Practice Problems Review
client with a duodenal ulcer is diagnosed with H. pylori infection. The physician prescribed Amoxicillin (Wymox), Pantoprazole (Prevacid), and Clarithromycin (Biaxin). Which statement made by the nurse correctly explains the purpose of these medications? "These medicines will minimize acid production and will coat the ulcer". "These medicines will stop the acid production and will kill the bacteria" "The ulcer will heal because the medications will kill the bacteria".
"These medicines will stop the acid production and will kill the bacteria"
fter drinking the prescribed dose of GOLYTELY and have numerous stools, the client reports feeling chest palpitations to the nurse. The nurse suspects an electrolyte imbalance and requests a physician order for Lab work. Which ones concern you? 1. sodium 126 mEq/ L 2. potassium 2.8 mEq/L 3. chloride 90 mEq/L 4. calcium 9.4 mEq/dL 5. phosphrous 3.5 mEq/dL 6. Blood Urea nitrogen (BUN) 16 mg/dL
,2,3 rationale: sodium is the most abundant cation in the blood and functions in the body to maintain osmotic pressure and acid-base balance to transmit nerve impulses, very low values can result in seizures and neurologic symptoms, normal adult range between 135 adn 146 mEq/L - Potassium is essential for maintaining fluid balance, nerve impulse function, muscle function, and cardiac (heart muscle) function. Very low values can cause cardiac arrhythmias, normal range in an adult is 3.5 and 5.5 mEq - Chloride is influenced by the extracellular fluid balance and acid-base balance. Choloride passively follows water and sodium. Normal adult range is 95 to 112 mEq/L
Henry is 82 years old and takes two aspirin every morning to treat the arthritis pain in his back. He states the aspirin helps him to "get going" each day. Lately he has had some heartburn from the aspirin. After ruling out an acute GI bleed, what would be an appropriate course of treatment for Henry? 1. Add an H2 blocker such as ranitidine to his therapy. 2. Discontinue the aspirin and switch him to Vicodin for the pain. 3. Decrease the aspirin dose to one tablet daily. 4. Have Henry take an antacid 15 minutes before taking the aspirin each day.
. Add an H2 blocker such as ranitidine to his therapy.
Sadie is a 72-year-old patient who takes omeprazole for her chronic GERD. Chronic long-term omeprazole use places her at increased risk for: 1. Megaloblastic anemia 2. Osteoporosis 3. Hypertension 4. Strokes
. Megaloblastic anemia
histamine (H2) - receptor antagonist will be prescribed for a client. The nurse understands that which medications are H2- receptor antagonists, one of which could be prescribed. Select all that apply. 1. Nizatidine (Axid) 2. Ranitidine (Zantac) 3. Famotidine (Pepcid) 4. Cimetidine (Tagamet) 5. Esomeprazole (Nexium) 6. Lansoprazole (Prevacid)
. Nizatidine (Axid) 2. Ranitidine (Zantac) 3. Famotidine (Pepcid) 4. Cimetidine (Tagamet) Esomeprazole (Nexium) 6. Lansoprazole (Prevacid) These are PPI
Sallie has been taking 10 mg per day of prednisone for the past 6 months. She should be assessed for: 1. Gout 2. Iron deficiency anemia 3. Osteoporosis 4. Renal dysfunction
. Osteoporosis
Jim presents with complaints of "heart burn" that is minimally relieved with Tums (calcium carbonate) and is diagnosed with GERD. An appropriate first step therapy would be: A. Omeprazole (Prilosec) twice a day B. Ranitidine (Zantac) twice a day C. Famotidine (Pepcid) once a day D. Metoclopramide (Reglan) four times a day
. Ranitidine (Zantac) twice a day, give ranitidine because it is an H2 blocker then add on a PPI (maybe the appropriate first step would be to start ranitidine which is an H2 blockers, which will start right away) omeprazole: PPI, Pepcid: usually bid, reglan: for nausea
The patient asks how stool softeners relieve constipation. Which of the following would be the best response by the nurse? Stool softeners relieve constipation by: a. stimulating the walls of the intestine b. promoting the retention of sodium in the fecal mass c. promoting the retention of water in the fecal mass d. lubricating the intestinal walls
. promoting the retention of water in the fecal mass
A client has been prescribed with Sucralfate (Carafate) for the treatment of gastric ulcer. The nurse instruct the client that this medication is taken? 1 hour before meals. 1 hour after meals. At the same time with an antacid. Lunch time
1 hour before meals. ucralfate is a gastric protective agent. It works by forming a protective layer on the ulcer to serve as a barrier against acid, bile salts, and enzymes in the stomach. Taken by mouth on an empty stomach at least 1 hour before
Long-term use of proton pump inhibitors may lead to: 1. Hip fractures in at-risk persons 2. Vitamin B6 deficiency 3. Liver cancer 4. All of the above
1. Hip fractures in at-risk persons
Patients who are on or who will be starting chronic corticosteroid therapy need monitoring of: 1. Serum glucose 2. Stool culture 3. Folate levels 4. Vitamin B12
1. Serum glucose
Patrick is a 10-year-old patient who presents with uncomfortable constipation. Along with diet changes, a laxative is ordered to provide more rapid relief of constipation. An appropriate choice of medication for a 10-year-old child would be: 1. PEG 3350 (Miralax) 2. Bisacodyl (Dulcolax) suppository 3. Docusate (Colace) suppository 4. Polyethylene glycol electrolyte solution
2. Bisacodyl (Dulcolax) suppository
Patients whose total dose of prednisone will exceed 1 gram will most likely need a second prescription for: 1. Metformin, a biguanide to prevent diabetes 2. Omeprazole, a proton pump inhibitor to prevent peptic ulcer disease 3. Naproxen, an NSAID to treat joint pain 4. Furosemide, a diuretic to treat fluid retention
2. Omeprazole, a proton pump inhibitor to prevent peptic ulcer disease
Patients who are on chronic long-term corticosteroid therapy need education regarding: 1. Receiving all vaccinations, especially the live flu vaccine 2. Reporting black tarry stools or abdominal pain 3. Eating a high carbohydrate diet with plenty of fluids 4. Small amounts of alcohol are generally tolerated.
2. Reporting black tarry stools or abdominal pain
Monotherapy effectiveness in eradication of H. pylori-- bismuth compounds A) 5% B) 20% C) 50% D) 90%
20%
When using the "Step-Up" approach in caring for patients with GERD, the "step up" from OTC antacid use is: A. Prokinetic (metoclopramide) for 4 to 8 weeks B. Proton pump inhibitor (omeprazole) for 12 weeks C. Histamine2 receptor antagonist (ranitidine) for 4 to 8 weeks D. Cytoprotective drug (misoprostol) for 2 weeks
C. Histamine2 receptor antagonist (ranitidine) for 4 to 8 weeks
Bismuth subsalicylate (Pepto Bismol) is a common OTC remedy for gastrointestinal complaints. Bismuth subsalicylate: 1. May lead to toxicity if taken with aspirin 2. Is contraindicated in children with flu-like illness 3. Has antimicrobial effects against bacterial and viral enteropathogens 4. All of the above
4. All of the above
Metoclopramide improves GERD symptoms by: A. Reducing acid secretion B. Increasing gastric pH C. Increasing lower esophageal tone D. Decreasing lower esophageal tone
C. Increasing lower esophageal tone
Question # 19 (Multiple Choice) Eradication of H. pylori effectiveness for bismuth compounds when using combination with antibiotics: A) 5% B) 20% C) 50% D) 80% E) 95%
95%
Patients who are on chronic long-term proton pump inhibitor therapy require monitoring for: A. Iron deficiency anemia, vitamin B12 and calcium deficiency B. Folate and magnesium deficiency C. Elevated uric acid levels leading to gout D. Hypokalemia and hypocalcemia
A. Iron deficiency anemia, vitamin B12 and calcium deficiency
Patrick is a 10 year old who presents with constipation. Along with diet changes, a laxative is ordered to provide more rapid relief of constipation. An appropriate choice of medication for a 10 year old would be: A. PEG 3350 (Miralax) B. Bisacodyl (Dulcolax) suppository C. Docusate (Colace) suppository D. Polyethylene glycol electrolyte solution
A. PEG 3350 (Miralax)
If a patient with H. pylori positive peptic ulcer disease fails first-line therapy the second-line treatment is: A. Proton pump inhibitor BID plus metronidazole plus tetracycline plus bismuth subsalicylate for 14 days B. Test H. pylori for resistance to common treatment regimens C. Proton pump inhibitor plus clarithromycin plus amoxicillin for 14 days D. Proton pump inhibitor and levofloxacin for 14 days
A. Proton pump inhibitor BID plus metronidazole plus tetracycline plus bismuth subsalicylate for 14 days
The physician prescribes docusate sodium (Colace) fo the client. The client asks the nurse to explain why the medication is needed. Which explanation given by the nurse correctly states the purpose of medication? A. To ease bowel evacuation and its related discomfort B. To irriatate the bowel and promote stool elimination C. To stimulate peristalsis to remove wastes after the digestion D. To reduce intestinal activity and decrease stool size
A. To ease bowel evacuation and its related discomfort Rationale: Docusate sodium (Colace) is a stool softner, retaining water in the stool, softens the mass and makes stool easier and less painful to pass.
A nurse is reviewing medications for a client who has a diagnosis of small bowel obstruction. The nurse should withhold Senna (Senoket) prescribed orally based on an understanding of which of the following? A. laxatives are contraindicated in clients who have small bowel obstruction B. Only bulk-forming laxatives such as psyllium (Metamucil) should be prescribed C. Medication should be administered via NG tube than oral route D. Opioid analgesics, rather than laxative should be prescribed to alleviate discomfort
A. laxatives are contraindicated in clients who have small bowel obstruction Rationale: Laxatives are contraindicated in clients who have fecal impactation, bowel obstruction, and acute abdominal surgery to prevent perforation. Laxatives will cause increased abdominal cramping and discomfort
Drug(s) used iin eradication of Helicobacter pylori infection: A) bismuth compounds B) metronidazole (Flagyl) C) clarithromycin (Biaxin) D) omeprazole (Prilosec) E) amoxicillin (Amoxil Polymox)
All
Multiple Answer) Omeprazole (Prilosec) and lansoprazole approved for clinical treatment of: A) duodenal ulcer B) erosive gastritis C) Zollinger-Ellison syndrome and other gastric acid hypersecretory states
All of the above
Examplesof H2 (histamine receptor Type II) antagonists: A) cimetidine (Tagamet) B) ranitidine (Zantac) C) nizatidine (Axid) D) famotidine (Pepcid) E) terfenadine
All of them!
Side effect profile-- antiulcer medication: urinary retention, blurred vision, xerostromia,: A) ranitidine (Zantac) B) atropine C) nifedipine (Procardia, Adalat) D) sucralfate (Carafate)
Anticholinergic Atropine
A physician has written an order for ranitidine (Zantac) once daily. The nurse schedules the medications for which of the following times? A. At bed time B. After lunch C. With supper D. Before breakfast
At bed time
Most successful protocol for eradication of H. pylori/treatment of peptic ulcer disease: A) bismuth monotherapy B) therapy using bismuth compounds, metronidazole (Flagyl), and amoxicillin (Amoxil Polymox) in combination -triple therapy C) bismuth compounds and amoxicillin (Amoxil Polymox) D) all of the above equally effective
B) therapy using bismuth compounds, metronidazole (Flagyl), and amoxicillin (Amoxil Polymox) in combination -triple therapy
A nurse is talking with a client who has peptic ulcer disease and is starting therapy with sucralfate (Carafate). The nurse should instruct the client to take this medication: A. with antacid B. 1 hr before meals C. with food or milk D. immediatly after meals
B. 1 hr before meals rationale: Sucralfate is a mucosal protectant, the client should take it on an empty stomach, 1 hr before meals, for maximum effectiveness
A nurse is caring for a client with cirrhosis who has a new prescription for cephulac (Lactulose). Following administration, the nurse will monitor the client for which adverse effect of this medication? A. Dry mouth B. Diarrhea C. Headache D. Peripheral edema
B. Diarrhea Rationale: The nurse will monitor for diarrhea, Lactulose is a synthetic disaccharide that the small intestine cannot utilize. It causes diarrhea by lowering the ph so that the bacterial flora are changed in the bowel`
A client is relying on OTC laxatives for regular elimination. Which of the following pieces of information is most important for the nurse to provide to the client? A. daily bowel movements are not necessary for good intestinal health B. Excessive laxative use may cause decreased sodium levels C. Chronic use of laxatives can lead to dependency of elimination D. The client should increase intake of high-fiber diet
B. Excessive laxative use may cause decreased sodium levels Rationale: Excessive laxative use causes G.I. system to become dependent on external methods to achieve elimination - Laxative dependence weakens peristalsis and musculature of colon
A client has been taking omeprazole (Prilosec) for 4 weeks. The nurse determines that the client is receiving the optimal intended effect of the medication if the client reports absence of which of the following symptoms? A. Diarrhea B. Heartburn C. Flatulence D. Constipation
B. Heartburn ,omeprazole (Prilosec) is used for GERD
When using "Step-Up" therapy for GERD, the next "step up" in treatment when a patient has been on proton pump inhibitors for 12 weeks is: A. Add a prokinetic (metoclopramide) B. Referral for endoscopy C. Switch to another proton pump inhibitor D. Add a cytoprotective drug
B. Referral for endoscopy
How should the patient be taking (Prilosec) Omeprazole? A. take drugs 2 hours after a meal B. take 1 hour before meals and swallow tablets as whole C. take it with juice and crush tablets D. all of the above
B. Take 1 hour before meals and swallow tablet as whole rationale: Proton Pump inhibitors, decreases gastric juices and reduces pain, they are taken 1 hour before meals, not after and we don't take it crushed, take it whole
A physician prescribes bisacodyl (Dulcolax) for a client in preparation for a diagnostic test and wants the client to achieve a rapid effect from the medication. The nurse then tells the client to take the medication: A. With a large meal B. On an empty stomach C. At bedtime with a snack D. With two glasses of juice
B. on an empty stomach, bisacodyl (Dulcolax) is a stool softner
A nurse is administering an IV bolus of Cimetidine (Tagamet). Which of the following should the nurse monitor closely follow the administration? Respiratory rate. Skin turgor. Blood pressure. Temperature
Blood pressure.
A nurse is caring for a caring for a client who is receiving esomeprazole (Nexium) to manage GERD. Which of the following best indicates the desired therapeutic effect? A. " I don't pass gas a often" B. "my abdomen is no longer firm" C. "I don't have pain in my stomach" D. " I have regular BM's"
C. "I don't have pain in my stomach" rationale: esomeprazole (Nexium) is proton pump inhibitor (PPI) and works in the parietal cells of the stomach by inhibiting the proton pump enzyme that generates gastric acid secretion. - Treatment is for gastric ulcers, duodenal ulcers and GERD. - an expected finding if medication is effective will be a decrease in the client's symptoms of an ulcer or GERD. Heartburns are a common sign of GERD, so absence of pain means the medication is working
Your elderly pt is being administered Lomotil, what kind of drug? A. Antiflatulent B. Laxative C. Antidiarrheal D. Emetic
C. Antidiarrheal, its a narcotic
An acceptable first-line treatment for peptic ulcer disease with positive H. pylori test is: A. Histamine2 receptor antagonists for 4 to 8 weeks B. Proton pump inhibitor BID for 12 weeks until healing is complete C. Proton pump inhibitor BID plus clarithromycin plus amoxicillin for 14 days D. Proton pump inhibitor BID and levofloxacin for 14 days
C. Proton pump inhibitor BID plus clarithromycin plus amoxicillin for 14 days
After H. pylori treatment is completed, the next step in peptic ulcer disease therapy is: therapy is: A. Testing for H. pylori eradication with a serum ELISA test B. Endoscopy by a specialist C. Proton pump inhibitor for 8 to 12 weeks until healing is complete D. All of the above
C. Proton pump inhibitor for 8 to 12 weeks until healing is complete
A nurse teaches a client taking metoclopramide (Reglan) to discontinue the medication immediately and call the physician if which side effect occurs with long- term use? A. Excessive excitability B. Anxiety or irritability C. Uncontrolled rhythmic movements of the face or limbs D. Dry mouth not helped by the use of sugar-free hard candy
C. Uncontrolled rhythmic movements of the face or limbs
A client has a PRN order for loperamide (Imodium). The nurse should plan to administer this medication if the client has: A. constipation B. abdominal pain C. episode of diarrhea D. Hematest-positive nasogastric tube drainage
C. episode of diarrhea, loperamide (Imodium) is an antidiarrheal
An 80- year-old client has recently been started on cimetidine (Tagamet). The nurse monitors the client for which most frequent central nervous system (CNS) side effect of this medication? 1. Tremors 2. Dizziness 3. Confusion 4. Hallucination
Confusion
A client has just taken a dose of trimethobenzamide (Tigan). The nurse plans to monitor this client for relief of: A. Heartburn B. Constipation C. Abdominal Pain D. Nausea and vomiting
D. Nausea and vomiting, trimethobenzamide (Tigan) is an antiemetic
A client with a gastric ulcer has an order for sucralfate (Carafate), 1 g orally four times a day. The nurse schedules the medications for which of the following times? A. With meals and at bedtime B. Every 6 hours around the clock C. One hour after meals and at bedtime D. One hour before meals and at bedtime
D. One hour before meals and at bedtime
The Patient has GERD and they are prescribed( Prilosec) Omeprazole What kind of a drug is it? A. Antacid B. Histamine H2 Antagonist C. Anticholinergic D. Proton Pump Inhibitor
D. Proton Pump inhibitor
When treating patients using the "Step-Down" approach the patient with GERD is started on ____ first. A. Antacids B. Histamine2 receptor antagonists C. Prokinetics D. Proton pump inhibitors
D. Proton pump inhibitors
A client has been taking omeprazole (Prilosec) for the past 4 weeks. The nurse determines that the medication is effective when the client reports? A. nausea B. diarrhea C.headache D. acid indigestion
D. acid indigestion Rationale: Omeprazole, a proton pump inhibitor, reduces gastric acid secretion and treats duodenal and gastric ulcers, prolonged dyspepsia, gastrointestinal reflux disease and erosive esophagitis
hat do you tell patients to do with tablets (antacid)? A. take drugs 30 minutes before meals B. crush it and mix with orange juice C. take 1 hour after meal D. chew thoroughly and take with full glass of water
D. chew thoroughly and take with a full glass of water
A charge nurse and a newly licensed nurse are providing care for a client who reports nausea and has a presciption for metoclopramide (Reglan) as an antiemetic. Which of the following statements by the newly licensed nurse indicates a correct understanding of the actions of the medication. "Metoclopramide": A. depresses vagal nerve activity B. decreases gastric acid secretions C. slows peristalsis D. promotes gastric emptying
D. promotes gastric emptying Rationale: Metoclopramide is a gastrointestinal stimulant used to relieve nausea, vomiting, heartburn, stomach pain, bloating, and persistent feeling of fullness after meals. - Metoclopramide works by promoting gastric emptying
A client is receiving Sulfasalazine (Azulfidine) for the treatment of ulcerative colitis. Which of the following assessment finding will concern the nurse most? Drowsiness. Decreased urine output. Urine discoloration. Vomiting
Decreased urine output.
A nurse is giving discharge instructions to a client who is receiving a bulk-forming laxative as part of the home medications. All of which are examples of bulk-forming laxative, except? Docusate Sodium (Colace). Methylcellulose (Citrucel). Polycarbophil (Fibercon). Psyllium (Metamucil)
Docusate Sodium (Colace).
Josie is a 5-year-old patient who presents to the clinic with a 48-hour history of nausea, vomiting, and some diarrhea. She is unable to keep fluids down and her weight is 4 pounds less than her last recorded weight. Besides IV fluids, her exam warrants the use of an antinausea medication. Which of the following would be the appropriate drug to order for Josie? 1. Prochlorperazine (Compazine) 2. Meclizine (Antivert) 3. Promethazine (Phenergan) 4. Ondansetron (Zofran)
Ondansetron (Zofran)
Sadie is a 72 year old who takes omeprazole for her chronic GERD. Chronic long-term omeprazole use places her at increased risk for: A. Megaloblastic anemia B. Osteoporosis C. Hypertension D. Strokes
Osteoporosis
Which of the following condition can you safely administer Metoclopramide (Reglan)? Patient with bowel obstruction. Patient with gastrointestinal hemorrhage. Patient undergoing radiation. Patients with pheochromocytoma.
Patient undergoing radiation. do not give metoclopramide in pt with pheochromocytoma because it could cause hypertensive crisis
n osmotic laxative will be prescribed for a client. The nurse understands that which medications are osmotic laxative? Select all that apply Senna (Senokot). Mineral Oil. Polyethylene glycol and electrolytes (GoLYTELY). Sodium Phosphate (Fleet enema). Bisacodyl (Dulcolax).
Polyethylene glycol and electrolytes (GoLYTELY). Sodium Phosphate (Fleet enema
A client is prescribed with Omeprazole (Prilosec). The nurse determines that the client is receiving its therapeutic effect if which of the following is stated by the client: Relief of nausea and vomiting. Decrease diarrheal episodes. The absence of constipation. Relief from GERD
Relief from GERD
A client has been taking Ibuprofen for some quite time and was given Misoprostol (Cytotec). Which of the following is exhibiting the therapeutic effect of Cytotec? Relief of gastric ulcer. Relief of diarrhea. Relief of vomiting. Relief of constipation.
Relief of gastric ulcer.
Reduces basal unstimulated gastric acid secretion; enhanced mucosal resistance to injury-- prostaglandins (PGE1/PGE2)
T
he nurse administers antidiarrheal drugs... a. after each loose bowel movement b. hourly until diarrhea ceases c. with food d. BID, in the AM and at bedtime
a. after each loose bowel movement
A geriatric patient is prescribed with Cimetidine (Tagamet) for the treatment of heartburn. Which of the following is the most frequent CNS side effect? Agitation. Drowsiness. Headache. `
agitation cimetidine passes the BBB, and CNS effects can occur
Antacid: constipation A) aluminum hydroxide B) magnesium hydroxide
aluminum hydroxide
Antacid: most likely to cause systemic phosphate depletion: A) sodium bicarbonate B) calcium carbonate C) magnesium hydroxide D) aluminum hydroxide
aluminum hydroxide
Mechanism of action: cytoprotection, binds to the ulcer base, antibacterial effect: A) metronidazole (Flagyl) B) tetracycline (Achromycin) C) bismuth compounds D) ranitidine (Zantac) E) omeprazole (Prilosec)
bismuth compounds
Antacid: melt-alkali syndrome: A) aluminum hydroxide B) magnesium hydroxide C) calcium carbonate D) sodium bicarbonate
calcium carbonate
1 (Multiple Choice) More likely to affect the cytochrome P450 drug metabolizing system: A) ranitidine (Zantac) B) cimetidine (Tagamet)
cimetidine (Tagamet)
Question # 2 (Multiple Choice) Only class of antiulcer drugs that can eradicate Helicobacter pylori and cure associated gastritis: A) sucralfate (Carafate) B) colloidal bismuth C) H2 blockers D) Anticholinergic agents
colloidal bismuth
Most widely used antacid in treating ulcer disease: A) sodium bicarbonate B) calcium carbonate C) magnesium hydroxide D) aluminum hydroxide E) combination of aluminum hydroxide and magnesium hydroxide
combo of aluminum hydroxide and magnesium hydroxide
Treatment of gastric a disease: atropine vs.H2-receptor blockers -- atropine is: A) more effective than H2 receptor blockers B) less effective than H2 receptor blockers C) equally effective
less effective than H2 receptor blockers
Antacid: loose stools A) aluminum hydroxide B) magnesium hydroxide C) both D) neither
magnesium hydroxide
A client has been given Loperamide hydrochloride (Imodium). Which of the following situation is the medication indicated to? Abdominal pain. Patients with an ileostomy. Bloody Diarrhea. Acute dysentery.
pt with ileostomy (antidiarrheal and reduces volume of drainage)
Antacid: effective, but associated with systemic alkalosis A) calcium carbonate B) sodium bicarbonate C) magnesium hydroxide D) aluminum hydroxide
sodium bicarbonate
