Test 3 - Practice Questions from Class

Medications that treat GERD:

-Cimetidine, Famotidine, Nizatidine, Ranitidine (H2 antagonist) -Esomeprazole, Lansoprazole, Omeprazole, Pantoprazole (PPI) -Aluminum hydroxide, calcium carbonate, sodium bicarbonate (antacids)

Medications that treat PUD:

-Cimetidine, Famotidine, Nizatidine, Ranitidine (H2 antagonist) -Esomeprazole, Lansoprazole, Omeprazole, Pantoprazole (PPI) -Aluminum hydroxide, calcium carbonate, sodium bicarbonate (antacids) -Sucralfate (mucosal protectant) -clarithromycin, amoxicillin, metronidazole, tetracycline (antibiotics to treat PUD cause by H. Pylori)

What side effects do aminosalicylates cause?

-May cause HA, pneumonitis, GI issues, skin issues, hematologic issues, and more -may turn skin or urine orangish color

What side effects do immunosuppressants have?

-May cause alopecia, rash, GI issues, hematologic issues, and more. -may need neutropenic precautions to prevent infection

What special considerations do stimulant laxatives have?

-Most widely abused laxative -should not be used with obstruction or obstipation

Medications used for nausea and vomiting:

-Ondansetron, palonsetron (5 HT3 serotonin antagonists) -metoclopramide, promethazine (dopamine antagonist)

What is the mechanism of action for dopamine antagonists?

-blocks dopamine receptors that trigger nausea and vomiting -increase GI motility

What is the mechanism of actions for antidiarrheals?

-decreases peristalsis and motility -increases fluid absorption

What medications are used for diarrhea?

-loperamide, diphenoxylate with atropine, bismuth (antidiarrheals)

What side effects do corticosteroids have?

-may cause suppression of the adrenal glands, hyperglycemia, fluid and electrolyte imbalances, infection, bone loss, or GI issues

What side effects do surfactants have?

-minimal side effects -can block absorption on fat-soluble vitamins

What is used to prevent ulcers caused by long term NSAID use?

-misoprostol (Prostaglandin E analog)

What medications treat constipation?

-psyllium methylcellulose (bulk forming laxatives) -docusate sodium, mineral oil (surfactant) -bisacodyl, senna (stimulant laxative) -linaclotide, lubiprostone, alosetron (prosecretory agents - severe)

What special considerations do antidiarrheals have?

-should not be used if diarrhea is caused by an infection (prolonged exposure to the pathogen) -short term use only

What special considerations do bulk-forming laxatives have?

-should not be used in patients with abdominal pain, nausea, vomiting, obstruction -take with 8ox of water

What medications treat ulcerative colitis and crohns disease?

-sulfasalazine (5 aminosalicylates) -azithioprine, methotrexate (immunosuppressant) -prednisone, hydrocortisone, methylprednisone (corticosteroids)

A client who is experiencing ulcerative colitis is receiving IV fluids that are to be infused at 125mL/hr. The IV tubing delivers 15gtt/ml. How quickly should the nurse infuse the fluids in drops per minute to infuse at the prescribed rate?

31gtt/min

A nurse is caring for a client who has diverticular disease. When palpating the client's abdomen, in which of the following locations should the nurse expect the client to report abdominal pain? A) LLQ B) LUQ C) RLQ D) RUQ

A) LLQ

A client with acute appendicitis develops a fever, tachycardia and hypotension. Based on these findings, the nurse should further assess the client for which of the following complications? A) Peritonitis B) Deficient fluid volume C) Intestinal obstruction D) Renal ischemia

A) Peritonitis

A nurse is caring for a client who is being admitted for an acute exacerbation of ulcerative colitis. Which of the following actions should the nurse take first? A) Review the client's electrolyte values B) Check the clients perianal skin integrity C) Investigate the clients emotional concerns D) Obtain a dietary history from the client

A) Review the client's electrolyte values

A nurse is caring for a client who has acute appendicitis. Which of the following results should the nurse anticipate when reviewing this client's lab values? A) WBC 17,000/mm3 B) Neutrophils 3,000/mm3 C) RBC 4.2 million/mm3 D) Lymphocytes 3,000/mm3

A) WBC 17,000/mm3

The nurse is taking care of a client with C. Diff. The nurse should do which of the following to prevent the spread of infection? A) Wash hands with soap and water B) Cleanse hands with alcohol based sanitizer C) Wear an N95 mask and a gown D) Wear sterile gloves when emptying the bedpan

A) Wash hands with soap and water

A nurse is providing teaching to a client who has a new colostomy. Which of the following information should the nurse include in the teaching? A) You make experience a small amount of bleeding around the stoma B) You can expect fecal output within 24 hrs C) You will need to increase your dietary intake of raw vegetables D) You can expect the stoma to be purplish in color for the first week

A) You make experience a small amount of bleeding around the stoma

A nurse is teaching a client who has a history of ulcerative colitis and a new diagnosis of anemia. Which of the following manifestations of colitis should the nurse identify as a contributing factor to the development of the anemia? A) chronic blood loss B) dietary iron restrictions C) intestinal malabsorption syndrome D) intestinal parasites

A) chronic blood loss

A client with diarrhea for the past 24hrs reports taking loperamide the previous day per dosage instructions without relief. Currently, the client has a temperature of 102*F, excessive thirst, and severe abdominal cramping. What is the highest priority action for the nurse at this time? A) notify the HCP B) obtain a further history of digestive disorders C) discuss dietary factors that might be causing the diarrhea D) suggest acetaminophen for fever and pain

A) notify the HCP

A nurse is caring for a client who is admitted with suspected acute appendicitis. Which of the following manifestations should indicate to the nurse that the clients' appendix is perforated? A) sudden decrease in abdominal pain B) absent Rovsing's sign C) flaccid abdomen D) low-grade fever

A) sudden decrease in abdominal pain

A nurse is implementing a bowel training program for a client. For the program to be effective, the nurse should take the client to the toilet at which of the following times? A) When the client has the urge to defecate B) Every 2 hours while the client is awake C) Immediately before the client has a meal D) After the client feels abdominal cramping

A) when the client has the urge to defecate

A nurse is prioritizing care for two clients at the start of her shift. The first client, who is 1 day post-op following a partial bowel resection, requires a dressing change, TPN administration and reports a pain level of 6/10. The second client, who has a newly inserted percutaneous gastrostomy tube, requires a tube feeding, dressing change, and daily weight. Which of the following nursing actions should the nurse plan to complete first? A) Weight the second client B) Obtain VS for both clients C) Administer pain medications to the first client D) Change the dressings of both clients

B) Obtain VS for both clients

A client newly diagnosed with ulcerative colitis who has been placed on steroids asks the nurse why steroids are prescribed. The nurse should respond with which of the following? A) Ulcerative colitis can be cured by the use of steroids B) Steroids are used in severe flare-ups because they can decrease the incidence of bleeding C) Long term use of steroids will prolong periods of remission D) The side effects of steroids outweigh their benefits to clients with ulcerative colitis

B) Steroids are used in severe flare-ups because they can decrease the incidence of bleeding

A nurse is preparing a teaching plan for a client who has chronic constipation secondary to irregular bowel habits. Which of the following should the nurse plan to include in the teaching? A) The client should drink two to three 8 oz glasses of water each day B) The client should follow a high-fiber diet to establish bowel regularity C) The client should try to take in all of the required dietary fiber with the morning meal D) The client should be taught that the goal of therapy is to have a bowel movement daily

B) The client should follow a high-fiber diet to establish bowel regularity

The client who has ulcerative colitis is scheduled for an ileostomy. When the client asks the nurse what to expect related to bowel function and care after surgery, what response should the nurse make? A) You will be able to have some control over your bowel movements B) The stoma will require that you wear a collection device all the time C) After the stoma heals, you can irrigate your bowel so you will not have to wear a pouch D) The drainage will gradually become semi-solid and formed

B) The stoma will require that you wear a collection device all the time

A nurse is caring for a client who is postoperative following abdominal surgery. The nurse discovers a loop of bowel through an opening in the surgical incision. Which of the following actions should the nurse take? A) gently reinsert the bowel back into the clients wound B) apply moistened sterile gauze to the site C) position the client on his left side D) place the head of of the clients bed in the flat position

B) apply moistened sterile gauze to the site

When planning diet teaching for a client with a colostomy, the nurse should develop a plan that emphasizes which of the following dietary instructions? A) foods containing roughage should not be eaten B) clients should experiment to find the diet that is best for them C) liquids are best limited to prevent diarrhea D) a high fiber diet will produce a regular passage of stool

B) clients should experiment to find the diet that is best for them

A nurse is caring for a client who reports taking bisacodyl to promote daily bowel movement. Which of the following assessment questions should be the nurse's priority? A) "Do you take the bisacodyl with a glass of milk?" B) "How long have you been taking the bisacodyl?" C) "How often do you have a bowel movement?" D) "What do your bowel movements look like?"

B) how long have you been taking the bisacodyl

A nurse is assessing a client who is 3 days postoperative following abdominal surgery and notes the absence of bowel sounds, abdominal distention, and the client passing no flatus. Which of the following conditions should the nurse suspect? A) Cholecystitis B) Paralytic ileus C) Wound dehiscence D) Ulcerative colitis

B) paralytic ileus

A client with diverticular disease is receiving psyllium fiber. Which of the following indicates that the mechanism is effective? The client_____ A) does not have diarrhea B) passes stool without cramping C) is no longer anxious D) does not expel flatus

B) passes stool without cramping

A nurse is planning care for a client who has manifestations of a C. Diff infection. Which of the following actions should the nurse plan to take A) place a surgical mask on the client during transport B) place the client on contact precautions C) use an alcohol-based agent to perform hand hygiene when caring for the client D) obtain a blood specimen to test for C. Diff

B) place the client on contact precautions

Which of the following should be a priority focus of care for a client experiencing an exacerbation of Crohns disease? A) encouraging regular ambulation B) promoting bowel rest C) maintaining current weight D) decreasing episodes of rectal bleeding

B) promoting bowel rest

A client with Crohn's disease has concentrated urine, decreased urinary output, dry skin with decreased turgor, hypotension, and weak, thready pulses. The nurse should do which of the following first? A) Encourage the client to drink at least 1,000 mL per day. B) Provide parenteral rehydration therapy ordered by the physician. C) Turn and reposition every 2 hours. D) Monitor vital signs every shift.

B) provide parenteral rehydration therapy ordered by the physician

What is the mechanisms of action for 5 HT3 serotonin antagonists?

Blocks action of serotonin in the chemoreceptor trigger zone in the brain

A nurse is caring for a client who has ulcerative colitis and is teaching the client about the common link with Crohns disease. Which of the following information should the nurse include? A) both manifest fistula formation B) both require frequent surgery C) both are inflammatory D) both begin in the rectum

C) Both are inflammatory

Which client comment indicates to the nurse that more teaching is needed for a client experiencing dumping syndrome after gastric surgery? A) I should eat 6 small meals per day B) I should not drink fluids with my meals C) I should use honey or jelly instead of butter D) I should lie down for 30-60 minutes after eating

C) I should use honey or jelly instead of butter

A client who is lactose intolerant is recovering from a surgical procedure. What impact does the nurse expect this to have when advancing the clients diet? A) The client will be able to progress from clear liquids to full liquids once bowel sounds return B) There is no impact on the clients diet progression because of lactose intolerance C) The clients full liquid diet may have to be altered because this diet contains milk products D) The clients diet can be progressed following a bowel movement

C) The clients full liquid diet may have to be altered because this diet contains milk products

The nurse should instruct the client with an ileostomy to report which of the following immediately? A) passage of liquid stool from the stoma B) occasional presence of undigested food in the effluent C) absence of drainage from the ileostomy for 6 or more hours D) temperature of 99.8*F

C) absence of drainage from the ileostomy for 6 or more hours

A nurse is reviewing the provider's prescriptions for a client experiencing a paralytic ileus following an appendectomy. Which of the following actions should the nurse take? A) administer an antacid B) provide a bulk-forming laxative C) insert NG tube D) apply a truss

C) insert NG tube

A client has a nasogastric tube inserted at the time of abdominal perineal resection with permanent colostomy for colon cancer. This tube will most likely be removed when the client demonstrates which of the following? A) absence of nausea and vomiting B) passage of mucus from the rectum C) passage of flatus and feces from the colostomy D) absence of stomach drainage for 24 hrs

C) passage of flatus and feces from the colostomy

A nurse is providing teaching to a client with a colostomy about appropriate food choices. Which of the following foods should the nurse include in the teaching? A) eggs B) dried peas C) pasta D) dried fruits

C) pasta

A nurse is assessing a client who has peritonitis. Which of the following findings should the nurse expect? A) hyperactive bowel sounds B) increased urinary output C) rigid abdomen D) frequent bowel movements

C) rigid abdomen

Which of the following positions would be best for a client in the early postoperative period after a hemorrhoidectomy? A) high fowlers B) supine C) side-lying D) Trendelenburg

C) side-lying

A nurse is assessing a client who has a colostomy. Which of the following findings should the nurse report to the provider? A) the stool is yellow-green B) the ostomy is draining frequently C) the stoma is pale in color D) the skin around the stoma is red

C) the stoma is pale in color

What side effects do prosecretory agents have?

Can cause severe constipation or ischemic colitis *Do not give to patients with history of mechanical obstruction

Which of the following items should the nurse encourage in the diet of a client diagnosed with celiac disease? A) oatmeal B) whole wheat toast C) beef barley soup D) cornflakes

D) cornflakes

A client who has a history of an inguinal hernia is admitted to the hospital with sudden, severe abdominal pain, vomiting, and abdominal distention. The nurse should assess the client further for which of the following complications? A) peritonitis B) incarcerated hernia C) intestinal perforation D) strangulated hernia

D) strangulated hernia

What can H2 antagonists also treat?

Dyspepsia, PUD

What can PPIs also treat?

Dyspepsia, PUD

What can antacids also treat?

Dyspepsia, PUD

What do surfactants also treat?

Fecal impaction, anorectal conditions

What side effects do H2 antagonists have?

HA, abdominal pain, constipation, diarrhea

What side effects do PPIs have?

HA, abdominal pain, nausea, diarrhea, vomiting, flatus. *Prolonged use or high doses may increase risk of bone fractures and C. Diff infections*

What do prosecretory agents also treat?

IBS (in women only)

What do bulk-forming laxatives also treat?

IBS, diverticulosis

Side effects of 5 HT3 serotonin antagonists?

May cause constipation, diarrhea, HA, fatigue, or dizziness

What side effects do antacids have? Special considerations?

May cause constipation, hypercalcemia, phosphorus depletion. *Take 1 to 3 hours after meals and at bedtime PRN *Chew thoroughly and drink with 8oz of water *Wait 1-2 hours to take any other medications

What side effects do mucosal protectants have? Special considerations?

May cause constipation. *Give on empty stomach before meals and at bedtime *Do not give within 30 minutes of antacids or within 2 hours of antibiotics.

What side effects do prostaglandin E analogs have? Special consideration?

May cause diarrhea and abdominal pain *Teratogenic drug: may cause uterine issues

What side effects do dopamine antagonists have?

May cause dry mouth, hypotension, drowsiness, rash, constipation, DRUG ALERTS PG 890 Metoclopramide can cause tardive dyskinesia Promethazine inj can cause tissue necrosis, give deep IM

What side effects do antibiotics have?

May cause nausea, vomiting, or diarrhea. May need more than one to kill H. pylori.

Just to remember:

Mucosal protectants only treat PUD. Antibiotics dont have a mechanism of action listed.

What is the mechanisms of action for H2 antagonists?

blocks action of histamine to decrease HCl acid secretion

What is the mechanism of action of corticosteroids?

decrease inflammation

What is the mechanism of action for 5 aminosalicylates?

decreases inflammation by suppressing cytokines and other mediators

What is the mechanism of action for bulk forming laxatives?

fiber draws water into bowel, increases bulk and peristalsis

What is the mechanism of action for mucosal protectants?

forms a protective layer and acts as a barrier to protect the stomach and uclers

What is the mechanism of action for prosecretory agents?

increases intestinal fluid secretion through direct action on epithelial cells, speeds up colonic transport

What is the mechanism of action for stimulant laxatives?

increases peristalsis and speeds up colonic transit

What is the mechanism of action for prostaglandin E analog?

increases secretion of gastric mucosa and decreases HCl acid production

What is the mechanism of actions for PPIs?

inhibits enzymes (proton pumps)

What is the mechanism of action for surfactants?

lubricates the intestinal tract (stool softener)

What is the mechanism of action of antacids?

neutralizes acid in the stomach

What do stimulant laxatives also treat?

prep for procedures such as surgery or colonoscopy

What is the mechanism of action for immunosuppressants?

suppresses the immune system