Week 7 Gastrointestinal System NCLEX questions

CHAPTER 40 A female client reports using OTC aluminum hydroxide (AlternaGel) for relief of gastric upset. She is on renal dialysis 3x a week. What should the nurse teach this client? 1) Continue using the antacids but if she needs to continue beyond a few months, she should consult the health care provider about different therapies. 2) Take the antacid no longer than 2 weeks; if it has not worked by then it will not be effective 3) Consult with the health care provider about the appropriate amount and type of antacid 4) Continue to take the antacid; it is OTC and safe

1) ANSWER 3 Rationale: Antacids are generally combinations of aluminum hydroxide, calcium, and/or magnesium hydroxide. Hypermagnesemia, hypercalcemia, or hypophosphatemia can develop with the use of OTC antacids. Because this client is on renal dialysis, her kidneys are unable to adequately control the excretion of electrolytes. The nephrologist should be contacted about whether an antacid is appropriate for this client. Options 1, 2, 4 are incorrect. Because of concerns about electrolyte imbalance, taking the antacid for limited periods may not be advisable. Because a drug is OTC does not guarantee its safety and it may produce adverse effects in clients

CRITICAL THINKING: 1) The patient has been taking diphenozylate with atropine (lomotil) for diarrhea for the past 3 days. The patient has had diarrhea 5x today. Identify the priorities in nursing care

ANSWER: A key priority for the nurse would be to assess the potential for dehydration. The nurse would assess for signs and symptoms including hypotension, tachycardia, increased temp, dry mucous membranes, and poor skin turgor. Because the diarrhea has continued despite the drug therapy, the cause should be evaluated by the health care provider

2) An older adult patient has been ordered prochlorperzine (Compazine) treatment for nausea and vomiting associated with a bowel obstruction, pending planned surgery. The nurse is preparing a plan of care for this patient. What should be included in this plan?

ANSWER: The nurse should plan to assess for signs of dehydration and plan for IV fluid replacement. Prochlorperazine (Compazine) may cause anticholinergic side effects such as dry mouth, sedation, constipation, orthostatic, hypotension, and tachycardia. The nurse will assess the patient for adverse effects and be particularly careful when helping the patient out of bed or with ambulation. If the drug is used for a prolonged period, extrapyramidal symptoms resembling Parkinson's disease are a serious concern, especially in older patients, and the nurse would assess for any motor-related symptoms

3) A patient comes to the clinic complaining of now bowel movement for 4 days. (other than small amts of liquid stool) The patient has been taking psyllium mucilloid (Metamucil) for his constipation and wants to know why this is not working. What is the nurse's response?

ANSWER: Bulk-forming laxatives promote bowel regulatity but they take several days or longer for best effects. The liquid stool the patient is experiencing is a concern and may be the result of a fecal impaction. In which only liquid seeps out around the impacted area. The nurse should assess the abdomen for bowel sounds and if hypoactive or absent, or if abdominal pain is present, the nurse should report the findings immediately to the health care provider. If the bowel sounds are normal, the nurse should also educated the patient about the need to drink plenty of fluids when taking bulk-forming laxatives.

Critical Thinking Questions: 1)A patient with chronic hyperacidity of the stomach takes calcium carbonate (Tums) on a regular basis. The patient comes to the clinic with complaints of fatigue, increasing weakness, and headaches. What may be the cause of these symptoms? What will the nurse recommend to this patient?

ANSWER: Regular use of calcium-containing antacids, especially along with milk products, may cause milk-alkali syndrome. Early symptoms are similar to those of hypercalcemia and include headache, urinary frequency, anorexia, nausea, and fatigue. The nurse should instruct the patient to stop taking the antacid and discuss more appropriate therapy with the health care provider

2) A 37 year old male patient has been taking NSAIDs for a shoulder injury. He develops abdominal pain, worse when his stomach is empty, and after trying several OTC remedies, schedules a visit with his primary health care provider. A breath test confirms H. pylori and a diagnosis of PUD is made. The patient is started on an omeprazole (Prilosec), clarithromycin (Biaxin), and amoxicillin. He asks about the purpose for the drugs. How should the nurse respond?

ANSWER: The antibiotics clarithromycin (Biaxin) and amoxicillin (Amoxil) are used to treat the infection with H. Pylori. Two or more antibiotics are given concurrently to increase the effectiveness of the therapy and to lower the potential for bacterial resistance. Omeprazole (Prilosec) or other PPIs are used to control gastric acidity, decreasing the irritation to the ulcer site

The nurse is caring for a client with gastroesophageal reflux disease (GERD) and would question an order for which of the following? 1)Amoxicillin (Amoxil) 2) Ranitidine (Zantac) 3) Pantoprazole (Protonix) 4) Calcium carbonate ( Tums)

ANSWER: 1 Antibiotics such as amoxicillin (Amoxil) are used in the treatment of peptic ulcers (PUD) caused by H. pylori. They are not indicated for the treatment of GERD. Options 2, 3, and 4 are incorrect. Antacids, H2 blockers, and PPIs are used in the treatment of GERD. Calcium carbonate, rantidine, and pantoprazole would be appropriate drugs to use.

The nurse is assisting the older adult diagnosed with a gastric ulcer to schedule her medication administration. What would be the most appropriate time for this client to take her lansoprazole (Prevacid)? 1) About 30 min before her morning meal 2) At night before bed 3) After fasting at least 2 hours 4) 30 min after each meal

ANSWER: 1 Rationale: PPIs such as lansoprazole (Prevacid) Should be taken before the first meal of the day. The proton pump is activated by food intake, and the administration of a PPI 20 to 30 min before the first major meal of the day will allow peak serum levels to coincide with when the maximum acidity is occurring. Options 2, 3, & 4 are incorrect. PPIs should be taken before the first major meal, not at night or after meals. Fasting is not required for this drug

Simethicone (Gas X, Mylicon) may be added to some medications or given plain for what therapeutic effect? 1) Decrease the amount of gas associate with GI disorders 2) Increase the acid fighting ability of some medications 3) Prevent constipation associated with GI drugs 4) Prevent diarrhea associated with GI drugs

ANSWER: 1 Rationale: Simethicone is used with other GI drugs or alone to decrease the amount of gas bubbles that accumulate with GI disorders or indigestion. Options 2, 3, and 4 are incorrect. Simethicone will not affect the acid-fighting ability of medications or prevent constipation or diarrhea from developing

5) Pancrelipase (Pancreaze) granules are ordered for a client. Which of the following will the nurse complete before administering the drug? (Select all that apply) 1) Sprinkle the granules on the nonacidic food 2) Give the granules with or just before a meal 3) Mix the granules with orange juice or grapefruit juice 4) Ask the client about an allergy to pork or pork products 5) Administer the granules followed by an antacid

ANSWER: 1, 2, 4 Rationale: Before administering pancrelipase (Pancreaze) the nurse should assess for an allergy to pork or pork products. The granules may be sprinkled on nonacidic foods and should be given 30 min before a meal or with meals. Options 3 and 5 are incorrect. Pancrealipase should not be given with acidic foods or beverages because the drug will be inactivated. It should not be taken with an antacid because the effect will be decreased

3) A 24 year old has been taking sulfasalazine (Azulfidine) for IBS and complains to the nurse that he wants to stop taking the drug because of the nausea, headaches, and abdominal pain it causes. What would be the nurse's best recommendation for this client? 1) The drug is absolutely necessary, even with the adverse effects 2) Talk to the health care provider about dividing the doses throughout the day 3) Stop taking the drug and see if the symptoms of IBS have resolved 4) Take an antidiarrheal drug such as loperamide (Imodium) along with the

ANSWER: 2 Rationale: Nausea, vomiting, diarrhea, dyspepsia, abdominal pain, and headache are common adverse effects of sulfasalazine (Azulfidine) Dividing the total daily dose evenly throughout the day and using an enteric-coated tablets may improve adherence. Options 1, 3, and 4 are incorrect. Clients who experience significant adverse effects of drug therapy are unlikely to adhere to a drug regimen if the effects are severe. Suggesting that the client take an antidiarrheal drug, or that he stop drug therapy, is not within the scope of a nurse's practice and should be items that he discusses with his health care provider

6) The nurse had administered prochlorperazine (Compazine) to a client for a postoperative nausea. Before administering this medication, it is essential that the nurse check which of the following? 1) Pain level 2) Blood pressure 3) Breath sounds 4) Temperature

ANSWER: 2 Rationale: Prochlorperzine (Compazine) may cause decreased blood pressure or hypotension as an adverse effect. The blood pressure should be taken before administering and the drug help if the BP is below 90/60 or is below HCP orders. Options, 1, 3, and 4 are incorrect. Although it is important to assess pain level, breath sounds, and temperature in a postoperative client, prochlorperzine does not directly affect these parameters

4) The client on home-based enteral nutrition via a gastric tube has a temp of 101.5. After assessing the client, the nurse uses the opportunity to talk with the family about which of the following preventative measures to decrease the risk of infection related to enteral nutrition? 1) Hang a feeding solution no longer than 2 hrs 2) Refrigerate any unused portions of feeding 3) Use plain water to irrigate the tube between feedings 4) Maintain sterile technique whenever initiating a new feeding solution

ANSWER: 2 Rationale: Refrigerating unused portions of feeding solution will help to decrease the bacterial growth, reducing the risk of infection. Options, 1, 3, & 4 are incorrect. Feedings may generally hang up to 4 hours unless otherwise ordered. Flushing with plain water is an acceptable technique because the water enters the GI tract but will not reduce the risk for infections. Maintaining sterile technique for eteral feedings is not required to administer the solution. The solution enters the GI tract

5) A client has been discharged home on total parenteral nutrition therapy. When making a home visit, which are the most important assessments that should be monitored by the family and the home care nurse? 1) Temperature and blood pressure 2) Temperature and weight 3) Pulse and blood pressure 4) Pulse and weight

ANSWER: 2 Rationale: The client's temperature should be monitored to detect early signs of an infection, which is a complication of total parental nutrition. Daily weight will be monitored to assist in determining the effectiveness of the nutrition and to detect for signs of fluid overload. Options 1, 3, and 4 are incorrect. Pulse and blood sugar are important parameters and will be monitored on the visit, but they are less priority in determining the client's status and safety while on nutrition

4) The nurse is preparing to administer chemotherapy to the oncology client who also has an order for ondansetron (Zofran). When should the nurse administer the odansetron? 1) Every time the client complains of nausea 2) 30 to 60 min before starting chemotherapy 3) Only when the client complains of nausea 4) When the client begins to experience vomiting during the chemotherapy

ANSWER: 2 Rationale: To be most effective, ondansetron (Zofran) or other antiemetics should be administered 30 to 60 min before initiating the chemotherapy drugs. Options 1, 3, and 4 are incorrect. Almost all chemotherapy drugs have emetic potential and the nurse should not wait until the client complains of nausea or experiences vomiting before giving the drug. The client may complain of nausea more frequently than is possible to give the drug. Other nondrug relief strategies such as diversion techniques or ginger should also be tried.

2) A client with severe diarrhea has an order for diphenoxylate with atropine (Lomotil). When assessing for therapeutic effects, which of the following will the nurse expect to find? 1) Increased bowel sounds 2) Decreased belching and flatus 3) Decrease in loose, watery stools 4) Decreased abdominal cramping

ANSWER: 3 Rationale: A decrease in the consistency of stools is a therapeutic effect of diphenoxylate with atropine (lomotil). Options, 1, 2, 4 are incorrect. A decrease in bowel sounds rather than an increase would not be noted if the drug is having a therapeutic effect. The drug has no direct effect on the causes of belching or flatus. Although reduction in abdominal cramping may occur due to the decreased peristalsis, it is not the therapeutic indication for this drug.

In taking a new client's history, the nurse notices he has been taking omeprazole (Prilosec) consistently over the past 6 months for epigastric pain. Which recommendation would be the best for the nurse to give this client? 1) Try switching to a different form of the drug 2) Try a drug like cimetidine (Tagament) or famotidine (Pepcid) 3) Try taking the drug after meals instead of before meals 4) Check with his health care provider about his continued discomfort

ANSWER: 4 Rationale: PPIs, omeprazole (Prilosec) are recommended for short-term therapy, approximately 4 to 8 weeks in length. If symptoms of epigastric pain and discomfort continue, other therapies and screenings for H. pylori may be indicated. Options, 1,2, and 3 are incorrect. Switching to another PPI still exceeds the recommended time of use for this category of drugs. h2 receptor blockers such as cimetidine (Tagamet) and famotidine (Pepcid) may be indicated but their use should be evaluated by a health care provider because a more definitive treatment may be required. PPI should be taken 30 min before meals.

CHAPTER 41 1) A client with constipation is prescribed psyllium (Metamucil) by his health care provider. What essential teaching will the nurse provide to the client? 1) Take the drug with meals and at bedtime 2) Take the drug with minimal water so that it will not be diluted in the GI tract 3) Avoid caffeine and chocolate while taking this drug 4) Mix the product in a full glass of water and drink another full glass of water after taking the drug

ANSWER: 4 Rationale: To avoid esophageal or gastric obstruction, psyllium (Metamucil) should be mixed with a full glass of water or joice and followed by another full glass of liquid. Options, 1, 2, and 3 are incorrect. The drug should not be taken directly with meals because the nutrients in the food may be bound into the psyllium and not absorbed. Psyllium should not be taken dry and should be taken with plenty of fluids. Caffeine and chocolate do not have to be avoided while on this medication

3) A patient who is on rantidine (Zantac) for PUD smokes and drinks alcohol daily. What education will the nurse provide to this patient?

ANSWER: The patient has a history of PUD and alcohol and smoking exacerbate the condition. Avoiding these substances as well as caffeinated beverages and foods known to trigger abdominal pain should be included as part of the antiulcer regimen. This patient on rantidine (Zantac), and smoking decreases the effectiveness of the medication

2) The nurse is preparing to administer magnesium sulfate intravenously to a client. The nurse should asses for which of the following early signs of magnesium toxicity? Select all that apply 1) Skin flushing 2) Anxiety or excitement 3) Complete heart block 4) Muscle weakness 5) Intense thirst

ANSWERS: 1, 4, 5 Rationale: Flushing of the skin, sedation, intense thirst, muscle weakness and confusion are all early signs of magnesium toxicity. Options 2 & 3 are incorrect. Circulatory collapse, complete heart block, and respiratory failure are all signs that a complete neuromuscular blockade has occurred due to the toxicity and are later signs. Sedation rather than anxiety or nervousness occurs.

A 35 year old male client has been prescribed omeprazole (Prilosec) for treatment of GERD. Which of the following assessment findings would assist the nurse to determine whether drug therapy has been effective? Select all the apply 1) Decreased "gnawing" upper abdominal pain on an empty stomach 2) Decrease belching 3) Decreased appetite 4) Decreased nausea 5) Decreased dysphagia

ANSWERS: 2, 3, 5 Rationale: Symptoms of GERD include dysphagia, dyspepsia, nausea, belching, and chest pain. Therapeutic effects of omeprazole (Prilosec) would include relief of these symptoms. Options, 1 and 3 are incorrect. Gnawing or burning supper abdominal pain is symptomatic of PUD, not GERD. A decreased appetite should not occur with omeprazole