Saunders-Pharmacology: Gastrointestinal

The nurse notes that a client is taking lansoprazole. On data collection the nurse should ask the client which question to determine medication effectiveness?

"Are you experiencing any heartburn?" Lansoprazole is a gastric acid pump inhibitor used to treat gastric and duodenal ulcers, erosive esophagitis, and hypersecretory conditions. It also is used to treat gastroesophageal reflux disease (GERD). It is not used to treat visual problems, problems with appetite, or leg pain.

The client who is scheduled for an intravenous pyelogram has been instructed to take liquid magnesium citrate on the day before the scheduled procedure. The client asks the nurse about the administration procedure for this medication. Which instruction should the nurse provide to the client?

"Take the medication on ice." Magnesium citrate is available as an oral solution. It is used commonly as a laxative before or following certain diagnostic studies. It should be served on ice and should not be allowed to stand for prolonged periods. This would reduce the carbonation and make the solution even less palatable.

A postoperative client requests medication for flatulence (gas pains). Which medication from the PRN list should the nurse administer to this client?

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

The client who frequently uses nonsteroidal antiinflammatory drugs (NSAIDs) has been taking misoprostol. The nurse determines that this medication is having the intended therapeutic effect if which is noted?

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

The client has begun prescribed lansoprazole. The nurse should primarily monitor for which intended effect of this medication?

Relief of nighttime heartburn Lansoprazole is a proton pump inhibitor that suppresses gastric acid secretion

The client diagnosed with peptic ulcer disease has a new prescription for propantheline. Which client teaching instructions should the nurse most reinforce?

Take the medication 30 minutes before meals. Propantheline is classified as an antimuscarinic, anticholinergic medication that decreases gastrointestinal secretions. It should be administered 30 minutes before meals.

The nurse is administering a dose of prochlorperazine to the client for nausea and vomiting. The nurse should instruct the client to report which frequent side effect of this medication?

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

Sucralfate 1 g four times daily has been prescribed for a client with a diagnosis of gastric ulcer. The nurse reinforces instructions to the client regarding administration of the medication. Which statement by the client indicates an understanding of the use of the medication?

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

Metoclopramide four times daily has been prescribed for a client with a diagnosis of reflux esophagitis. The nurse reinforces instructions to the client regarding administration of the medication. Which statement by the client indicates an understanding of the use of the medication?

"I need to take the medication 30 minutes before meals and at bedtime." Metoclopramide stimulates activity of the upper gastrointestinal tract. The client should be taught to take this medication 30 minutes before meals and at bedtime. This allows the medication time to begin working before the client takes in food, which requires digestion and movement.

The client asks the nurse about which product should be taken for a headache. The client is taking lansoprazole for long-term management of the diagnosis of Zollinger-Ellison syndrome. The nurse should determine that which medication is the most appropriate choice for this client?

Acetaminophen Zollinger-Ellison syndrome is a hypersecretory condition of the stomach. The client should avoid taking medications that are irritating to the stomach lining. Irritants would include aspirin and nonsteroidal anti-inflammatory drugs (naproxen and ibuprofen). The client should be advised to take acetaminophen for headache.

The client uses the alternative therapy of cascara sagrada, known as Californian buckthorn, for ongoing management of chronic constipation. The nurse should monitor the client's laboratory results for which electrolyte imbalance specifically related to long-term use of this medication?

Hypokalemia Hypokalemia can result from long-term use of cascara sagrada, an alternative therapy laxative. The medication stimulates peristalsis and alters fluid and electrolyte transport, thus helping fluid to accumulate in the colon.

A primary health care provider has written a prescription for ranitidine 300 mg once daily on the client's discharge medication list. The nurse determines to instruct the client to take the medication at which time?

At bedtime A single daily dose of ranitidine should be taken at bedtime. This allows for prolonged effect and the greatest protection of gastric mucosa.

Psyllium is prescribed for the client diagnosed with a cardiac disorder to facilitate defecation and prevent straining with bowel movements. The nurse reinforces instructions to the client regarding administration of the medication. Which statement by the client indicates an understanding of the use of the medication?

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

A client with a peptic ulcer is diagnosed with a Helicobacter pylori infection. The nurse is reinforcing teaching for the client about the medications prescribed, including clarithromycin, esomeprazole, and amoxicillin. Which statement by the client indicates the best understanding of the medication regimen?

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

An adult client with hepatic encephalopathy has a serum ammonia level of 120 mcg/dL (72 mcmol/L) and receives treatment with lactulose syrup. The nurse determines that the client has the best response if the level changes to which after medication administration?

70 mcg/dL (42 mcmol/L) The normal serum ammonia level is 10 to 80 mcg/dL (6 to 47 mcmol/L). In the client with hepatic encephalopathy, the serum level is not likely to drop below normal. The most optimal yet realistic change from the options provided would be to 70 mcg/dL (42 mcmol/L), which falls in the normal range. A level of 100 mcg/dL (60 mcmol/L) represents an insufficient effect of the medication. Lactulose is administered for its hyperosmotic laxative effect, thus removing ammonia from the colon. The client should also be monitored for hypokalemia resulting from the severe purging lactulose causes.

An older client has recently been taking cimetidine. The nurse should monitor the client for which most frequent central nervous system side effect of this medication?

Confusion Cimetidine is a histamine 2 (H2)-receptor antagonist. Older clients are especially susceptible to the central nervous system side effects of cimetidine. The most frequent of these is confusion. Less common central nervous system side effects include headache, dizziness, drowsiness, and hallucinations.

The nurse is preparing to reinforce instructions to the client who has been given a prescription for diphenoxylate with atropine. Which instructions should the nurse include?

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

The client is taking docusate sodium. The nurse should monitor which result to determine the client is having a therapeutic effect from this medication?

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

A client diagnosed with hepatic encephalopathy is receiving lactulose. The nurse determines that the medication is effective if which finding is observed?

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

The primary health care provider has written a prescription for ranitidine, for a client with gastrointestinal reflux disease. The nurse is explaining how this medication works to treat this disease. Which explanation should the nurse give?

The medication suppresses acid secretion by blocking H2 receptors. Ranitidine suppresses acid secretion by blocking H2 receptors on parietal cells. Antacids neutralize stomach acid. Metoclopramide hastens gastric emptying time. Proton pump inhibitors suppress secretion of gastric acid

The client with diagnosed peptic ulcer disease has been prescribed misoprostol and sucralfate. The nurse reinforces teaching the client that these two medications will work primarily for which reason?

The medications protect the gastric mucosa. Both of these medications protect the stomach lining. Misoprostol increases mucous production and bicarbonate levels, although sucralfate coats the ulcer surface.

The client has a prescription for metoclopramide four times a day. The nurse determines that which is the most appropriate time to schedule this medication?

Thirty minutes before meals and at bedtime Metoclopramide is a gastrointestinal stimulant. The client should be taught to take this medication 30 minutes before meals and at bedtime.

The client has a new prescription for metoclopramide. On review of the chart, the nurse identifies that this medication can be safely administered with which condition?

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

The client with recurrent constipation has begun using psyllium. The nurse should instruct the client that this medication should be taken in which manner?

With a full glass of liquid, followed by a second glass of liquid Metamucil is a bulk-forming laxative. It should be taken with a full glass of water or juice, followed by another glass of liquid. This will help prevent impaction of the medication in the stomach or small intestine.

The nurse has reinforced instructions to the client who has been prescribed cholestyramine. Which statement by the client indicates a need for further teaching?

"This medication should only be taken with water." Cholestyramine is a bile acid sequestrant used to lower the cholesterol level, and client compliance is a problem because of its taste and palatability. The use of flavored products or fruit juices can improve the taste. Some side effects of bile acid sequestrants include constipation and decreased vitamin absorption.

A histamine (H2)-receptor antagonist will be prescribed for a client. The nurse understands that which medications are H2-receptor antagonists? Select all that apply.

1.Nizatidine 2.Ranitidine 3.Famotidine 4.Cimetidine H2-receptor antagonists suppress secretion of gastric acid, alleviate symptoms of heartburn, and assist with preventing complications of peptic ulcer disease. These medications also suppress gastric acid secretions and are used in active ulcer disease, erosive esophagitis, and pathological hypersecretory conditions.

The client has an as needed prescription for loperamide hydrochloride. For which condition should the nurse administer this medication?

An episode of diarrhea Loperamide is an antidiarrheal agent. It is used to manage acute and also chronic diarrhea in conditions such as inflammatory bowel disease. Loperamide also can be used to reduce the volume of drainage from an ileostomy.

The client diagnosed with portosystemic encephalopathy is receiving oral lactulose daily. The nurse should check which to determine medication effectiveness?

Blood ammonia level Lactulose is a hyperosmotic laxative and ammonia detoxicant. It is used to prevent or treat portosystemic encephalopathy, including hepatic precoma and coma. It also is used to treat constipation. The medication retains ammonia in the colon (decreases the blood ammonia concentration), producing an osmotic effect. It promotes increased peristalsis and bowel evacuation, expelling ammonia from the colon.

A long-term care nurse is caring for an older client taking cimetidine. The nurse should observe this client frequently for which most common central nervous system (CNS) side effect of this medication?

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

The client with a diagnosis of gastric ulcer has a prescription for oral sucralfate four times daily. The nurse reinforces instructions to the client about which adverse or side effect that can occur while taking this medication?

Constipation Sucralfate can cause constipation. Metoclopramide can cause ataxia and restlessness and metronidazole can cause neurotoxicity.

The client has an as needed prescription for ondansetron. For which condition should the nurse administer this medication?

Nausea and vomiting Ondansetron is an antiemetic used to treat postoperative nausea and vomiting, as well as nausea and vomiting associated with chemotherapy.

The client has been taking omeprazole for 4 weeks. The nurse evaluates that the client is receiving the optimal intended effect of the medication if the client reports the absence of which symptom?

Heartburn Omeprazole is a proton pump inhibitor classified as an antiulcer agent. The intended effect of the medication is relief of pain from gastric irritation, often called "heartburn" by clients.

A client has just taken a dose of trimethobenzamide. The nurse determines that the medication has been effective if the client reports which outcome?

Nausea and vomiting has been relieved. Trimethobenzamide is an antiemetic agent used in the treatment of nausea and vomiting.

The client with peptic ulcer disease has been prescribed to take cimetidine. The nurse determines that which is the primary action of this medication?

Inhibits histamine action Cimetidine is a histamine antagonist and works by inhibiting histamine action.

Atropine sulfate is prescribed for the client diagnosed with gastrointestinal hypermotility, and the nurse reviews the client's record before administering the medication. Which finding, if noted on the client's record, most indicates the need to contact the primary health care provider before administering the medication?

Narrow-angle glaucoma Atropine sulfate can cause mydriasis (dilation of the pupil) and cycloplegia (relaxation of the ciliary muscles). It is contraindicated in clients with narrow-angle glaucoma.

The nurse is assigned to care for the client with a diagnosis of hepatic encephalopathy. Which prescribed medication should the nurse most anticipate administering?

Lactulose syrup Lactulose syrup is a hyperosmotic laxative agent that has the adjunct benefit of lowering serum ammonia levels. This occurs because the medication lowers bowel pH which aids the conversion of ammonia in the gut to the ammonium ion which is poorly absorbed. Magnesium hydroxide is a saline laxative; however, phenolphthalein is a stimulant laxative. Psyllium hydrophilic mucilloid is a bulk laxative.

The client with a gastric ulcer has a prescription for sucralfate 1 g by mouth four times daily. The nurse should schedule the medication to be administered at which times?

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

The client has a prescription for sucralfate 1 g by mouth 4 times daily. The nurse should best schedule the administration of the medication at which time?

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

The client has begun medication therapy with pancrelipase. The nurse evaluates that the medication is having the optimal intended benefit if which effect is observed?

Reduction of steatorrhea Pancrelipase is a pancreatic enzyme used in clients with pancreatitis as a digestive aid. The medication should reduce the amount of fatty stools (steatorrhea). Another intended effect could be improved nutritional status. It is not used to treat abdominal pain or heartburn. Its use could result in weight gain but should not result in weight loss if it is aiding in digestion.

The nurse is collecting data from a client who is taking pantoprazole. The nurse determines that the medication is most effective if the client states relief of which symptom?

Heartburn Pantoprazole is a gastric acid pump inhibitor that increases the gastric pH and reduces gastric acid production. It is used to treat gastric and duodenal ulcers and gastroesophageal reflux disease. It is not used to treat cough, constipation, or migraine headaches.

The nurse reinforces medication instructions to a client with peptic ulcer disease. Which statement by the client indicates the best understanding of the medication therapy?

"The nizatidine will cause me to produce less stomach acid." Nizatidine, a histamine H2-receptor blocker, is frequently used in the management of peptic ulcer disease. Histamine H2-receptor blockers decrease the secretion of gastric acid (HCL). Antacids are used as adjunct therapy and neutralize acid in the stomach. Omeprazole is a proton pump inhibitor. Sucralfate promotes healing by covering the ulcer, thus protecting it from erosion caused by gastric acids.

A client is taking lansoprazole for the chronic management of Zollinger-Ellison syndrome. If prescribed, which medication would be appropriate for the client if needed for a headache?

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

The client arrives at the clinic complaining of dyspepsia and pain that occurs about 90 minutes after eating. The client also reports that the pain became worse this afternoon about 3 hours after eating a large bowl of spaghetti with tomato sauce. Laboratory tests reveal the presence of Helicobacter pylori (H. pylori). The nurse anticipates that the primary health care provider should prescribe which medications? Select all that apply.

1.Esomeprazole 2.Metronidazole 3.Clarithromycin The client is describing symptoms associated with a duodenal ulcer. Clarithromycin and metronidazole are two of the antibiotics frequently prescribed to treat H. pylori infection, which is a common cause of duodenal ulcers. A proton pump inhibitor, like esomeprazole, is prescribed to help decrease gastric acid secretions. Tums is contraindicated because it can trigger gastrin release resulting in rebound acid secretion and more pain. The ibuprofen (like all NSAIDs) can aggravate the ulcer.