GI Homework Pharmacology

The nurse is counseling a client with gastroesophageal reflux disease (GERD) who has been taking prescribed famotidine for two days. Which statement would require immediate follow up by a healthcare provider? "I take digoxin for my heart failure." "I use calcium carbonate if I have symptoms after meals." "I use alendronate for my osteoporosis." "I'm still having some symptoms of heartburn."

"I take digoxin for my heart failure." Rationale: Most medications for heartburn decrease stomach acid. Histamine blocking drugs such as famotidine (H2 receptor antagonist) are available as both prescription and over-the-counter. It is often advised to take an antacid with an H2RA to relieve pain. Symptoms should be improved after one week. Famotidine does not cause bone loss, unlike proton pump inhibitors, and is an acceptable choice for clients with osteoporosis. Famotidine is used cautiously in clients on digoxin as it decreases absorption. This client needs to have their digoxin level checked, and the dosage may need to be adjusted.

Which statement by a client who has a gastric ulcer and asks what to do if epigastric pain occurs indicates that teaching was effective? "Eliminating fluids with meals will prevent pain." "I will increase my food intake to avoid an empty stomach." "Taking an aspirin with milk will relieve my pain and coat my ulcer." "Taking an antacid preparation will decrease pain due to gastric acid."

"Taking an antacid preparation will decrease pain due to gastric acid." Rationale: Over-the-counter antacid preparations neutralize gastric acid and relieve pain. Reduction of fluids with meals does not affect pain. Although eating food initially prevents gastric acid from irritating the gastric walls, it can precipitate acid production. Aspirin is contraindicated because it irritates gastric mucosa and promotes bleeding by preventing platelet aggregation.

The nurse is providing medication teaching for a client prescribed famotidine for the treatment of gastroesophageal reflux disease (GERD). Which statement by the client indicates an understanding of the teaching? "I will take this medication once a day in the morning." "I will no longer have discomfort at night once I begin this medication." "This medication will both prevent and treat heartburn." "My treatment will be done in one week."

"This medication will both prevent and treat heartburn." Rationale: H2 receptor blockers (antagonists) are used to prevent and treat conditions caused by too much acid being produced in the stomach. These conditions include gastric ulcers, duodenal ulcers, and GERD. Famotidine may be prescribed to take twice a day, in the morning and evening, or just once daily in the evening. Duration of treatment varies but is at a minimum two weeks.

A health care provider prescribes oral antacids and intravenous ranitidine for a client with burns and crushing injuries caused by an accident. The client asks how these medications work. Which explanation would the nurse provide? 'These medications work together to decrease bowel irritability.' 'They limit acidity in the gastrointestinal tract.' 'They are very effective in clients with multiple trauma.' 'These medications decrease nausea and vomiting.'

'They limit acidity in the gastrointestinal tract.' Rationale: Increased acidity caused by the stress occurring with burns and crushing injuries contributes to the formation of Curling ulcer; ranitidine, an H 2 antagonist, decreases the formation of gastric acid, and an antacid neutralizes gastric acid once it is formed. These medications do not decrease irritability of the bowel; their purpose is to decrease gastrointestinal acidity. The response, 'They are very effective in clients with multiple trauma,' does not answer the client's question. Their purpose is not that of an antiemetic.

The nurse is assessing a client who began taking omeprazole a month ago. Which finding by the nurse, indicates that the drug has had the desired effect? Blood pressure readings are lower Feelings of depression are not as severe Chronic pain level is markedly decreased Heartburn discomfort is lessened

Heartburn discomfort is lessened Rationale: Omeprazole is a proton pump inhibitor used to decrease stomach acid and relieve symptoms of gastroesophageal reflux disorder (GERD), such as heartburn. Omeprazole is also used to treat gastric ulcers and esophagitis. Omeprazole does not affect blood pressure. A lower blood pressure reading in this client would not be related to administration of medication. Omeprazole is not indicated for depression. Although omeprazole can alleviate abdominal pain in an individual who has a gastric ulcer or suffers from gastric bleeding, the option does not specify what type of pain is being discussed. Secondly, omeprazole is not typically indicated for chronic pain. The desired outcome for this client is to have a decrease in symptoms of GERD within 4 weeks.

Which antidiarrheal medication would the nurse anticipate administering to a client with severe diarrhea who is prescribed intravenous fluids, sodium bicarbonate, and an antidiarrheal medication? Psyllium Bisacodyl Loperamide Docusate sodium

Loperamide Rationale : Loperamide inhibits peristalsis and prolongs transit time by its effect on the nerves in the muscle wall of the intestines. Psyllium is not an antidiarrheal; it is a bulk laxative that promotes easier expulsion of feces. Bisacodyl is a laxative, not an antidiarrheal; it increases gastrointestinal motility. Docusate sodium s constipation, not diarrhea; water and fat are increased in the intestine, permitting easier expulsion of feces.

Which medication for treatment of gastroesophageal reflux disease would be contraindicated in the pregnant client? Ranitidine Misoprostol Esomeprazole Calcium carbonate

Misoprostol Rationale: Misoprostol is contraindicated in pregnancy because it can cause uterine contractions, expelling the developing fetus. Ranitidine, esomeprazole, and calcium carbonate are not contraindicated during pregnancy.

Which information would be included in the teaching plan for the older adult client with peptic ulcer disease who is taking an antacid and sucralfate? Antacids should be taken 30 minutes before a meal. Sucralfate should be taken on an empty stomach 1 hour before meals. Sucralfate is prescribed for the long-term maintenance of peptic ulcer disease. Sodium bicarbonate is an inexpensive over-the-counter antacid with few adverse effects.

Sucralfate should be taken on an empty stomach 1 hour before meals. Rationale: Sucralfate works best in a low pH environment; therefore it should be given on an empty stomach either 1 hour before or 2 hours after meals. Sucralfate also should be administered no sooner than 30 minutes before or after an antacid. The acid-neutralizing effects of antacids last approximately 30 minutes when taken on an empty stomach and 3 to 4 hours when taken after meals. When sucralfate and an antacid are both prescribed, they are each most effective when the sucralfate is scheduled an hour before meals and the antacid is scheduled after meals. Sucralfate is prescribed for the short-term treatment of peptic ulcers. Its use is limited to 4 to 8 weeks. The client should follow the recommendations of the primary health care provider with regard to antacid selection. Sodium bicarbonate can produce acid-base imbalances, which could be harmful, especially in older adult clients.

The nurse is providing teaching to the client taking metoclopramide. Serious side effects that should be reported to the provider are included in the teaching plan. Which of the following side effects is the priority? Involuntary muscle movements Report of increased fatigue Onset of headaches Difficulty with sleep

Involuntary muscle movements Rationale: Metoclopramide is a GI stimulant that is effective in reducing headache, nausea, and vomiting. Metoclopramide can cause a serious movement disorder called tardive dyskinesia (TD). This condition is often irreversible. TD is characterized by involuntary movements of the face, tongue, or extremities. The risk of developing TD is increased with longer treatment and increased dosage. To help prevent TD, this drug shouldn't be used for longer than 12 weeks. The more common side effects of metoclopramide can include headache, confusion, drowsiness, dizziness, restlessness, and insomnia.

Famotidine is prescribed for a client with peptic ulcer disease. Which mechanism of action is a characteristic of this medication? Increases gastric motility Neutralizes gastric acidity Facilitates histamine release Inhibits gastric acid secretion

Inhibits gastric acid secretion Rationale: Famotidine decreases gastric secretion by inhibiting histamine at H 2 receptors. Increasing gastric motility, neutralizing gastric acidity, and facilitating histamine release are not actions of famotidine.

The nurse is reviewing a plan of care for a client who was admitted with dehydration as a result of prolonged watery diarrhea. Which new prescription will the nurse question? Oral psyllium Oral potassium supplement Intravenous normal saline Magnesium citrate

Magnesium citrate Rationale : Oral psyllium will absorb the watery diarrhea, giving more bulk to the stool. An oral potassium supplement is appropriate because diarrhea causes potassium loss. Intravenous normal saline is the intervention of choice to manage dehydration due to diarrhea. Magnesium citrate has a laxative effect and would worsen the client's dehydration.

Which medication is classified as an H 2 receptor antagonist? Select all that apply. One, some, or all responses may be correct. Nizatidine Ranitidine Famotidine Lansoprazole Metoclopramide

Nizatidine Ranitidine Famotidine Rationale : Nizatidine, ranitidine, and famotidine are H 2 receptor antagonists that reduces gastric acid secretion and provide symptomatic improvement in GERD. Lansoprazole is a proton pump inhibitor that inhibits gastric secretion up to 90% with one dose daily and provides for symptomatic improvement in GERD. Metoclopramide is a prokinetic agent that increases the rate of gastric emptying; it has multiple side effects and is not appropriate for long-term treatment of GERD.

A client has had a recent brain attack (cerebrovascular accident/stroke). Which preventative would the nurse anticipate will be prescribed daily to avoid straining due to constipation? Stimulant laxatives such as bisacodyl Tap-water enemas Stool softener Saline laxatives such as magnesium citrate

Stool softener Rationale: A stool softener can soften stool and promote defecation, thus avoiding the Valsalva maneuver. Enemas may precipitate a forcible exhalation against a closed glottis (Valsalva maneuver) during evacuation. Elevated intraabdominal and intrathoracic pressures associated with the Valsalva maneuver increase intracranial pressure and should be avoided. Also, daily enemas promote dependence. Stimulant laxatives are not recommended for daily use because laxative dependency has occurred in some clients. Saline laxatives can cause hypermagnesemia if given this frequently.

A client is scheduled for discharge after surgery. The medical record indicates that the client has not had a bowel movement since before surgery, which was 4 days ago. Which prescribed medication will the nurse administer to ensure a bowel movement before discharge? Lactulose Docusate sodium Bisacodyl suppository Psyllium

Bisacodyl suppository Rationale: A bisacodyl suppository should produce results before the client leaves the facility; it usually takes effect in 15 to 60 minutes. Lactulose takes about 24 hours to take effect; docusate sodium takes 1 to 3 days; psyllium takes 12 to 24 hours.

The nurse is evaluating an older adult client with an upper gastrointestinal bleed who received several packed red blood cell transfusions in the past 24 hours. Assessment findings include crackles to auscultation, bounding pulses, orthopnea and an oxygen saturation of 90% on room air. Vital signs include heart rate of 106 bpm, blood pressure 160/80 mm Hg, respirations 24 and temperature 98.6°F (37°C). Which adverse transfusion reaction is the client most likely experiencing? Bacterial transfusion reaction Transfusion-associated graft-versus-host disease Hemolytic transfusion reaction Circulatory overload

Circulatory overload Rationale: The client's symptoms are most likely related to circulatory overload. Transfusion-associated circulatory overload can occur when a blood product is infused too quickly, especially in an older adult. This is most common with whole-blood transfusions or when the patient received multiple packed red blood cell transfusions. Symptoms include: hypertension, bounding pulse, distended jugular veins, dyspnea, restlessness and confusion.

The nurse is caring for a pregnant client who is receiving intravenous magnesium sulfate therapy. Which of the following medication prescriptions should the nurse clarify with the provider? Nifedipine Ondansetron Lactated ringers Betamethasone

Nifedipine Rationale: The effect of the calcium channel blocker can be increased if it is taken with magnesium sulfate; therefore, the nurse should question a new prescription of nifedipine. All other medications will not create adverse effects if given with magnesium sulfate.

Why would lactulose be prescribed for a client with a history of cirrhosis of the liver? The desire to drink alcohol is decreased. Diarrhea is controlled and prevented. Elevated ammonia levels are lowered. Abdominal distension secondary to ascites is decreased.

Elevated ammonia levels are lowered. Rationale: Lactulose is an ammonia detoxicant. It decreases serum ammonia concentration by preventing reabsorption of ammonia. Lactulose has been used to lower blood ammonia content in clients with portal hypertension and hepatic encephalopathy secondary to chronic liver disease. Lactulose has no effect on the craving for alcohol or reduction of ascites or abdominal distension. Lactulose is also used as a hyperosmotic laxative; therefore it will not relieve diarrhea.

Which potential side effect of docusate sodium would a nurse include in discharge teaching of a client who had repair of an inguinal hernia? Rectal bleeding Fecal impaction Nausea and vomiting Mild abdominal cramping

Mild abdominal cramping Rationale: Mild abdominal cramping is the only side effect of docusate sodium; this emollient laxative permits water and fatty substances to penetrate and mix with fecal material. Rectal bleeding is more likely to occur with a saline-osmotic laxative. Docusate sodium promotes defecation, not constipation. Nausea and vomiting are more likely to occur with a saline-osmotic laxative.

The nurse observes a new nurse administering a rectal suppository to a client. Which actions are appropriate for the new nurse to implement? Select all that apply. One, some, or all may be correct. The nurse places the client on the left side during insertion. The nurse pushes the suppository in, up to the second knuckle. After 10 minutes, the nurse turns the client to the right side. The nurse applies water-soluble lubricant to the suppository. The nurse instructs clients to hold their breath and bear down.

The nurse places the client on the left side during insertion. The nurse pushes the suppository in, up to the second knuckle. After 10 minutes, the nurse turns the client to the right side. The nurse applies water-soluble lubricant to the suppository. Rationale: Left side-lying position is the optimal position for the client receiving rectal medications. Due to the position of the descending colon, placing the client on their left side allows the medication to be inserted and move along the natural curve of the intestine and facilitates retention of the medication. The suppository should be somewhat melted after 10 to 15 minutes and turning the client to the right side will aid in further absorption. The suppository should be lubricated to ease insertion and reduce discomfort for the client. Bearing down will place pressure on the anal sphincter and may cause the suppository to be expelled. The client should be instructed to breathe slowly and try to relax.

Which condition is treated with a proton pump inhibitor (PPI)? Diarrhea Vomiting Cardiac dysrhythmias Gastroesophageal reflux disease (GERD)

Gastroesophageal reflux disease (GERD) Rationale: PPIs are effective in decreasing the secretion of gastric acid, helping alleviate the symptoms of GERD. PPIs are not used for the treatment of diarrhea, vomiting, or cardiac dysrhythmias.

The nurse is administering docusate sodium to a postpartum client. Which of the following should the nurse include in the medication teaching? "This medication will help with your uterine cramping." "Breastfeeding is contraindicated while taking this medication." "Report to the healthcare provider if you experience diarrhea." "This medication lowers your risk of hemorrhage."

"Report to the healthcare provider if you experience diarrhea." Rationale: Docusate sodium is a stool softener/laxative and should not be administered to a client who is experiencing diarrhea. This medication does not directly affect breastfeeding or the risk of hemorrhage. Docusate sodium does not affect uterine cramping.

Which antidiarrheal agent should be used with caution in clients taking high dosages of aspirin for arthritis? Loperamide (Imodium). Probanthine (Propantheline). Bismuth subsalicylate (Pepto Bismol). Diphenoxylate hydrochloride with atropine (Lomotil).

Bismuth subsalicylate (Pepto Bismol). Rationale: Bismuth subsalicylate (Pepto Bismol) contains a subsalicylate that increases the potential for salicylate toxicity when used concurrently with aspirin (acetylsalicylic acid, another salicylate preparation).

Which action is responsible for the therapeutic effect of docusate sodium? Lubricates the feces Creates an osmotic effect Stimulates motor activity Softens the feces

Softens the feces Rationale: The detergent action of docusate sodium promotes the drawing of fluid into the stool, which softens the feces. Lubricating the feces in the gastrointestinal (GI) tract is the action of lubricant laxatives such as mineral oil. Creating an osmotic effect in the GI tract is the action of saline laxatives, such as magnesium hydroxide, or other osmotics, such as lactulose. Stimulating motor activity of the GI tract is the action of peristaltic stimulants, such as cascara.

A client with cirrhosis of the liver asks the nurse about the purpose of taking lactulose. How should the nurse respond? "It is used to control portal hypertension." "It adds dietary fiber to your diet." "It helps to regenerate your liver." "It helps to reduce ammonia levels in your blood."

"It helps to reduce ammonia levels in your blood." Rationale: Lactulose is a synthetic disaccharide that can be given orally or rectally. It blocks the absorption and production of ammonia from the gastrointestinal tract, reducing serum ammonia levels, and is used to treat hepatic encephalopathy. The other answers are in.

How can the nurse prevent vomiting in a client who reports feeling nauseated after cataract surgery? Administer the prescribed antiemetic medication. Provide some dry crackers for the client to eat. Explain that this is expected after surgery. Teach how to breathe deeply until the nausea subsides.

Administer the prescribed antiemetic medication. Rationale: An antiemetic will prevent vomiting; vomiting increases intraocular pressure and should be avoided. Providing some dry crackers for the client to eat, explaining that this is expected after surgery, and teaching how to breathe deeply until the nausea subsides are unsafe; vomiting increases intraocular pressure, and aggressive intervention is required.

Which statement is important for the nurse to teach a client prescribed psyllium 3.5 g twice a day for constipation? "Urine may be discolored." "Each dose should be taken with a full glass of water." "Use only when necessary because it can cause dependence." "Daily use may inhibit the absorption of some fat-soluble vitamins."

"Each dose should be taken with a full glass of water." Rationale: Because this medication has a strong affinity for fluids, it will swell in the intestine. The large bulk stimulates peristalsis. A full glass of fluid taken at the same time will help minimize the risk of esophageal obstruction or fecal impaction. Senna, a stimulant laxative, may discolor urine, not psyllium. Psyllium, a bulk-forming laxative, is among the safest laxatives on the market. It is useful with prolonged therapy because it is not systemically absorbed and is not potent in its action. Prolonged use of lubricant or saline/osmotic laxatives, not bulk-forming laxatives, can inhibit the absorption of some fat-soluble vitamins.

Which statement indicates that a client understands how to take antacids appropriately? "I will take this antacid at the onset of pain." "I will take this antacid 30 minutes after meals." "I will take this antacid every 4 hours around the clock." "I will take this antacid each time I have something to eat."

"I will take this antacid 30 minutes after meals." Rationale: Antacids are most effective when taken after digestion has started but before the stomach begins to empty. Antacids should be taken before the onset of pain; pain indicates that gastric irritation has begun, and the aim of treatment is to protect the gastrointestinal mucosa. Antacids taken every 4 hours around the clock interfere with the absorption of nutrients. Antacids taken with food interfere with the absorption of nutrients.

The nurse is preparing to administer a prescribed dose of lactulose to a client who has cirrhosis. Which lab value will the nurse monitor to evaluate the therapeutic effect of the medication? Glucose Ammonia Potassium Bicarbonate

Ammonia Rationale: Hepatic encephalopathy is a manifestation of liver disease that has neurotoxic effects of ammonia. Lactulose acidifies feces in the intestines, which traps ammonia that can be then eliminated with defecation.

Which mechanism is specifically responsible for the action of the medication ranitidine? Inhibiting proton pumps Promoting the release of gastrin Regenerating the gastric mucosa Inhibiting the histamine at H 2 receptors

Inhibiting the histamine at H 2 receptors Rationale: Ranitidine inhibits histamine at H 2 receptor sites in parietal cells, which limits gastric secretion. It does not inhibit proton pumps. Promoting the release of gastrin is undesirable; gastric hormones increase gastric acid secretion. Ranitidine does not regenerate the gastric mucosa; the medication prevents its erosion by gastric secretions.

A client is to receive metoclopramide intravenously 30 minutes before initiating chemotherapy for cancer of the colon. The nurse explains that metoclopramide is given for which purpose? To stimulate production of gastrointestinal (GI) secretions To stimulate peristalsis of the upper gastrointestinal (GI) tract To prolong excretion of the chemotherapeutic medication To increase absorption of the chemotherapeutic medication

To stimulate peristalsis of the upper gastrointestinal (GI) tract Rationale: Prokinetic medications such as metoclopramide stimulate peristalsis in the GI tract. This enhances the emptying of stomach contents into the duodenum to decrease gastroesophageal reflux and vomiting, all of which are precipitated by chemotherapeutic agents. Metoclopramide does not stimulate the production of gastrointestinal secretions. Metoclopramide has no effect on the excretion of chemotherapeutic medications. Metoclopramide has no effect on the absorption of chemotherapeutic medications.

The nurse evaluates that teaching for the oral pancreatic enzymes pancrelipase is understood when the client identifies which time for medication scheduling? At bedtime With meals One hour before meals On arising each morning

With meals Rationale: The pancreatic enzymes (amylase, trypsin, and lipase) must be present when food is ingested for digestion to take place. At bedtime the food eaten for dinner has passed beyond the duodenum, so at bedtime the enzyme is given too late to aid digestion. Taking pancrelipase 1 hour before meals or on arising each morning will have no chyme in the duodenum on which the enzyme can act.

The nurse administers lactulose to a client with cirrhosis of the liver. Which laboratory test change leads the nurse to determine that the lactulose is effective? Decreased amylase Decreased ammonia Increased potassium Increased hemoglobin

Decreased ammonia Rationale: Lactulose destroys intestinal flora that break down protein and, in the process, give off ammonia. In clients with cirrhosis, ammonia is inadequately detoxified by the liver and can build to toxic levels. Amylase levels are associated with pancreatic problems. Increased potassium levels are associated with kidney failure. Hemoglobin is increased when the body needs more oxygen-carrying capacity, such as in smokers, or in high altitudes.

Which explanation would the nurse provide to a client with gastric ulcer disease who asks the nurse why the health care provider has prescribed metronidazole? To augment the immune response To potentiate the effect of antacids To treat Helicobacter pylori infection To reduce hydrochloric acid secretion

To treat Helicobacter pylori infection Rationale: Approximately two-thirds of clients with peptic ulcer disease are found to have Helicobacter pylori infecting the mucosa and interfering with its protective function. Antibiotics do not augment the immune response, potentiate the effect of antacids, or reduce hydrochloric acid secretion.

A client calls the clinic and states to the triage nurse: "I had an upset stomach and took Pepto-Bismol and now my tongue looks black. What's happening to me?" What would be the nurse's best response? "This is a common and temporary side effect of this medication." "How long have you had an upset stomach?" "Come to the clinic so you can be seen by the health care provider." "Are your stools also black?"

"This is a common and temporary side effect of this medication." Rationale: The best response would be to explain that a dark tint of the tongue is a common and temporary side effect of bismuth subsalicylate (Pepto-Bismol). Although it may also turn stools a darker color, do not confuse this with black, tarry stools, which is a sign of bleeding in the intestinal tract. After addressing the client's initial concern and the reason for the call, the nurse can ask about the upset stomach and then ask the client to come to the clinic if necessary.

Which nursing intervention would prevent stimulation of the pancreas in a client with acute pancreatitis? Maintain the gastric pH at a level of less than 3.5. Encourage the resumption of activities of daily living. Administer the histamine H 2-receptor antagonist as prescribed. Ensure that the nasogastric tube remains in the fundus of the stomach.

Administer the histamine H 2-receptor antagonist as prescribed. Rationale: The histamine H 2-receptor antagonist medication inhibits histamine at H 2-receptor sites in parietal cells, thus decreasing gastric secretion and preventing pancreatic stimulation. A lower pH will stimulate pancreatic secretion, which contains bicarbonate ions that neutralize the acid. The client should rest to decrease stimulation of the pancreas. The tube should be positioned nearer the pylorus for the removal of gastric contents.

Which concern would prompt the nurse to contact the health care provider when a client with gastric ulcers receives a prescription for ranitidine 150 mg twice a day? Ranitidine can increase the risk for gastrointestinal bleeding. An administration route is not specified. Ranitidine is contraindicated for gastric ulcers. Ranitidine should be given with an adjuvant.

An administration route is not specified. Rationale: It is necessary to clarify the route of administration because ranitidine can be given by mouth, intravenously, or intramuscularly; the health care provider's prescription is incomplete. Ranitidine does not increase the risk of gastrointestinal bleeding. Ranitidine is used to decrease gastric acid and is helpful for clients with a gastric ulcer. An adjuvant is not indicated.

The nurse in a primary care clinic is reviewing the medical record of a client with chronic gastroesophageal reflux disease (GERD). Which findings are risk factors for developing GERD? Select all that apply. One, some, or all may be correct. Being overweight or obese Diabetes mellitus type 2 Helicobacter pylori infection Taking a calcium channel blocker Smoking Essential hypertension

Being overweight or obese Helicobacter pylori infection Taking a calcium channel blocker Smoking Rationale: Gastroesophageal reflux disease or GERD occurs as a result of backward flow of stomach contents into the esophagus. The most common cause of GERD is excessive relaxation of the lower esophageal sphincter (LES), which allows the reflux of gastric contents into the esophagus and exposure of the esophageal mucosa to acidic gastric contents. A number of factors can decrease LES pressure including calcium channel blockers, smoking and alcohol. Clients who are overweight or obese are at highest risk for development of GERD because increased weight increases intra-abdominal pressure, which contributes to reflux of stomach contents into the esophagus. Helicobacter pylori infection can also contribute to GERD. Diabetes and hypertension are not considered risk factors for GERD.

The nurse is preparing to administer prescribed IV pantoprazole to the hospitalized client. The medication has been stocked in tablet form. Which action by the nurse is appropriate? Administer the medication to the client in oral form Call the pharmacy to stock the form of the medication Request that the healthcare provider change the order to tablets Ask the pharmacist if it is safe to give the client oral pantoprazole

Call the pharmacy to stock the form of the medication Rationale: Safety is of the utmost importance in preparing and administering medications. Suggested rights of administration vary from the classic five rights (listed first) through upward of eleven rights, including right medication, right patient, right dosage, right route, right time, right reason, right assessment data, right documentation, right response, right education, and right to refuse. In this case, the nurse has identified a potential issue with the right route of administration. The nurse should call the pharmacy and have the form of the medication provided for administration. Administering the medication by the in route is considered a medication error. The healthcare provider's order is not in, and the safety of administration via this route is not what is in question.

A health care provider prescribes famotidine for a client with dyspepsia. Which statement is important to include in a teaching session about famotidine? Lowers the stress level Neutralizes gastric acidity Reduces gastrointestinal peristalsis Decreases secretions in the stomach

Decreases secretions in the stomach Rationale: Famotidine inhibits histamine at H 2-receptor sites in the stomach, inhibiting gastric acid secretion. Famotidine does not affect stress levels. Famotidine inhibits, rather than neutralizes, gastric secretion. Famotidine inhibits gastric secretion, not peristalsis.

A client who has returned from surgery reports feeling nauseated and later has an emesis. The nurse administers promethazine per standing orders. In addition to relief from nausea, what other effects of this medication does the nurse expect? Select all that apply. One, some, or all may be correct. Dry mouth Sedation Pinpoint pupils Heart palpitations Rhinorrhea

Dry mouth Sedation Heart palpitations Rationale: Promethazine is used as an antihistamine, sedative and antiemetic. It produces anticholinergic effects, such as dry mouth and reduced nasal congestion, dilated pupils and urinary retention. Although promethazine is a sedative, the nurse should understand that it can cause some people to have heart palpitations and to feel restless and unable to sleep.

Which intervention is indicated for treatment of a client admitted to the hospital with a diagnosis of acute salmonellosis? Cathartics Electrolytes Antidiarrheals Antispasmodics

Electrolytes Rationale: Fluids of dextrose and normal saline and electrolytes are administered to prevent profound dehydration caused by excessive loss of water and electrolytes through diarrheal output. Cathartics are not necessary; salmonellosis is a condition that increases intestinal peristalsis, causing diarrhea. Antidiarrheals are not used when a bacterial infection is diagnosed because slowed peristalsis impedes the excretion of the microorganism. Antispasmodics are not used when bacterial infection is diagnosed because slowed peristalsis decreases excretion of the microorganism.

A health care provider prescribes bed rest, loperamide, and esomeprazole for a client who just had major surgery. After several days of this regimen, the client complains of diarrhea. Which treatment strategy would the nurse conclude is the cause of the diarrhea? Loperamide Esomeprazole Bed rest Diet alteration

Esomeprazole Rationale: Esomeprazole, a proton-pump inhibitor, may cause diarrhea. Loperamide, an antidiarrheal, may cause constipation, not diarrhea. Immobility causes constipation, not diarrhea. Although diet can affect elimination, no data are presented to support this conclusion.

How does sodium biphosphate, prescribed for a client before a colonoscopy, accomplish its therapeutic effect? Irritates the intestinal mucosa Provides water-absorbing bulk Softens stool by exerting a detergent effect Increases osmotic pressure in the intestines

Increases osmotic pressure in the intestines Rationale: Sodium biphosphate is a saline (hypertonic) cathartic that increases osmotic pressure within the intestine so that body fluids are drawn into the bowel, stimulating bowel stretching, peristalsis, and defecation. Intestinal stimulants increase peristalsis by irritating the mucosa. Bulk-forming laxatives are cellulose derivatives that remain in the intestinal tract and absorb water; they stimulate peristalsis by increasing bulk. Emollients have a detergent action, softening stool by facilitating its absorption of water.

A client is prescribed aluminum hydroxide for peptic ulcer disease. Which statement by the client demonstrates an understanding of the action of the medication? It decreases the production of gastric secretions. It produces an adherent barrier over the ulcer. It helps maintain a gastric pH of 3.5 or above. It slows down the gastric motor activity.

It helps maintain a gastric pH of 3.5 or above. Rationale: The objective of antacids is to neutralize gastric acids and keep a gastric pH of 3.5 or above, which is necessary for pepsinogen inactivity.

A client with advanced liver disease has been taking rifaximin. Which assessment finding would indicate that the medication is being effective? Less jaundice Increased appetite Less confusion Less edema

Less confusion Rationale: Clients with advanced liver disease experience elevated serum ammonia levels which typically lead to hepatic encephalopathy. Signs and symptoms of hepatic encephalopathy include personality changes, confusion, restlessness and forgetfulness. Rifaximin is an antibiotic that helps reduce ammonia levels and hepatic encephalopathy by stopping the growth of bacteria and production of ammonia in the GI tract. Lessening confusion would indicate that the medication is being effective.

The nurse administers cimetidine to a 75-year-old client diagnosed with a gastric ulcer. The nurse should monitor the client for which adverse reaction? Mental status change Increased liver enzymes Constipation Hearing loss

Mental status change Rationale: Cimetidine is a histamine H2-receptor antagonist used to treat gastric ulcers. It has been found to cause confusion in susceptible clients, such as the elderly and debilitated clients. Clients over age 50 or who are severely ill may become temporarily confused while taking H2 blockers, especially cimetidine.

The nurse teaches a client about the dangers of using sodium bicarbonate regularly. Which effect of sodium bicarbonate is the nurse trying to prevent? Gastric distention Metabolic alkalosis Chronic constipation Cardiac dysrhythmias

Metabolic alkalosis Rationale: Prolonged use of sodium bicarbonate may cause systemic alkalosis, as well as retention of sodium and water. Gastric distention is not an effect of sodium bicarbonate. Chronic constipation is not an effect of sodium bicarbonate. Cardiac dysrhythmias are not an effect of sodium bicarbonate.

Which information would the nurse include when teaching a client about the administration of ranitidine? Ranitidine increases gastrointestinal peristalsis. Ranitidine reduces gastric acidity in the stomach. Ranitidine neutralizes the acid that is present in the stomach. Ranitidine stops the production of hydrochloric acid in the stomach.

Ranitidine reduces gastric acidity in the stomach. Rationale: Ranitidine inhibits histamine at H 2-receptor sites in the stomach, resulting in reduced gastric acid secretion. Ranitidine does not increase gastrointestinal peristalsis, and it does not completely stop the production of hydrochloric acid in the stomach. Ranitidine reduces, rather than neutralizes, gastric acidity.

Which effect may be experienced by a client who reports frequently taking calcium carbonate? Diarrhea Water retention Rebound hyperacidity Bone demineralization

Rebound hyperacidity Rationale: The antacid action of calcium carbonate adds alkalinity, neutralizing gastric pH; this in turn stimulates renewed secretion of acid by the gastric mucosa. This medication causes constipation, not diarrhea. Calcium carbonate does not contain sodium, as do some antacids; thus it does not promote fluid retention. This antacid provides a source of calcium, which helps prevent bone demineralization.

A health care provider prescribes bisacodyl for a client with constipation. The nurse explains to the client that this medication acts by which mechanism? Producing bulk Softening feces Lubricating feces Stimulating peristalsis

Stimulating peristalsis Rationale: Bisacodyl stimulates nerve endings in the intestinal mucosa, precipitating a bowel movement. Bisacodyl is not a bulk cathartic. Bulk-forming laxatives, such as psyllium hydrophilic mucilloid, form soft, pliant bulk that promotes physiological peristalsis. Bisacodyl is not a stool softener. Stool softeners, such as docusate sodium, permit fat and water to penetrate feces, which softens and delays the drying of the feces. Bisacodyl is not an emollient. Emollient laxatives, such as mineral oil, lubricate the feces and decrease absorption of water from the intestinal tract.

The nurse is administering a histamine H 2 antagonist to a client who has extensive burns. Which complication will it prevent? Colitis Gastritis Stress ulcer Metabolic acidosis

Stress ulcer Rationale: An ulcer of the upper gastrointestinal tract is related to excessive secretion of stress-related hormones, which increases hydrochloric acid production. Histamine H 2 antagonists decrease acid secretion. Colitis is not a complication of burns. Gastritis is not a complication of burns. Metabolic acidosis is not a complication of burns unless hypermetabolism or renal failure occurs; metabolic acidosis is not treated with H 2 antagonists.

Which advantage does aluminum and magnesium hydroxide have over baking soda (sodium bicarbonate) for the treatment of heartburn? They can be used for short-term relief. Absorption by the stomach mucosa is markedly enhanced. There is no direct effect on the systemic acid-base balance when taken as directed. Fewer side effects, such as diarrhea or constipation, are experienced when they are used properly.

There is no direct effect on the systemic acid-base balance when taken as directed. Rationale: Nonsystemic antacids are not readily absorbed, so they do not alter the acid-base balance. Sodium bicarbonate is absorbed and can alter the acid-base balance. For this reason, sodium bicarbonate should not be taken long-term. Both nonsystemic antacids and sodium bicarbonate can be used for short-term use. Nonsystemic antacids are insoluble and not readily absorbed. Diarrhea and constipation are side effects of nonsystemic antacids.

A female client with rheumatoid arthritis takes ibuprofen (Motrin) 600 mg PO 4 times a day. To prevent gastrointestinal bleeding, misoprostol (Cytotec) 100 mcg PO is prescribed. Which information is most important for the nurse to include in client teaching? Use contraception during intercourse. Ensure the Cytotec is taken on an empty stomach. Encourage oral fluid intake to prevent constipation. Take Cytotec 30 minutes prior to Motrin.

Use contraception during intercourse. Rationale: Cytotec, a synthetic form of a prostaglandin, is classified as pregnancy Category X and can act as an abortifacient, so the client should be instructed to use contraception during intercourse to prevent loss of an early pregnancy. A common side effect of Cytotec is diarrhea, so constipation prevention strategies are usually not needed. Cytotec and Motrin should be taken together to provide protective properties against gastrointestinal bleeding.

The nurse in the primary care office is following up with a client who has been experiencing frequent constipation. Which statement by the client about using psyllium indicates that additional teaching is needed? "I will take it in the morning with lots of water." "I will only take it until my constipation is relieved." "I will take it together with my other medications." "I may notice some bloating while I am taking it."

"I will take it together with my other medications." Rationale: When using psyllium to manage constipation, it needs to be taken with at least 240 mL of water. The client may experience abdominal discomfort or bloating while taking psyllium. When using psyllium to treat constipation, it should not be used long-term and be discontinued when the constipation has resolved. Bulk laxatives can interfere with the absorption of some medications, so it should be taken two hours before or two hours after other medications. The client's statement about taking the psyllium with other medications requires additional teaching.

Which information would the nurse include when teaching a client about antacid tablets? "Take them at 4-hour intervals." "Take them 1 hour before meals." "They are as effective as the liquid forms." "They interfere with the absorption of other medications."

"They interfere with the absorption of other medications." Rationale: Antacids interfere with absorption of drugs such as anticholinergics, barbiturates, some antibiotics, and cardiac medications. They may be taken as frequently as every 1 to 2 hours without adverse effects. Antacids should be given 1 or 2 hours after meals and at bedtime. Liquid antacids have a faster onset of action than tablets.

A client prescribed omeprazole for gastroesophageal reflux disease reports a new occurrence of significant diarrhea. Which response by the nurse is most appropriate? 'Stop taking your omeprazole.' 'This is a normal side effect of omeprazole.' 'We are going to collect a stool sample for testing.' 'Antidiarrheal medication can be used to decrease this.'

'We are going to collect a stool sample for testing.' Rationale: Omeprazole has been linked to an increased risk of diarrhea because of Clostridium difficile, so the stool should be tested. The nurse would not instruct the client to stop any medications without consulting the prescribing health care provider. Significant diarrhea in the setting of omeprazole is not a normal finding and should be investigated for Clostridium difficile. Antidiarrheal medication should not be recommended until Clostridium difficile infection is investigated and ruled out.

A client diagnosed with gastroesophageal reflux disease (GERD) is being treated with antacid therapy. When teaching the client about the antacids, which information would the nurse reinforce? Antacids should be taken 1 hour before meals. These should be scheduled at 4-hour intervals. Antacid tablets are just as fast and effective as the liquid form. Antacids commonly interfere with the absorption of other medications.

Antacids commonly interfere with the absorption of other medications. Rationale: Antacids interfere with absorption of medications such as anticholinergics, barbiturates, tetracycline, and digoxin. Liquid antacids are faster acting and more effective than antacid tablets. Antacids should be taken 1 or 2 hours after meals and at bedtime. Antacid tablets may be taken more frequently than every 4 hours.

Which statement is important for the nurse to include in the teaching plan of a client with irritable bowel syndrome who has instructions to take psyllium for constipation? "Urine may be discolored." "Stop taking the laxative once a bowel movement occurs." "Each dose should be taken with a full glass of water or juice." "Daily use may inhibit the absorption of some fat-soluble vitamins."

"Each dose should be taken with a full glass of water or juice." Rationale: This bulk-forming laxative works by absorbing water into the intestine, which increases bulk and distends the bowel to initiate reflex bowel activity, thus promoting a bowel movement. A full glass of fluid taken at the same time will help minimize the risk of esophageal obstruction or fecal impaction. Senna, a stimulant laxative, may cause urine discoloration. Bulk-forming laxatives, such as psyllium, are the only laxatives that are recommended for long-term use and in cases of irritable bowel syndrome; they are used to prevent constipation and should not be stopped once a bowel movement occurs. Prolonged use of lubricant laxatives, such as mineral oil, can inhibit the absorption of some fat-soluble vitamins.

The nurse gave a client the prescribed sodium polystyrene sulfonate. Which assessment finding indicates that the medication has been effective? Control of diarrhea An increase in serum sodium level An increase in serum calcium level A decrease in serum potassium level

A decrease in serum potassium level Rationale: Sodium polystyrene sulfonate is given to treat hyperkalemia. The effectiveness of the medication is determined by a decreasing serum potassium level. Sodium polystyrene sulfonate binds with the potassium in the gastrointestinal system and often causes diarrhea. Sodium retention and hypernatremia may occur as an adverse effect; this does not indicate effectiveness. Sodium polystyrene sulfonate decreases serum calcium levels in a small number of clients but does not increase calcium.

Which administration instruction would the nurse give a client prescribed ranitidine 150 mg daily to treat peptic ulcer disease (PUD)? As needed With meals At bedtime Before meals

At bedtime Rationale: Ranitidine is typically administered in a single dose at bedtime. This medication is used for 4 to 6 weeks in combination with other therapy; it is not used as needed, with meals, or when indigestion occurs.

In evaluating the effects of lactulose (Cephulac), which outcome would indicate that the drug is performing as intended? An increase in urine output. Two or three soft stools per day. Watery, diarrhea stools. Increased serum bilirubin.

Two or three soft stools per day. Rationale: The medication lactulose can be administered for either chronic constipation or for portal-systemic encephalopathy in clients with hepatic disease. Two to three stools a day indicate that lactulose is performing as intended for chronic constipation. This would also indicate it should be effective for the clients with encephalopathy because the lactulose's action prevents absorption of ammonia in the colon as it increases water absorption and softens the stool. The efficacy of the use for ammonia absorption would have to be verified by a serum ammonia level and observation of clearing of the client's mental status.

A nurse administers cimetidine to a 79-year-old male with a gastric ulcer. Which parameter may be affected by this drug and should be closely monitored by the nurse? Blood pressure Liver enzymes Mental status Hemoglobin

Mental status Rationale: Cimetidine is an H2 receptor blocker used in treatment of gastric ulcers. Cimetidine should be used cautiously in the elderly, as it is known to cause a change in mental status such as confusion in the elderly population. Cimetidine does not impact the blood pressure, liver enzymes, or hemoglobin.