Pharm Module 6 Chapter 38 & 39

Which of the following nursing diagnoses is a priority for a client who is 89 years old and has frequent liquid stools?

Deficient Fluid Volume related to excessive losses in liquid stools

What is the priority nursing diagnosis for an 89-year-old client with frequent liquid stools?

Deficient fluid volume

A client has been prescribed rabeprazole (Aciphex). It will be important for the nurse to assess the client's drug history to determine if the client is taking which drug?

Digoxin

Administering an antacid to a client taking which medications will decrease the absorption of the medication and result in a decreased drug effect?

Digoxin

A client taking a remedy for constipation and has been advised to avoid taking the drug with milk. The nurse knows which drug has this recommendation?

Bisacodyl (Dulcolax) Explanation: Bisacodyl tablets are enteric-coated. They do not dissolve in stomach acid, but do dissolve as pH becomes more alkaline in the small intestine. Milk makes gastric pH more alkaline. The tablets dissolve too soon and cause gastric irritation. Antacids and drugs, which decrease gastric acid secretion (proton-pump inhibitors and histamine antagonist antiulcer drugs) will also have this effect. Docusate, milk of magnesia, and psyllium are not affected by gastrointestinal pH.

A critical care nurse is preparing to administer an intragastric drip of an antacid to a client through a nasogastric tube. How should the nurse most accurately titrate the dose and frequency?

By aspirating stomach contents and measuring the pH Explanation: For clients with a nasogastric tube in place, antacid dosage may be titrated by aspirating stomach contents, determining pH, and then basing the dose on the pH. Accurate measurement of gastric pH cannot be determined from the buccal mucosa or urine.

A nurse is caring for a client who has developed diarrhea after antibiotic administration. The client has a BUN of 35 and creatinine of 1.8. The provider has ordered diphenoxylate with atropine for the client. What action should the nurse implement?

Call the prescriber about the laboratory tests. Explanation: The nurse knows that the use of diphenoxylate with atropine requires caution with clients that have renal or hepatic compromise. The nurse should call the provider and make sure the provider is aware of the laboratory values before administering the medication. Discussion with other nurses is not warranted. The medication does not need to be held at this time as diphenoxylate with atropine is not contraindicated with renal or hepatic compromise but can be administered with caution.

What instruction should be included in the plan of care as nonpharmacologic interventions for an older adult client experiencing diarrhea? Select all that apply.

Eat a diet of bland foods such as rice, soup, and crackers. Increase fluid intake to 2-3 liters per day.

An older adult client has received a third dose of diphenoxylate. In addition to monitoring the number and consistency of the client's stools, the nurse should prioritize what assessment?

Fluid and electrolyte balance

The client states that prior to exams at school, the client has abdominal cramping and diarrhea. What does the nurse suspect is the trigger for these signs and symptoms?

Functional diarrhea disorder Explanation: The client is describing functional diarrhea disorder where the diarrhea occurs as a result of stress or anxiety.

The health care provider has prescribed ranitidine for a hospitalized client on a unit. Prior to administering the drug for the first time, which adverse effects should the nurse mention to the client?

Headache Explanation: Adverse effects with H2RAs such as ranitidine are typically uncommon and mild with the usual doses and duration of treatment. However, effects can include diarrhea or constipation, headache, dizziness, muscle aches, and fatigue.

Which adverse reaction of proton pump inhibitors is specific to menopausal women with osteoporosis?

Increased fracture risk

A client arrives at the walk-in clinic reporting vomiting and a burning sensation in the mid-epigastric region. The nurse suspects that the client has peptic ulcer disease. Which is a potential cause of peptic ulcer disease?

Infection with H. pylori Explanation: Peptic ulcers can result from cell destruction caused by Helicobacter pylori infection, gastric acid, pepsin, and ingestion of nonsteroidal anti-inflammatory drugs (NSAIDs).

A client develops Clostridium difficile after receiving antibiotic therapy. The client asks the nurse how this occurs. Which is the nurse's best response?

"By suppressing normal flora, antibiotics allow proliferation of the organism."

A caregiver of a 1-year-old asks the nurse if they can give the diphenoxylate that was prescribed for an older sibling to the child. Which is the nurse's best response?

"Children younger than 1 year of age should not be given this medication."

A nurse is teaching a client about omeprazole, which has been prescribed as part of a regimen to treat an H. pylori infection. What statement, made by the client, suggests that the client understands proper use of the drug?

"I need to swallow the drug whole."

The health care provider has determined that an older adult client would benefit from using a bulk-forming laxative. What instruction should the nurse include when providing education related to proper drug use?

"Make sure you take the laxative with a glass of water."

A nurse is teaching a client about prescribed lansoprazole. The nurse instructs the client to take the drug at which time?

1 hour before eating

A client is prescribed a proton pump inhibitor to treat erosive gastritis. How soon will the client's symptoms be resolved?

1 to 2 weeks

When administering a bulk laxative to a client, which action is important for the nurse to take?

Administer the laxative with a full glass of water or juice.

A client with a diagnosis of peptic ulcer disease has begun taking sucralfate. The nurse should caution the client against the concurrent use of which classification of medications?

Antacids Explanation: Antacids decrease the effects of sucralfate, and people should not take them within 30 minutes before or after administration of sucralfate.

The nurse should warn a client taking aluminum- and calcium-containing antacids about which adverse effects?

Constipation

A student nurse is caring for a client who is to receive magnesium citrate in 2 hours. What would the nursing instructor suggest to make the medication more palatable while retaining its potency?

Chilling it

A 29-year-old woman has been prescribed alosetron (Lotronex) for irritable bowel syndrome. Before starting the drug therapy, the nurse will advise the client about which adverse effect(s)?

Constipation

A client reports to the nurse about needing to strain to defecate. The client adds that defecating is very painful. What laxative will the nurse suggest to the prescriber based on the painful defecation?

Docusate Explanation: A laxative such as a stool softener like docusate sodium is recommended for clients who are straining or for whom defecation is painful. Sorbitol may be given with activated charcoal to remove toxic substances. Bulk-forming laxatives such as psyllium are used in clients who are debilitated, older, or unable or unwilling to eat an adequate diet. Fluids and fiber are indicated for all clients to encourage a healthy bowel regimen.

What recommendations should be included in client teaching as a means of avoiding constipation? (Select all that apply.)

Drink plenty of fluids. Be active and exercise daily. Eat foods high in bulk or roughage.

What nonpharmacologic intervention is included in the plan of care for an adult client experiencing diarrhea? Select all that apply.

Increase fluids intake to 2-3 liters per day. Diet of bland foods such as rice, soup, and applesauce Explanation: In most cases of acute, nonspecific diarrhea in adults, fluid losses are not severe, and clients need only simple replacement of fluids and electrolytes to replace those lost in the stool. Acceptable replacement fluids during the first 24 hours include 2 to 3 liters of clear fluids. Also, a diet consisting of bland foods such as rice, soup, salted crackers, cooked cereals, baked potatoes, eggs, and applesauce is best. Increasing the intake of protein is not warranted. Clients should be careful exercising and should not add weight training while experiencing diarrhea.

A 33-year-old woman has irritable bowel syndrome (IBS). The physician has prescribed simethicone (Mylicon) for her discomfort. Which will the nurse monitor most closely during the client's drug therapy?

Increased abdominal pain and vomiting Explanation: The nurse needs to closely monitor the client for increased abdominal pain, nausea, fever, and vomiting. These symptoms are not indicative of excessive flatus, for which simethicone is prescribed, but indicate that the client needs urgent medical attention for another condition.

The home health nurse is caring for an 82-year-old client who reports almost daily diarrhea. The nurse should assess for what common cause of diarrhea in older adults?

Laxative overuse

The client diagnosed with peptic ulcer disease states, "I've never been a really anxious type of person, so I never thought I'd develop ulcers." The nurse has responded with health education addressing the etiology of peptic ulcer disease (PUD). What causative factors should the nurse cite? Select all that apply.

Physiologic or psychological stress Cigarette smoking Infections Nonsteroidal anti-inflammatory drugs

The nurse administers ranitidine cautiously to clients with evidence of what condition?

Renal disease

The client has a magnesium-based antacid prescribed for administration before meals. The nurse knows to withhold the medication if the client exhibits what?

Renal dysfunction Explanation: Magnesium-based antacids are contraindicated in clients with renal failure.

A client with a history of constipation has been taking over-the-counter laxatives with good success. The client tells the nurse that he or her is relieved to have found a solution to his or her constipation. When providing health education, the nurse should prioritize what topic?

Strategies for preventing dependence on laxatives

An adult client asks the nurse how many stools per week is considered "normal." The nurse should indicate that there is no fixed number but that functional constipation is diagnosed at what frequency?

Three stools per week the traditional medical definition of constipation includes three or fewer bowel movements per week.

A client taking a chemical stimulant laxative and medications for heart failure and osteoarthritis calls the clinic and reports, "I'm just not feeling right." What is the priority question the nurse should ask this client?

Timing of medication administration

The client will receive cimetidine 800 mg PO at bedtime. Prior to administration, the nurse should inform the client that common side effects related to this medication include:

headache.

A nurse assesses a client for signs and symptoms of tardive dyskinesia when the client is receiving which drug?

metoclopramide Explanation: Tardive dyskinesia (nonreversible, involuntary muscle spasms), which is typically associated with conventional antipsychotics, is known to occur with long-term use (12 weeks or more) of metoclopramide. Ondansetron is used in the treatment of nausea and vomiting and works by blocking serotonin. Famotidine is used to treat esophagitis and is used cautiously in clients with diabetes. Lansoprazole is used to treat gastric and duodenal ulcers, GERD, and pathologic hypersecretory condition and prolonged treatment may decrease the body's ability to absorb vitamin B12, resulting in anemia.

A client is prescribed cimetidine for the treatment of a peptic ulcer disease and gastric reflux. The dosage of this drug should be reduced if the client has:

renal disease. Explanation: H2RAs must be used with caution in clients with renal disease. Since these drugs are eliminated through the kidneys, dosages are reduced to avoid adverse effects.

A client who is postoperative day one following a metatarsal amputation is experiencing nausea and vomiting. Consequently, the nurse has administered an intravenous dose of metoclopramide. This drug will relieve the client's nausea by:

stimulating the motility of the client's upper GI tract. Explanation: Metoclopramide's mechanism of action is unclear. However, it appears to sensitize tissues to the effect of acetylcholine. It has the cholinergic-like effect on the upper GI tract of stimulating motility but does not stimulate gastric, pancreatic, or gallbladder secretions. The drug does not affect gastric pH, inhibit proton pumps, or eradicate H. Pylori.

The nurse develops a teaching plan for a 77-year-old client who has been prescribed loperamide PRN. The nurse's priority teaching point is what?

"Take the drug after each loose stool." Explanation: Loperamide is taken repeatedly after each loose stool. Teaching the client when to take the drug is the priority teaching point. Paregoric, and not loperamide, can cause hallucinations and respiratory depression. The drug is absorbed systemically. There is no absolute contraindication against the use of vitamin supplements.

The nurse is about to administer diphenoxylate (Lomotil) to a client for the first time. Which of the following side effects should be included in the teaching about this medication?

"This medication may make you feel lightheaded or drowsy."

A female client has GERD and is taking cimetidine. She continues to have gastric discomfort and asks whether she can take an antacid. Which is an appropriate response by the nurse?

"Yes, but be sure to wait at least 2 hours to take the antacid after you take the cimetidine."

The client prescribed nizatidine chooses to take the medication once a day at bedtime. What dosage will the nurse administer?

150 to 300 mg

The nurse should counsel a client to discontinue use of over-the-counter antidiarrheals and seek treatment from a health care provider if diarrhea persists for how long?

2 days Explanation: The nurse should counsel a client to discontinue use of over-the-counter antidiarrheals and seek treatment from a health care provider if diarrhea persists for more than 2 days. Diarrhea lasting more than 2 days can indicate infection or a condition that will require more intense treatment with prescription medication. Dehydration can occur if untreated. Diarrhea of 12 hours to 1 day can be viral. Diarrhea for 7 days can be life threatening.

A client has been prescribed 200 micrograms of misoprostol to be taken 4 times a day orally for the prevention of gastric ulcers. The drug is available in 100 microgram tablets. How many tablets should the nurse administer to the client each time?

2 tablets

The nurse is seeing a 69-year-old client who is highly physically active and consumes a balanced diet that includes adequate fluid intake. Despite this, the client states experiencing occasional constipation in recent months. What remedy should be the nurse's first suggestion?

A bulk-forming (fiber) laxative Explanation: Bulk-forming (fiber) laxatives are considered the safest and most physiologic of the laxatives. As such, they are normally preferable to stimulant and hyperosmotic laxatives for occasional relief of constipation. Bismuth subsalicylate does not relieve constipation.

A client has been prescribed chlorpromazine hydrochloride for nausea. What assessment should the nurse perform before the drug is administered to the client?

Assess signs of fluid and electrolyte imbalances Explanation: Before chlorpromazine hydrochloride is administered to the client, the nurse should assess for signs of fluid and electrolyte imbalances. When antacids are given, the nurse keeps a record of the client's bowel movements because these drugs may cause constipation or diarrhea. The nurse should monitor continuous spitting of blood and measure oral fluid intake after chlorpromazine hydrochloride is administered. While the client is undergoing chlorpromazine hydrochloride therapy, the nurse needs to provide the client mouthwash or frequent oral rinses to remove the disagreeable taste that accompanies vomiting.

A client presents to the walk-in clinic reporting vomiting and burning in the mid-epigastria. The nurse suspects peptic ulcer disease and knows that to confirm peptic ulcer disease, the provider is likely to order a diagnostic test to detect the possible presence of what?

Infection with Helicobacter pylori Explanation: Peptic ulcers may result from increased acid production, decrease in the protective mucous lining of the stomach, infection with Helicobacter pylori bacteria, or a combination of these. Peptic ulcers do not result from decreased acid secretion. While gastric irritation can be caused by NSAIDs, gastric irritation can result from many different causes so this would not be specifically assessed for unless the client was found to use NSAIDs frequently, which is not indicated by the question.

The nurse should be aware that ranitidine achieves a therapeutic effect by which means?

Inhibiting the secretion of gastric acid

What is the correct rationale for why the nurse would administer a laxative at a separate time from the client's other medications?

Laxatives may reduce absorption of other drugs present in the GI tract. Explanation: Laxatives may reduce absorption of other drugs present in the GI tract by combining with them chemically, or hastening their passage through the intestinal tract

A client is diagnosed with peptic ulcer due to H. pylori. The nurse would anticipate administering which agent in conjunction with an antibiotic?

Omeprazole Explanation: Omeprazole is a proton pump inhibitor which is used as part of combination therapy to treat H. pylori infections. Magaldrate is an antacid that is used to relieve GI hyperacidity. Sucralfate is a GI protectant that is used as short-term treatment of duodenal ulcers. Cimetidine is a H-2 receptor antagonist used to treat duodenal and benign gastric ulcers.

A nurse is providing education to an adult female client who has been prescribed misoprostol. What instruction should the nurse include in the teaching?

Use effective contraceptive measures.

A client experiencing diarrhea asks the nurse about over-the-counter (OTC) antidiarrheals. Which OTC should not be taken with aspirin?

bismuth subsalicylate Explanation: Bismuth subsalicylate is a commonly used OTC medication for diarrhea. It has a salicylate, which is in the family of aspirin. A nurse should teach the client that use of the medication with aspirin can cause an overdose.

A nurse is caring for a client experiencing stomach hyperacidity. The health care provider has prescribed aluminum carbonate gel. The nurse would administer this drug cautiously to the client with which condition?

upper GI bleeding Explanation: The nurse should administer the aluminum carbonate gel with caution in clients with upper GI bleeding. Calcium-containing antacids are used with caution in clients with renal impairment. Misoprostol is contraindicated in clients with pheochromocytoma. Metoclopramide is contraindicated in clients with GI obstruction.

The following data identified during a nursing assessment and interview. When considering risks for the development of a peptic ulcer, which situation should the nurse discuss with the client?

Self medicates with a nonsteroidal anti-inflammatory drug (NSAID) daily. Explanation: The leading cause of peptic ulcers in the United States is the use of NSAIDs. NSAIDS inhibit cyclooxygenase receptors, and one of the functions of these sites is the production of the mucous lining in the stomach. While the other situations may contribute to GI distress, NSAID used in primary risk factor for this client.

Client teaching should include what instruction about antacids?

Take antacid 1 hour before other medications.

The nurse is caring for a client who has recently been prescribed misoprostol. What change in the client's health status should the nurse communicate most promptly to the care provider?

The client believes that she may be pregnant. Explanation: Misoprostol is absolutely contraindicated during pregnancy because it is an abortifacient. None of the other listed aspects of the client's recent health history contraindicate the safe use of the drug.

A client is admitted to the hospital for pneumonia. Since admission, the client has not had a bowel movement. The physician prescribes magnesium hydroxide. What should be an outcome of this therapy?

The client will have a bowel movement after taking the drug.

While reviewing the medication history of a client newly prescribed omeprazole, the nurse sees that the client is also taking warfarin. What potential interaction should the nurse account for when developing the plan of care for this client?

hemorrhage Explanation: Omeprazole increases blood levels of the anticoagulant warfarin, thus creating a risk for bleeding.

The parent of an adolescent client reports that the teen has chronic diarrhea and lacks an appetite. Assessment reveals that the client is significantly underweight, has dry hair, and exhibits erosion of tooth enamel. When asked, the client reports occasional laxative use for "constipation." What condition does the nurse consider most likely?

bulimia with laxative abuse Explanation: Enamel erosion is a hallmark of bulimia. The report of "occasional" laxative use plus the report of chronic diarrhea raises the strong potential for laxative abuse. None of the other options would account for the tooth enamel erosion.

What is the benefit of adding proton pump inhibitors (PPIs) to the treatment regime treating an H. pylori bacterial infection?

decreases production of gastric secretions Explanation: PPIs decrease gastric acid secretion. Antimicrobials and bismuth can eliminate H. pylori infection. Sucralfate provides a protective barrier between mucosal erosions or ulcers and gastric secretions. Antacids neutralize gastric acid and decrease pepsin production

The nurse is providing care to a client with hepatic encephalopathy. Which would the nurse anticipate administering to assist in lowering the client's blood ammonia level?

lactulose Explanation: A client with hepatic encephalopathy may have high levels of ammonia in their blood; lactulose can be used to lower the level of ammonia in the client's blood. Lubiprostone is a hyperosmotic agent that is used to relieve constipation. Psyllium is a bulk-forming laxative. Mineral oil is an emollient that lubricates the intestinal walls and softens the stool, thereby enhancing passage of fecal material.

Chapter 39: A client needing to evacuate the colon for endoscopy would likely be prescribed which medication solution?

polyethylene glycol electrolyte Explanation: A client needing to evacuate the colon for endoscopy would likely take polyethylene glycol electrolyte solution as it is a bowel evacuant. Methylcellulose and psyllium are bulk-forming laxatives and will not evacuate the bowel for endoscopy. Mineral oil is an emollient that lubricates the intestinal walls and softens the stool, thereby enhancing passage of fecal material.

A hospital client has been scheduled for a barium enema the following morning. The nurse should anticipate what prescription for the client's bowel preparation?

polyethylene glycol-electrolyte solution Explanation: Polyethylene glycol-electrolyte solution is often prescribed for bowel preparation before diagnostic tests. Magnesium sulfate is more commonly used for emergency situations. Senna and polycarbophil are most often used for short-term relief of constipation.

A client, with recent abdominal pain and a 40-pack per year smoking history, is prescribed a treatment regimen for a diagnosis of duodenal ulcer. What important teaching would the nurse include in relation to treatment?

smoking effects on the healing of ulcers