ATI: The Gastrointestinal System

A nurse is assessing a client who was administered ondansetron IV 1 hr ago. Which of the following findings should the nurse recognize as an adverse effect of this drug? Dizziness Bradycardia Tardive dyskinesia Dyspepsia

Dizziness Rationale: Dizziness and lightheadedness are the most common adverse effects of ondansetron.

A nurse should recognize that sulfasalazine is contraindicated for clients who have which of the following conditions? Pancreatitis Aspirin sensitivity Bronchitis GERD

Aspirin sensitivity Rationale: Any sensitivity to salicylates, sulfonamides, or trimethoprim is a contraindication for the use of sulfasalazine, a 5-aminosalicylate. This is because intestinal bacteria metabolize the drug into 5-aminosalicylic acid, a salicylate. Aspirin is also a salicylate.

A nurse is teaching a client who has a new prescription for methotrexate. The nurse should instruct the client to monitor for manifestations of which of the following conditions? Gout Constipation Insomnia Hirsutism

Gout Rationale: An adverse effect of methotrexate is hyperuricemia, which causes gout. The nurse should instruct the client to drink plenty of fluids to minimize this effect, and to report edema or pain in the joints.

A nurse should recognize that diphenoxylate/atropine should be used with caution for a client who has which of the following conditions? Inflammatory bowel disease Thrombophlebitis Agranulocytosis Immunization with a live virus vaccine within the last 6 weeks

Inflammatory bowel disease Diphenoxylate is an opioid, which can cause the severe complication of toxic megacolon in clients who have inflammatory bowel disease. The nurse should have the client monitor the consistency and frequency of stools throughout therapy.

A nurse is caring for an older adult client who has kidney disease and a new prescription for cimetidine. The nurse should instruct the client to report which of the following manifestations? Lethargy Cellulitis Dry mouth Myalgia

Lethargy Rationale: Cimetidine is a histamine2 receptor antagonist, which can potentially cross the blood-brain barrier. Older adult clients who have kidney impairments are at risk for central nervous system (CNS) effects such as lethargy, depression, confusion, and seizures. The nurse should instruct the client to report these manifestations to their provider.

A nurse is caring for a client who has a prescription for alosetron. The nurse should recognize that alosetron therapy is effective when the client reports which of the following? One formed stool per day Urination without burning Cessation of nausea or vomiting Reduced GI reflux effects

One formed stool per day Rationale: Alosetron, a serotonin 5-HT3 receptor antagonist, treats the diarrhea and pain of severe irritable bowel syndrome. One formed stool per day indicates effective therapy.

A nurse is teaching a client who recently had a myocardial infarction and has a new prescription for docusate sodium. The nurse should inform the client that docusate sodium has which of the following therapeutic effects? Reduces inflammation Reduces gastric acid Prevents diarrhea Prevents straining

Prevents straining Rationale: Docusate sodium, a stool softener, prevents straining during defecation and prevents the elevation in blood pressure that can result from straining. It also helps relieve constipation and reduces the painful elimination of hard stools.

A nurse is providing teaching to a client who has a new prescription for dimenhydrinate to prevent motion sickness. Which of the following instructions should the nurse include? (Select all that apply.) Sit upright for 30 min after taking the drug. Avoid antacids. Take the drug 30 to 60 min before activities that trigger nausea. Avoid activities that require alertness.

Take the drug 30 to 60 min before activities that trigger nausea. Avoid activities that require alertness. Rationale: The nurse should instruct the client to take dimenhydrinate 30 to 60 min before activities that trigger nausea, and again before meals and at bedtime. Rationale: Dimenhydrinate can cause sedation. The nurse should instruct the client to avoid activities that require alertness. Rationale: Dimenhydrinate can cause anticholinergic effects, such as dry mouth and constipation. The nurse should instruct the client to increase activity level, and fluid and fiber intake.

A nurse is teaching a client who has a new prescription for sulfasalazine. Which of the following statements should the nurse make? "Use sunscreen and protective clothing while taking sulfasalazine to prevent sunburn." "The medication can stain your contact lenses green." "The medication can color your urine dark brown." "Take an iron supplement when you take sulfasalazine to prevent anemia."

"Use sunscreen and protective clothing while taking sulfasalazine to prevent sunburn." Rationale: Photosensitivity is a possible adverse effect of sulfasalazine that makes the skin sensitive to light. The nurse should instruct the client to wear sunscreen and protective clothing when outdoors to prevent burning.

A nurse should recognize that misoprostol is contraindicated for a client who has which of the following conditions? A seizure disorder Rheumatoid arthritis A positive pregnancy test Heart failure

A positive pregnancy test Rationale: Misoprostol, a prostaglandin E1 analog, is a teratogenic drug. It can cause uterine contractions and induce spontaneous abortion; therefore, providers must confirm that clients are not pregnant before prescribing the drug; and clients who take misoprostol must use contraception.

A nurse is caring for a client who is taking allopurinol to treat gout and has a new prescription for azathioprine to treat ulcerative colitis. For which of the following reasons should the nurse clarify these prescriptions with the provider? Allopurinol delays the conversion of azathioprine and can lead to toxicity. Azathioprine increases the effectiveness of allopurinol. Allopurinol increases the metabolism of azathioprine and can require an increased dosage. Azathioprine decreases the effectiveness of allopurinol.

Allopurinol delays the conversion of azathioprine and can lead to toxicity. Rationale: Allopurinol delays the conversion of azathioprine to an inactive form and can lead to toxicity. If used concurrently, the dose of azathioprine must be reduced.

Which of the following drugs has protocols that require clients to meet specific risk-management criteria and sign a treatment agreement before the nurse can administer the drug? Lubiprostone Azathioprine Sulfasalazine Alosetron

Alosetron Rationale: Clients who take alosetron, a serotonin 5-HT3 receptor antagonist, can develop severe constipation that can lead to impaction, bowel obstruction, perforation, and potentially fatal ischemic colitis. Because of these risks, nurses must inform clients of the benefits and risks of the drug therapy, and clients must sign a treatment agreement.

A nurse is caring for a client who has peptic ulcer disease. The nurse should monitor the client's phosphorus levels when administering which of the following drugs? Omeprazole Aluminum hydroxide Sucralfate Famotidine

Aluminum hydroxide Rationale: Antacids that contain aluminum, such as aluminum hydroxide, can cause hypophosphatemia because of aluminum's ability to bind with phosphate and decrease its absorption. The nurse should monitor the client's phosphorus levels while administering this drug.

A nurse is caring for a client who has a new prescription for famotidine to treat GERD. The nurse should instruct the client to wait at least 1 hr between taking famotidine and which of the following over-the-counter drugs? Ginkgo biloba Antidiarrheals St. John's wort Antacids

Antacids Rationale: Antacids can decrease the absorption of famotidine, a histamine2-receptor antagonist. The nurse should instruct the client to wait at least 1 hr between taking famotidine and taking an antacid.

A nurse is planning care for a client who is receiving chemotherapy and has a new prescription for ondansetron. Which of the following actions should the nurse plan to take? (Select all that apply.) Infuse the drug 30 min prior to chemotherapy. Administer the drug when the client reports nausea. Infuse the drug slowly over 15 min. Administer the drug immediately following chemotherapy. Repeat the dose 4 hr after chemotherapy.

Infuse the drug 30 min prior to chemotherapy. Infuse the drug slowly over 15 min. Repeat the dose 4 hr after chemotherapy. Rationale: The nurse should administer IV ondansetron, a serotonin antagonist, 30 min prior to chemotherapy to prevent chemotherapy-induced nausea and vomiting. When treating radiation-induced nausea and vomiting, the nurse should give the drug orally 1 to 2 hr prior to radiation therapy and again every 8 hr. Rationale: The nurse should infuse ondansetron slowly over 15 min to prevent chemotherapy-induced nausea. Rationale: For maximum effectiveness, the nurse should administer ondansetron 4 hr after chemotherapy, and again 8 hr after chemotherapy. When treating anesthesia-induced nausea and vomiting, the nurse can give the drug 1 hr before anesthesia induction.

A nurse is caring for a client who is taking lubiprostone. The nurse should tell the client that lubiprostone can cause which of the following adverse drug reactions? Nausea Constipation Urinary retention Sore throat

Nausea Rationale: Lubiprostone, a chloride channel activator, can cause nausea. Clients who develop this effect do not need to discontinue the drug but should take it with food and water to minimize GI upset.

A nurse is administering sulfasalazine to a client. Which of the following data should the nurse collect to help identify an adverse drug reaction? (Select all that apply.) Level of consciousness Skin integrity Temperature Urine output CBC

Skin integrity Temperature CBC Rationale: Sulfasalazine can cause a skin rash, so the nurse should check the client's skin for rashes. The drug can also cause nausea. If the client reports nausea, the nurse should suggest taking the drug with food or water. Rationale: Sulfasalazine can cause a fever, so the nurse should check the client's temperature and treat fever with an antipyretic. Rationale: Sulfasalazine can cause hematologic disorders, such as agranulocytosis and hemolytic and macrocytic anemia. The nurse should check the client's CBC periodically during therapy and tell the client to report sore throat or fatigue.

A nurse is caring for a client who is taking phenytoin for a seizure disorder and has a new prescription for sucralfate to treat a duodenal ulcer. The nurse should instruct the client to take the drugs at least 2 hr apart for which of the following reasons? Phenytoin increases the metabolism of sucralfate. Phenytoin reduces the effectiveness of sucralfate. Sucralfate increases the risk for phenytoin toxicity. Sucralfate interferes with the absorption of phenytoin.

Sucralfate interferes with the absorption of phenytoin. Rationale: Sucralfate decreases the absorption of phenytoin. The nurse should instruct the client to allow at least 2 hr between taking the two drugs and should monitor the client's phenytoin levels.

A nurse is providing teaching to a client who has a new prescription for omeprazole to treat a duodenal ulcer. Which of the following instructions should the nurse include? Take the medication with food. Swallow the capsules whole. Dissolve the tablets in water. Take the medication at bedtime.

Swallow the capsules whole. Rationale: Omeprazole, a proton pump inhibitor, is unstable in stomach acid. The nurse should instruct the client to swallow the capsules or tablets whole and not to crush or chew the capsules or tablets.

A nurse is planning teaching for a client who has been prescribed loperamide to treat diarrhea. Which of the following statements should the nurse plan to include? "Avoid driving or activities requiring alertness." "If you miss a dose, double the next dose." "Rinsing the mouth with alcohol-based mouthwash can reduce dryness." "Having one glass of wine each night can improve medication effectiveness."

"Avoid driving or activities requiring alertness." Rationale: Loperamide can cause drowsiness and dizziness. The client should avoid driving or activities requiring alertness while taking the drug.

A nurse is caring for a client who has a new prescription for alosetron to treat irritable bowel syndrome. The nurse should instruct the client to report which of the following adverse effects of the drug? Headache Drowsiness Abdominal pain Sore throat

Abdominal pain Rationale: Alosetron, a serotonin 5-HT3 receptor antagonist, can cause ischemic colitis. The nurse should tell the client to report abdominal pain, bloody diarrhea, or rectal bleeding, and to stop taking the drug if these manifestations occur.

A nurse is reviewing the medical record of a client who has a new prescription for famotidine. The nurse should recognize that which of the following drugs interacts with famotidine? Phenobarbital sodium Ketoconazole Lisinopril Hydrochlorothiazide

Ketoconazole Rationale: Famotidine reduces the absorption of ketoconazole.

A nurse is providing teaching to a client who is about to start taking psyllium to treat constipation. Which of the following instructions should the nurse include? (Select all that apply.) Expect results in 6 to 12 hr. Urinate every 4 hr. Take the drug with at least 8 oz (237 mL) of fluid. Avoid activities that require alertness. Increase fluid and fiber intake.

Take the drug with at least 8 oz (237 mL) of fluid. Increase fluid and fiber intake. Rationale: To prevent esophageal obstruction, clients should take psyllium with at least 8 oz of fluid; and after mixing the powdered form, clients should drink it immediately. Rationale: The nurse should tell the client to increase activity, fluid intake, and fiber intake, and to keep track of bowel function.

A nurse is caring for a male client who asks the nurse about taking alosetron for irritable bowel syndrome with diarrhea (IBS-D) lasting 3 months. Which of the following information should the nurse provide the client about alosetron? The drug is prescribed to female clients who have IBS-D lasting more than 6 months. The drug is prescribed to clients who have chronic diarrhea lasting more than 12 months. The drug is most beneficial for male clients who have inflammatory bowel disease. The drug is most beneficial in treating clients who have constipation-predominant IBS (IBS-C).

The drug is prescribed to female clients who have IBS-D lasting more than 6 months. Rationale: Alosetron is approved only to be prescribed to females who have IBS-D lasting 6 months or longer that has not been controlled by conventional treatment.

A nurse is providing teaching to a client who has a new prescription for loperamide. Which of the following instructions should the nurse include? Dissolve the powder thoroughly in 8 oz (237 mL) of water. Take with diphenhydramine to prevent extrapyramidal effects. Avoid activities that require alertness. Take 30 min before activities that trigger nausea.

Avoid activities that require alertness. Rationale: Loperamide, an opioid agonist, can cause sedation and dizziness. The nurse should instruct the client to avoid taking it before activities that require alertness.