion sickness and pregnancy.

A nurse is preparing to administer hydroxyzine to the nauseated client. Which is included in the teaching plan about the medication? a - "the medication may make you feel more alert, like coffee." b - "the drug will aid in making you feel less nauseated by stimulating your intestines." c - "this medication will help with the nausea by making you drowsy." d - "I will mix this medication with applesauce to help you feel better."

(C) Hydroxyzine works by blocking the action of acetylcholine in the brain, which relieves the nausea and vomiting and causes the client to feel less nauseated and sleepy. Hydroxyzine does not affect the intestines and does not need to be mixed with applesauce or food.

The nurse is caring for a client with a hepatic impairment. The nurse knows that the dose of ondansetron should not exceed what amount? a - 12mg b - 10mg c - 8mg d - 6mg

(C) Most antiemetic drugs are metabolized in the liver and should be used cautiously in clients with impaired hepatic function. With oral ondansetron, do not exceed an 8-mg dose; with IV use, a single, maximal daily dose of 8 mg is recommended.

While discussing the use of laxatives a student asks the nursing instructor what indicates normal bowel elimination. What would be the best response by the instructor? a - "A semi-formed stool." b - "One bowel movement daily in the morning." c - "A soft, formed stool." d - "One bowel movement daily after dinner."

(C) Normal bowel elimination should produce a soft, formed stool without pain.

Medications are given post-operatively to prevent or treat severe nausea and vomiting associated with the surgery. What serotonin receptor antagonist would the nurse expect the surgeon to order? a - levodopa b - promethazine c - ondansetron d - metoclopramide

(C) Ondansetron, granisetron, dolasetron, and palonosetron are used to prevent or treat moderate to severe nausea and vomiting associated with cancer chemotherapy, radiation therapy, and post-operative status.

The nurse is preparing medications for a client experiencing nausea. Which action will the nurse take when preparing a dose of ondansetron for this client? a - crush the tablet before providing b - provide fruit juice to be used to ingest the medication c - leave the tablet in the blister pack until just before administration d - push the tablet through the foil on the blister pack.

(C) Oral ondansetron is well absorbed from the gastrointestinal tract to treat nausea. It is important to leave the disintegrating tablet in the blister pack until administration. The tablet is not crushed before administering because it rapidly dissolves on the tongue. Gentle removal of the tablet from the blister pack is needed; rather than push the pill through the foil backing, the nurse should peel the foil away. Fluids are not required for this medication as it will dissolve on the tongue.

The nurse is discussing the possible side effects of chemotherapy with a client. What information obtained during the client's admission assessment and interview will have a direct influence on the management of nausea and vomiting. a- the cancer has been identified at stage 2 b - there is a history of cancer in the client's family c - The client has been prescribed phenothiazine for anxiety. d - the client has identified several food allergies

(C) Phenothiazine is antianxiety drug that blocks the responsiveness of the CTZ to stimuli, leading to a decrease in nausea and vomiting. None of the other options are related to chemotherapy induced nausea and vomiting.

A client is advised to use a bulk-forming laxative to alleviate constipation. The nurse will recommend: a - mineral oil. b - milk of magnesia. c - Docusate (Colace). d - Psyllium (Metamucil).

(D)

The 5-HT3 receptor blocker, palonosetron, is especially suited for administration to which client? a - a 16yo experiencing intractable hiccoughs b - an 8 yo receiving radiation therapy c - a 79 yo who is recovering from hip surgery d - a 10 month old experiencing vomiting after chemotherapy

(D) - Palonosetron is approved for use in children 1 month of age and older. None of the other The 5-HT3 receptor blockers have been approved for children under the age of 2 years.

A client has been told that stimulation of their chemoreceptor trigger zone (CTZ) is responsible for their current symptoms. What nursing action indicates that the nurse is aware of the role of the CTZ? a - planning interventions to address safety issues associated with orthostatic hypotension b - assessing the client for indications of cardiac arrhythmias c - assessing skin for signs of photosensitivity d - planning care to manage the client's nausea & vomiting

(D) - The CTZ, located in the brain is referred to as the vomiting center. Nausea and vomiting are experienced when this center is stimulated. The remaining options are associated with adverse reactions to antiemetic medications.

The nurse is caring for a 19-month-old child who has been hospitalized with dehydration secondary to nausea and vomiting. The nurse is aware that promethazine will not be used for this client because it can cause what in children under the age of 2? a - life-threatening cardiac arrhythmias b - fatal hypovolemia secondary to hemorrhage c - fatal hypertension and subsequent cerebral vascular accident d - fatal respiratory depression

(D) A black box warning alerts nurses that promethazine is contraindicated in children younger than 2 years of age because of the risk of potentially fatal respiratory depression. When using promethazine, the lowest effective dosage should be used, and other drugs with respiratory depressant effects should not be given concurrently. Excessive doses may cause hallucinations, convulsions, and sudden death.

A client reports taking antihistamines to treat nausea. The nurse correctly suspects that the nausea results from what trigger? a - surgery b - radiation therapy c - drugs d - motion sickness

(D) Antihistamines are usually effective in preventing or treating nausea and vomiting induced by motion sickness. They are not prescribed for nausea triggered by drugs, surgery, or radiation therapy.

When considering the tendency of antiemetic agents to cross the placenta, which assessment question should the nurse initially ask every childbearing aged woman before initiating the therapy? a - "are you aware that this medication crosses the placenta?" b - "do you plan to get pregnant anytime soon?" c - "have you ever been pregnant?" d - "are you pregnant?"

(D) Assess for possible contraindications or cautions that include the current status of pregnancy and lactation because of the potential for adverse effects on the fetus or nursing baby. None of the other questions addresses the status of the woman regarding a current pregnancy.

The nurse has just finished client education with a client who is being discharged home on bulk-forming laxatives. The nurse knows the client understands discharge instructions regarding these medications when which statement is made? a - "I will decrease the roughage in my diet while I am using this medication." b - "I will use milk of magnesia in conjunction with this medication until I am having daily bowel movements." c - "I will mix the dry medication with applesauce." d - "I will mix the medication with 4 to 8 ounces of liquid and follow it by an additional 4 to 8 ounces."

(D) Bulk-forming laxatives need to be taken with at least 8 oz of water or other liquid. The other options are incorrect statements and would indicate further need for teaching.

A client is receiving a phenothiazine antiemetic. The nurse instructs the client to use the call light if he needs to get out of bed to go to the bathroom based on the understanding that this group of drugs is associated with: a - urinary abnormalities b - gastrointestinal overstimulation c - endocrine effects d - Central nervous system effects

(D) CNS effects, especially dizziness and drowsiness, are associated with phenothiazines and necessitate safety measures such as assistance with ambulation. GI overstimulation could result in diarrhea or additional vomiting, which might require the client to use the bathroom but not be the basis for assisting the client. The nurse's actions are not related to urinary abnormalities or endocrine effects.

A female client is receiving chemotherapy to treat her cancer. Several antiemetics have been prescribed, and each has been unsuccessful in treating her nausea and vomiting. The health care provider chooses to prescribe what cannabinoid drug to manage her symptoms? a - scopolamine b - ondansetron c - fosaprepitant d - dronabinol

(D) Dronabinol is a cannabinoid used in the management of nausea and vomiting associated with chemotherapy unrelieved by other antiemetic drugs. It is a Schedule III drug under federal narcotic laws.

An adult client asks the nurse how many stools per week is considered "normal." The nurse should indicate that there is no fixed number but that functional constipation is diagnosed at what frequency? a - Six stools per week b - Four stools per week c - Five stools per week d - Three stools per week

(D) Due to variations in diet and other factors, there is no "normal" number of stools, but the traditional medical definition of constipation includes three or fewer bowel movements per week.

Which is an important assessment for the nurse to make before administering a laxative? a - An abdominal circumference measurement is an important assessment for the nurse to make in order to evaluate medication effectiveness. b - Once a medication is ordered by the health care provider, it is unnecessary to make any additional assessments before administering the medication. c - It is imperative to ask clients whether they are expecting any visitors because the effects of the medication may hinder visitation. d - Question the client regarding the type and intensity of symptoms to provide a baseline evaluation.

(D) It is important to assess the client before giving any medication. Important assessments include a review of the client's chart for the course of treatment, and discovering the reason for administration of the prescribed drug. Question the client regarding the type and intensity of symptoms (e.g., pain, discomfort, diarrhea, or constipation) to provide a baseline for evaluation of the effectiveness of drug therapy. Listen first to bowel sounds and then palpate the abdomen, monitoring the client for signs of guarding or discomfort. An abdominal circumference measurement and the presence of visitors are not critical assessments prior to administration of the medication.

The nurse is assessing a client who reports constipation. The use of a medication to treat this problem is contraindicated if the client reports what symptom? a - Lack of bowel movement for 5 days b - Frequent episodes of flatulence c - Lack of urge to defecate d - Abdominal pain and fever

(D) Laxatives and cathartics are contraindicated in clients with abdominal pain. The presence of fever would also be a possible indication of infection.

A nurse correctly identifies which body system as being associated with most of the adverse effects of antiemetics? a - renal b - cardiovascular c - integumentary d - central nervous system (CNS)

(D) Most antiemetics cause some CNS depression. Specific antiemetics may cause adverse effects associated with the renal, cardiovascular, and the integumentary systems, but these systems are not associated with the entire classification of antiemetics.

What are the most common adverse effects associated with drug therapy? a - lethargy and elevated temperature b - elevated temperature and anorexia c - respiratory depression and skin rash d - nausea and vomiting

(D) Nausea and vomiting are the most common adverse effects of drug therapy. While the other options are possible, they are not as common as is nausea and vomiting.

Which intervention has priority when caring for an older adult client who has been prescribed a phenothiazine for reported nausea? a - assessing the client for pink tinged urine b - frequent oral care to manage oral dryness c - monitoring the client for signs for anorexia d - the client is identified as a possible falls risk

(D) Older adults are more likely to develop adverse effects associated with the use of these drugs. Safety measures may be needed if these effects occur and interfere with the patient's mobility and balance increasing their risk for falls. While the other options present possible side effects, none have the priority of falls management.

A client is scheduled for a colonoscopy. The nurse knows that the preferred drug for bowel cleansing before this procedure is: a - Polyethylene glycol solution (MiraLAX) b - Bisacodyl (Dulcolax) c - Psyllium (Metamucil) d - Polyethylene glycol-electrolyte solution (NuLYTELY)

(D) Polyethylene glycol-electrolyte solution taken orally will rapidly provoke extensive diarrhea with complete emptying of the lower intestine. Polyethylene glycol solution, bisacodyl, and psyllium work much more slowly and are useful in managing constipation.

The nurse is giving instructions to a client who will be having a colonoscopy in the morning. The client will be taking polyethylene glycol-electrolyte solution for bowel cleaning. What information will help increase the palatability of this medication? a - Warm the liquid in the microwave for 25 seconds before using it. b - Add ice cubes to each glass of liquid. c - Allow the liquid to warm up before drinking it. d - Refrigerate the solution until it is cold.

(D) The client should refrigerate the solution to increase the palatability and also to ensure its potency.

A client has been prescribed promethazine for recurrent nausea. The nurse should anticipate what preferred route for administration? a - intravenous infusion b - subcutaneous injection c - topical application d - intramuscular injection

(D) The preferred parenteral route of administration is intramuscular, which reduces risk of surrounding muscle and tissue damage. The FDA has issued a black box warning alerting nurses that promethazine is contraindicated for subcutaneous administration. Intravenous administration should be avoided, if possible, because the drug can cause severe tissue injury. Topical application is not an option.

The nurse has administered a prescribed dose of ondansetron IV to a client. What assessment finding best indicates therapeutic effect? a - client participates in activities b - client requests food c - client denies nausea d - client's vital signs are within reference ranges

(c) Nausea is a subjective symptom. The client telling the nurse about a decrease in nausea would be the best indication the drug is working, even though all the listed assessment findings are beneficial.

A hospitalized toddler has been prescribed an antiemetic. The nurse will implement which intervention based on the child's unique needs? a - monitor for liver dysfunction b - providing the child with developmentally appropriate activities c - encouraging a family member to stay with the child d - monitoring for electrolyte imbalances

(d) Antiemetics should be used with caution in children who are at higher risk for adverse effects, including CNS effects, as well as fluid and electrolyte disturbances. The older adult is at risk for liver related issues when prescribed an antiemetic. Both of the remaining options would be appropriate for any hospitalized child.

Nausea and vomiting have many, many causes. Which of the following are causes for nausea and/or vomiting? Select all that apply. a - neurological disorders b - metabolic disorders c - urticaria d - progesterone preparations

A & B - Causes of nausea and vomiting include neurologic disorders and metabolic disorders.

Which medications are especially associated with the adverse effects of nausea and vomiting? Select all that apply. a - digoxin b - opioid analgesics c - anticancer drugs d - beta-adrenergic blockers e - selective serotonin reuptake inhibitors (SSRIs)

A, B, C - Nausea and vomiting are especially associated with alcohol, aspirin, digoxin, anticancer drugs, antimicrobials, estrogen preparations, and opioid analgesics. Neither beta-blockers nor SSRIs are especially responsible for nausea and vomiting.

The nurse instructs a client with constipation on the use of a bulk-forming laxative. Which client responses indicate that the teaching has been effective? Select all that apply. a - "I will expect the laxative to work within 3 days." b - "I will take the laxative with a full glass of water." c - "I will take another dose if the first one does not work." d - "I can sprinkle it over my oatmeal at breakfast." e - "I will call the doctor if I get stomach pain after taking."

A, B, E - When teaching on bulk-forming laxatives, the client should be instructed to expect the preparation to work within 12 to 72 hours. Stomach pain is not expected with a bulk-forming laxative and should be reported to the health care provider. Bulk-forming laxatives should be mixed in a full glass of liquid; they should not be sprinkled over food or taken dry. The client should be instructed to take the laxative only as prescribed, not to repeat doses.

Which of the following produce their laxative effect by dehydrating local tissues, which causes irritation and increased peristalsis, with consequent evacuation of the fecal mass? Select all that apply: a - Bisacodyl (Dulcolax) b - Docusate sodium (Colace) c - Lactulose (Chronulac) d - Methylcellulose (Citrucel) e - Glycerin (Fleet Babylax)

A, C

The home care nurse is visiting a client who is receiving antiemetics. Which actions will the nurse perform to ensure safe and effective treatment for the client? (Select all that apply.) a - do not drive while taking anti nausea medicine b - encourage the client to get up and walk after taking the medication c - encourage client to sip on clear fluids to prevent dehydration d - reinforce teaching about dosage e - take the medication approximately 5 minutes before taking the medication that makes you nauseated.

A, C, D - The home care nurse would reinforce medication teaching which would include how much medication and when to take the medication. It is usually taken 30 to 60 minutes before the event that causes nausea. The client should sit or lie quietly after taking the medication because it may cause sedation. This is also a reason that the client should not drive. The client should be encouraged to drink clear liquids to prevent dehydration.

A patient develops significant nausea and vomiting related to antineoplastic chemotherapy. Which agent would be most appropriate to use in this situation? (Select all that apply.) a - granisetron b - hydroxyzine c - aprepitant d - dolasetron e - nabilone

A, C, D, E - Dolasetron is a 5-HT3 receptor blocker indicated for use with cancer chemotherapy. Granisetron is a 5-HT3 receptor blocker indicated for use with cancer chemotherapy. Aprepitant is a substance P/neurokinin I receptor antagonist indicated for use with cancer chemotherapy. Nabilone is a cannabinoid agent indicated for use with cancer chemotherapy. Hydroxyzine is typically used to treat prepartum, postpartum, and postoperative nausea and vomiting.

A nurse is preparing to administer ondansetron to a client with vomiting. A nurse should be aware of what drug-related information before administering ondansetron? Select all that apply. a - constipation is a common adverse effect of the medication b - St. John's wort should be used judiciously with the medication c - the medication may decrease mental alertness d - for pediatric clients, ondansetron can be used safely e - no dosage adjustment is necessary for older adult clients

A, C, D, E - Ondansetron can be used safely with pediatric and older adult clients. Adverse effects of ondansetron are usually mild to moderate and include decreased mental alertness, diarrhea, headache, dizziness, constipation, fatigue, and transient elevation of liver enzymes. St. John's wort and ondansetron should be used cautiously as a significant drop in blood pressure or loss of consciousness can occur.

The nurse knows that clinical conditions that can promote constipation include which of the following? Select all that apply. a - Antihistamines for allergy b - Hyperthyroidism c - Hypocalcemia d - Parkinson's disease e - Anorexia

A, D, E - Hyperthyroidism frequently causes diarrhea. Hypothyroidism causes constipation. Hypocalcemia induces diarrhea, while elevated levels of calcium promote constipation. Some antihistamines used to manage allergy symptoms have anticholinergic action, which decreases gastrointestinal motility and results in constipation. This is true especially of the first-generation histamine-1 receptor antihistamines such as diphenhydramine (Benadryl and a component of many over-the-counter [OTC] preparations) and chlorpheniramine (Chlor-Trimeton and OTC preparations), which have significant anticholinergic effects. Second-generation antihistamines such as fexofenadine (Allegra), cetirizine (Zyrtec), and loratadine (Claritin) have much less anticholinergic action. These drugs also are available OTC. Parkinson's disease and anorexia are often characterized by decreased intestinal motility and constipation.

The nurse is aware that critically ill clients are more at risk for constipation for what reasons? (Select all that apply.) a - Increased access to a high-fiber diet b - Decreased activity c - Decrease in the amount of family interaction d - Change in bowel routines e - Use of opioid medications

B, D, E -

A client with nausea is prescribed promethazine. The nurse will confirm the prescription with the health care provider if what condition is documented in the client's record? a - cancer b - glaucoma c - multiple sclerosis d - irritable bowel syndrome

Cautious use of promethazine is necessary in people with glaucoma because the drug possesses antimuscarinic activity. There is no reason for caution with use of promethazine for cancer, multiple sclerosis, or irritable bowel syndrome.