NCLEX_Gastrointestinal Medications

A histamine (H2)-receptor antagonist will be prescribed for a client. The nurse understands that which medications are H2-receptor antagonists? Select all that apply. 1. Nizatidine (Axid) 2. Ranitidine (Zantac) 3. Famotidine (Pepcid) 4. Cimetidine (Tagamet) 5. Esomeprazole (Nexium) 6. Lansoprazole (Prevacid)

1. Nizatidine (Axid) 2. Ranitidine (Zantac) 3. Famotidine (Pepcid) 4. Cimetidine (Tagamet) Rationale: H2-receptor antagonists suppress secretion of gastric acid, alleviate symptoms of heartburn, and assist in preventing complications of peptic ulcer disease. These medications also suppress gastric acid secretions and are used in active ulcer disease, erosive esophagitis, and pathological hypersecretory conditions. The other medications listed are proton pump inhibitors.

Psyllium (Metamucil) is prescribed for a client with a cardiac disorder to facilitate defecation and prevent straining with bowel movements. The nurse reinforces instructions to a client regarding administration of the medication. Which statement by the client indicates an understanding of the use of the medication? 1. "I need to mix the medication with custard." 2. "I should mix the medication with a full glass of water." 3. "I should decrease the amount of fiber in my diet when I take this medication." 4. "I need to decrease my fluid intake following administration of the medication."

2. "I should mix the medication with a full glass of water." Rationale: Metamucil is a bulk-forming laxative. It should be taken with a full glass of water or juice (not custard), followed by another glass of liquid. This will help prevent impaction of the medication in the stomach or small intestine. Both fiber in the diet and fluid intake should not be decreased unless specifically prescribed by the health care provider.

A client has been given a prescription for metoclopramide (Reglan) four times a day. Which is the optimal time to take this medication? 1. With each meal and at bedtime 2. 30 minutes before meals and at bedtime 3. One hour after each meal and at bedtime 4. Every 6 hours spaced evenly around the clock

2. 30 minutes before meals and at bedtime Rationale: Metoclopramide is a gastrointestinal stimulant. The client should be taught to take this medication 30 minutes before meals and at bedtime. Therefore, the other options are incorrect.

A client with Crohn's disease is scheduled to receive an infusion of infliximab (Remicade). The nurse assisting in caring for the client should take which action to monitor the effectiveness of treatment? 1. Monitoring the leukocyte count for 2 days after the infusion 2. Checking the frequency and consistency of bowel movements 3. Checking serum liver enzyme levels before and after the infusion 4. Carrying out a Hematest on gastric fluids after the infusion is completed

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

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

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

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

2. Relief of epigastric pain Rationale: The client who frequently uses nonsteroidal antiinflammatory drugs (NSAIDs) is prone to gastric mucosal injury. Misoprostol is a gastric protectant and is given specifically to prevent this occurrence. Diarrhea can be a side effect of the medication, but it is not an intended effect. Options 3 and 4 are incorrect.

A postoperative client requests medication for flatulence (gas pains). Which medication from the following PRN list should the nurse administer to this client? 1. Ondansetron (Zofran) 2. Simethicone (Mylicon) 3. Acetaminophen (Tylenol) 4. Magnesium hydroxide (milk of magnesia, MOM)

2. Simethicone (Mylicon) Rationale: Simethicone is an antiflatulent used in the relief of pain caused by excessive gas in the gastrointestinal tract. Ondansetron is used to treat postoperative nausea and vomiting. Acetaminophen is a nonopioid analgesic. Magnesium hydroxide is an antacid and laxative.

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

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

A client is taking lansoprazole (Prevacid) for the chronic management of Zollinger-Ellison syndrome. If prescribed, which medication would be appropriate for the client if needed for a headache? 1. Naprosyn (Aleve) 2. Ibuprofen (Advil) 3. Acetaminophen (Tylenol) 4. Acetylsalicylic acid (aspirin)

3. Acetaminophen (Tylenol) Rationale: Zollinger-Ellison syndrome is a hypersecretory condition of the stomach. The client should avoid taking medications that are irritating to the stomach lining. Irritants would include aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) such as naprosen and ibuprofen. Acetaminophen would likely be prescribed for headache for this client because it would not be irritating to the stomach.

The nurse is administering a dose of prochlorperazine to a client for nausea and vomiting. The nurse tells the client to report which frequent side effect of this medication? 1. Diarrhea 2. Drooling 3. Blurred vision 4. Excessive perspiration

3. Blurred vision Rationale: The nurse would assess the client for blurred vision as a frequent side effect of prochlorperazine. Other frequent side effects of this phenothiazine-type antiemetic and antipsychotic are dry eyes, dry mouth, and constipation. The other options are incorrect.

A long-term care nurse is caring for an older client taking cimetidine (Tagamet). The nurse observes this client frequently for which most common central nervous system (CNS) side effect of this medication? 1. Tremors 2. Dizziness 3. Confusion 4. Hallucinations

3. Confusion Rationale: Older clients are especially susceptible to CNS side effects of cimetidine, of which confusion is most common. Less common ones are headache, dizziness, drowsiness, and hallucinations.

Atropine sulfate is prescribed for a client with gastrointestinal hypermotility, and the nurse reviews the client's record before administering the medication. Which finding, if noted on the client's record, indicates the need to contact the health care provider before administering the medication? 1. Biliary colic 2. Sinus bradycardia 3. Narrow-angle glaucoma 4. History of peptic ulcer disease

3. Narrow-angle glaucoma Rationale: Atropine sulfate can cause mydriasis (dilation of the pupil) and cycloplegia (relaxation of the ciliary muscles). It is contraindicated in clients with narrow-angle glaucoma. Options 1, 2, and 4 are all therapeutic reasons for using the medication.

A client has begun taking lansoprazole (Prevacid). The nurse monitors for which intended effect of this medication? 1. Relief of abdominal pain 2. Decrease in intestinal gas 3. Relief of nighttime heartburn 4. Absence of nausea and vomiting

3. Relief of nighttime heartburn Rationale: Lansoprazole is a proton pump inhibitor that suppresses gastric acid secretion. It is not used as an antiemetic (option 4). It is not used to directly treat abdominal pain or intestinal gas.

Sucralfate (Carafate) 1 g four times daily has been prescribed for a client with a diagnosis of gastric ulcer, and the nurse reinforces instructions to the client regarding administration of the medication. Which statement by the client indicates an understanding of the use of the medication? 1. "I need to take the medication every 6 hours around the clock." 2. "I need to take the medication with my meals and again at bedtime." 3. "I need to take the medication 1 hour after meals and again at bedtime." 4. "I need to take the medication 1 hour before my meals and at bedtime."

4. "I need to take the medication 1 hour before my meals and at bedtime." Rationale: This medication is timed to allow it to form a protective coating over the gastric ulcer before food intake stimulates gastric acid production and mechanical irritation. Therefore, the medication should be scheduled for administration 1 hour before meals and at bedtime. The other options are incorrect.

A health care provider has written a prescription for ranitidine (Zantac) 300 mg once daily on the client's discharge medication list. The nurse plans to instruct the client to take the medication at which time? 1. At bedtime 2. After lunch 3. With supper 4. Before breakfast

4. Before breakfast Rationale: A single daily dose of ranitidine should be taken at bedtime. This allows for prolonged effect and the greatest protection of gastric mucosa. Therefore, the other options are incorrect.

The nurse is preparing to reinforce instructions to the client who has been given a prescription for diphenoxylate with atropine (Lomotil). Which instructions should the nurse include? 1. Anticipate excitability as a side effect. 2. Take the medication with a bulk-forming laxative. 3. Expect increased saliva production while taking the medication. 4. Do not exceed the recommended dose because it can be habit forming.

4. Do not exceed the recommended dose because it can be habit forming. Rationale: Diphenoxylate with atropine is an antidiarrheal, and the client should not exceed the recommended dose because it may be habit forming. Because it is an antidiarrheal, it should not be taken with a laxative. Side effects of the medication include dry mouth and drowsiness.

The client has a PRN prescription for ondansetron (Zofran). For which condition should this medication be administered to the postoperative client? 1. Paralytic ileus 2. Incisional pain 3. Urinary retention 4. Nausea and vomiting

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

A client has just taken a dose of trimethobenzamide (Tigan). The nurse determines that the medication has been effective if the client reports which outcome? 1. Heartburn has been relieved. 2. Passage of hard stool has occurred. 3. Abdominal pain has been alleviated. 4. Nausea and vomiting has been relieved.

4. Nausea and vomiting has been relieved. Rationale: Trimethobenzamide is an antiemetic agent used in the treatment of nausea and vomiting. The other options are incorrect.

A client with a diagnosis of gastric ulcer has a prescription for oral sucralfate (Carafate) four times daily. At which time should the nurse plan to administer the medication? 1. With meals and at bedtime 2. Every 6 hours around the clock 3. One hour after meals and at bedtime 4. One hour before meals and at bedtime

4. One hour before meals and at bedtime Rationale: Sucralfate (Carafate) should be scheduled for administration 1 hour before meals and at bedtime. This timing will allow the medication to form a protective coating over the gastric ulcer before it becomes irritated by food intake, gastric acid production, and mechanical movement. The other options are incorrect.

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

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

A client has a prescription for sucralfate (Carafate) 1 g by mouth 4 times daily. The nurse writes in the medication record to administer the medication at which time? 1. With meals and at bedtime 2. Every 6 hours around the clock 3. One hour after meals and at bedtime 4. One hour before meals and at bedtime

4. One hour before meals and at bedtime Rationale: Sucralfate is a medication that should be scheduled for administration 1 hour before meals and at bedtime. The medication is scheduled so that it has time to form a protective coating over the ulcer before food intake stimulates chemical and mechanical irritation. Therefore, the other options are incorrect.

A client is taking docusate sodium (Colace). The nurse monitors which result to determine whether the client is having a therapeutic effect from this medication? 1. Abdominal pain 2. Reduction in steatorrhea 3. Hematest-negative stools 4. Regular bowel movements

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

A client with peptic ulcer disease has a new prescription for propantheline (Pro-Banthine). Which client teaching instructions should the nurse reinforce? 1. Take the medication with meals. 2. Take the medication with antacids. 3. Take the medication just after meals. 4. Take the medication 30 minutes before meals.

4. Take the medication 30 minutes before meals. Rationale: Propantheline is classified as an antimuscarinic, anticholinergic medication that decreases gastrointestinal secretions. It should be administered 30 minutes before meals. Therefore, the other options are incorrect.

A client with hepatic encephalopathy is receiving lactulose (Cephulac). The nurse determines that the medication is effective if which finding is observed? 1. There is an absence of blood in emesis and stool. 2. Urine output increases from 250 to 400 mL per 8-hour shift. 3. Episodes of frequent liquid bowel movements diminish to one time per day. 4. The client who was previously oriented to person only can now state name, year, and present location.

4. The client who was previously oriented to person only can now state name, year, and present location. Rationale: Hepatic encephalopathy produces alterations in level of consciousness because of the liver's inability to metabolize and cleanse the blood of ammonia and mercaptans. Lactulose is administered to decrease serum ammonia levels by facilitating movement of ammonia from the blood to the stool. Effectiveness is evident if the client has an improvement in level of consciousness.

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

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