GI medications HESI
A client has received a dose of dimenhydrinate (Dramamine). The nurse should observe relief of what symptom to evaluate that the medication has been effective? a) Chills b) Headache c) Nausea and vomiting d) Buzzing sound in the ears
c) Nausea and vomiting Rationale: Dimenhydrinate is used to prevent and treat the symptoms of dizziness, vertigo, nausea, and vomiting that accompany motion sickness.
An older client recently has been taking cimetidine (Tagamet). The nurse monitors the client for which most frequent central nervous system side effect of this medication? a) Tremors b) Dizziness c) Confusion d) Hallucinations
c) Confusion Rationale: Cimetidine is a histamine (H2)-receptor antagonist. Older clients are especially susceptible to 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 client who chronically uses nonsteroidal anti-inflammatory drugs (NSAIDs) has begun taking misoprostol (Cytotec). Which statement by the client indicates that the misoprostol is effective? a) "I have fewer muscle aches." b) "My joint mobility has improved." c) "I no longer have pain above my stomach." d) "I am no longer experiencing constipation."
c) "I no longer have pain above my stomach."
A client in the postanesthesia care unit (PACU) has a prescription for droperidol (Inapsine). The nurse determines that this medication has been prescribed to treat which condition? a) Pain b) Nausea c) Headache d) Confusion
b) Nausea Rationale: Droperidol is an antiemetic and is used to treat nausea.
A client has begun taking cascara sagrada. In monitoring the client for medication side effects, the nurse is likely to note which finding? a) Abdominal cramps b) Peptic ulcer disease c) Gastrointestinal bleeding d) Partial bowel obstruction
a) Abdominal cramps Rationale: Cascara sagrada is a laxative that causes nausea and abdominal cramps as the most frequent side effects.
The adult client with hepatic encephalopathy has a serum ammonia level of 95 mcg/dL and receives treatment with lactulose (Chronulac). The nurse determines that the client had the best and most realistic response if the serum ammonia level changed to which value after medication administration? a) 5 mcg/dL b) 10 mcg/dL c) 40 mcg/dL d) 90 mcg/dL
c) 40 mcg/dL Rationale: The normal serum ammonia level is 10 to 80 mcg/dL. In the client with hepatic encephalopathy, the serum level is not likely to drop below normal, nor is it likely to drop into the low-normal range. The most optimal but realistic change would be to 40 mcg/dL, which falls into the middle-normal range. A level of 90 mcg/dL represents insufficient effect of the medication. The nurse should also monitor the client for signs and symptoms that indicate improvement in the condition.
The nurse is preparing to administer prescribed medications to a client with hepatic encephalopathy. The nurse anticipates that the health care provider's prescriptions will include which medication? a) Bisacodyl (Dulcolax) b) Lactulose (Chronulac) c) Magnesium hydroxide (Milk of Magnesia) d) Psyllium hydrophilic mucilloid (Metamucil)
b) Lactulose (Chronulac) Rationale: Lactulose is a hyperosmotic laxative agent that has the adjunct benefit of lowering serum ammonia levels. This occurs because the medication lowers bowel pH and aids in the conversion of ammonia in the gut to the ammonium ion, which is poorly absorbed. Bisacodyl is a stimulant laxative. Magnesium hydroxide is a saline laxative. Psyllium hydrophilic mucilloid is a bulk laxative.
A client who has had a myocardial infarction has a prescription to take a powdered form of psyllium (Metamucil) after discharge. The nurse should plan to include which information when teaching the client about this medication? a) Mix the medication with applesauce. b) Mix the medication with a full glass of water or juice. c) Decrease fluid intake following administration of the medication. d) Decrease the amount of fiber in the diet when taking this medication.
b) Mix the medication with a full glass of water or juice. Rationale: Metamucil is a bulk-forming laxative that should be taken with a full glass of water or juice (not applesauce), followed by another glass of liquid. This will help prevent impaction of the medication in the stomach or small intestine. Fiber in the diet and fluid intake should not be decreased unless specifically prescribed by the health care provider.
A client who chronically uses nonsteroidal antiinflammatory drugs (NSAIDs) has been taking misoprostol (Cytotec). The nurse determines that the medication is having the intended therapeutic effect if which finding is noted? a) Resolved diarrhea b) Relief of epigastric pain c) Decreased platelet count d) Decreased white blood cell count
b) Relief of epigastric pain Rationale: The client who chronically 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 is not an intended effect.
The client with gastroesophageal reflux disease (GERD) has a new prescription for pantoprazole (Protonix). Which instruction should the nurse provide to the client? a) Chew the pill thoroughly. b) Swallow the tablet whole. c) Headache is expected to occur. d) Crush the pill if it is difficult to swallow.
b) Swallow the tablet whole.
A calcium carbonate antacid (such as Tums) has been prescribed for a client, and the nurse provides instructions to the client about the medication. The nurse should tell the client that it is best to take with the antacid with which item? a) Milk b) Water c) Yogurt d) Cheese
b) Water Rationale: Calcium carbonate antacids should not be taken with milk, milk products, or foods or supplements high in vitamin D because milk-alkali syndrome (headache, urinary frequency, anorexia, nausea, vomiting, fatigue) can occur. The best item to consume when taking calcium carbonate is water.
A client with a peptic ulcer is diagnosed with a Helicobacter pylori infection. The nurse is teaching the client about the medications prescribed, including clarithromycin (Biaxin), esomeprazole (Nexium), and amoxicillin (Amoxil). Which statement by the client indicates the best understanding of the medication regimen? a) "My ulcer will heal because these medications will kill the bacteria." b) "These medications are only taken when I have pain from my ulcer." c) "The medications will kill the bacteria and stop the acid production." d) "These medications will coat the ulcer and decrease the acid production in my stomach."
c) "The medications will kill the bacteria and stop the acid production." Rationale: Triple therapy for Helicobacter pylori infection usually includes two antibacterial medications 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 older client has recently been started on cimetidine (Tagamet). The nurse updates the care plan to include assessment for central nervous system (CNS) effects of this medication. Which is the most frequent CNS side effect of cimetidine? a) Tremors b) Dizziness c) Confusion d) Hallucinations
c) Confusion Rationale: Cimetidine is a histamine2-receptor antagonist that suppresses gastric acid secretion. Older clients are especially susceptible to the CNS effects of cimetidine, of which confusion is most frequent. Less common CNS side effects include headache, dizziness, drowsiness, and hallucinations.
The nurse has administered prochlorperazine to a client for relief of nausea and vomiting. The nurse should then assess the client for which frequent side effect of this medication? a) Diarrhea b) Drooling c) Blurred vision d) Excessive tearing
c) Blurred vision Rationale: Prochlorperazine is a phenothiazine-type antiemetic and antipsychotic agent. A frequent side effect is blurred vision. Other frequent side effects of this medication are constipation, dry mouth, and dry eyes.
A client who is in the postanesthesia care unit (PACU) has received a dose of ondansetron (Zofran). The nurse evaluates that this medication was effective if relief was obtained from which problem? a) Paralytic ileus b) Incisional pain c) Urinary retention d) Nausea and vomiting
d) Nausea and vomiting
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 (Axid) 2. Ranitidine (Zantac) 3. Famotidine (Pepcid) 4. Cimetidine (Tagamet) 5. Esomeprazole (Nexium) 6. Lansoprazole (Prevacid)
1. Nizatidine (Axid) 2. Ranitidine (Zantac) 3. Famotidine (Pepcid) 4. Cimetidine (Tagamet) Rationale: H2-receptor antagonists suppress secretion of gastric acid, alleviate symptoms of heartburn, and assist in 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 other medications listed are proton pump inhibitors.
The health care provider has written a prescription for ranitidine (Zantac), 300 mg once daily. Which time should the nurse schedule the medication? a) At bedtime b) After lunch c) With supper d) Before breakfast
a) At bedtime
The client in the preoperative holding area has been given a dose of scopolamine. The nurse should assess the client for which side effect of the medication? a) Dry mouth b) Diaphoresis c) Excessive urination d) Pupillary constriction
a) Dry mouth
A nurse notes that a client is taking lansoprazole (Prevacid). On assessment of the client, the nurse should ask which question to determine the effectiveness of this medication? a) "Has your appetite increased?" b) "Are you experiencing any heartburn?" c) "Do you have any problems with vision?" d) "Do you experience any leg pain when walking?"
b) "Are you experiencing any heartburn?"
The nurse notes in the medication record that a client is taking calcium carbonate chewable tablets. Based on this data, the nurse should ask the client about a history of which symptom? a) Flatus b) Heartburn c) Rectal pain d) Muscle twitching
b) Heartburn Rationale: Calcium carbonate can be used as an antacid for the relief of heartburn and indigestion. It also can be used as a calcium supplement or to bind phosphorus in the gastrointestinal tract in clients with chronic kidney disease.
A client is taking lansoprazole (Prevacid) for the chronic management of peptic ulcer disease. The nurse expects that the health care provider will advise the client to take which product if needed for a headache? a) Naproxen (Aleve) b) Ibuprofen (Motrin IB) c) Acetaminophen (Tylenol) d) Acetylsalicylic acid (aspirin)
c) Acetaminophen (Tylenol)
The nurse is preparing to give a client directions for proper use of aluminum hydroxide tablets. Which instruction by the nurse is appropriate? a) "Take the tablet at the same time as an antacid." b) "Swallow the tablet whole with a full glass of water." c) "Take each dose with a laxative to prevent constipation." d) "Chew the tablet thoroughly and then drink 8 ounces of water."
d) "Chew the tablet thoroughly and then drink 8 ounces of water." Rationale: Aluminum hydroxide tablets are an antacid and should be chewed thoroughly before swallowing to prevent them from entering the small intestine undissolved. An antacid should not be taken with the medication to prevent additive and interactive effects. Constipation is a side effect of the use of aluminum products, but the client should not take a laxative with each dose. This would promote laxative abuse and should be avoided if less habit-forming means can be used.
A client has begun medication therapy with pancrelipase (Pancrease MT). Which finding indicates that the medication is effective? a) Relief of heartburn b) Elimination of abdominal pain c) Stabilization of blood glucose levels d) A decrease in the amount of fat in the stools
d) A decrease in the amount of fat in the stools
A nurse is giving the client directions for proper use of aluminum hydroxide (Amphojel) tablets. What should the nurse tell the client? a) Swallow the tablets whole with a full glass of water. b) Take the tablets at the same time as other medications. c) Take each dose with a laxative to prevent constipation. d) Chew the tablets thoroughly and follow with 4 oz of water.
d) Chew the tablets thoroughly and follow with 4 oz of water.
An older client has been receiving cimetidine (Tagamet). The nurse should report to the health care provider (HCP) that the client is experiencing a side effect of the medication if which finding is noted during the assessment? a) Tremors b) Confusion c) Stiff joints d) Constipation
b) Confusion
A client is told by the health care provider to take aluminum hydroxide (Amphojel) as needed for heartburn. The nurse advises the client to watch for which common side effect of this medication? a) Dizziness b) Excitability c) Muscle pain d) Constipation
d) Constipation
A client with portal-systemic encephalopathy is receiving oral lactulose (Chronulac) daily. The nurse should check which item to determine the effectiveness of this medication? a) Lung sounds b) Blood pressure c) Blood ammonia level d) Serum potassium level
c) Blood ammonia level
A hospitalized client asks the nurse for sodium bicarbonate to relieve heartburn after a meal. The nurse reviews the client's medical record, knowing that the medication is contraindicated in which condition? a) Urinary calculi b) Chronic bronchitis c) Metabolic alkalosis d) Respiratory acidosis
c) Metabolic alkalosis
Which finding suggests to the nurse that a client with bleeding esophageal varices is experiencing an adverse effect of vasopressin therapy? a) Complaints of chest pain b) Temperature of 102° F c) Bounding peripheral pulses d) Blood urea nitrogen (BUN) of 20 mg/dL
a) Complaints of chest pain Rationale: Vasopressin therapy causes vasoconstriction, and adverse effects include myocardial ischemia, which may be evident by the client's complaints of chest pain. Options 2, 3, and 4 are not adverse effects. Vasopressin therapy can cause hypothermia. Because vasopressin has potent vasoconstrictive effects on the peripheral arterioles, weak versus bounding pulses may be found. The BUN noted in option 4 is normal.
A preoperative client receives a dose of scopolamine. The nurse determines that which sign or symptom later displayed by the client is a result of medication side effects? a) Dry mouth b) Diaphoresis c) Excessive urination d) Pupillary constriction
a) Dry mouth Rationale: Side effects of scopolamine, an anticholinergic medication, are dry mouth, urinary retention, decreased sweating, and dilation of the pupils.
A client with gastrointestinal hypermotility has a prescription to receive atropine sulfate. The nurse should withhold the medication and question the prescription if the client has a history of which disease process? a) Biliary colic b) Sinus bradycardia c) Peptic ulcer disease d) Narrow-angle glaucoma
d) Narrow-angle glaucoma Rationale: Atropine sulfate can cause a blockade of muscarinic receptors on the iris sphincter, producing mydriasis (dilation of the pupils). It also produces cycloplegia (relaxation of the ciliary muscles). It is contraindicated in clients with narrow-angle glaucoma. The other options are therapeutic reasons for using the medication.
A client has a PRN prescription for ondansetron (Zofran). For which condition should the nurse administer this medication to the postoperative client? a) Paralytic ileus b) Incisional pain c) Urinary retention d) Nausea and vomiting
d) Nausea and vomiting Rationale: Ondansetron is an antiemetic used to treat postoperative nausea and vomiting, as well as nausea and vomiting associated with chemotherapy.
A client who has been chronically taking acetylsalicylic acid (aspirin) for arthritis has been given a prescription for misoprostol (Cytotec). The nurse determines that the new medication is effective if the client states relief from which problem? a) Diarrhea b) Bleeding c) Joint aches d) Epigastric pain
d) Epigastric pain Rationale: A client who chronically uses aspirin is prone to gastric mucosal injury, which causes epigastric pain as a symptom. Misoprostol is a gastric protectant specifically given to prevent this occurrence. Diarrhea can be a side effect of the medication, but it is not an intended effect. Bleeding and joint aches are not relieved by misoprostol.
A client has a PRN prescription for trimethobenzamide (Tigan). The nurse should assess the client for which sign or symptom to determine whether the client needs a dose of this medication? a) Heartburn b) Constipation c) Abdominal pain d) Nausea and vomiting
d) Nausea and vomiting Rationale: Trimethobenzamide is an antiemetic agent used for relief of nausea and vomiting. The medication is not used to treat heartburn, constipation, or abdominal pain.
A client taking an oral laxative wants to obtain a rapid effect from the medication. How should the nurse instruct the client to take the medication? a) At bedtime b) With breakfast c) With the noon meal d) On an empty stomach
d) On an empty stomach
A client rings the call bell and asks for medication to relieve postoperative gas pains. The nurse selects which medication to be given as prescribed on the medication sheet? a) Droperidol b) Simethicone (Mylicon) c) Acetaminophen (Tylenol) d) Magnesium hydroxide (MOM)
b) Simethicone (Mylicon) Rationale: Simethicone is an antiflatulent used in the relief of pain caused by excessive gas in the gastrointestinal tract. Droperidol relieves postoperative nausea and vomiting. Acetaminophen is a nonopioid analgesic. Magnesium hydroxide is an antacid and laxative.
A client is complaining of gas pains after surgery and requests medication. The nurse selects which agent from the list of medications prescribed on an as-needed basis to give to the client? a) Droperidol (Inapsine) b) Simethicone (Mylicon) c) Acetaminophen (Tylenol) d) Magnesium hydroxide (Milk of Magnesia)
b) Simethicone (Mylicon) Rationale: Simethicone is an antiflatulent used to relieve pain caused by excessive gas in the gastrointestinal tract. Droperidol is used to treat postoperative nausea and vomiting. Acetaminophen is a nonopioid analgesic. Magnesium hydroxide is an antacid and laxative.
A home health nurse is visiting a client with a diagnosis of gastric ulcer. The nurse is providing instructions to the client regarding the administration of sucralfate (Carafate). The nurse instructs the client to take the medication four times daily and to take the medication at which times? a) 1 hour before meals and at bedtime b) After meals and at bedtime with a snack c) With meals and at bedtime with a glass of milk d) Spaced around the clock, taking it every 6 hours
a) 1 hour before meals and at bedtime Rationale: Sucralfate forms a protective coating over the gastric ulcer. It should be taken 1 hour before meals because food intake will stimulate gastric acid production and mechanical irritation, causing irritation to the gastric ulcer. It also is taken at bedtime to provide a protective coating over the gastric ulcer during the nighttime hours.
A health care provider has written a prescription for ranitidine (Zantac) 300 mg once daily. The client indicates understanding of use of this medication by stating that the prescribed dose is best taken at what time? a) At bedtime b) After lunch c) With supper d) Before breakfast
a) At bedtime Rationale: Ranitidine is a histamine2 (H2)-receptor antagonist and should be taken at bedtime, when it is given as a single daily dose. This allows for prolonged effect and provides the greatest protection of the gastric mucosa both during sleep and around the clock.
A client has a prescription for magnesium citrate to prevent constipation after undergoing barium studies of the gastrointestinal tract. How should the nurse administer the magnesium citrate? a) With fruit juice only b) At room temperature c) With a full glass of water d) After it is chilled in the refrigerator
d) After it is chilled in the refrigerator Rationale: Magnesium citrate is available as an oral solution and should be served chilled to make it more palatable.
The nurse has administered a dose of docusate (Colace). The nurse later evaluates that the medication has the intended effect if the client experiences which finding? a) Decreased heartburn b) Decrease in fatty stools c) Relief of sharp abdominal pain d) Bowel movement with soft formed stool
d) Bowel movement with soft formed stool Rationale: Docusate is a stool softener that relieves constipation because it promotes absorption of water into the stool, producing a softer consistency of stool.
Oral neomycin has been prescribed for a client with a diagnosis of portosystemic encephalopathy. The nurse reviews the health care provider's prescription and determines that this medication has been prescribed for which purpose? a) Prevent infection. b) Prevent restlessness in the client. c) Prevent fluid retention and ascites. d) Destroy normal bacteria found in the bowel.
d) Destroy normal bacteria found in the bowel. Rationale: Neomycin may be prescribed for the client with portosystemic encephalopathy. It is a broad-spectrum antibiotic that destroys normal bacteria found in the bowel, thereby decreasing protein breakdown and ammonia production.
A client with a history of duodenal ulcer is taking calcium carbonate (Tums) chewable tablets. Which finding indicates that the client is experiencing optimal effects of the medication? a) Heartburn is relieved. b) Muscle twitching stops. c) The serum calcium level increases. d) The serum phosphorus level decreases.
a) Heartburn is relieved.
A client is taking docusate sodium (Colace). The nurse monitors for which finding to determine whether the client is having a therapeutic effect from this medication? a) Reduction in steatorrhea b) Hematest-negative stools c) Regular bowel movements d) Absence of abdominal pain
c) Regular bowel movements
A client with peptic ulcer disease who has been given a prescription for propantheline (Pro-Banthine) asks the nurse how to take the medication. The nurse explains that this medication should be taken in which way? a) With meals b) With antacids c) Just after meals d) 30 minutes before meals
d) 30 minutes before meals
A client admitted to the medical nursing unit has a diagnosis of gastroesophageal reflux disease (GERD). Metoclopramide (Reglan) has been prescribed four times a day. The nurse should schedule administration of the medication for which times? a) Every 8 hours b) With meals and at bedtime c) Right after meals and at bedtime d) 30 minutes before meals and at bedtime
d) 30 minutes before meals and at bedtime Rationale: Metoclopramide is a gastrointestinal stimulant. Administration should be scheduled 30 minutes before meals and at bedtime to allow the medication time to begin working before food intake and digestion. The other options are incorrect.
A client with recurrent constipation has been prescribed psyllium (Metamucil). Teaching provided by the nurse should include which instruction? a) Mix the psyllium powder with any cold beverage. b) Mix the psyllium powder with 4 oz of a hot beverage. c) Mix the psyllium powder with gelatin, applesauce, or pudding. d) Mix the psyllium powder with 8 oz of water or juice followed by drinking an additional 8 oz of liquid.
d) Mix the psyllium powder with 8 oz of water or juice followed by drinking an additional 8 oz of liquid.
A client has just taken a dose of trimethobenzamide hydrochloride (Tigan). Which finding indicates that this client has had a therapeutic response to the medication? a) Relief of constipation b) Decrease in heartburn c) Absence of abdominal pain d) Relief of nausea and vomiting
d) Relief of nausea and vomiting
The nurse is administering senna (Senokot) to an older client for the treatment of constipation. The client's spouse asks the nurse how the medication works. The nurse incorporates which information in formulating a reply? a) It increases peristalsis b) It lines the wall of the bowel. c) It adds fiber and bulk to the stool. d) It stimulates the vagus nerve to improve bowel tone.
a) It increases peristalsis Rationale: Senna works by altering the transport of water and electrolytes in the large intestine, which causes accumulation of water in the mass of stool and increased peristalsis.
The nurse is reading the medication list for a postoperative client and notes that a PRN prescription for ondansetron was administered. Evaluation of the effectiveness of the medication is determined by the nurse if the client makes which statement? a) "My headache is gone." b) "I no longer feel nauseous." c) "The dizziness has stopped." d) "The pain at my incision has decreased."
b) "I no longer feel nauseous."
Dicyclomine hydrochloride (Bentyl) has been prescribed for a client with irritable bowel syndrome, and the nurse provides instructions to the client about how to take this medication. Which statement, if made by the client, best indicates an understanding of how to take this medication? a) "I should take the pill with food and at meal times." b) "I should take the pill 30 minutes before each meal." c) "I should take the pill after I have finished eating my meal." d) "I should take the pill when I first wake up in the morning and right before I go to bed."
b) "I should take the pill 30 minutes before each meal." Rationale: Dicyclomine hydrochloride is an anticholinergic, antispasmodic agent often used to treat irritable bowel syndrome that is unresponsive to diet therapy. To be effective in decreasing bowel motility, antispasmodic medication should be administered 30 minutes before meals.
A client has just been given a prescription for diphenoxylate with atropine (Lomotil). The nurse determines that the client understands important information about this medication if the client makes what statement? a) "It's best to take this medication with a laxative." b) "This medication contains a habit-forming ingredient." c) "Drooling may occur while I am taking this medication." d) "Irritability may occur while I am taking this medication."
b) "This medication contains a habit-forming ingredient." Rationale: The client should understand that an adverse effect of this medication is that it may be habit-forming, so careful adherence to proper dose is important. The medication is an antidiarrheal and therefore should not be taken with a laxative. Side effects of the medication include dry mouth and drowsiness. Drooling and irritability are not associated with the use of this medication.
A client has been told by a health care provider to take psyllium (Metamucil) daily. The nurse should tell the client to take the medication with which item? a) A dose of antacid b) A total of two glasses of liquid c) Gelatin, applesauce, or pudding d) A multivitamin and mineral supplement
b) A total of two glasses of liquid Rationale: Psyllium (Metamucil) is a bulk-forming laxative that 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.
A client has been given lansoprazole (Prevacid) for the chronic management of Zollinger-Ellison syndrome. The nurse instructs the client to take which product for pain while taking this medication? a) Ibuprofen (Motrin IB) b) Acetaminophen (Tylenol) c) Naproxen sodium (Aleve) d) Acetylsalicylic acid (aspirin)
b) Acetaminophen (Tylenol) Rationale: Lansoprazole is a proton pump inhibitor. Zollinger-Ellison syndrome is a hypersecretory condition of the stomach, associated with increased risk of problems from irritation of the stomach lining. The client should take acetaminophen for pain relief. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen sodium, should be avoided, as should aspirin, because they are potential stomach irritants.
A client with Crohn's disease is scheduled to receive an infusion of infliximab (Remicade). What intervention by the nurse will determine the effectiveness of treatment? a) Monitoring the leukocyte count for 2 days after the infusion b) Checking the frequency and consistency of bowel movements c) Checking serum liver enzyme levels before and after the infusion d) Carrying out a Hematest on gastric fluids after the infusion is completed
b) Checking the frequency and consistency of bowel movements Rationale: The principal manifestations of Crohn's disease are diarrhea and abdominal pain. Infliximab (Remicade) is an immunomodulator that reduces the degree of inflammation in the colon, thereby reducing the diarrhea.
The nurse reads that metoclopramide (Reglan) is prescribed for a client. Based on this prescription, the nurse expects to note that which diagnosis documented? a) Asthma b) Gastroparesis c) Allergic rhinitis d) Chronic kidney disease
b) Gastroparesis Rationale: Metoclopramide (Reglan) stimulates motility of the upper gastrointestinal track. It is used to stimulate gastric emptying, for the treatment of gastroparesis and to treat gastroesophageal reflux disease. It may also be prescribed to relieve nausea and vomiting. It is not a respiratory medication or a renal/urinary medication and is not used to treat the conditions noted in the incorrect options.
Mineral oil has been prescribed for a child with constipation, and the nurse teaches the mother about administration of the mineral oil. Which statement by the mother indicates effective teaching? a) "I will administer the mineral oil before each meal." b) "I will administer the mineral oil followed by a glass of warm water." c) "I will mix the mineral oil with a chilled drink before administration." d) "I will mix the mineral oil with 8 ounces of warm juice before administration."
c) "I will mix the mineral oil with a chilled drink before administration." Rationale: Mineral oil is best tolerated when it is given chilled or mixed with cold drinks. Mixing the oil with chocolate milk, blending it with ice cubes and fruit juice, or chilling it helps to disguise the taste. Administering mineral oil before meals would affect the child's appetite.
A client with constipation has been directed to take oral bisacodyl (Dulcolax). The nurse instructs the client on how to receive the most rapid effect from the medication. The client demonstrates understanding of use of this medication by stating that which method will produce the most rapid effect? a) At bedtime b) With a large meal c) On an empty stomach d) With two glasses of milk
c) On an empty stomach Rationale: The most rapid results from bisacodyl occur when it is taken on an empty stomach. If it is taken at bedtime, the client will have a bowel movement in the morning. It will not have a rapid effect if taken with a large meal or with two glasses of milk.
A client has begun medication therapy with pancrelipase (Pancrease MT). The nurse evaluates that the medication is having the optimal intended benefit if which effect is observed? a) Weight loss b) Relief of heartburn c) Reduction of steatorrhea d) Absence of abdominal pain
c) Reduction of steatorrhea Rationale: Pancrelipase (Pancrease, Creon) 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.
A client is taking cascara sagrada and develops abdominal cramps. What interpretation by the nurse is most likely correct? a) The client has peptic ulcer disease. b) The client is experiencing a case of influenza. c) This is a common side effect of this medication. d) The client may have a partial bowel obstruction.
c) This is a common side effect of this medication.
A client has a prescription for sucralfate (Carafate), orally four times daily. The nurse writes which schedule for this medication on the medication administration record? a) Every 6 hours b) With meals and at bedtime c) 1 hour after meals and at bedtime d) 1 hour before meals and at bedtime
d) 1 hour before meals and at bedtime Rationale: Sucralfate is prescribed to treat gastric ulcers. It should be scheduled for administration 1 hour before meals and at bedtime to allow it to form a protective coating over the gastric ulcer to prevent irritation by food, gastric acid, and mechanical movement of the stomach.
A client has a new prescription for metoclopramide (Reglan). On review of the chart, the nurse identifies that this medication can be safely administered with which condition? a) Intestinal obstruction b) Peptic ulcer with melena c) Diverticulitis with perforation d) Vomiting following cancer chemotherapy
d) Vomiting following cancer chemotherapy Rationale: Metoclopramide is a gastrointestinal stimulant and antiemetic. Because it is a gastrointestinal stimulant, it is contraindicated with gastrointestinal obstruction, hemorrhage, or perforation. It is used in the treatment of emesis after surgery, chemotherapy, and radiation.
An older client takes cascara sagrada for ongoing management of chronic constipation. The nurse assesses the client's laboratory results for which electrolyte imbalance related to long-term use of this medication? a) Hypokalemia b) Hyperkalemia c) Hyponatremia d) Hypernatremia
a) Hypokalemia Rationale: Hypokalemia can result from long-term use of cascara sagrada, a laxative. The medication stimulates peristalsis and alters fluid and electrolyte transport, thus helping fluid to accumulate in the colon.
The nurse instructs a client taking aluminum hydroxide (Amphojel) that the most common side effect associated with administration of this medication is which effect? a) Diarrhea b) Headache c) Constipation d) Muscle weakness
c) Constipation Rationale: Aluminum-containing antacids are constipating, so the client should be instructed to take a stool softener or additional bulk-type laxatives to relieve this uncomfortable side effect.
A client reports frequent use of sodium bicarbonate to relieve heartburn after meals. The nurse should monitor the client for which condition that the client is at risk for with long-term frequent use of this medication? a) Urinary calculi b) Chronic bronchitis c) Metabolic alkalosis d) Respiratory acidosis
c) Metabolic alkalosis Rationale: Sodium bicarbonate is an electrolyte modifier and antacid. With large doses or long-term use, it can cause metabolic alkalosis.
The nurse has just given a client a dose of a PRN medication called loperamide (Imodium). The nurse documents in the client's record that the client received this medication for complaints of what symptom? a) Diarrhea b) Tarry stools c) Constipation d) Abdominal pain
a) Diarrhea Rationale: Loperamide is an antidiarrheal agent commonly administered after the client experiences loose stools. It is used to treat both acute diarrhea and chronic diarrhea from disorders such as inflammatory bowel disease. It also can be used to reduce the volume of drainage from an ileostomy.
The nurse has given instructions to a client who has just been prescribed cholestyramine (Questran). Which statement by the client indicates a need for further instructions? a) "I will continue taking vitamin supplements." b) "This medication will help lower my cholesterol." c) "This medication should only be taken with water." d) "A high-fiber diet is important while taking this medication."
c) "This medication should only be taken with water." Rationale: Cholestyramine (Questran) 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 client has been taking omeprazole (Prilosec) for 4 weeks. The ambulatory care nurse evaluates that the client is receiving the optimal intended effect of the medication if the client reports the absence of which symptom? a) Diarrhea b) Heartburn c) Flatulence d) Constipation
b) Heartburn Rationale: 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.
Lactulose (Chronulac) is prescribed for a client with a diagnosis of hepatic encephalopathy. The nurse should determine that this medication has had a therapeutic effect if assessment reveals which finding? a) Increased protein level b) Increased red blood cell count c) Decreased serum ammonia level d) Decreased white blood cell count
c) Decreased serum ammonia level Rationale: Lactulose is prescribed for the client with hepatic encephalopathy to reduce bacterial breakdown of protein in the bowel. The medication creates an acidic environment in the bowel and causes the ammonia to leave the bloodstream and enter the colon. Ammonia then becomes trapped in the bowel. Lactulose also has a laxative effect that allows for the elimination of the ammonia.
A client is experiencing diarrhea. The nurse reviews the client's PRN medication prescription sheet and should plan to administer which medication for this problem? a) Psyllium (Metamucil) b) Sennosides (Senokot) c) Loperamide (Imodium) d) Bisacodyl (Dulcolax Bowel Prep Kit)
c) Loperamide (Imodium) Rationale: Loperamide is an antidiarrheal agent. It inhibits peristalsis in the intestinal wall and inhibits intestinal secretion so that the number of stools and water content are decreased. Psyllium (Metamucil), sennosides (Senokot), and bisacodyl (Dulcolax Bowel Prep Kit) are laxatives.
A client with a gastric ulcer has a prescription for sucralfate (Carafate), 1 g by mouth four times daily. The nurse should schedule the medication for which times? a) With meals and at bedtime b) Every 6 hours around the clock c) One hour after meals and at bedtime d) One hour before meals and at bedtime
d) One hour before meals and at bedtime Rationale: 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.
A client has been taking omeprazole (Prilosec) for 4 weeks. The ambulatory care nurse evaluates medication effectiveness by asking the client if relief was obtained from which symptom? a) Diarrhea b) Heartburn c) Flatulence d) Constipation
b) Heartburn Rationale: Omeprazole is a proton pump inhibitor and is classified as an antiulcer agent. The medication relieves pain from gastric irritation, which often is experienced as "heartburn" by clients.
A client has a PRN prescription for loperamide hydrochloride (Imodium). For which condition should the nurse administer this medication? a) Constipation b) Abdominal pain c) An episode of diarrhea d) Hematest-positive nasogastric tube drainage
c) An episode of diarrhea Rationale: Loperamide is an antidiarrheal agent. It is used to manage acute and chronic diarrhea in conditions such as inflammatory bowel disease. Loperamide also can be used to reduce the volume of drainage from an ileostomy.
