Week 9 GI medication
Proton Pump Inhibitors (PPIs)
"PRAZOLEs" Omeprazole (Prilosec®) Lansoprazole (Prevacid®) Pantoprazole (Protonix®)
A nurse is teaching a client with a new diagnosis of peptic ulcer disease (PUD) who has a prescription for bismuth subsailcylate. The client asks the nurse, "how will this medication help my ulcer?" which of the following statements should the nurse make?
"this medication can decrease bacteria in the GI tract"
H2 blockers
-TIDINE RANITIDINE, FAMOTIDINE take 30 min before the meal
Sulcrafate
2 HOURS BEFORE YOU ATE TAKEN LATE
when do we give ondansetron?
30-60 min before going to chemo or before or with pain medication
The order reads: "Give promethazine (Phenergan) 12.5 mg IM q4hr prn nausea/vomiting." The medication is available in 25-mg/mL vials. How many milliliters will the nurse draw up for this dose?
ANSWER: 0.5 mL
The order reads: "Give pantoprazole (Protonix) 40 mg in 100 mL normal saline IVPB once daily. Infuse over 30 minutes." The infusion pump can only be programmed to deliver over 1 hour (mL per hour). The nurse will set the pump to deliver how many mL per hour for each IVPB dose?
ANSWER: 200 ml/hour multiply by 2
When the nurse teaches a patient about taking bisacodyl tablets, which instruction is correct? a. "Take this medication on an empty stomach." b. "Chew the tablet for quicker onset of action." c. "Take this medication with juice or milk." d. "If it upsets your stomach, take this medication with an antacid."
ANSWER: A "TAKE THIS ON AN EMPTY STOMACH"
A patient who is taking oral tetracycline complains of heartburn and requests an antacid. Which action by the nurse is correct? a. Give the tetracycline, but delay the antacid for 1 to 2 hours. b. Give the antacid, but delay the tetracycline for at least 4 hours. c. Administer both medications together. d. Explain that the antacid cannot be given while the patient is taking the tetracycline.
ANSWER: A GIVE THE TETRACYCLINE, BUT DELAY THE ANTACID FOR 1 TO 2 HOURS
The nurse will assess which laboratory test results before the administration of vitamin K? a. Prothrombin time and international normalized ratio b. Red blood cell and white blood cell counts c. Phosphorous and calcium levels d. Total protein and albumin levels
ANSWER: A PROTHROMBIN TIME AND INTERNATIONAL NORMALIZED RATIO
The nurse is assessing a patient who has been recently admitted to the hospital after living on the streets for over 1 year. The nurse notes that the patient has severely chapped and fissured lips. This could be a sign of which vitamin deficiency? a. vitamin B2 b. vitamin B6 (riboflavin) (pyridoxine) c. vitamin C (ascorbic acid) d. vitamin E (tocopherols)
ANSWER: A VITAMIN B2
While caring for a newly admitted patient who has a long history of alcoholism, the nurse anticipates that part of the patient's medication regimen will include which vitamin(s)? (Select all that apply.) a. vitamin B1 b. vitamin B2 (thiamine) (riboflavin) c. vitamin B6 (pyridoxine) d. vitamin C (ascorbic acid) e. vitamin A (retinol)
ANSWER: A,B,C VITAMIN B1, B2, B6
When the nurse is administering a proton pump inhibitor (PPI), which actions by the nurse are correct? (Select all that apply.) a. Giving the PPI on an empty stomach b. Giving the PPI with meals c. Making sure the patient does not crush or chew the capsules d. Instructing the patient to open the capsule and chew the contents for best absorption e. Administering the PPI only when the patient complains of heartburn
ANSWER: A,C GIVE PPI ON EMPTY STOMACH MAKING SURE THE PATIENT DOES NOT CRUSH OR CHEW THE CAPSULES
A patient with a history of renal problems is asking for advice about which antacid he should use. The nurse will make which recommendation? a. "Patients with renal problems cannot use antacids." b. "Aluminum-based antacids are the best choice for you." c. "Calcium-based antacids are the best choice for you." d. "Magnesium-based antacids are the best choice for you."
ANSWER: B "ALUMINUM-BASED ANTACIDS ARE THE BEST CHOICE FOR YOU"
A patient has GI malabsorption due to severe intestinal damage from a gastrointestinal infection. The nurse will need to assess for signs of a deficiency of which vitamin? a. vitamin A (retinol) b. vitamin B12 (cyanocobalamin) c. vitamin B6 (pyridoxine) d. vitamin E (tocopherols)
ANSWER: B VITAMIN B12
Which is the correct action when the nurse is administering sucralfate? (Select all that apply.) a. Giving the drug with meals b. Giving the drug on an empty stomach c. Instructing the patient to restrict fluids d. Waiting 30 minutes before administering other drugs e. Giving other drugs 2 hours before giving the sulcrafate
ANSWER: B,E GIVING THE DRUG ON EMPTY STOMACH GIVING OTHER DRUGS 2 HOURS BEFORE GIVING SULCRAFATE
The nurse is preparing to administer the first dose of misoprostol (Cytotec) for a patient who has been diagnosed with a gastric ulcer. What condition would be a contraindication to this medication? a. Hypothyroidism b. Type 2 diabetes mellitus c. Pregnancy d. Hypertension
ANSWER: C PREGNANCY
The nurse is evaluating the medication list of a patient who will be starting therapy with an H2 receptor antagonist. Which of these drugs may cause an interaction? a. codeine b. penicillin c. phenytoin d. acetaminophen
ANSWER: C phenytoin
The nurse is providing wound care for a patient with a stage IV pressure ulcer and expects that the patient will receive which supplements to assist in wound healing? (Select all that apply.) a. vitamin K b. vitamin B12 c. zinc d. calcium e. vitamin C
ANSWER: C,E ZINC & VITAMIN C
A parent calls to ask about giving a medication for diarrhea to his child, 15 years of age, who is recovering from the flu. The nurse expects the prescriber to recommend which medication? a. bismuth subsalicylate (Pepto-Bismol) b. Lactobacillus GG (Culturelle) c. belladonna alkaloid/phenobarbital combination (Donnatal Elixir) d. loperamide (Imodium A-D)
ANSWER: D LOPERAMIDE
When giving calcium intravenously, the nurse needs to administer it slowly, keeping in mind that rapid intravenous administration of calcium may cause which problem? a. Ototoxicity b. Renal damage c. Tetany d. Cardiac irregularities
ANSWER: D cardiac irregularities
A patient is taking simethicone for excessive flatus associated with diverticulitis. The nurse is teaching about the mechanism of action of simethicone. Which statement is correct? a. "It neutralizes gastric pH, thereby preventing gas." b. "It buffers the effects of pepsin on the gastric wall." c. "It decreases gastric acid secretion and thereby minimizes flatus." d. "It causes mucus-coated gas bubbles to break into smaller ones."
ANSWER: D. "It causes mucus-coated gas bubbles to break into smaller ones."
CLIENT TEACHING ANTIEMETICS
AVOID DRIVING AND PROVIDING HAZARDOUS TASKS DUE TO SEDATION DO NOT COMBINE ALCOHOL AND ANTIEMETICS----CNS DEPRESSION CHANGE POSITIONS SLOWLY INCREASE FLUID INTAKE
Metoclopramide (Reglan)
Antiemetic. ADVERSE effects: EPS, tardive dyskinesia, sedation & diarrhea contraindicated: bleeding duodenal ulcer
Ondansetron (Zofran)
Antiemetic. ADVERSE effects: headache, dizziness, dysrhythmias, diarrhea can cause serotonin syndrome= high risk for injury
Histamine 2 Receptor Antagonists
Block H2 receptor of parietal cells, resulting in a decrease in the volume of acid secreted. Used to treat GERD, duodenal ulcers
DO NOT NEED TO REPORT FOR ANTIEMETICS
DIZZINESS, HEADACHE, DRY MOUTH, CONSIPATION
Which of the following medications is an opioid antidiarrheal agent given for active diarrhea to decrease the motility or movement of the intestines and increase the absorption of sodium and water?
Loperamide loperamide is an opioid antidiarrheal agent. Loperamide directly acts on opioid receptors in the GI tract to decrease the rate of fluid in the bowel and inhibit contraction of the bowel to alleviate symptoms of diarrhea.
A client has complaints indicative of peptic ulcer disease (PUD). The primary health care professional (HCP) prescribes the client a combination of ranitidine and sucralfate. The nurse questions the HCP's orders with concerns that:
Ranitidine will inhibit the action of sucralfate
acid prevention drugs
SCAM SODIUM BICARBONATE CALCIUM CARBONATE ALUMINUM HYDROXIDE MAGNESIUM HYDROXIDE (MILK OF MAG)
when do we contact HCP for laxatives??
SEVERE abdominal pain, muscle weakness, cramps
during infusion, child reports nausea and vomits, what is the priority nursing action?
STOP the chemo, flush the line and administer ondansetron
Anti-diarrheals
Stops further occurrence of diarrhea. Notable medicines are Loperamide "Immodium" and Diphenoxylate with Atropine "Lomotil" increase absorption of sodium and water
Mucosal Protectant
Sucralfate (Carafate) may cause dry mouth, nausea, constipation take on empty stomach 1-2 hour before or after taking med do NOT TAKE WITH ANY OTHER MED
Fat soluble vitamins
Vitamins A, D, E, K STORED IN LIVER AND FATTY TISSUES A: normal vision D: calcification of bone and teeth E: antioxidant K: synthesis of blood coagulation factors
A client is prescribed cimetidine for peptic ulcer disease. Which of the following is an adverse effect that the nurse must inform the client?
a decrease in libido
constipation
abnormally infrequent and difficulty passage of feces through the lower GI tract
nursing implications for laxatives
assess fluid and electrolytes before initiating therapy
when do we give bisaodyl (laxative)?
bedtime results: 6-12 hours other suppositories are effective within 1 hour **milk and antacids can destroy enteric coating**
A client presents with diarrhea caused by Escherichia coli (E. coli) after a trip to Mexico. Which of the following medications is the most appropriate treatment for this client's symptoms?
bismuth subsailcylate
antiemetic drug action
block neurologic stimulus that induces vomiting
Psyllium Husk (Metamucil)
bulk-forming laxative -absorbs water to increase bulk
what is a medication error?
calcium given with ferrous sulfate= BLOCKED absorption
adverse effects of aluminum and calcium
constipation
antacids
counteract or neutralize acidity, usually in the stomach NEVER MIX WITH OTHER DRUGS
A client with liver cirrhosis is prescribed lactulose. What is an additional function of the administered medication?
decreases ammonia through stool
what do PPIs prevent?
development of ulcer due to surgery or hospital stays
A client is prescribed loperamide. Which of the following conditions does this medication treat?
diarrhea
magnesium side effect
diarrhea
patient education for h2 blockers
do not over eat, no stress, no smoking, no NSAIDS
key points for antacids
do not prevent overproduction of acid 1 hour before or after other meds! not for heart failure patients (nothing OTC)
Docusate sodium (Colace)
docusate sodium (Colace) -stool softener -helps treat constipation -usually taken to treat constipation caused by opioid use take w/ full glass of water..increase fluid intake
A nurse is caring for a patient who has been taking cimetidine for treatment of a duodenal ulcer. Which of the following manifestations related to the medication should the nurse report to the provider?
emesis that looks like coffee grounds
Which of the following pharmacological therapies, used to treat clients with gastrointestinal reflux disease (GERD), reduces acid by blocking the histamine receptors in parietal cells?
famotidine
adverse effect of sodium
fluid retention alkalosis
vitamin c
helps with absorption but NOT TAKEN AT SAME TIME AS IRON
adverse effects of cimetidine
impotence and gynecomastia -confusion and disorientation in elderly
client teaching for constipation
increase fiber (ex: bran, fresh fruit, veggies) increase fluids (2-3 L/day) maintain regular exercise regimen take with 6-8 oz water
A client is prescribed bismuth subsalicylate as treatment for abdominal pain, watery diarrhea, and nausea and vomiting. Which of the following correctly describes the mechanism of action of the drug?
inhibition of prostaglandin and chloride secretion in the GI tract to reduce gut motility
A client is admitted with iron deficiency anemia. He has been having black tarry stools for 3 days. Which of the following would the nurse expect to be prescribed for the client?
intravenous dextran Intravenous dextran is an iron replacement product.
adverse effect of calcium
kidney stones
Which of the following agents that act on the lower gastrointestinal (GI) tract acts to increase gut motility and decrease ammonia levels in the body?
lactulose
A client experiences worsening constipation for three months and is diagnosed with a bowel obstruction. Which of the following is contraindicated for the client?
laxatives
when do we question the order for metoclopramide & report to the HCP immediately?
lip smacking, puffing of the cheeks, blinking of the eyes, twisting of the tongue
A client is prescribed loperamide for chronic diarrhea. What additional information about the adverse effects of this medication should the nurse provide the client?
loperamide may cause severe constipation with long-term use
Which of the following therapeutic agents for the treatment of constipation increases fluid content within the lumen of the large intestine and stimulates peristalsis?
magnesium hydroxide
Magnesium Sulfate
mellows the muscles could cause respiratory depression antidote: calcium gluconate
A client is concerned about the long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) as a therapy for pain management. Which of the following therapeutic agents should the nurse recommend?
misoprostol misoprostol is a synthetic prostaglandin that increases protective mucous inside the stomach that prevents and protects against gastric ulcers caused by long-term NSAID therapy. Clients on long-term NSAID therapy that are prescribed misoprostol can continue taking NSAIDs.
A client is prescribed antacids for dyspepsia. Which of the following correctly describes the mechanism of action of the drug?
neutralizes gastric acid, reduces pepsin levels, and stimulates prostaglandin production
A client is prescribed sucralfate for the treatment and prevention of stomach and duodenal ulcers. Which of the following adverse effects must the nurse educate the client?
no adverse effects
loperamide
opioid antidiarrheal agent low and slow side effect: CONSTIPATION
Which of the following is indicated for the use of misoprostol?
prevention of gastric ulcers
key points for PPIs
prevents holes- stress ulcer prophylaxis we want regular bone density tests (take calcium and vitamin D) possible c. diff diarrhea
Misoprostol
prostaglandins- protects against ulcers GIVEN TO PTS ON LONG-TERM NSAID MEDS MISCARRIAGE RISK
A client complains of infrequent bowel movements three times a week for the past six months and reports straining during bowel movements. Which of the following is the most appropriate therapeutic agent for the client?
psyllium husk psyllium husk is a bulk-forming laxative that acts on the lumen of the large intestine to increase fluid production in the bowel and retain it in the bowel. **drink lots of fluids**
vitamin B12
red blood cell formation pernicious anemia; chronic fatigue, dyspnea, diarrhea, tachycardia, loss of appetite, bleeding gums
what is the indication for mag sulfate?
replace for low magnesium treatment for Torsades de Pointes (crazyyyyy heartbeat)
when do we stop infusion of magnesium sulfate?
respiratory rate below 12
potassium
slow infusion rate if irritation no need to notify HCP, just slow monitor HOURLY
A nurse is caring for a client receiving treatment for hepatic encephalopathy. The client is administered an oral laxative. How will the nurse evaluate the effectiveness of the medication?
the client is awake and speaking oral lactulose has drawn ammonia from the bloodstream and into the colon where it is removed from the body through stools. Nurses must evaluate the effectiveness of lactulose for the treatment of hepatic encephalopathy, which is seen as an improved mental status in the client.
adverse effects of famotidine and ranitide?
thrombocytopenia
Antiemetic drugs
treat nausea and vomiting and motion sickness
A client presents with complaints of passing fewer than three hard stools a week and straining during bowel movements. Which of the following food items should the nurse inform the client to add to their diet?
veggies, water, whole grain bread
