Drugs affecting the Gastrointestinal system ( Chap 78, 79, 80)

Question 1

A patient who takes nonsteroidal anti-inflammatory drugs (NSAIDs) for arthritis asks a nurse what can be done to prevent ulcers. The nurse will recommend asking the provider about using which medication?

a. Antacids
b. Antibiotics
c. Antisecretory agents
d. Mucosal protectants

Answer 1

ANS: C
Patients taking NSAIDs should use antisecretory agents for ulcer prophylaxis. The other agents are not used for prophylaxis.

Question 2

A patient admitted to the hospital has a history of peptic ulcer disease. The patient takes ranitidine (Zantac) and sucralfate (Carafate). The patient tells the nurse that discomfort is usually controlled but that symptoms occasionally flare up. What will the nurse do?

a. Ask the provider about ordering an endoscopic examination.
b. Contact the provider to discuss serologic testing and an antibiotic.
c. Contact the provider to discuss switching to a proton pump inhibitor.
d. Counsel the patient to avoid beverages containing caffeine.

Answer 2

ANS: B
The recommendation for all patients with gastric or duodenal ulcers and documented Helicobacter pylori infection is treatment with antibiotics. The nurse is correct to ask about serologic testing for this organism and to suggest adding an antibiotic to this patient’s regimen. An endoscopic examination is not recommended. Changing to a proton pump inhibitor may not change the symptoms. There is no evidence that caffeine contributes to peptic ulcer disease (PUD).

Question 3

A patient newly diagnosed with PUD reports taking low-dose aspirin (ASA) for prevention of cardiovascular disease. The nurse learns that the patient drinks 2 to 3 cups of coffee each day and has a glass of wine with dinner 3 or 4 nights per week. The patient eats three meals a day. The nurse will counsel this patient to:

a. change the meal pattern to five or six smaller meals per day.
b. discontinue taking aspirin, because it can irritate the stomach.
c. stop drinking wine or any other alcoholic beverage.
d. switch to a decaffeinated coffee and reduce the number of servings.

Answer 3

ANS: A
Consumption of five or six smaller meals a day can reduce fluctuations in the intragastric pH, which may facilitate recovery. ASA should be avoided, along with other NSAIDs except for low-dose ASA used for the prevention of cardiovascular disease. No hard data implicate alcohol as a contributor to PUD. No data indicate that caffeine contributes to PUD.

Question 4

A patient is diagnosed with peptic ulcer disease. The patient is otherwise healthy. The nurse learns that the patient does not smoke and that he drinks 1 or 2 glasses of wine with meals each week. The nurse anticipates that the provider will prescribe which drugs?

a. Amoxicillin (Amoxil), clarithromycin, and omeprazole (Prilosec)
b. Amoxicillin (Amoxil), metronidazole (Flagyl), and cimetidine (Tagamet)
c. Clarithromycin, metronidazole (Flagyl), and omeprazole (Prilosec)
d. Tetracycline, cimetidine (Tagamet), and lansoprazole (Prevacid)

Answer 4

ANS: A
The regimen recommended for the treatment of PUD includes two antibiotics and an antisecretory agent. Amoxicillin, clarithromycin, and omeprazole would meet this recommendation. Patients taking metronidazole cannot consume alcohol, as this would precipitate a disulfiram-like reaction. The last option does not include two antibiotics.

Question 5

A 30-year-old male patient will begin a three-drug regimen to treat peptic ulcer disease. The regimen will consist of bismuth subsalicylate, tetracycline, and cimetidine (Tagamet). The nurse will include which information when teaching this patient about this drug regimen?

a. Black discoloration of the tongue and stools should be reported immediately.
b. Central nervous system depression and confusion are likely to occur.
c. Decreased libido, impotence, and gynecomastia are reversible side effects.
d. Staining of the teeth may occur and is an indication for discontinuation of these drugs.

Answer 5

ANS: C
Cimetidine has antiandrogenic effects and can cause decreased libido, impotence, and gynecomastia. These effects are reversible. Black stools and discoloration of the tongue are side effects associated with bismuth but are not harmful. Central nervous system (CNS) depression and confusion are not likely. Staining of the teeth associated with tetracycline use occurs only in developing teeth; it is a problem in children younger than 8 years and in pregnant woman because of this risk to the fetus.

Question 6

When metronidazole (Flagyl) is a component of the H. pylori treatment regimen, the patient must be instructed to do what?

a. Avoid any alcoholic beverages
b. Avoid foods containing tyramine
c. Take the drug on an empty stomach
d. Take the drug with food

Answer 6

ANS: A
The patient should be instructed to avoid alcoholic beverages, because a disulfiram-like reaction can occur if metronidazole is taken with alcohol. Nothing indicates that the patient should avoid foods containing tyramine. Metronidazole may be taken with or without food.

Question 7

The nurse is providing education to a patient who has been prescribed both an antacid and ranitidine (Zantac). Which instruction should the nurse give the patient about taking the medications?

a. “Take the antacid 1 hour after the ranitidine.”
b. “The antacid and ranitidine should be taken at the same time for better effect.”
c. “Take the antacid 15 minutes before the ranitidine.”
d. “Take the antacid 30 minutes after the ranitidine.”

Answer 7

ANS: A
Because antacids raise the gastric pH, they can affect the dissolution and absorption of ranitidine; therefore, 1 hour should separate administration of antacids and ranitidine. Antacids and ranitidine should not be taken at the same time, because dissolution and absorption of ranitidine will be reduced. One hour should separate administration of antacids and ranitidine; intervals of 15 minutes and 30 minutes are not long enough.

Question 8

A patient is diagnosed with Zollinger-Ellison syndrome. Which medication does the nurse expect the provider to order for this patient?

a. Cimetidine (Tagamet)
b. Esomeprazole (Nexium)
c. Ranitidine (Zantac)
d. Sucralfate (Carafate)

Answer 8

ANS: C
Ranitidine is used to treat Zollinger-Ellison syndrome. Although cimetidine can also be used, ranitidine is more potent and therefore is preferred. Esomeprazole and sucralfate are not indicated.

Question 9

An older adult patient with severe gastroesophageal reflux disease (GERD) has had only minimal relief using a histamine2-receptor antagonist (H2RA). The patient is to begin taking omeprazole (Prilosec). What will the nurse teach this patient?

a. A complete cure is expected with this medication.
b. Lifestyle changes can be as effective as medication therapy.
c. Long-term therapy may be needed.
d. The medication will be used until surgery can be performed.

Answer 9

ANS: C
Proton pump inhibitors, such as omeprazole, are much better than H2RAs for treating GERD. For patients with severe GERD, long-term maintenance therapy is recommended. These drugs do not cure GERD; relapse is common when the drugs are discontinued. Lifestyle changes can help but should not be considered a substitute for drugs. Surgery is reserved for young, healthy patients who cannot or will not stick to a drug regimen.

Question 10

A patient stops taking a proton pump inhibitor (PPI) after 6 weeks of therapy for treatment of peptic ulcer disease. The patient reports symptoms of dyspepsia to the nurse. The nurse will tell this patient to:

a. come to the clinic to be tested for Clostridium difficile.
b. resume taking the PPI, because long-term therapy is necessary.
c. resume taking the PPI until symptoms resolve completely.
d. try an antacid to see whether it relieves these symptoms.

Answer 10

ANS: D
When patients stop taking a PPI, a rebound hypersecretion of gastric acid can cause dyspepsia. This can be managed with an antacid. Although C. difficile infection is associated with dose-related increases in PPIs, the symptoms include diarrhea, not dyspepsia, so testing is not indicated for this patient. Resuming the PPI is not indicated, because these symptoms can be managed with antacids.

Question 11

A nursing student is caring for a patient who is taking sucralfate (Carafate) and ciprofloxacin (Cipro) to treat peptic ulcer disease. The student asks the nurse about the pharmacokinetics of sucralfate. Which statement by the student indicates a need for further teaching?

a. “Sucralfate adheres to the ulcer and blocks the back-diffusion of hydrogen ions.”
b. “Sucralfate and ciprofloxacin should be administered 1 hour apart.”
c. “Sucralfate does not cause systemic side effects.”
d. “Sucralfate has a moderate acid-neutralizing capacity.”

Answer 11

ANS: D
Sucralfate does not have any acid-neutralizing capacity, so this statement is incorrect. The other statements about sucralfate are correct.

Question 12

Which behavior can be used to reduce symptoms of gastroesophageal reflux disease? (Select all that apply.)

a. Avoiding late-night meals
b. Consuming a glass of wine with meals
c. Drinking soft drinks
d. Losing weight
e. Stopping smoking

Answer 12

ANS: A, E

Avoiding late-night meals and stopping smoking may help with symptoms of GERD.

Question 13

A nurse is taking a history on a clinic patient who reports being constipated. Upon further questioning, the nurse learns that the patient’s last stool was 4 days ago, that it was of normal, soft consistency, and the patient defecated without straining. The patient’s abdomen is not distended, and bowel sounds are present. The patient reports usually having a stool every 1 to 2 days. What will the nurse do?

a. Ask about recent food and fluid intake.
b. Discuss the use of polyethylene glycol (MiraLax).
c. Recommend a bulk laxative.
d. Suggest using a bisacodyl (Dulcolax) suppository.

Answer 13

ANS: A
Constipation cannot necessarily be defined by the frequency of bowel movements, because this varies from one individual to another. Constipation is defined in terms of a variety of symptoms, including hard stools, infrequent stools, excessive straining, prolonged effort, and unsuccessful or incomplete defecation. A common cause of constipation is diet, especially fluid and fiber intake; therefore, when changes in stool patterns occur, patients should be questioned about food and fluid intake. Because this patient has only more infrequent stools and is not truly constipated, laxatives are not indicated.

Question 14

A patient is admitted with lower abdominal pain and nausea. The nurse performing the initial assessment notes that the patient’s abdomen is distended and firm, and hypoactive bowel sounds are present. The patient has not had a stool for 3 days. The nurse will contact the provider, who will:

a. order a bulk-forming laxative.
b. order extra fluids and fiber.
c. perform diagnostic tests.
d. prescribe a cathartic laxative.

Answer 14

ANS: C
Laxatives are contraindicated for patients with abdominal pain, nausea, cramps, or other symptoms of abdominal disease or an acute surgical abdomen. Laxatives should not be used in patients with obstruction or impaction. This patient shows signs of abdominal obstruction, and laxatives could cause a bowel perforation secondary to increased peristalsis. A bulk-forming laxative is contraindicated. Patients with acute abdomens should be kept NPO pending diagnosis. A cathartic laxative is contraindicated.

Question 15

A patient with renal disease is scheduled for a colonoscopy. Before the procedure, the nurse will anticipate administering:

a. glycerin suppository.
b. magnesium hydroxide (MOM).
c. polyethylene glycol and electrolytes.
d. sodium phosphate.

Answer 15

ANS:	C
Polyethylene glycol (PEG) plus electrolytes (ELS) is one of two bowel cleansers used before colonoscopy to clear the bowel. PEG-ELS products are preferred, because unlike sodium phosphate, they are isotonic and do not increase the likelihood of dehydration and electrolyte imbalance. Glycerin suppositories and magnesium hydroxide are not used for bowel cleansing.

Question 16

The parent of a child with cerebral palsy reports that the child has pebble-like stools most of the time and seems uncomfortable if several days have passed between stools. The nurse will suggest that the parent discuss which medication with the child’s provider?

a. Bisacodyl (Dulcolax) suppositories
b. Magnesium citrate
c. Methylcellulose (Citrucel)
d. Polyethylene glycol (MiraLax)

Answer 16

ANS: D
Polyethylene glycol is an osmotic laxative widely used for chronic constipation, which this child has, because it provides relief from abdominal discomfort, improves stool consistency, and increases frequency. Bisacodyl is not recommended for long-term use. Magnesium citrate causes increased water loss, and methylcellulose can also cause impaction.

Question 17

A patient’s provider has recommended a bulk-forming laxative for occasional constipation. Which statement by the patient indicates understanding of the teaching about this agent?

a. “I can take this medication long term.”
b. “I should not take this drug if I have diverticulitis.”
c. “I should take each dose with a full glass of water.”
d. “This drug can cause severe diarrhea.”

Answer 17

ANS: C
Bulk-forming laxatives provide insoluble substances that swell in water to both soften and increase the size of the fecal mass. Patients should be taught to take the dose with a full glass of water. Laxatives in general are not recommended for long-term use. Bulk-forming laxatives are safe for patients with diverticulitis. They are often used to treat diarrhea, because they help form the fecal mass.

Question 18

A patient has been taking psyllium (Metamucil) 2 to 3 times daily for several days. The patient complains of stomach pain but has not had a stool. What will the nurse do?

a. Ask the patient to drink a full glass of water.
b. Give another dose of the psyllium.
c. Request an order for a bisacodyl (Dulcolax) suppository.
d. Palpate the patient’s abdomen and auscultate for bowel sounds.

Answer 18

ANS: D
Psyllium is a bulk-forming laxative and can cause a fecal impaction or obstruction. Abdominal pain can be a sign of impaction or obstruction, so the nurse should assess the patient for this complication. Giving fluids by mouth, administering more laxative, or giving a suppository are all contraindicated if an obstruction has developed and should not be done until this condition is ruled out.

Question 19

A 6-year-old child has frequent constipation. The nurse provides teaching after the parent asks the nurse why the provider recommended using laxatives only when needed. Which statement by the parent indicates a need for further teaching?

a. “Children who take laxatives regularly can become dehydrated.”
b. “Chronic laxative use can cause electrolyte imbalances.”
c. “Frequent use of laxatives can cause diverticulitis.”
d. “The normal reflex to defecate can be inhibited with overuse of laxatives.”

Answer 19

ANS: C
Laxatives do not cause diverticulitis, although some laxatives can aggravate this condition. Chronic use of laxatives can cause dehydration and electrolyte imbalances and can suppress the normal defecation reflex.

Question 20

Which condition would cause the nurse to withhold a PRN order for magnesium hydroxide?

a. Chronic renal failure
b. Cirrhosis
c. Hemorrhoids
d. Prostatitis

Answer 20

ANS: A
Magnesium can accumulate to toxic levels in patients with renal dysfunction. The nurse should withhold the medication. Magnesium hydroxide is not contraindicated for patients with hemorrhoids, prostatitis, or cirrhosis.

Question 21

The nurse is caring for an older adult patient after a right hip open reduction internal fixation (ORIF). The patient is taking an opioid every 6 hours as needed for pain. The nurse discusses obtaining an order from the prescriber for which medication?

a. Docusate sodium (Colace)
b. GoLYTELY
c. Lactulose
d. Polyethylene glycol (MiraLax)

Answer 21

ANS: A
Oxycodone can be constipating. The patient needs something prophylactically, such as docusate sodium, that can be taken daily to prevent constipation. In addition, the patient’s mobility is limited, which can further increase the risk of constipation. GoLYTELY is not indicated for constipation; it is used for cleansing the bowel before diagnostic procedures. Lactulose is not indicated; it typically is used for reducing ammonia levels in hepatic encephalopathy. Polyethylene glycol is indicated for occasional constipation; no information suggests that the patient is constipated.

Question 22

A patient will undergo a colonoscopy, and the provider has ordered sodium phosphate as a bowel cleanser before the procedure. The nurse reviews the patient’s chart and notes that the patient’s creatinine clearance and blood urea nitrogen are both elevated. What will the nurse do?

a. Reduce the amount of fluid given with the laxative to prevent fluid retention
b. Request an order to give polyethylene glycol and electrolytes (PEG-ELS) instead.
c. Suggest that the patient reduce the dietary sodium intake.
d. Suggest using a suppository laxative instead.

Answer 22

ANS: B
PEG-ELS solutions provide an isosmotic solution and do not cause dehydration or electrolyte imbalance. They are safe to use in patients with renal impairment or cardiovascular disease. This patient’s laboratory values suggest renal impairment. Sodium phosphate products can cause kidney damage; giving them with less fluid only increases this possibility. Reducing the dietary intake of sodium is not recommended. Suppositories are not effective bowel cleansing agents.

Question 23

A patient reports taking an oral bisacodyl laxative (Dulcolax) for several years. The provider has suggested discontinuing the laxative, but the patient is unsure how to do this. The nurse will tell the patient to:

a. stop taking the oral laxative and use a suppository until normal motility resumes.
b. stop taking the laxative immediately and expect no stool for several days.
c. switch to a bulk-forming laxative, such as methylcellulose (Metamucil).
d. withdraw from the laxative slowly to avoid a rebound constipation effect.

Answer 23

ANS: B
The first step in breaking the laxative habit is abrupt cessation of laxative use. Bowel movements will be absent for several days after laxative withdrawal. Using a suppository, a bulk-forming laxative, or tapering the laxative only prolongs the habit and prevents normal function from returning.

Question 24

A patient with a history of chronic alcohol abuse has been admitted to the unit with cirrhosis. Upon review of the patient’s laboratory test results, the nurse notes that the patient’s ammonia level is elevated at 218 mcg/dL. What medication should the nurse prepare to administer?

a. 0.9% NS
b. Docusate sodium (Colace)
c. Lactulose
d. Polyethylene glycol (MiraLax)

Answer 24

ANS: C
Lactulose is the only laxative known to lower ammonia levels in patients with portal hypertension and hepatic encephalopathy secondary to liver disease. No information suggests that the patient needs fluid or electrolyte replacement. Docusate sodium and polyethylene glycol are not effective at lowering ammonia levels.

Question 25

A patient has been taking senna (Senokot) for several days, and the nurse notes that the urine is yellowish-brown. What does the nurse know about this symptom?

a. It indicates that renal failure has occurred.
b. It is caused by dehydration, which is a laxative side effect.
c. It is a sign of toxicity, indicating immediate withdrawal of the drug.
d. It is an expected, harmless effect of senna.

Answer 25

ANS: D
Systemic absorption of senna, followed by renal excretion, may impart a harmless yellowish-brown or pink color to the urine. This symptom is not an indication of renal failure, dehydration, or toxicity.

Question 26

A nurse caring for a patient who is undergoing a third round of chemotherapy is preparing to administer ondansetron (Zofran) 30 minutes before initiation of the chemotherapy. The patient tells the nurse that the ondansetron did not work as well the last time as it had the first time. What will the nurse do?

a. Administer the ondansetron at the same time as the chemotherapy.
b. Contact the provider to suggest using high-dose intravenous dolasetron (Anzemet).
c. Request an order to administer dexamethasone with the ondansetron.
d. Suggest to the provider that loperamide (Lomotil) be given with the ondansetron.

Answer 26

ANS:	C
Ondansetron is a serotonin receptor antagonist; drugs in this class are the most effective drugs available for suppressing nausea and vomiting associated with anticancer drugs. The drug is even more effective when combined with dexamethasone. For best effect, ondansetron should be given 30 minutes before beginning chemotherapy. Dolasetron is similar to ondansetron, but when given intravenously in high doses, it is associated with fatal dysrhythmias. Loperamide is used to treat diarrhea.

Question 27

A pregnant patient who is taking ondansetron (Zofran) for morning sickness tells the nurse she is experiencing headache and dizziness. What will the nurse tell her?

a. It is not safe to take this drug during pregnancy.
b. These are common side effects of ondansetron.
c. She should stop taking the ondansetron immediately.
d. She should report these adverse effects to her provider.

Answer 27

ANS: B
The most common side effects of ondansetron are headache, diarrhea, and dizziness. Ondansetron is used off-label to treat morning sickness. These side effects do not indicate a need to stop taking the drug or to report the side effects to the provider.

Question 28

A patient is being treated for chemotherapy-induced nausea and vomiting (CINV) with ondansetron (Zofran) and dexamethasone. The patient reports getting relief during and immediately after chemotherapy but has significant nausea and vomiting several days after each chemotherapy treatment. What will the nurse do?

a. Contact the provider to discuss increasing the dose of ondansetron.
b. Suggest giving prolonged doses of dexamethasone.
c. Suggest adding aprepitant (Emend) to the medication regimen.
d. Tell the patient to ask the provider about changing the ondansetron to aprepitant.

Answer 28

ANS: C
The current regimen of choice for patients taking highly emetogenic drugs consists of three agents: aprepitant plus dexamethasone plus a 5-HT3 antagonist, such as ondansetron. Aprepitant has a prolonged duration of action and can prevent delayed CINV as well as acute CINV. Increasing the dose of ondansetron will not help treat the delayed CINV. Glucocorticoids should be given intermittently and for short periods to avoid side effects. Changing the ondansetron to aprepitant is not recommended.

Question 29

A patient is receiving intravenous promethazine (Phenergan) 25 mg for postoperative nausea and vomiting. What is an important nursing action when giving this drug?

a. Giving the dose as an IV push over 3 to 5 minutes
b. Infusing the dose with microbore tubing and an infusion pump
c. Observing the IV insertion site frequently for patency
d. Telling the patient to report dry mouth and sedation

Answer 29

ANS: C
If IV administration must be done with this drug, it should be given through a large-bore, freely flowing line. The site should be monitored closely for local burning or pain or any sign of extravasation, which can cause abscess formation, tissue necrosis, and gangrene requiring amputation. Giving the medication as a rapid IV push or through microbore tubing does not adequately slow the infusion or dilute the drug. Dry mouth and sedation are expected side effects of this drug and are not dangerous.

Question 30

A nursing student is discussing with a nurse the plan of care for a patient about to undergo a third round of chemotherapy with cisplatin. Which statement by the nursing student about the treatment of CINV is correct?

a. “Aprepitant (Emend) will be necessary to treat CINV caused by cisplatin.”
b. “Antiemetics are most effective if given just as the chemotherapy is finished.”
c. “Lorazepam probably would not be helpful for this patient.”
d. “This patient will need intravenous antiemetics for best effects.”

Answer 30

ANS: A
CINV caused by cisplatin is maximal 48 to 72 hours after dosing and can persist for 6 to 7 days, so an antiemetic such as aprepitant, which treats delayed emesis, is an important part of antiemetic therapy. Antiemetics should be started 30 minutes before initiation of chemotherapy. Lorazepam should be given to this patient, because the patient has had some experience with chemotherapy and is likely to have anticipatory emesis. There is no benefit to IV over oral dosing unless the patient has ongoing emesis.

Question 31

A patient who is in her first trimester of pregnancy asks the nurse to recommend nonpharmaceutical therapies for morning sickness. What will the nurse suggest?

a. Avoiding fatty and spicy foods
b. Consuming extra clear fluids
c. Eating three meals daily
d. Taking foods later in the day

Answer 31

ANS: A
Nausea and vomiting of pregnancy (NVP) can be treated with nondrug measures, including avoiding fatty and spicy foods. Consuming extra fluids does not help with nausea and vomiting (N/V) but may be needed to prevent dehydration. Patients should be advised to eat small portions of food throughout the day rather than three complete meals. “Morning sickness” may actually occur all day, so delaying intake is not recommended.

Question 32

A patient who experiences motion sickness is about to go on a cruise. The prescriber orders transdermal scopolamine (Transderm Scop). The patient asks the nurse why an oral agent is not ordered. The nurse will explain that the transdermal preparation:

a. can be applied as needed at the first sign of nausea.
b. has less intense anticholinergic effects than the oral form.
c. is less sedating than the oral preparation.
d. provides direct effects, because it is placed close to the vestibular apparatus of the ear.

Answer 32

ANS: B
The transdermal system of scopolamine is preferred, because it may have less intense anticholinergic effects than oral or subcutaneous dosing. Antinausea medications for motion sickness are more effective if given prophylactically than after symptoms begin. Sedation side effects are similar with all forms. Placement near the ear does not cause the medication to absorb directly into the vestibular apparatus.

Question 33

A nurse explains to a nursing student why opioid antidiarrheal medications are classified as drugs with little or no abuse potential. Which statement by the student indicates a need for further teaching?

a. “Formulations for the treatment of diarrhea have very short half-lives.”
b. “Opioid antidiarrheal drugs contain other drugs with unpleasant side effects at higher doses.”
c. “Some opioid antidiarrheal drugs do not cross the blood-brain barrier.”
d. “Some opioid antidiarrheal medications are not water soluble and cannot be given parenterally.”

Answer 33

ANS: A
The half-life of the opioid antidiarrheal drugs is the same as that of the opioid analgesics. The formulations of opioid antidiarrheal medications that are classified with low abuse potential are often combined with atropine, which has unpleasant side effects at higher doses. Some opioid antidiarrheal drugs are formulated so that they do not cross the blood-brain barrier. Others are not water soluble and therefore cannot be dissolved and injected.

Question 34

A patient is taking bismuth subsalicylate (Pepto-Bismol) to prevent diarrhea. The nurse performing an assessment notes that the patient’s tongue is black. What will the nurse do?

a. Assess further for signs of gastrointestinal (GI) bleeding.
b. Reassure the patient that this is an expected side effect of this drug.
c. Request an order for liver function tests to evaluate for hepatotoxicity.
d. Withhold the drug, because this is a sign of bismuth overdose.

Answer 34

ANS: B
Bismuth subsalicylate can cause blackening of the tongue and stools, an expected side effect. This finding does not indicate GI bleeding, hepatotoxicity, or drug overdose.

Question 35

A patient is preparing to travel to perform missionary work in a region with poor drinking water. The provider gives the patient a prescription for ciprofloxacin (Cipro) to take on the trip. What will the nurse instruct this patient to do?

a. Combine the antibiotic with an antidiarrheal medication, such as loperamide.
b. Start taking the ciprofloxacin 1 week before traveling.
c. Take 1 tablet of ciprofloxacin with each meal for best results.
d. Use the drug if symptoms are severe or do not improve in a few days.

Answer 35

ANS: D
Traveler’s diarrhea is generally caused by Escherichia coli; treatment is usually unnecessary, because the disease runs its course in a few days. If symptoms are severe or prolonged, an antibiotic, such as ciprofloxacin, may be helpful. Patients should be instructed to take it only if needed. Antidiarrheal medications may just slow the export of the organism and prolong the course of the disease, but they may be used when symptoms are mild for relief from discomfort. Prophylactic treatment with antibiotics is not recommended. Ciprofloxacin is given twice daily, not with meals.

Question 36

A nurse is admitting a patient to the hospital who reports having recurrent, crampy abdominal pain followed by diarrhea. The patient tells the nurse that the diarrhea usually relieves the pain and that these symptoms have occurred daily for the past 6 months. The patient undergoes a colonoscopy, for which the findings are normal. The nurse will plan to teach this patient to:

a. use antispasmodic medications.
b. avoid food containing lactose and gluten.
c. keep a food, stress, and symptom diary.
d. use antidiarrheal drugs to manage symptoms.

Answer 36

ANS: C
This patient shows signs of irritable bowel syndrome (IBS), which can be managed with drug and nondrug therapies. Patients should be taught to keep a log to identify foods and stressors that trigger symptoms. Antispasmodic medications frequently are used, but there is no clear evidence of their benefit. Patients with malabsorption disorders may need to avoid lactose or gluten but only if indicated. Antidiarrheal drugs do not have clear benefits, even though they are commonly used.

Question 37

A nurse is providing teaching to a nursing student about to care for a woman with irritable bowel syndrome with diarrhea (IBS-D) who is receiving alosetron (Lotronex). Which statement by the student indicates a need for further teaching?

a. “I should evaluate the patient’s abdomen for distension and bowel sounds.”
b. “Patients with diverticulitis and IBS-C may take this drug.”
c. “There are no known serious drug interactions with alosetron.”
d. “This drug is given only to women with severe IBS-D.”

Answer 37

ANS: B
Alosetron is approved for use in women only with diarrhea-predominant IBS; it is contraindicated in patients with diverticulitis. Constipation can be a severe adverse effect, so patients should be assessed for signs of constipation, such as abdominal distension and diminished bowel sounds. There are no known adverse interactions with other drugs. Alosetron is approved for use in women with IBS-D regardless of the severity of the disease.

Question 38

The nurse is providing education to a patient with ulcerative colitis who is being treated with sulfasalazine (Azulfidine). What statement by the patient best demonstrates understanding of the action of sulfasalazine?

a. “It treats the infection that triggers the condition.”
b. “It reduces the inflammation.”
c. “It enhances the immune response.”
d. “It increases the reabsorption of fluid.”

Answer 38

ANS: B
Sulfasalazine reduces the inflammation seen with ulcerative colitis; this statement indicates understanding. Although similar to sulfonamides, sulfasalazine is not used to treat infections; further teaching is needed. Sulfasalazine does not enhance the immune response or increase the reabsorption of fluid; further teaching is needed.

Question 39

A nurse is discussing the use of immunosuppressants for the treatment of inflammatory bowel disease (IBD) with a group of nursing students. Which statement by a student indicates understanding of the teaching?

a. “Azathioprine (Imuran) helps induce rapid remission of IBD.”
b. “Cyclosporine (Sandimmune) can be used to induce remission of IBD.”
c. “Cyclosporine (Sandimmune) does not have serious adverse effects.”
d. “Methotrexate is used long term to maintain remission of IBD.”

Answer 39

ANS: B
Cyclosporine can be given intravenously to induce rapid remission of IBD. Azathioprine has delayed onset of effects up to 6 months and is not used to induce rapid remission. Cyclosporine is a toxic compound that can cause renal impairment, neurotoxicity, and immune suppression. Methotrexate is used to promote short-term remission.

Question 40

A patient with Crohn’s disease will begin receiving an initial infusion of infliximab (Remicade). The nurse explains how this drug works to treat this disease. Which statement by the patient indicates a need for further teaching?

a. “I may have an increased risk of infections, such as tuberculosis, when taking infliximab.”
b. “I should report chills, fever, itching, and shortness of breath while receiving the infusion.”
c. “This drug sometimes provides a complete cure of inflammatory bowel disease.”
d. “I will take the second dose in 2 weeks, the third dose in 6 weeks, and then a dose every 8 weeks thereafter.”

Answer 40

ANS: C
None of the drugs used to treat obstructive bowel disease (OBD) are curative. Patients taking immunomodulators, such as infliximab, have an increased risk of infection, especially opportunistic infections such as TB. Infusion reactions may occur and include chills, fever, itching, and shortness of breath. The induction regimen is 5 mg/kg infused at 0, 2, and 6 weeks, followed by a maintenance regimen every 8 weeks.

Question 41

A nurse is caring for a patient with cancer who has been undergoing chemotherapy. The patient has oral mucositis as a result of the chemotherapy, and the provider has ordered palifermin (Kepivance). Which is an appropriate nursing action when giving this drug?

a. Administering the drug as a slow IV infusion
b. Flushing the IV line with heparin before infusing the drug
c. Giving the drug within 6 hours of the chemotherapy
d. Warning the patient about the potential for distortion of taste

Answer 41

ANS: D
Palifermin is generally well tolerated but commonly causes reactions involving the skin and mouth, including taste distortion. The drug should be given as an IV bolus. Palifermin binds with heparin, so the IV line should not be flushed with heparin before giving palifermin. If the interval between administration of palifermin and the chemotherapeutic drugs is too short, palifermin actually may increase the severity and duration of oral mucositis; therefore, palifermin should be given 24 hours before the chemotherapeutic drugs.

Question 42

A patient with gastroesophageal reflux disease (GERD) is to begin taking oral metoclopramide (Reglan). The patient asks the nurse about the medication. Which response by the nurse is correct?

a. “After 3 months, if the drug is not effective, you may need to increase the dose.”
b. “Metoclopramide may cause hiccups, especially after meals.”
c. “Serious side effects may occur but will stop when the drug is discontinued.”
d. “You should take the drug 30 minutes before each meal and at bedtime.”

Answer 42

ANS: D
Metoclopramide should be given 30 minutes before meals and at bedtime. Metoclopramide should not be used long term, and increasing the dose after 3 months of therapy is not recommended. Metoclopramide is used to treat hiccups; it does not cause hiccups. Tardive dyskinesia is a serious and irreversible side effect.

Question 43

Which patients would be candidates for the use of dronabinol (Marinol) to treat nausea and vomiting? (Select all that apply.)

a. A patient with a history of a psychiatric disorder
b. A patient with acquired immunodeficiency syndrome (AIDS)–induced anorexia
c. A patient with chemotherapy-induced nausea and vomiting
d. A patient with nausea who has used marijuana in the past
e. A patient with postoperative nausea and vomiting

Answer 43

ANS: B, C, D
Two cannabinoids have been approved for medical use in the United States for AIDS-induced anorexia and CINV. Because these drugs do not produce the same “high” that smoking marijuana does, their use is not contraindicated in patients who have used marijuana in the past. They do cause potentially unpleasant effects, such as temporal disintegration, dissociation, depersonalization, and dysphoria, so they are contraindicated in patients with psychiatric disorders. They are not approved for postoperative nausea and vomiting.

Question 44

Which types of drugs are used to treat inflammatory bowel disease (IBD)? (Select all that apply.)

a. Aminosalicylates
b. Glucocorticoids
c. Immunomodulators
d. Opioid antidiarrheals
e. Sulfonamide antibiotics

Answer 44

ANS: A, B, C
Five types of drugs are used to treat IBD: aminosalicylates, glucocorticoids, immunosuppressants, immunomodulators, and antibiotics such as metronidazole and ciprofloxacin. Opioid antidiarrheal drugs and sulfonamide antibiotics are not used for this purpose.