Patho/Pharm: GI System Pharm Success ?'s

Which side effects would the nurse explain to the male client who is prescribed cimetidine (Tagamet), a histamine2blocker? 1.The medication can cause indigestion and heartburn. 2.The medication can cause impotence and gynecomastia. 3.The medication can cause insomnia and hypervigilance. 4.The medication can cause Zollinger-Ellison syndrome.

Answer: 2 Rationale: 1.Tagamet is used to treat indigestion and heartburn (pyrosis). 2.Over time, Tagamet can cause males to become impotent, have decreased libido, and have breast development (gynecomastia). 3.Tagamet can cause lethargy and somnolence, not insomnia and hypervigilance. 4.Tagamet is used to treat Zollinger-Ellison syndrome, a syndrome characterized by hypersecretion of gastric acid and the formation of peptic ulcers.

The client taking orlistat (Xenical), a lipase inhibitor, reports copious frothy diarrhea stools. Which data should the nurse suspect is the cause of the diarrhea? 1.The client has consumed an excessive amount of fats. 2.The client is also taking a lipid-lowering medication. 3.This is a desired effect of the medication. 4.The client has developed a chronic bowel syndrome.

Answer: 1 Rationale: 1. If a client consumes more than 30% of daily calories in fats while taking Xenical, the fats will not be absorbed by the gastrointestinal tract and the result is foul-smelling, frothy, diarrhea stools. 2. The "statins," or lipid-lowering medications, would not cause this response. 3. This is an uncomfortable and sometimes embarrassing possibility with this medication; it is not desired. 4. The foul-smelling, frothy, diarrhea stool indicates that the stool contains undigested fats. This is not a symptom of chronic bowel syndrome.

The client with inflammatory bowel disease has been on hyperalimentation, total parenteral nutrition (TPN), for 2 weeks. The HCP has written orders to discontinue TPN. Which intervention should the nurse implement? 1.Notify the health-care provider and question the order. 2.Discontinue the TPN and flush the subclavian port. 3.Do not implement the order and talk to the HCP on rounds. 4.Discuss the order with the pharmacist before discontinuing.

Answer: 1 Rationale: 1. TPN must be tapered off because of its high glucose content; if TPN is not tapered, the client may experience hypoglycemia. Therefore, the nurse should call the HCP to request an order to taper the TPN. 2. TPN must be tapered; therefore, the nurse should not discontinue the TPN abruptly. 3. If the nurse is not going to implement the order as written, the nurse should notify the HCP immediately and not wait for the HCP to make rounds. TPN is a medication and the client should not be taking it any longer than necessary. 4. The pharmacist cannot change a health-care provider's order; therefore, there is no reason for the nurse to talk to the pharmacist.

The client who had an elective cholecystectomy is receiving a prophylactic antibiotic. Which information indicates the medication is not effective? 1.The client's white blood cell (WBC) count is 18,000. 2.The client refuses to turn, cough, and deep breathe. 3.The client's sodium level is 139 mEq/L. 4.The client's nasogastric tube has green drainage.

Answer: 1 Rationale: 1. The WBC count is elevated, indicating an infection. The surgeon would not have performed an elective surgery if the client had an infection at the time. This indicates the antibiotic is not working. 2. This might indicate that the pain medication is not relieving the client's pain, but it does not provide information about the antibiotic. 3. The sodium level is within normal limits;it does not provide information about the antibiotic. 4. This is normal color of drainage of a nasogastric tube, but it does not provide information about the antibiotic. MEDICATION MEMORY JOGGER: The nurse determines the effectiveness of a medication by assessing for the symptoms, or lack thereof, for which the medication was prescribed.

Which client should the nurse question administering the antidiarrheal medication diphenoxylate (Lomotil)? 1.The 68-year-old client diagnosed with glaucoma. 2.The 78-year-old client with traveler's diarrhea. 3.The 44-year-old client with coronary artery disease. 4.The 28-year-old client receiving aminoglycoside antibiotics.

Answer: 1 Rationale: 1. The client with glaucoma should not receive Lomotil because of the drug's anticholinergic effect, which will increase the intraocular pressure. 2.Lomotil is prescribed for adult clients diagnosed with traveler's diarrhea. In children, diarrhea should be allowed to run its course. 3.Lomotil is not contraindicated in clients with coronary artery disease. 4.Antibiotics sometimes cause a superinfection that kills the normal flora in the bowel, resulting in diarrhea. This client may receive an antidiarrheal medication. MEDICATION MEMORY JOGGER: Glaucoma Is a condition that the nurse should recognize. Its presence precludes the use of many medications.

The nurse is discussing the problem of constipation with an elderly client. Which information should the nurse discuss with the client concerning laxative abuse? 1.Explain that stimulant laxatives, the chewing gum and chocolate types, are the kind most often abused. 2.Discuss that laxative abuse can occur if the client takes bulk-forming laxatives on a daily basis. 3.Tell the client that taking a Fleet enema daily will help prevent the client from becoming dependent on laxatives. 4.Recommend to the client that eating a high-fiber diet and increasing fluid consumption will ensure the client will not get constipated.

Answer: 1 Rationale: 1. This information is true and should be shared with the client. Chronic exposure to laxatives can diminish defecatory reflexes, leading to further reliance on laxatives. It may also cause serious pathologic changes, including electrolyte imbalance, dehydration, and colitis. 2.Bulk-forming laxatives increase fiber, which will help decrease constipation, but they do not cause laxative abuse. 3.A daily Fleet enema should be discouraged because it causes laxative dependency and can irritate the rectum and anal area. 4. The nurse should recommend a high-fiber diet and an increase in fluid intake, but that does not ensure that an elderly client will not get constipated. The client may need laxatives occasionally, and the nurse should always provide correct information to the client.

The nurse is administering 0800 medications. Which medication should the nurse question? 1.Misoprostol (Cytotec), a prostaglandin analog, to a 29-year-old female with an NSAID-produced ulcer. 2.Omeprazole (Prilosec), a proton-pump inhibitor, to a 68-year-old male with a duodenal ulcer. 3.Furosemide (Lasix), a loop diuretic, to a 56-year-old male with a potassium level of 4.2 mEq/L. 4.Acetaminophen (Tylenol), a nonnarcotic analgesic, to an 84-year-old female with a frontal headache.

Answer: 1 Rationale: 1.A 29-year-old female is of childbearing age. The nurse should determine that the client is not pregnant before administering this medication. Misoprostol can be used in a combination with mifepristone to produce an abortion 2.Prilosec is prescribed to treat duodenal and gastric ulcers; the nurse would not question this medication. 3. The potassium level is within normal range (3.5-5.5 mEq/L); the nurse would not question this medication. 4.Tylenol is frequently administered for headaches; the nurse would not question this medication. MEDICATION MEMORY JOGGER: Whenever age is mentioned in the stem of the question or in the answer options, one or more of the ages will be important. The Only option that gives the test taker a clue regarding the correct answer is the 29-year-old, and the test taker should also note that it is a female client. Twenty-nine-year-old females are of childbearing age, so the nurse has two potential clients to consider.

The nurse on a medical unit has received the morning report. Which medication should the nurse administer first? 1. The proton-pump inhibitor pantoprazole (Protonix) to a client on call to surgery. 2. The antacid calcium carbonate (TUMS) to a client complaining of indigestion. 3. The antimicrobial bismusth (Pepto-Bismol) to a client diagnosed with an ulcer. 4. The H2 blocker famotidime (Pepcid) to a client diagnosed with GERD.

Answer: 1 Rationale: 1.A medication for a client on call to surgery is a priority; the client's surgery could be delayed if the medication has not been administered when the call to surgery comes. 2. This would be the second medication to administer; this client has a complaint of discomfort. 3. This medication is a routine medication and could be administered at any time. 4. This medication is a routine medication and could be administered at any time.

.The client diagnosed with severe ulcerative colitis is prescribed azathioprine (Imuran), an immunosuppressant. Which assessment data concerning the medication warrants immediate intervention by the nurse? 1.Complaints of a sore throat, fever, and chills. 2.Reports of 10-20 loose stools a day. 3.Complaints of abdominal pain and tenderness. 4.Reports of dry mouth and oral mucosa.

Answer: 1 Rationale: 1.Azathioprine can cause a decrease in the number of blood cells in the bone marrow (agranulocytosis). Signs or symptoms that would warrant intervention by the nurse include sore throat, fever, chills, unusual bleeding or bruising, pale skin, headache, confusion, tachycardia, insomnia, and shortness of breath. 2.Ten to 20 loose, watery stools a day are characteristic of an acute exacerbation of ulcerative colitis and would not warrant intervention by the nurse secondary to the medication. 3.Abdominal pain and tenderness are characteristic of an acute exacerbation of ulcerative colitis and would not warrant intervention by the nurse secondary to the medication. 4.Dehydration may occur with ulcerative colitis, but it does not warrant intervention by the nurse secondary to the medication MEDICATION MEMORY JOGGER: If the client verbalizes a complaint or if the nurse's assessment data or laboratory data indicates an adverse effect secondary to a medication, the nurse must intervene. The nurse must implement an independent intervention or notify the health-care provider because medications can result in serious or even life-threatening complications.

The 62-year-old client suspected of having diverticulosis is scheduled for a colonoscopy and is prescribed sodium biphosphate (Fleet's Phospho-Soda) the night before the procedure. Which priority intervention should the nurse implement prior to the procedure? 1.Assess the client's skin turgor and oral mucosa. 2.Initiate intravenous therapy for the client. 3.Determine if the client has iodine allergies. 4.Monitor the client's bowel movements.

Answer: 1 Rationale: 1.In addition to being given an osmotic laxative, such as Fleet's Phospho-Soda, the client will be NPO. This can lead to dehydration. Skin turgor and the condition of the oral mucosa should be monitored to assess for dehydration. 2. The client will need an intravenous line, but it is not priority over assessing the client. 3.Iodine is not used in a colonoscopy, so the nurse need not ask this question. 4. The client should not be having any bowel movements at this time; the bowel should be cleaned out prior to the colonoscopy.

The nurse is administering medications to the following clients. Which medication should the nurse question administering? 1. Maalox, an antacid, to a client diagnosed with chronic kidney disease. 2. Prevacid, a proton-pump inhibitor, to a client diagnosed with ulcer disease. 3. Surfak, a stool softener, to a client diagnosed with diverticulosis. 4. Metamucil, a bulk laxative, to a client diagnosed with diarrhea.

Answer: 1 Rationale: 1.Maalox should not be administered to a client with chronic kidney disease because it contains magnesium, and diseased kidneys are unable to excrete magnesium, resulting in the client developing hypermagnesemia. If the client needs an antacid, he or she should receive aluminum hydroxide(Amphogel) because it helps remove phosphates. 2.A proton-pump inhibitor decreases gastric secretion and would be prescribed for a client with PUD. 3.A stool softener would be prescribed for a client with diverticulosis to help prevent constipation. 4.A bulk laxative adds substance to the fece sand will help decrease watery stools.

The male client diagnosed with peptic ulcer disease (PUD) has been taking magnesium hydroxide (Milk of Magnesia) for indigestion. The client complains that he has been having diarrhea. Which intervention should the nurse implement? 1.Suggest that the client use magnesium hydroxide with aluminum hydroxide (Mylanta). 2.Encourage the client to discuss the problem with the health-care provider. 3.Tell the client to take loperamide (Imodium), over the counter. 4.Discuss why the client is concerned about experiencing diarrhea.

Answer: 1 Rationale: 1.Milk of Magnesia is the most potent antacid, but it is usually used as a laxative because of the actions of magnesium hydroxide on the bowel. A combination antacid—magnesium hydroxide (produces diarrhea) and aluminum hydroxide (produces constipation)—is preferred to balance the side effects. 2. The nurse can answer the client's question. It is only necessary to discuss this with the health-care provider if antacids are not resolving the client's complaints of indigestion. 3. The Milk of Magnesia is causing the problem, and changing antacids should resolve the situation. 4.Most clients are concerned about diarrhea, and the nurse should be concerned about fluid and electrolyte imbalances resulting from diarrhea.

The adult client recently has been diagnosed with asthma. Which medication is recommended to treat this problem? 1.Omeprazole (Prilosec), a proton-pump inhibitor, daily. 2.Amoxicillin (Amoxil), an antibiotic, twice daily. 3.Loratadine (Claritin), an antihistamine, twice daily. 4.Prednisone, a glucocorticoid, daily.

Answer: 1 Rationale: 1.Up to 90% of adult-onset asthma is the result of gastroesophageal reflux disease (GERD). Treating the gastric reflux will treat the asthma. 2. The client is diagnosed with asthma, not an infection. There is no reason to administer an antibiotic. 3.Antihistamines such as Claritin are used to treat allergic reactions to pollens, dust, or other irritating substances. They are not effective against asthma. 4.Glucocorticoids are prescribed daily for clients with chronic lung diseases, such as emphysema or chronic bronchitis. A client with asthma would not be prescribed daily steroid.

.The client is prescribed orlistat (Xenical), a lipase inhibitor. Which statement by the client indicates the client requires more teaching? 1."It does not matter what I eat because I will still lose weight." 2."I will limit the amount of fat in my diet to 30%." 3."I may need to take Metamucil daily with the orlistat." 4."I will take a daily multivitamin supplement."

Answer: 1 Rationale: 1.Xenical acts by inhibiting the absorption of fats and cholesterol in the GI tract. The client should eat a reduced-calorie diet with no more than 30% of the calories coming from fats. Increasing the fat intake can result in foul-smelling, frothy, diarrhea stools. The client needs more teaching. 2. The client should eat a reduced-calorie diet with no more than 30% of the calories coming from fats. Increasing the fat intake can result in foul-smelling, frothy, diarrhea stools. This statement does not require intervention. 3.Metamucil will add bulk to the stool and limit the diarrhea that can occur with Xenical. This statement does not require intervention. 4.Xenical can interfere with the absorption of needed vitamins and minerals. This statement does not require intervention.

The female client tells the clinic nurse that she gets carsick every time the family goes on a vacation and the health-care provider prescribed the anticholinergic scopolamine (Transderm Scop). Which statement indicates the client understands the medication teaching? Select all that apply. 1."I will put the Transderm Scop patch behind my ear." 2."I will put the patch on for 12 hours and take it off at night." 3."If my car sickness does not go away, I will wear two patches." 4."I should leave the patch on for 3 days before changing it." 5."I should take the medication with one glass of water.

Answer: 1, 4 Rationale: 1. The Transderm Scop patch is applied behind the ears. 2. The patch can be left on for up to 3 days before changing, but it should not be alternated on and off. 3. The client should not wear two patches a tone time because of the anticholinergic effect of the medication. 4. The patch is effective up to 3 days; therefore, this indicates the client understands the medication teaching. 5.Transderm should indicate to the nurse the medication is a patch not a pill to be taken with water.

The client is prescribed a bulk-forming agent. Which statement best describes the scientific rationale for administering this medication? 1.The medication acts by lubricating the stool and the colon mucosa. 2.Bulk-forming agents irritate the bowel to increase peristalsis. 3.The medication causes more water and fat to be absorbed into the stool. 4.Bulk-forming agents absorb water, which adds size to the fecal mass.

Answer: 4 Rationale: 1.Lubricating the stool and colon mucosa is the rationale for administering mineral oil. 2.Irritating the bowel to increase peristalsis is the rationale for administering stimulants. 3.Stool softeners or surfactants cause more water and fat to be absorbed into the stool. 4.Bulk-forming agents absorb water and swell, thus increasing the size of the fecal mass. The larger the fecal mass, the more the defecation reflex is stimulated and the passage of stool is promoted.

The nurse is transcribing the admitting health-care provider's orders for an elderly client diagnosed with diverticulitis. Which orders would the nurse question? Select all that apply. 1.Administer one bisacodyl (Dulcolax), by mouth, daily. 2.Insert a nasogastric tube to intermittent low suction. 3.Administer morphine 2 mg intravenous push for pain every 4 hours. 4.Infuse D5 0.45 NS intravenously at 100 mL an hour. 5.Administer a Fleet's enema after each bowel movement.

Answer: 1, 5 Rationale: 1. The client should be NPO and not have any fecal matter going through an inflamed descending and sigmoid bowel; therefore, the nurse would question administering a stimulant laxative, which would cause the client to have a bowel movement. 2.Because the client is NPO, a nasogastric tube is inserted to remove gastric acid and decompress the bowel. 3. The client would have pain medication; therefore, this order would not be questioned. 4.Because the client is NPO the nurse would not question an order for intravenous fluids. 5. The client's rectum and sigmoid colon are irritated secondary to the diverticulitis, and nothing should be inserted to the rectum to further irritate rectum; and the client is not constipated, so therefore Fleet enema should be questioned by the nurse. MEDICATION MEMORY JOGGER: The nurse must be knowledgeable about accepted standards of practice for disease processes and conditions. If the nurse administers a medication the health-care provider has prescribed and it harms the client, the nurse could be held accountable. Remember that the nurse is a client advocate.

The nurse is discharging a client 2 days postoperative hiatal hernia repair. Which discharge instructions should the nurse include? Select all that apply. 1.Take all the prescribed antibiotic. 2.Eat six small meals per day. 3.Use the legs to bend down, not the back. 4.Take esomeprazole (Nexium) twice a day. 5.Use the pain medication when the pain is at 8-10.

Answer: 1,2,3 Rationale: 1.Prophylactic antibiotics are frequently prescribed both pre-surgery and post-surgery. The client should be instructed to take all the medication as directed. 2.Hiatal hernia repair may not last and the client should continue the recommended lifestyle modifications, such as eating small meals. 3.Part of the lifestyle modifications for hiatal hernia is to limit pressure on the abdominal cavity, especially after a meal. Using the leg muscles to bend down, rather than bending over, should be taught to the client. 4.Nexium is administered daily, not twice a day. 5.For best relief, pain medication should be taken at the onset of the pain. The clients should not wait until the pain is an 8-10 before taking the pain medication.

The client with inflammatory bowel disease is prescribed the glucocorticoid prednisone. Which interventions should the nurse implement? Select all that apply. 1.Monitor the client's blood glucose level. 2.Discuss the long-term side effects of prednisone. 3.Administer the medication with food. 4.Explain prednisone will be tapered when being discontinued. 5.Tell the client to notify HCP if moon face occurs.

Answer: 1,2,3,4 Rationale: 1.Prednisone increases the glucose level; therefore, it should be monitored by the nurse 2.Long-term side effects occur and the nurse should teach when administering the medication. 3.Steroids are notorious for causing gastric irritation that may result in peptic ulcers; therefore, administering the prednisone with food is priority 4.Explaining to the client about tapering the medication is important. 5.A moon face is an expected sign of prednisone toxicity so the client should not notify the health-care provider.

The elderly client calls the clinic and is complaining of loose, watery stools. Which interventions should the nurse implement? Select all that apply. 1.Instruct the client to take the antidiarrheal exactly as recommended. 2.Recommend the client drink clear liquids only, such as tea or broth. 3.Determine how long the client has been having the loose, watery stool. 4.Tell the client to go to the emergency department as soon as possible. 5.Ask the client what other medications he or she has taken in the past 24 hours.

Answer: 1,2,3,5 Rationale: 1.Some antidiarrheal medications contain habit-forming drugs and should be used as directed only. 2.Clear liquids allow the bowel to rest. A client with diarrhea should be consuming clear liquids only for 24 hours, then move on to eating a bland diet, and after that progress to eating more solid food if the diarrhea does not reoccur. 3.If the client has had diarrhea more than 48 hours, the nurse should recommend the client come to the office because an elderly client is at risk for dehydration. 4. The client does not need to go to the emergency department but may need to be seen in the clinic if the diarrhea has occurred for longer than 24 hours or the client shows signs of dehydration. 5. The nurse should determine what other medications the client is taking because diarrhea is a side effect of digoxin toxicity and may be a side effect of many other medications. The nurse should always ask what other medications the client is taking.

The client with a severe acute exacerbation of Crohn's disease is prescribed total parenteral nutrition (TPN). Which interventions should the nurse implement when administering TPN? Select all that apply. 1.Monitor the client's glucose level every 6 hours. 2.Administer the TPN on an intravenous pump. 3.Assess the peripheral intravenous site every 4 hours. 4.Check the TPN according to the five rights prior to administering. 5.Encourage the client to eat all of the food offered at meals.

Answer: 1,2,4 Rationale: 1.TPN is 50% dextrose; therefore, the client's blood glucose level should be checked every 6 hours; sliding-scale regular insulin coverage is usually ordered. 2.TPN should always be administered using an intravenous pump and not via gravity; fluid volume resulting from an overload of TPN could cause a life-threatening hyperglycemic crisis. 3.TPN must be administered via a subclavian line because a peripheral line will collapse as a result of the hyperosmolarity of the TPN and phlebitis may occur. 4.TPN is considered a medication and should be administered as any other medication. 5. The client with severe acute exacerbation of Crohn's is NPO to rest the bowel. When on TPN, the client is usually NPO because the TPN provides all necessary nutrients; therefore, the nurse would not encourage the client to eat food.

The male client who has essential hypertension tells the clinic nurse he is taking the over-the-counter stool softener docusate sodium (Colace). Which priority action should the clinic nurse implement? 1.Determine how often the client has a bowel movement. 2.Discuss the importance of not taking this stool softener. 3.Ask the client what was his last blood pressure reading. 4.Obtain a stool specimen for an occult blood test.

Answer: 2 Rationale: 1.Stool softeners do not increase the number of bowel movements; they make the stool softer and easier to pass. Therefore, determining how often the client has a bowel movement is not priority. 2.A client with essential hypertension would be on a low-sodium diet; docusate sodium (Colace) should not be given to clients on sodium restriction. 3. The client's current blood pressure should be assessed; the client's last blood pressure would not be priority. 4.There is nothing to indicate that the client is at risk for gastrointestinal bleeding; therefore, this is not a priority intervention.

The client taking antibiotics calls the clinic and tells the nurse the client has diarrhea. Which interventions should the nurse implement? Select all that apply. 1.Recommend the client take lactobacillus (Bacid), an antidiarrheal agent. 2.Explain diarrhea is a side effect of antibiotics and should be reported to health-care provider. 3.Ask the client if he or she has had any type of bad-tasting or -smelling food. 4.Instruct the client to quit taking the antibiotic for 24 hours, and then start taking again. 5.Tell client to take one diphenoxylate/atropine (Lomotil) after each loose stool up to 8 a day.

Answer: 1,2,5 Rationale: 1. Bacid is a non-prescription product specifically used to treat diarrhea caused by antibiotics. It re-establish normal intestinal flora and may be used prophylactically in clients with a history of antibiotic-induced diarrhea. 2.Diarrhea is a side effect of some antibiotics because antibiotics kill the good flora in the bowel, but the HCP needs to be notified so something can be done about the diarrhea. 3. The nurse should realize that antibiotics can cause diarrhea and should not assess for possible gastroenteritis. 4. The client should not quit taking the antibiotic because there may be a relapse of the infection for which the antibiotic is prescribed and the full dosage of antibiotic prescribed should always be taken. 5. Lomotil may cause serious health problems when overdosed which is why the client cannot take more than eight tablets in 24 hours.

The HCP wrote an order for "0.33% dextrose solution IV" for a 6-year-old child diagnosed with gastroenteritis. Which interventions should the nurse implement? Select all that apply. 1.Monitor the serum sodium and potassium levels. 2.Check the fontanels for the hydration status. 3.Discuss the order with the health-care provider. 4.Use a chamber infusion device on the IV pump. 5.Assess the intravenous site every hour.

Answer: 1,3,4,5 Rationale: 1. The client is receiving IV fluids and the nurse should monitor the child's electrolytes. 2.A 6-year-old child's fontanels have closed; the child is assessed for dehydration by checking skin turgor on the abdomen. 3.The order is incomplete. No rate has been given. The nurse should clarify the order with the HCP. 4.All pediatric intravenous infusions require safety measures to make sure the child is not fluid overloaded. Using a pump is a method of ensuring that the rate of infusion is maintained and that too much fluid is not infused at one time. Most hospitals also require simultaneous use of a chambered infusion device (Buretrol). 5. The nurse should assess pediatric IV sites at least every hour.

The client who has had an abdominal surgery has returned from the post-anesthesia care unit (PACU) with a patient-controlled analgesia (PCA) pump. Which interventions should the nurse implement? Select all that apply. 1.Check the PCA setting with another nurse. 2.Administer a bolus by pushing the button. 3.Instruct the client to push the PCA button when in pain. 4.Change the patient-controlled analgesia cartridge. 5.Assess the client's intravenous insertion site.

Answer: 1,3,5 Rationale: 1.For safety the nurse should double-check PCA settings with another nurse. This ensures that the correct dosage is being administered when the client pushes the PCA button. 2. The initial bolus should have been administered by the PACU nurse; the PCA button should be controlled by the client and no one else. 3. The client is the only person who should push the PCA button and it should be pushed when the client is in pain. 4. The client is returning from PACU. The Cartridge holds 30 mL of medication and should not have been completely used in the PACU. 5. The PCA pump is administered intravenously and the nurse should assess the insertion site to ensure it is not inflamed or infiltrated.

The client who has had abdominal surgery has an IV at 150 mL/hour for 12 hours and two IVPBs of 50 mL each. How much fluid would the nurse document on the intake and output (I & O) record?

Answer: 1900 mL of IV fluid. Rationale: 1900 mL of IV fluid. 150 mL multiplied by 12 equals 1800 mL, plus 100 mL of IVPB fluid equals 1900 mL of IV fluid.

The client diagnosed with inflammatory bowel disease (IBD) has been prescribed the oral glucocorticosteroid prednisone daily. The client has pyrosis. Which statement would be the clinic nurse's best response? 1."What type of diet are you currently following?" 2."When do you take your prednisone?" 3."Have you had a change in your weight?" 4."Have you discussed this with your healthcare provider?"

Answer: 2 Rationale: 1. The client's diet does not have any bearing on the client's heartburn. 2. Pyrosis, or heartburn, could be secondary to the client's taking the prednisone on an empty stomach. Prednisone is very irritating to the stomach and must be taken with food to prevent severe heartburn and possible peptic ulcer. 3.A weight change is not significant to the client's complaint of heartburn. 4. The nurse should assess the client's complaint before referring the client to the HCP. If the nurse can give factual information, the nurse should teach the client.

The client in the post-anesthesia care unit (PACU) has an order for meperidine (Demerol), an opioid, 75 mg IV every 2-3 hours PRN for pain. The nurse working in the PACU administers Demerol 50 mg IM and 25 mg IVP. Which statement best exhibits how the medication should be charted? 1.Demerol administered IM and IVP, incident report completed. 2.Demerol 50 mg IM in R gluteus maximus and 25 mg slow IVP. 3.Demerol 75 mg administered by slow intravenous route. 4.Demerol 25 mg IM in L ventrogluteal and 50 mg slow IVP.

Answer: 2 Rationale: 1. The nurse should never write "incident report" in a client's chart; this sends a red flag to an attorney that an error has been made. When an error is made, the facts should be charted honestly and succinctly. 2.Many PACU nurses are given standing orders to use their judgment about the route of administration of postoperative pain medications. The theory of administering the medications by both routes is that the client will receive immediate relief from the IV route and the IM route will provide relief when the IV medication has worn off. The nurse should always chart accurately what was done and how. 3. This would be dishonest and could cost the nurse his or her license. 4. The number of milligrams of medication has been reversed in this option.97.1900 mL of IV fluid.150 mL multiplied by12 equals 1800 mL, plus 100 mL of IVPB fluid, equals 1900 mL of IV fluid.

The client diagnosed with inflammatory bowel disease is prescribed mesalamine (Asacol), an aspirin product, suppositories. Which statement indicates the client understands the medication teaching? 1."I should retain the suppository for at least 15 minutes." 2."The suppository may stain my underwear or clothing." 3."I should store my medication in the refrigerator." 4."I should have a full rectum when applying the suppository."

Answer: 2 Rationale: 1. The suppository should be retained for 1-3 hours if possible to get the maximum benefit of the medication. 2. The client should use caution when using the suppository because it may stain clothing, flooring, painted surfaces, vinyl, enamel, marble, granite, and other surfaces. This statement indicates the client understands the teaching. 3. The medication should be stored at room temperature away from moisture and heat. 4. The client should empty the bowel just before inserting the rectal suppository.

The elderly client with diverticulosis is instructed to take the bulk laxative psyllium mucilloid (Metamucil). Which question is most important for the nurse to ask the client? 1."When was your last bowel movement?" 2."Do you have any difficulty swallowing?" 3."How much fiber do you eat daily?" 4."Do you ever notice any abdominal tenderness?"

Answer: 2 Rationale: 1. This is a question that the nurse could ask the client, but it is not specific or important to ask for a client taking Metamucil; therefore, it is not the most important question to ask the client. 2.Bulk laxatives can swell and cause obstruction of the esophagus; there-fore, the most important question to ask the client is if he or she has difficulty swallowing. If the client has difficulty swallowing, the nurse should question the client taking Metamucil. 3.Fiber helps decrease constipation, but fiber does not affect the effectiveness of Metamucil; therefore, it is not the most important question the nurse should ask the client. 4.Metamucil may cause abdominal cramping, but abdominal tenderness is not pertinent information regarding taking a bulk laxative daily; therefore, it is not the most important question for the nurse to ask the client.

The female client diagnosed with low back pain has been self-medicating with ibuprofen (Motrin), a nonsteroidal anti-inflammatory drug (NSAID), around the clock. The client calls the clinic and tells the nurse that she has been getting dizzy and light-headed. Which intervention should the nurse implement? 1. Tell the client to get up from a sitting or lying position slowly. 2. Have the client come to the clinic for lab work immediately. 3. Suggest the client take the ibuprofen with food or an antacid. 4. Discuss changing to a different nonsteroidal anti-inflammatory medication.

Answer: 2 Rationale: 1. This is information to teach when the client is taking antihypertensive medications, not NSAIDs. 2.A life-threatening complication of NSAID use is the development of gastric ulcers that can hemorrhage; dizziness and lightheadedness could indicate a bleeding problem. The client has been taking the medications "around the clock," indicating use during the night when it would be unusual for the client to consume food along with the medication. 3.NSAID medications should be taken with food or something to coat the stomach lining, but this client is symptomatic and should be seen by an HCP. 4.There is no reason to suggest a change in NSAID; the nurse should be concerned that the client has developed an NSAID-produced ulcer.

The female client calls the clinic complaining of diarrhea and reports that she just came back from vacation in Mexico. Which intervention should the nurse implement first? 1.Instruct the client to take loperamide (Imodium), an antidiarrheal medication. 2.Ask how long the client has had the diarrhea and when she returned from Mexico. 3.Explain that an antibiotic should be prescribed, and that the client needs to see the HCP. 4.Tell the client this is probably traveler's diarrhea and it will run its course.

Answer: 2 Rationale: 1. This is known as traveler's diarrhea caused by Escherichia coli bacteria. If the client takes an antidiarrheal agent, it will slow peristalsis, delay export of the causative organism, and prolong the infection. Therefore, this should not be the nurse's first intervention. 2.Tourists are often plagued by infectious diarrhea, known as traveler's diarrhea, Montezuma's revenge, or Aztec two-step, which is caused by the bacteria Escherichia coli. As a rule, treatment is not necessary and the diarrhea is self-limiting. If diarrhea is severe, it is treated with an antibiotic. Therefore, the nurse should assess the severity of the diarrhea first. 3. This is probably traveler's diarrhea, and as a rule treatment is not necessary because it is self-limiting. If diarrhea is severe, it is treated with an antibiotic. Therefore, the nurse should assess the severity of the diarrhea first. 4. This is a possibility, but the nurse should assess the severity, length of time of diarrhea, and whether the client is dehydrated before making this statement. MEDICATION MEMORY JOGGER: When answering test questions or when caring for clients at the bedside, the nurse should remember that assessing the client is usually the first intervention, but when the client is in distress, the nurse may need to intervene directly to help the client.

.The 80-year-old client with diverticulosis is prescribed the stool surfactant docusate sodium (Colace). Which assessment data indicate the medication is effective? 1.The client has a bowel movement within 8 hours. 2.The client has soft, brown stools. 3.The client has a soft, non-tender abdomen. 4.The client has bowel sounds in all four quadrants

Answer: 2 Rationale: 1.A stool surfactant or softener does not stimulate a bowel movement. 2.Colace is a stool softener; if the client has soft brown stools, the medication is effective. 3. The abdomen should be soft and nontender, but this does not indicate that the medication is effective. 4. The client should have bowel sounds in all four quadrants of the abdomen, but this does not indicate the medication is effective. MEDICATION MEMORY JOGGER: To determine if the medication is effective, the nurse should think about why the medication is being administered. Consider what disease process or condition the medication is being prescribed to treat.

The client is prescribed the stimulant laxative senna (Senokot) for constipation. The client calls the clinic and reports yellow-green-colored feces. Which intervention should the clinic nurse implement? 1.Have the client come to the clinic immediately. 2.Explain that this is a common side effect of Senokot. 3.Instruct the client to get a stool specimen to bring to the clinic. 4.Determine if the client has eaten any type of yellow or green food.

Answer: 2 Rationale: 1.Senna may cause the stool to turn this color; therefore, there is no need for the client to come to the clinic. 2.Senna (Senokot, Ex-Lax, and Agoral)may cause a yellow or yellow-greencast to feces; it may cause a red-pink discoloration of alkaline urine or yellow-brown color in acid urine. The Nurse should teach the client about this when the medication is prescribed. 3.Because this change in the color of the stool is common with senna, there is no need for the client to bring a stool specimen to the clinic. 4.Some foods can cause a discoloration of feces, but yellow-green feces are a side effect of the medication. MEDICATION MEMORY JOGGER: If the client verbalizes a complaint, if the nurse assesses data, or if laboratory data indicates an adverse effect secondary to a medication, the nurse must intervene. The nurse must implement an independent intervention or notify the health-care provider because medications can result in serious or even life-threatening complications.

The client complaining of "acid" when lying down at night asks the nurse if there is any medication that might help. Which statement is the nurse's best response? 1. "There are no medications to treat this problem but losing weight will sometimes help the symptoms." 2. "There are several over-the-counter and prescription medications available to treat this. You should discuss this with the HCP." 3. "Have you had any x-rays or other tests to determine if you have cancer or some other serious illness?" 4. "Acid reflux at night can lead to serious complications. You need to have tests done to determine the cause."

Answer: 2 Rationale: 1.There are several classifications of medications used to treat acid reflux problems. Sometimes losing weight will help relieve symptoms, but the client did not ask about lifestyle modifications. 2.Proton-pump inhibitors, histamine2blockers, and antacids all treat the symptoms of acid reflux. The nurse should encourage the client to discuss which medication is best with the HCP. 3. The symptoms do not indicate cancer. The nurse should not scare the client. 4.Acid reflux can lead to complications, including adult-onset asthma, that should be treated, but most HCPs will empirically treat the symptoms of acid reflux before ordering tests to determine the cause or possible complications.

The nurse is discharging a client diagnosed with gastroesophageal reflux disease (GERD). Which information should the nurse include in the teaching? 1. There are no complications of GERD as long as the client takes the medications. 2. Notify the health-care provider if the medication does not resolve the symptoms. 3. Immediately after a meal, lie down for at least 45 minutes. 4. If any discomfort is noted, take an NSAID for the pain.

Answer: 2 Rationale: 1.There may be several complications of GERD. Adult-onset asthma and Barrett's esophagus leading to cancer of the esophagus are two complications of GERD. The chance of developing these problems is less if the GERD is adequately treated, but there are no guarantees. 2. The client should always be informed of what symptoms to report to the HCP. 3. The client should be instructed to sit upright for at least 60 minutes following a meal to prevent reflux from occurring. 4.NSAIDs can increase gastric distress. Ulcers caused by NSAID use may be asymptomatic, or the symptoms may be attributed to the GERD. The client should use the prescribed H2receptorblocker, proton-pump inhibitor, or an antacid to relieve the discomfort associated with GERD

The elderly client diagnosed with irritable bowel syndrome (IBS) is prescribed propantheline (Pro-Banthine), an antispasmodic. Which signs or symptoms indicate an adverse reaction to the medication? 1.Flatus, abdominal pain, and cramping. 2.Agitation, confusion, and drowsiness. 3.Diarrhea alternating with constipation. 4.Mucus in the stool and low-grade fever.

Answer: 2 Rationale: 1.These are the signs or symptoms of IBS. 2. Agitation, confusion, and drowsiness are signs or symptoms of an adverse reaction in the client who is elderly or debilitated that requires discontinuation of the medication. 3.Diarrhea alternating with constipation is sign of IBS, not an adverse reaction to the medication. 4.Mucus in the stool is a sign of IBS, but low-grade fever is not. However, neither of these indicates an adverse reaction to the medication.

The day surgery nurse is admitting a client for repair of an inguinal hernia. Which information provided by the client is most important to report to the surgical team? Select all that apply. 1.The client has never had surgery before. 2.The client is allergic to shellfish. 3.The client had breakfast this morning. 4.The client had a sinus infection last month. 5.The client has had a productive cough for a week.

Answer: 2,3,5 Rationale: 1. This does not need to be reported to the surgical team. 2.Allergy to shellfish usually indicates an allergy to iodine, the active ingredient in iodine (Betadine) surgical scrub. The Nurse should place an allergy alert on the front of the client's chart, put an allergy bracelet on the client, and document the finding on the preoperative checklist. 3.If the client has had something to eat the surgery must be cancelled because food can lead to potential aspiration pneumonia. 4.An infection last month should be cleared by now; this does not need to be reported to the surgical team. 5. If the client has a productive cough, the surgery may be cancelled because coughing postoperatively could cause a dehiscence of the wound. MEDICATION MEMORY JOGGER: The Nurse must be knowledgeable about diagnostic tests and surgical procedures.If the client provides information that would cause harm to the client, then the nurse must intervene.

The nurse is preparing to administer the proton-pump inhibitor esomeprazole (Nexium). Which intervention should the nurse implement? Select all that apply. 1.Order an infusion pump for the client. 2.Elevate the client's head of the bed. 3.Check the client's ID band with MAR. 4.Check for allergies to cephalosporin. 5.Ask the client his or her date of birth.

Answer: 2,3,5 Rationale: 1.Nexium is an oral medication; an intravenous pump is not needed. 2. The head of the bed is elevated for the client to be able to swallow the medication. 3. The nurse must check the medication administration record (MAR) with the client's ID band to ensure the correct client is receiving the medication. 4.Nexium is not a cephalosporin. The cephalosporins are a class of antibiotics. 5. The Joint Commission requires that two patient identifiers be used to determine the "right patient." Most health-care facilities use the client's name and date of birth as these identifiers.

The home health-care nurse is discussing bowel elimination patterns with an elderly client. The client tells the nurse he must take something to make his bowels move every day. Which information should the nurse discuss with the client? Select all that apply. 1.Tell the client to take a cathartic laxative daily. 2.Encourage the client to take a bulk laxative daily. 3.Demonstrate how to give a Fleets enema. 4.Instruct the client to take a daily stool softener. 5.Recommend the client drink at least 2000 mL of water a day.

Answer: 2,4,5 Rationale: 1.A cathartic laxative is a stimulant laxative, and daily use can lead to laxative dependence. Elderly clients should be encouraged to use other methods to ensure a daily bowel movement. 2.A bulk laxative is recommended for daily use because it increases fiber and requires the colon to function normally. Stimulant laxatives may cause "laxative dependency," which is not healthy for the client. 3. The client should not be encouraged to take Fleet's enemas unless recommended by an HCP because they may cause dependence. The nurse should encourage the use of medications that require the bowel to function normally. 4.If the client needs to have a bowel movement daily, then a stool softener should be encouraged because it does not stimulate the bowel; it just softens the stool. 5.Increasing the client's water intake will help soften the stool.

The child diagnosed with gastroenteritis is scheduled for an endoscopic examination of the stomach and duodenum. Which intervention is priority for the nurse assisting with the procedure? 1.Watch the screen for abnormal data. 2.Hand the physician the instruments. 3.Monitor the child's respiratory status. 4.Clean the instruments between clients.

Answer: 3 Rationale: 1. The HCP is responsible for identifying abnormal data noted during the procedure. 2. The instrument being used is a fiberoptic scope, and it will be in the HCP's hands during the procedure. The instrument that might be handed is the biopsy instrument, but this is not a priority over the respiratory function of the client. 3. The child will have received conscious sedation; the nurse should monitor the child's respiratory status to make sure that respiratory depression leading to respiratory failure does not occur. 4. The nurse or a technician will clean the instruments after a procedure, but this is not priority over monitoring the client.

The client diagnosed with inflammatory bowel disease taking mesalamine (Asacol), an aspirin product, has complaints of nausea, vomiting, and diarrhea. Which intervention should the clinic nurse take? 1.Instruct the client to quit taking the medication immediately. 2.Tell the client to take Prevacid, a proton-pump inhibitor, with the medication. 3.Advise the client to keep taking the medication, but notify the HCP. 4.Explain that these symptoms are expected and will resolve with time.

Answer: 3 Rationale: 1. The client should not quit taking the medication abruptly because that would result in an acute exacerbation of the inflammatory bowel disease. 2.A PPI will not help treat these symptoms. 3.These are side effects of the medication, and the HCP should be notified, but the client should not stop taking the medication. 4.These symptoms will not resolve with time and should be reported to the HCP.

The client had a general anesthetic for an abdominal surgery. When taking off the postoperative orders the charge nurse notes there is no antiemetic medication ordered. Which action should the charge nurse take? 1.Continue transcribing the orders and do nothing. 2.Ask the anesthesiologist if the client was nauseated during surgery. 3.Contact the surgeon and request an order for an antiemetic. 4.Tell the client's nurse to notify the charge nurse if there is nausea.

Answer: 3 Rationale: 1. The client who has had general anesthesia frequently experiences nausea while the effects of the anesthetic agents are wearing off. The charge nurse should anticipate the client's needs and prepare for them. 2. The client would have been "asleep" while under general anesthesia and could not complain of nausea to the anesthesiologist. 3. The surgeon may have overlooked the need for an antiemetic while writing the orders; the nurse should contact the surgeon and ask for the order. 4. The charge nurse should not have to request a primary nurse to keep the charge nurse informed of the client's condition.

The client diagnosed with peptic ulcer disease is admitted to the medical unit with a hemoglobin level of 6.2 g/dL and a hematocrit level of 18%. Which intervention should the nurse prepare to implement first? 1.Obtain an order for an oral proton-pump inhibitor. 2.Instruct the client to save all stools for observation. 3.Initiate an IV with 0.9% NS with an 18-gauge catheter. 4.Place a bedside commode in the client's room.

Answer: 3 Rationale: 1. The client would need an intravenous proton-pump inhibitor at first and then later could be changed to an oral PPI. The client may also need a nasogastric tube or to be NPO. This client has a very low hemoglobin and hematocrit level, indicating active bleeding and the need for a fast route for the delivery of fluids and medications. 2. The nurse should observe the stool for color (black) and consistency (tarry) indicating blood, but this is not the first action. 3. This client has very low blood counts; is at risk for shock; and should be assessed for hypotension, tachycardia, and cold clammy skin. The client will need fluid and blood cell replacement. The nurse should start the IV as soon as possible. 4. The client should have a bedside commode for safety, but it is not the first intervention. Prevention of or treating shock is the first intervention. MEDICATION MEMORY JOGGER: The stem told the test taker the client's hemoglobin and hematocrit levels, which were levels indicating a "crisis" situation. The first step in many crises is to make sure that anIV access is available to administer fluids and medications.

The client is scheduled for a bowel resection in the morning. The nurse administered one bottle of GoLYTELY. Which task is most appropriate for the nurse delegate to the unlicensed assistive personnel (UAP)? 1.Remove the client's water pitcher from the room. 2.Take the client's vital signs every 2 hours. 3.Place a bedside commode in the client's room. 4.Administer moisture barrier cream to the anal area.

Answer: 3 Rationale: 1. The client would not be NPO at this time because the client will have to drink a gallon of GoLYTELY. There is no reason for the UAP to remove the water pitcher. 2.There is no reason for the client's vital signs to be taken every 2 hours preoperatively. Vital signs are tasks that can be delegated to a UAP. 3.GoLYTELY is a colonic stimulant that is prescribed to cleanse the bowel prior to bowel surgery; therefore, the client should have a bedside commode readily available and the nurse can delegate the UAP to perform this task. 4. The UAP is allowed to apply a moisture barrier to excoriated perianal areas, but nothing in the stem indicates the client has this need.

The client post gastrectomy has a patient-controlled analgesia (PCA) pump. Which data requires immediate intervention by the nurse? 1.The client complains that the pain is still a 3. 2.The client has serous drainage on the dressing. 3.The client has a T 99.2, P 78, R 10, and BP 110/82. 4.The client splints the incision before trying to cough.

Answer: 3 Rationale: 1. The client's pain level is in the mild range. The nurse can discuss non pharmacological methods to decrease the pain further, such as distraction or guided imagery, but this level of pain is not a reason for immediate intervention. 2.Serous drainage is expected after a surgery and does not warrant immediate intervention. 3. The client's respiration rate is low, indicating a potential overdose of narcotic medication depressing the respiratory drive. This situation requires immediate intervention. 4. The client should splint the incision prior to coughing. The nurse should praise the client.

The 72-year-old client is admitted to the medical unit diagnosed with an acute exacerbation of diverticulosis. The health-care provider has prescribed the intravenous antibiotic ceftriaxone (Rocephin). Which intervention should the nurse implement first? 1.Monitor the client's white blood cell count. 2.Assess the client's most recent vital signs. 3.Determine if the client has any known allergies. 4.Send a stool specimen to the laboratory.

Answer: 3 Rationale: 1. The white blood cell count is monitored to determine the effectiveness of the medication and would not be checked prior to administering the first dose of the antibiotic medication. 2. The nurse should monitor the client's vital signs, especially the temperature, but it would not affect the nurse administering the first dose of antibiotics. 3.Antibiotics are notorious for causing allergic reactions, and the nurse should make sure the client is not allergic to any antibiotics prior to administering this medication. Therefore, this is the first intervention. 4.Stool specimens are sent to the laboratory to detect ova or parasites. Diverticulitis is not the result of ova or parasites; therefore, there is no need for the client to have a stool specimen sent to the laboratory.

The home health-care nurse is caring for a male client diagnosed with a hiatal hernia and reflux. Which data indicates the medication therapy is effective? 1.The client takes the antacid 1 hour before and 3 hours after a meal. 2.The client complains of indigestion after eating a large meal. 3.The client states that he did not wake up with heartburn during the night. 4. The client has lost 3 pounds in the past 2 weeks.

Answer: 3 Rationale: 1. This indicates client compliance with the dosing regimen for antacids, not that the medication is effective. 2. The return of symptoms indicates the medication is not effective. 3. This indicates an improvement in symptoms and that the medication is effective. 4.Losing weight would not indicate that a medication for hiatal hernia is effective. MEDICATION MEMORY JOGGER: The nurse determines the effectiveness of a medication by assessing for the symptoms, or lack thereof, for which the medication was prescribed.

The client with cancer is not eating and has lost 15 lb in the past month. The health-care provider has prescribed the cannabinoid dronabinol (Marinol). Which statement indicates the client needs more teaching concerning this medication? 1."This medication will help stimulate my appetite." 2."It is not uncommon to get drowsy when taking this medication." 3."This is marijuana and I do not want to get addicted to it." 4."I should chew sugarless gum when taking this medication."

Answer: 3 Rationale: 1. This medication is prescribed to help stimulate the client's appetite; therefore, the client does not need more teaching. 2.A side effect of this medication is drowsiness; therefore, the client does not need more teaching. 3. Cannabinoid, the active ingredient in marijuana, is frequently abused as an illegal drug, but it is not addicting. 4.A side effect of this medication is a dry mouth, so chewing sugarless gum indicates the client understands the medication teaching.

Which information should the nurse discuss with the 75-year-old client diagnosed with diverticulosis who is prescribed methylcellulose (Citrucel), a bulk laxative? 1.Notify the health-care provider if abdominal cramping occurs. 2.Explain that results should be evident within 24 hours. 3.Encourage the client to increase the intake of fluids, especially water. 4.Instruct the client to decrease fiber intake while taking this medication.

Answer: 3 Rationale: 1.Abdominal cramping is expected when this medication is first started; therefore, the client would not need to notify the HCP. 2.It takes 2-3 days after the initial dose for the medication to work. 3.Esophageal or intestinal obstruction may result if the client does not take inadequate amounts of fluid with the medication. 4.When taking this medication, the client should increase dietary fiber, such as whole grains, fibrous fruits, and vegetables.

The nurse is working at a senior citizen center. She is giving a lecture on health-promotion activities for the elderly. Which information should the nurse discuss with the group to help prevent constipation? 1.The antispasmodic dicyclomine (Bentyl), taken every morning with the breakfast meals, will help prevent constipation. 2.Eating five to six small meals a day including low-residue foods will help prevent the development of constipation. 3.Taking a daily stool softener along with daily exercise, increased fluids, and a high-fiber diet will help prevent constipation from developing. 4.Elderly clients must have at least one bowel movement a day to prevent the development of constipation.

Answer: 3 Rationale: 1.An antispasmodic medication controls spasms of the gastrointestinal tract and may help with irritable bowel syndrome, but it does not help prevent constipation. 2.Low-residue foods have low fiber and will cause the client to become constipated. 3.Getting daily exercise, increasing fluid intake, eating a high-fiber diet, and using a stool softener that lubricates the stool lead to regular bowel movements, which, in turn, prevent constipation. 4.A daily bowel movement is not required to prevent constipation; some clients have bowel movements every other day, which is fine as long as the bowel movements are regular. Regular bowel movements prevent the development of constipation.

Which statement is the scientific rationale for administering a proton-pump inhibitor(PPI) to a client diagnosed with gastrointestinal reflux disease (GERD)? 1.PPI medications neutralize the gastric secretions. 2.PPI medications block H2receptors on the parietal cells. 3.PPI medications inhibit the enzyme that generates gastric acid. 4.PPI medications form a protective barrier against acid and pepsin.

Answer: 3 Rationale: 1.Antacids, not proton-pump inhibitors, neutralize gastric secretions. 2.Histamine2blockers block receptors on the parietal cells. 3.Proton-pump inhibitors inhibit the enzyme that generates gastric acid. 4.Mucosal barrier agents form a protective barrier against acid and pepsin.

The client diagnosed with lactose intolerance is prescribed lactase (Lactaid), a digestive enzyme. Which intervention should the nurse implement when administering this medication? 1.Administer the medication on an empty stomach. 2.Administer the medication with a full glass of water. 3.Administer the medication with the client's food. 4.Administer the medication with vitamin D.

Answer: 3 Rationale: 1.Enzymes break down food; therefore, they must be administered with food. 2. This medication does not need to be administered with water to be effective. 3.Lactaid is a gastrointestinal enzyme essential for the absorption of lactose from the intestines. It must be taken with food. 4.Vitamin D deficiency results from a lack of milk and milk products in the diet. Lactaid is administered so the client can tolerate milk products, but it does not need to be administered with vitamin D.

The intensive care nurse is preparing to administer the H2 Receptor blocker ranitidine (Zantac) IVPB to a client with severe burns. Which statement is the scientific rationale for administering this medication? 1.Zantac will prevent an H. pylori infection. 2.The client has a history of ulcer disease. 3.It is for prophylaxis to prevent Curling's ulcer. 4.There is no rationale; the nurse should question the order.

Answer: 3 Rationale: 1.H. pylori is a bacterial infection. Zantac is not an antibiotic and would not prevent an infection. 2.In this situation, Zantac or a proton-pump inhibitor would be administered to all clients, not just those with a history of ulcer disease. 3.Because of the fluid shifts that occur as a result of severe burn injuries, the blood supply to the gastrointestinal tract is diminished while the stress placed on the body increases the gastric acid secretion, leading to gastric ulcers, a condition called Curling's ulcer. Zantac would be administered to decrease the production of gastric acid. 4. The nurse should request an H2 Receptor Blocker or a proton-pump inhibitor if one is not ordered; the nurse would not question the order.

The charge nurse notices that the primary nurse is preparing to administer the antacid Maalox to the client receiving his routine morning medications. Which intervention should the charge nurse take first? 1.Take no action because this is acceptable standard of practice. 2.Discuss changing the administration time with the pharmacist. 3.Inform the primary nurse to not administer the Maalox. 4.Instruct the primary nurse to shake the Maalox container

Answer: 3 Rationale: 1.Taking antacids with other medications is not an acceptable standard of practice. 2. The charge nurse should discuss changing the times of Maalox administration to 1-2 hours before or after taking other drugs because Maalox could affect the absorption of the other drugs. However, this is not the first intervention. 3. The client should not receive any oral medications 1-2 hours before or after taking an antacid because the antacid may interfere with absorption of the other medications. 4.Maalox is a suspension and should be shaken, but this is not the first action the nurse should take.

Which laboratory data should the nurse monitor for the client with inflammatory bowel disease who is prescribed sulfasalazine (Azulfidine), a sulfonamide antibiotic? 1.The client's liver function tests. 2.The client's serum potassium level. 3.The client's serum creatinine level. 4.The client's International Normalized Ratio (INR).

Answer: 3 Rationale: 1.There is no indication that sulfasalazine is hepatotoxic; therefore, liver function tests do not need to be monitored when administering this medication. 2. The serum potassium level is not affected by sulfasalazine; therefore, the nurse does not need to monitor this laboratory data. 3.Sulfasalazine is insoluble in acid urine and can cause crystalluria and hematuria, resulting in kidney damage. Therefore, the nurse should monitor the serum creatinine level, which is normally 0.5-1.5 mg/dL. 4.Sulfasalazine may cause abnormal bleeding and bruising, but the INR is monitored for clients taking the oral anticoagulant warfarin (Coumadin). MEDICATION MEMORY JOGGER: The nurse must be knowledgeable about accepted standards of practice for medication administration, including which client assessment data and laboratory data should be monitored prior to and during the use of the medication.

Which medication should be the most appropriate medication for the client who is obese who is trying to quit smoking? 1.Orlistat (Xenical), a lipase inhibitor. 2.Sibutramine (Meridia), an appetite suppressant. 3.Bupropion (Zyban), an antidepressant. 4.Olestra (Olean), a fat substitute.

Answer: 3 Rationale: 1.Xenical will decrease the absorption of fats and cholesterol in the GI tract, but it will not help the client to quit smoking. 2.Meridia can suppress the appetite, but it will not address the smoking. 3.Zyban is an antidepressant that is used to assist clients to quit smoking. It has also been shown to suppress the appetite by suppressing the uptake of norepinephrine and serotonin. 4.Olean is a non absorbable fat substitute; it does not help with nicotine withdrawal or suppress the appetite.

The client is diagnosed with a Helicobacter pylori infection and peptic ulcer disease (PUD). Which discharge instructions should the nurse teach? Select all that apply. 1.Discuss placing the head of the bed on blocks to prevent reflux. 2.Teach to never use nonsteroidal anti-inflammatory drugs again. 3.Encourage the client to quit smoking cigarettes. 4.Instruct the client to eat a soft, bland diet. 5.Take the combination of medications for 14 days as directed.

Answer: 3,5 Rationale: 1. The client has PUD, not gastroesophageal reflux disease (GERD), for which elevating the head of the bed would be recommended. 2. The client's ulcer is caused by a bacterial infection, not NSAID use. The client should limit use of NSAIDs until the ulcer has healed to prevent complicating the healing process, but the client should be able to use NSAID medications once the H. pylori infection has been treated. 3.Smoking decreases prostaglandin production and results in decreased protection of the mucosal lining. Smoking should be stopped. 4.A soft, bland diet is not ordered for a client with peptic ulcer disease. 5.H. pylori is a bacterial infection that is treated with a combination of medications. At least two antibiotics and an antisecretory medication will be ordered. As with all antibiotic prescriptions, the client should be taught to take all the medications as ordered. Resistant strains of H. pylori are being documented in clients who have not been compliant with the treatment program.

The client is on call for surgery. Which order should the nurse implement when the operating room nurse notifies the floor that the orderly is on the way to pick up the client? 1.Have the client sign the operative permit. 2.Teach the client to turn, cough, and deep breathe. 3.Notify the family to wait in the OR waiting room. 4.Administer the preoperative antibiotic IVPB.

Answer: 4 Rationale: 1. The client should have signed the consent form before the call that the orderly is coming to get the client for surgery is placed. Waiting until this point does not give the client time to ask questions and get clarification of concerns. 2. This should have been done the night before or at least earlier on the day of surgery. 3. The family can walk with the client to the operating room entrance and then be escorted or guided to the waiting room. 4. This is the appropriate time to administer any preoperative medication.

The client diagnosed with ulcerative colitis is prescribed mesalamine (Asacol), an aspirin product. Which information should the nurse discuss with the client? 1.Explain to the client that undissolved tablets may be expelled in stool. 2.Discuss the importance of taking the medication on an empty stomach only. 3.Tell the client to avoid drinking any type of carbonated beverages. 4. Instruct the client not to crush, break, or chew the tablets or capsules.

Answer: 4 Rationale: 1. The client should notify the health-care provider if undissolved tablets or capsules are found in the stool because this is not expected. 2. This medication can be taken with or without food; food does not affect the effectiveness of the medication. 3.There are no restrictions on foods, beverages, or activities when taking this medication unless the health-care provider directs otherwise. 4. The tablets must be swallowed whole because they are specially formulated to release the medication after it has passed through the stomach.

The client is being prepped for an open cholecystectomy. Which preoperative instruction is most important for the nurse to teach? 1.There will be an upper-left abdominal incision. 2.The client will be turned to the left side every hour. 3.The client will be placed on total parenteral nutrition. 4.Discuss pain medications and the 1-10 pain scale.

Answer: 4 Rationale: 1. The incision is a right upper-abdominal incision for a gallbladder. 2.Clients should be turned every 2 hours, not every hour, and will be turned from side to side and to the back. 3. The client will be NPO for a day or two and will have intravenous fluids, but unless complications occur there is no reason for total parenteral nutrition (TPN). 4. The nurse should discuss pain control procedures with all clients having surgery.

The client diagnosed with diverticulitis is requesting pain medication. Which intervention should the medical nurse implement first? 1.Administer the client's pain medication as requested. 2.Check the client's serum sodium and potassium level. 3.Determine when the last pain medication was administered. 4.Assess the client's bowel sounds and abdomen for tenderness.

Answer: 4 Rationale: 1. The nurse should not administer pain medication without first assessing the client for any complications. 2.Electrolyte levels do not need to be monitored prior to administering pain medication for clients with diverticulitis. 3. The nurse should determine when the next pain medication could be administered, but the first intervention is always assessing the client. 4. The nurse must assess the client to determine if the pain is pain expected with diverticulitis or if it is a result of a complication of diverticulitis, such as bowel obstruction or bowel perforation. Remember that the first intervention is assessment. MEDICATION MEMORY JOGGER: Remember that pain may be expected as a result of the disease process or the condition, but it may also indicate a complication. Assessment is the first intervention when addressing the client's complaints of pain.

The client is diagnosed with end-stage liver disease and is prescribed hydroxyzine(Atarax), an antipruritic. Which assessment data indicates the medication is effective? 1.The client reports a decrease in nausea. 2.The client reports an increase in appetite. 3.The client reports being more alert. 4.The client reports a decrease in itching.

Answer: 4 Rationale: 1. This medication is being used as an antipruritic; therefore, a decrease in nausea does not indicate the effectiveness of the medication. 2. This medication does not stimulate the appetite; therefore, assessment of the appetite does not determine the effectiveness of the medication. 3.Atarax will cause drowsiness and is not administered to increase the client's cognitive ability. 4. The client in end-stage liver disease often has jaundice, which causes pruritus (itching). A decrease in itching indicates the medication is effective. MEDICATION MEMORY JOGGER: The test taker must note the drug classification to determine the effectiveness of the medication. Many medications are administered for different reasons, which changes their drug classification.

The client has been on a therapeutic regimen for an H. pylori infection. Which data suggests the medication is not effective? 1.The client states that the midepigastric pain has been relieved. 2.The client's hemoglobin is 15 g/dL and the hematocrit is 44%. 3.The client has gained 3 pounds in 1 week. 4.The client's pulse is 124 and blood pressure is 92/48.

Answer: 4 Rationale: 1.A lack of epigastric pain would indicate the medication is effective. The question asks for which data indicates the medication is not effective. 2.A hemoglobin of 15 g/dL and hematocrit of 44% are within normal limits and would indicate that the client is not bleeding as a result of the ulcer. 3.Clients who experience a gastric ulcer lose weight because of the pain associated with eating. A weight gain would indicate less pain and the client being able to consume nutrients. 4. The client has a rapid pulse and low blood pressure, which indicate shock. This could be caused by hemorrhage from the ulcer. This client's treatment has not been effective. MEDICATION MEMORY JOGGER: The Nurse determines the effectiveness of medication by assessing for the symptoms, or lack thereof, for which the medication was prescribed.

The client with gastroenteritis is being discharged from the emergency department with a prescription for promethazine (Phenergan), an antiemetic. Which information should the nurse discuss with the client? 1.Explain that a sore throat and mouth sores are expected side effects. 2.Tell the client to call the doctor if the urine turns light-amber colored. 3.Encourage the client to drink carbonated beverages. 4.Instruct the client not to drink alcohol with the medication.

Answer: 4 Rationale: 1.A sore throat and mouth sores could indicate that the client is experiencing agranulocytosis, which is a possible adverse effect of Phenergan and should be reported to the HCP. The HCP would have a complete blood cell count (CBC) drawn to evaluate for this adverse effect. 2.Light-amber-colored urine indicates the client is no longer dehydrated and would not warrant notifying the HCP. 3.Non Pharmacological measures of alleviating nausea and vomiting, such as flattened carbonated beverages, weak tea, crackers, and dry toast, should be discussed with the client. Drinking carbonated beverages should be discouraged. 4. The client should not consume alcohol when taking antiemetics because it can intensify the sedative effect. MEDICATION MEMORY JOGGER: Drinking alcohol is always discouraged when taking any prescribed or over-the-counter medication because of adverse interactions. The nurse should encourage the client not to drink alcoholic beverages.

The client with diarrhea is taking diphenoxylate (Lomotil). Which intervention should the nurse discuss with the client? 1.Instruct the client to take one pill after each loose stool until the diarrhea stops. 2.Discuss the need to decrease fluid intake to help decrease loose, watery stool. 3.Explain that the medication should be taken once a day for 1 week. 4.Tell the client not to take more than eight tablets in a 24-hour period.

Answer: 4 Rationale: 1.Because Lomotil has atropine and is a Schedule V controlled substance, the client should not take more than eight in a 24-hour period. 2. The client should drink clear liquids and increase fluid intake to help prevent dehydration. 3.Lomotil should not be taken for more than 2-3 days. If the diarrhea persists more than 48 hours, the client should notify the health-care provider. 4.An adult should take two tablets and then one tablet after each loose stool up to a maximum of eight tablets in 24 hours. Atropine in the medication helps prevent narcotic abuse, but atropine is an anticholinergic medication, which dries up secretions.

The nurse is administering 0900 medications to a client diagnosed with peptic ulcer disease (PUD). Which medication should the nurse question? 1.Metronidazole (Flagyl), an anti-infective. 2.Bismuth subsalicylate (Pepto Bismol), an antibiotic. 3.Lansoprazole (Prevacid), a proton-pump inhibitor. 4.Sucralfate (Carafate), a mucosal barrier agent.

Answer: 4 Rationale: 1.Flagyl is administered in combination with Pepto Bismol, Prevacid, and one other antibiotic to treat PUD; the nurse would not question this medication. 2.Pepto Bismol is administered in combination with Flagyl, Prevacid, and one other antibiotic to treat PUD; the nurse would not question this medication. 3.Prevacid is administered with a combination of antibiotics to treat PUD; the nurse would not question this medication. 4.Sucralfate (Carafate) is a mucosal barrier agent and must be administered on an empty stomach for the medication to coat the stomach lining. The nurse should question the time the medication is scheduled for and arrange for the medication to be administered at 0730.

The client with hepatitis is being treated with interferon alfa (Roferon), a biological response modifier. Which information should the clinic nurse discuss with the client? 1. Explain that if flu like symptoms occur, the client must stop taking the medication. 2.Discuss that the client may experience some abnormal bruising and bleeding. 3.Tell the client that the skin will become yellow while taking this medication. 4.Recommend taking acetaminophen (Tylenol), two tablets, before the injection.

Answer: 4 Rationale: 1.Flu Like symptoms are expected and should be treated with Tylenol. 2.Abnormal bleeding and bruising are not expected and should be reported to the HCP. 3. The client may be jaundiced from the hepatitis but not from taking the medication. 4.Interferon is naturally produced by the body in response to a viral infection. The administration of synthetic interferon produces the same flu like symptoms and should be treated with Tylenol, which will help decrease the severity of the symptoms from the injection. After multiple interferon injections, the client will no longer have the flu like symptoms. MEDICATION MEMORY JOGGER: Usually if a client is prescribed a new medication and has flu like symptoms within 24 hours of taking the first dose, the client should contact the HCP. These are signs of agranulocytosis, which indicates the medication has caused a sudden drop in the white blood cell count, which, in turn,leaves the body defenseless against bacterial invasion. Biological response modifiers are the exception to the rule.

The client who is obese is participating in an investigational study using metformin (Glucophage), a biguanide antidiabetic medication, for weight loss. Which data should the nurse monitor? 1.The hemoglobin A1C every 2 months. 2.Daily fasting glucose levels. 3.The urine ketones every 2 weeks. 4.The client's weight every month.

Answer: 4 Rationale: 1.Glucophage is being investigated for weight loss in clients who do not have diabetes. There is no need to monitor the hemoglobin A1C. Glucophage acts on the liver to prevent gluconeogenesis; it does not increase insulin levels. 2.Glucophage is being investigated for weight loss in clients who do not have diabetes. There is no need to monitor daily fasting blood glucose levels. Glucophage acts on the liver to prevent gluconeogenesis; it does not increase insulin levels. 3.Urine ketones are monitored when a client diagnosed with diabetes has a high glucose level and sometimes by clients on the Atkins Diet to monitor if they are having success. Normal diets do not monitor urine ketones. 4. The medication is being administered for weight loss; the client's weight should be monitored.

Which statement is an advantage to administering a histamine 2 blocker rather than an antacid to a client diagnosed with gastroesophageal reflux disease (GERD)? 1.Antacids are more potent than H2blockers in relieving the symptoms of GERD. 2.Histamine2blockers have more side effects than antacids. 3.Histamine2 blockers are less expensive than antacids. 4.Histamine2 blockers require less frequent dosing than antacids.

Answer: 4 Rationale: 1.H2blockers actually block the production of gastric acid; they have a longer effect than an antacid. 2.An increase in side effects would not be an advantage. 3.Antacids are usually less expensive than H2blockers. 4.H2blockers require less frequent administration than do antacids, which require frequent administration, seven or more times a day, for therapeutic effects. The fewer times a client is expected to take a medication, the more likely the client is to comply with a medication regimen.

The client diagnosed with end-stage liver failure is taking lactulose (Chronulac), a laxative. Which assessment data indicates the medication is effective? 1.The client reports a decrease in pruritus. 2.The client's abdominal girth has decreased. 3.The client is experiencing diarrhea. 4.The client's ammonia level is decreased.

Answer: 4 Rationale: 1.Lactulose is not administered to help with the client's complaints of itching. 2.Lactulose will not help decrease the client's ascites. 3.Diarrhea is a sign of medication toxicity and would warrant decreasing the medication dose. 4.Lactulose is administered to decrease the client's serum ammonia level; the normal adult level is 19-60 mcg/dL.

The client calls the clinic and reports large amounts of watery stool for the past 3 days. Which intervention should the clinic nurse implement? 1.Instruct the client to take diphenoxylate (Lomotil) after each loose stool. 2.Recommend the client eat some cheese or constipating-type food. 3.Request that the client write down all foods ingested in the past 3 days. 4.Make an appointment for the client to come to the clinic today.

Answer: 4 Rationale: 1.Lomotil is an antidiarrheal medication, but because the client has had diarrhea the past 3 days, the nurse should have the client come to the clinic. 2. The client with diarrhea should be restricted to clear liquids such as tea, gelatin, or broth. 3.Determining what the client has eaten may help determine the cause of the diarrhea, but 3 days is too long to have diarrhea. The client may become dehydrated. 4. Diarrhea that persists for more than 48 hours should not be self-treated. The client should be seen by the HCP for further evaluation and diagnosis.

The client is 2 days post-gastric bypass surgery and is complaining of nausea. The nurse is preparing to administer promethazine (Phenergan) 12.5 mg intravenous push. The client has a peripheral IV line infusing normal saline at 100 mL/hour. Which interventions should the nurse implement? Select all that apply. 1.Flush the peripheral IV prior to administering medication. 2.Administer the Phenergan undiluted via the port closest to client. 3.Start a saline lock in the other arm to administer Phenergan. 4.Dilute the Phenergan with 9 mL normal saline. 5.Administer the intravenous medication slowly.

Answer: 4,5 Rationale: 1. The primary IV is normal saline; therefore, the nurse does not need to flush the tubing prior to administering the medication. 2.Phenergan is caustic to the peripheral vein and should be diluted when administered intravenously. 3.Phenergan is compatible with normal saline; therefore, the nurse need not start a saline lock in the other arm, causing the patient discomfort. 4.Phenergan is caustic to peripheral veins, is very painful when administered peripherally, and may result in a chemical phlebitis. The nurse must dilute the medication and push slowly to prevent pain and sclerosing of the vein. 5. The nurse must dilute the medication and push slowly to prevent pain and sclerosing of the vein.

The nurse is preparing to administer pantoprazole (Protonix), a proton-pump inhibitor, IVPB, in 50 mL of fluid over 20 minutes to a client diagnosed with peptic ulcer disease. The IVPB set delivers 20 drops per mL. At what rate would the nurse set the infusion?

Answer: 50 gtt per minute. Rationale: 50 gtt per minute. The nurse must first determine the rate per hour: 20 minutes into 60 minutes = 3 (20-minute time segments). 50 mL of fluid ×3 = 150 mL per hour. 150 mL ÷ 60 minutes = 2.5 mL/min to infuse. 2.5 mL/min ×20 drops per mL = 50 gtt per minute.

The child diagnosed with infectious gastroenteritis is prescribed Bactrim, a sulfa antibiotic, 10 mg/kg/day in divided doses twice a day. The child weighs 60 pounds. The medication comes 100 mg/5 mL. How many milliliters will the nurse administer with the morning dose?

Answer: 6.8 mL per dose. Rationale: 6.8 mL per dose. The first step is to determine the body weight in kilograms. 60 pounds divided by the 2.2 conversion factor is 27.272, or 27.27 kg. Multiply 27.27 times 10 to find the milligrams, which results in 272.2 or 272 mg of medication each 24 hours. Divide 272 mg by 2 to determine the amount of medication to be administered each dosing time; this equals 136 mg per dose. To set up the algebraic formula:136 x= 100 Then cross multiply:100 x= 680 To solve for x, divide each side of the equation by 100:x =6.8 mL per dose