Exam 4 Pt. 1

Prompt, fluid evacuation of the bowel Fast and intense

Catharsis

A patient is experiencing chemotherapy-induced nausea. Which prescribed medication would be most effective for this patient? A. Ondansetron [Zofran] B. Prochlorperazine [Compazine] C. Dexamethasone [Decadron] D. Promethazine [Phenergan]

A

1. A patient is prescribed acyclovir [Zovirax] by mouth. The nurse should assess the patient for which adverse effects associated with oral acyclovir therapy? A. Stomatitis and gastritis B. Nausea, vomiting, and diarrhea C. Hives, difficulty breathing, and angioedema D. Tinnitus and decreased hearing

B

1.4 million people have chronic hepatitis___

B

2. A patient asks the nurse what he can do to prevent influenza. What should the nurse do? A. Teach the patient about antiviral medications. B. Instruct the patient to obtain an influenza vaccination. C. Tell the patient that frequent hand washing is effective. D. Have the patient wear a mask when in public areas.

B

2. Which patient would most likely need intravenous antibiotic therapy to treat a urinary tract infection? A. A patient with an uncomplicated urinary tract infection caused by Escherichia coli B. A patient with pyelonephritis with symptoms of high fever, chills, and severe flank pain C. A patient with acute cystitis who complains of dysuria, frequency, and urgency D.A patient with acute bacterial prostatitis with a mild fever, chills, and nocturia

B

The nurse identifies which of the following laxatives as having the added response of ridding the body of ammonia? Polyethylene glycol Lactulose Lubiprostone Mineral oil

B

1. Which patient does the nurse identify as most likely to need treatment with trimethoprim/sulfamethoxazole [Bactrim] for a period of 6 months? A. A female patient with acute pyelonephritis B. A male patient with acute prostatitis C. A female patient with recurring acute urinary tract infections D. A male patient with acute cystitis

C

2. A patient with irritable bowel syndrome is prescribed alosetron [Lotronex]. Before this drug is administered, it is most important for the nurse to do what? A. Assess for abdominal bruits. B. Check serum potassium and sodium levels. C. Ask the patient about any problems with constipation. D.Mix the powder in 8 ounces of fruit juice.

C

3. Which drug does the nurse identify as a urinary tract antiseptic? A. Ciprofloxacin B. Ceftriaxone C. Nitrofurantoin D. Ceftazidime

C

3. Which statement about oseltamivir [Tamiflu] does the nurse identify as true? A. Oseltamivir must be administered on an empty stomach. B. The drug is administered via an inhaler. C. Oseltamivir can be used to treat and prevent influenza. D. The drug is approved for use in infants 6 months of age or older.

C

The nurse identifies which of the following as the most common type of laxative abused by the general public? Magnesium hydroxide [Milk of Magnesia] Docusate sodium [Colace] Bisacodyl [Dulcolax] Polyethylene glycol [MiraLax]

C

Immunosuppressed patients at high risk for reactivation of dormant virus or from an initial infection -Common sites: lungs, GI tract, eyes -Dx with AIDS: CMV retinitis primary cause for blindness

CMV

50% to 80% of Americans age 40 years or older harbor the virus; minimal symptoms in healthy people therefore often goes undetected or diagnosed

CMV

Absorbs water and electrolytes Absorption of nutrients is minimal 1500 mL of fluid enters colon each day 90% of fluid is absorbed

Colon Function

one of the most common GI disorders

Constipation

3. Which statement about metoclopramide [Reglan] does the nurse identify as true? A. High-dose therapy causes nervous excitability. B. High-dose therapy causes constipation. C. Long-term high-dose therapy causes reversible tardive dyskinesia. D. The drug is contraindicated in patients with GI obstruction, perforation, or hemorrhage.

D

4. A patient has been prescribed docosanol [Abreva] cream for herpes labialis. Which statement will the nurse include in patient teaching? A. Apply the cream twice a day. B. Use of the cream will cut the duration of the herpes simplex lesion in half. C. Many serious adverse effects are associated with use of this medication. D. Apply the cream at the first sign of recurrence.

D

A patient is prescribed bisacodyl. Which of the following should the nurse include in patient teaching? Your urine will turn yellow-brown when taking this medication. Crush the bisacodyl tablet and sprinkle it on your food. Chew the bisacodyl tablet. Do not take the bisacodyl with an antacid.

D

A patient who has been taking a long-acting morphine to treat severe pain for a few months complains of constipation. The nurse anticipates which of the following will be prescribed for the patient? Polycarbophil [FiberCon] Mineral oil Psyllium [Metamucil] Senna [Senokot]

D

First-line therapy of pregnancy nausea and vomiting consists of a two-drug combination

Doxylamine plus vitamin B6

80% of uncomplicated, community-acquired UTIs caused by

E.coli

Complex reflex that occurs after activation of vomiting center in the medulla oblongata

Emetic response

second most common cause of PUD

NSAIDs

-Causes ulcers directly by injuring cells of the GI mucosa and indirectly by activating pepsin -Increased acid alone does not increase ulcers but is a definite factor in PUD -Zollinger-Ellison syndrome

Gastric Acid

Act rapidly (within 2 to 6 hours) and give stool a watery consistency; useful for preparing bowel for diagnostic procedures or surgery

Group 1 laxative

influenza vaccine has a small risk for

Guillain-Barré syndrome

60% to 70% of patients with PUD have _____-___infection

H. pylori

Aggressive factors of PUD

H. pylori, NSAIDs, acid, pepsin, smoking

Chronic infection can lead to cirrhosis, hepatic failure, hepatocellular carcinoma, and death Transmission via blood and semen

HBV

Transmission: Primarily through exchange of blood; controversy over sexual transmission -Even with no symptoms, can be transmitted -Slow progression can lead to liver failure, cancer, and death -Leading reason for liver transplantation Primary goal of therapy is to cure

HCV

Dehydration, ketonuria, hypokalemia, and loss of 5% or more of body weight

Hyperemesis gravidarum

Caused by exaggerated immune response to normal bowel flora

IBD

Most common disorder of GI tract Affects 20% of Americans Incidence in women is 3 times higher than in men

IBS

when abdominal pain or discomfort that cannot be explained by structural or chemical abnormalities has been present for 12 weeks over the past year and that has at least two of the following features: -Pain is related to defecation. -Onset was associated with a change in frequency of stool. Onset of pain occurred in association with a change in stool consistency (from normal to loose, watery, or pellet-like).

IBS

3 types of flu vaccines

Inactivated (IIV) Recombinant hemagglutinin (RIV) Live, attenuated (LAIV)

causes of diarrhea

Infection Maldigestion Inflammation Functional disorders of the bowel

Hospital-acquired UTIs (nosocomial) caused by

Klebsiella, Proteus, Enterobacter, Pseudomonas, staphylococci, enterococci, and E. coli

Production of soft, formed stool over 1 or more days Relatively mild

Laxative

-Obtain fresh stool sample -Empty bowel before treatment or procedure -Expel dead parasites after treatment -Modify the effluent (the fecal drainage) from ileostomy or colostomy -Constipation (multiple causes, including pregnancy and opioid use) -Prevent fecal impaction in bedridden patients -Remove poisons

Laxative uses

Used to ease or stimulate defecation -Soften the stool -Increase stool volume -Hasten fecal passage through the intestine -Facilitate evacuation from the rectum -Misuse comes from misconceptions of what constitutes normal bowel function

Laxatives

Goal of Antibiotic therapy

Minimize emergence of resistance; guidelines recommend using at least two antibiotics, preferably three

-Inhibit the biosynthesis of prostaglandins -Reduce blood flow, mucus, and bicarbonate

NSAIDs

Long-standing "standard of care" for HCV

Pegylated interferon alfa combined with ribavirin

Group of upper GI disorders Degrees of erosion of the gut wall Severe erosion can be complicated by hemorrhage and perforation Cause: imbalance between mucosal and aggressive factors

Peptic ulcer disease

Which medication is used to promote gastric ulcer healing by providing a protective barrier? a. Cimetidine b. Misoprostol c. Omeprazole d.Sucralfate

d

receptors involved in emetic response

Serotonin, glucocorticoids, substance P, neurokinin1, dopamine, acetylcholine, histamine

-Second most common infection -Sexually active young women -Older adult women in nursing homes

UTI

Inflammation of the mucosa and submucosa of the colon and rectum May cause rectal bleeding May require hospitalization

Ulcerative Colitis

A, B, C, D, E, and G can all cause

acute hepatitis

3 types of emesis

anticipatory acute delayed

Given to suppress nausea and vomiting -emetic response

antiemetics

A patient is prescribed amoxicillin and tetracycline to treat peptic ulcer disease. The nurse will instruct the patient that these medications will do what? a. Prevent GI infections that cause gastric bleeding. b. Destroy the bacteria in the stomach that are causing ulceration. c. Reduce gastric acid production and alkalize the stomach fluids. d. Reduce the secretion of pepsin in the stomach.

b

Intermediate latency (6 to 12 hours); produce a semifluid stool

group 2 laxative

The nurse identifies which of the following as the most common type of laxative abused by the general public? a. Magnesium hydroxide [Milk of Magnesia] b. Docusate sodium [Colace] c. Bisacodyl [Dulcolax] d. Polyethylene glycol [MiraLax]

c

Only B, C, and D can also cause

chronic hepatitis

Hard stools, infrequent stools, excessive straining, prolonged effort, sense of incomplete evacuation, unsuccessful defecation

constipation

-Abdominal pain, nausea, cramps, or other symptoms of appendicitis, regional enteritis, diverticulitis, or ulcerative colitis -Acute surgical abdomen -Fecal impaction or bowel obstruction -Habitual use -Use with caution in pregnancy and lactation

contraindications of laxative use

Goal of PUD drug therapy

create conditions conducive to healing

Characterized by transmural inflammation Usually affects terminal ileum (can affect all parts of GI tract)

crohn's disease

A patient is prescribed cimetidine [Tagamet] and aluminum hydroxide [Maalox] for the treatment of peptic ulcer disease. What should the nurse teach the patient to do? a. Drink an 8-ounce glass of water when taking these medications. b. Take the medications together to enhance their effectiveness. c. Take the Tagamet 2 hours before the Maalox d. Wait at least 1 hour between administration of the two medications

d

Characterized by stools of excessive volume and fluidity and increased frequency of defecation

diarrhea

Proper bowel function is highly dependent on

dietary fiber

Benefits of _____ -Absorbs water: Softens feces and increases size -Can be digested by colonic bacteria, whose growth increases fecal mass

fiber

Most frequently abused by the general public; act slowly (1 to 3 days) to produce a soft, formed stool; uses include treating chronic constipation and preventing straining at stool

group III laxative

cause of PUD

imbalance between mucosal and aggressive factors

-Diminished defecatory reflexes, leading to further reliance on laxatives -Electrolyte imbalance, dehydration, colitis

laxative abuse

causes of ____ -Misconception that bowel movements must occur daily -Can perpetuate their own use -Bowel replenishment after evacuation can take 2 to 5 days; often mistaken for constipation

laxative abuse

Acute cystitis Acute urethral syndrome Recurrent urinary tract infections

lower UTI

Defensive factors of PUD

mucus, bicarbonate, blood flow, prostaglandins

Proteolytic enzyme in gastric juice

pepsin

Increase tone and motility of GI tract; Suppress emesis and increase upper GI motility

prokinetic agent

80% of recurrent UTIs in females Usually involves lower urinary tract and may be related to sexual intercourse

recurrent

20% recolonization with the original infecting organism Suggests structural abnormality of urinary tract, involvement of kidneys, or chronic bacterial prostatitis

relapse

Drugs for motion sickness

scopolamine antihistamines

Delays ulcer healing and increases risk for recurrence

smoking

Antibiotics largely ineffective in which IBD

ulcerative colitis

Acute pyelonephritis Acute bacterial prostatitis

upper UTI

best strategy for preventing HBV

vaccine

most common liver disorder

viral hepatitis