final chapters

Question 1

A patient asks the nurse about whether it is necessary to take vitamin supplements. The patient is a 26-yearold
female who is contemplating pregnancy. The nurse will recommend which supplement?

a. Calcium and vitamin D
b. Folic acid (folate)
c. Iron
d. Vitamin C

Answer 1

b. Folic acid (folate)

Folic acid deficiency during the first trimester of pregnancy can affect the development of the CNS of the fetus, so women of childbearing age are encouraged to take folic acid. Other supplements are not necessary with a well-balanced diet unless a deficiency is noted.

Question 2

A patient reports wanting to take vitamin A to prevent blindness. Which response by the nurse is correct?

a. “Vitamin A can be taken prophylactically without serious adverse effects.”
b. “Vitamin A does not have any effects on vision.”
c. “Vitamin A is difficult to obtain through dietary intake alone.”
d. “Vitamin A is stored in the liver for up to 2 years, and toxicity can occur.”

Answer 2

d. “Vitamin A is stored in the liver for up to 2 years, and toxicity can occur.”

Vitamin A is stored in the liver for up to 2 years, and toxicity can occur. The effects of toxicity can be severe. Vitamin A is essential for the maintenance of eye function. Vitamin A can be obtained in foods.

Question 3

A young woman tells the nurse that she has a strong family history of osteoporosis and that she has been
taking calcium supplements. Which vitamin will the nurse recommend as an adjunct to calcium supplementation?

a. Vitamin A
b. Vitamin D
c. Vitamin E
d. Vitamin K

Answer 3

b. Vitamin D

Vitamin D is needed for calcium absorption from the intestines and plays a major role in regulating calcium
and phosphorus metabolism.

Question 4

A patient who spends most of the time indoors has been taking megadoses of vitamin D and is worried
about vitamin D toxicity. The nurse will tell this patient to report which sign that may indicate vitamin D toxicity?

a. Blurred vision
b. Darkening of the skin
c. Nausea and vomiting
d. Palpitations

Answer 4

c. Nausea and vomiting

Anorexia, nausea, and vomiting are early signs of vitamin D toxicity.

Question 5

Supplementation with which fat-soluble vitamin should a patient discuss with a provider before having
surgery?

a. Vitamin A
b. Vitamin D
c. Vitamin E
d. Vitamin K

Answer 5

c. Vitamin E

Vitamin E may prolong the prothrombin time, so patients planning surgery should stop taking it before
surgery.

Question 6

A child is brought to the emergency department after ingesting a grandparent’s warfarin (Coumadin) tablets.
The nurse will anticipate administering which form of vitamin K?

a. K1 (phytonadione)
b. K2 (menaquinone)
c. K3 (menadione)
d. K4 (menadiol)

Answer 6

a. K1 (phytonadione)

For oral anticoagulant overdose, vitamin K1 is the only vitamin K form available for therapeutic use and is most
effective in preventing hemorrhage.

Question 7

The nurse is teaching a patient about water-soluble vitamins. Which statement by the patient indicates understanding of the teaching?

a. “Water-soluble vitamins are excreted in the urine.”
b. “Water-soluble vitamins are generally toxic.”
c. “Water-soluble vitamins are highly protein-bound.”
d. “Water-soluble vitamins are usually metabolized in the liver.”

Answer 7

a. “Water-soluble vitamins are excreted in the urine.”

Water-soluble vitamins are not stored in the body as they are readily excreted in the urine. Because they are
not stored, they are usually not toxic unless taken in extremely excessive amounts. They are not highly protein bound and are not generally metabolized in the liver.

Question 8

The nurse is caring for a patient who has a history of chronic alcohol abuse. The patient is confused and exhibits nystagmus and blurred vision. Which vitamin will the nurse expect to administer to this patient?

a. Nicotinic acid
b. Pyridoxine
c. Riboflavin
d. Thiamine

Answer 8

d. Thiamine

Alcoholics can develop Wernicke-Korsakoff syndrome characterized by these symptoms related to thiamine deficiency. Thiamine must be given quickly to prevent progression of the disease causing irreversible brain
damage.

Question 9

The nurse is caring for an elderly patient who has poor nutrition. The nurse notes cracked skin at the corners
of the patient’s mouth along with generalized scaly dermatitis. The nurse will contact the provider to discuss a possible deficiency of which vitamin?

a. Nicotinic acid
b. Pyridoxine
c. Riboflavin
d. Thiamine

Answer 9

c. Riboflavin

Riboflavin deficiency is characterized by scaly dermatitis, cracked corners of the mouth, and inflammation of
the mouth and tongue.

Question 10

A patient is taking nicotinic acid (Niacin) to treat hyperlipidemia. The patient reports a flushing sensation
along with gastrointestinal irritation. The nurse will perform which action?

a. Contact the provider to discuss possible thromboembolism.
b. Discuss decreasing the patient’s dose of nicotinic acid with the provider.
c. Reassure the patient that these effects will decrease over time.
d. Suggest that the patient take niacin with a full glass of cool water.

Answer 10

b. Discuss decreasing the patient’s dose of nicotinic acid with the provider.

Large doses of niacin can cause gastrointestinal irritation and vasodilation, resulting in a flushing sensation.
Decreasing the dose can alleviate these symptoms. They do not indicate development of thromboembolism.
Taking niacin with a full glass of water does not alleviate these symptoms.

Question 11

A patient reports having taken a large dose of ascorbic acid (vitamin C) and is experiencing diarrhea and
gastrointestinal upset. The nurse will prepare to take which action?

a. Administer activated charcoal.
b. Administer sodium bicarbonate.
c. Perform gastric lavage.
d. Provide symptomatic care.

Answer 11

d. Provide symptomatic care.

The patient is experiencing uncomfortable side effects of excess vitamin C intake, but they are not life-threatening,
so no antidotes or treatment are indicated.

Question 12

A patient reports taking megadoses of vitamin C to prevent upper respiratory infections. The nurse will perform which action?

a. Monitor the patient for hyperglycemia.
b. Notify the provider and discuss a gradual taper of vitamin C.
c. Request an order for a CBC to assess the patient’s hemoglobin.
d. Tell the patient that studies have confirmed this use of vitamin C.

Answer 12

b. Notify the provider and discuss a gradual taper of vitamin C.

Patients who take megadoses of vitamin C should be weaned off gradually to avoid vitamin deficiency. Vitamin
C can produce a false positive Clinitest but does not affect blood glucose. It does not affect hemoglobin. Studies have not demonstrated the effectiveness of vitamin C in preventing or treating colds.

Question 13

The nurse is teaching a patient who has a folic acid deficiency about treatment for this disorder. Which
statement by the patient indicates understanding of the teaching?

a. “Food sources of folic acid are better than synthetic folic acid products.”
b. “I should take megadoses of folic acid to compensate for the deficiency.”
c. “Most folic acid is stored in the liver.”
d. “Symptoms of folic acid deficiency often do not appear for months.”

Answer 13

d. “Symptoms of folic acid deficiency often do not appear for months.”

Symptoms of folic acid deficiency usually are not noted until 2 to 4 months after folic acid storage is depleted.
Synthetic folate is more stable than food folate with greater bioavailability. Megadoses are not recommended.
One-third of folic acid is stored in the liver with the rest stored in tissues.

Question 14

A patient is diagnosed with anemia and asks the nurse why the provider has ordered vitamin B12 instead
of iron. Which answer by the nurse is correct?

a. “Vitamin B12 is given to improve your overall energy level.”
b. “Vitamin B12 is necessary for the development of red blood cells.”
c. “Vitamin B12 prevents excess iron loss to reduce demand.”
d. “Vitamin B12 will help you absorb iron more efficiently.”

Answer 14

b. “Vitamin B12 is necessary for the development of red blood cells.”

Vitamin B12 is essential for DNA synthesis and aids in the conversion of folic acid to its active form and is also
needed for the development of red blood cells. It does not directly improve energy level and does not affect
iron loss or iron absorption.

Question 15

The nurse is teaching a patient who has iron-deficiency anemia about iron supplementation. Which statement
by the patient indicates understanding of the teaching?

a. “I may improve iron absorption by taking this with orange juice.”
b. “I should take iron tablets with an antacid to reduce gastrointestinal upset.”
c. “Nausea and vomiting are minor side effects and will decrease over time.”
d. “Taking iron with food will help to increase the amount absorbed.”

Answer 15

a. “I may improve iron absorption by taking this with orange juice.”

Orange juice, which is high in vitamin C, increases the absorption of iron in the stomach. Antacids interfere
with iron absorption. Nausea and vomiting should be reported since they are signs of toxicity. Food slows absorption but is sometimes recommended to reduce gastrointestinal upset.

Question 16

A female patient who has a history of heavy menstrual periods is experiencing shortness of breath with exertion,
pallor, and fatigue. Her hemoglobin and hematocrit levels are both lower than normal, and her CBC reveals
microcytic and hypochromic erythrocytes. What will the nurse do?

a. Contact the provider to discuss an order for 600 mg of PO ferrous sulfate BID.
b. Recommend an over-the-counter folic acid supplement of 400 mcg/day.
c. Suggest an over-the-counter iron supplement of 325 mg/day.
d. Tell her to consult a dietician about including iron-rich foods in her diet.

Answer 16

a. Contact the provider to discuss an order for 600 mg of PO ferrous sulfate BID.

This patient has positive findings for iron-deficiency anemia and will need therapeutic doses of iron, which is
600 to 1200 mg/day in divided doses. Her lab tests are not consistent with folic acid deficiency. Iron supplementation
of 300 to 325 mg/day is correct for prophylactic supplementation. When deficiency is present, it is
very difficult to obtain the necessary amount of iron from food sources alone.

Question 17

A parent calls the nurse to report that a 5-year-old child has taken five children’s vitamins. Which action will
the nurse take first?

a. Ask whether the vitamins contain iron.
b. Reassure the parent that over-the-counter vitamins are not toxic.
c. Recommend that the parent take the child to the emergency department (ED).
d. Tell the parent to watch for tarry stools and report them immediately.

Answer 17

a. Ask whether the vitamins contain iron.

Iron toxicity is a serious cause of poisoning in children, and as few as 10 to 12 tablets of ferrous sulfate can be
fatal within 12 to 48 hours. The nurse should first determine whether the vitamins contain iron. If so, the family should take the child to the ED.

Question 18

The nurse is caring for a child who receives all nutrition parenterally. The nurse will be alert for signs of a
deficiency of which mineral in this child?

a. Chromium
b. Copper
c. Iron
d. Zinc

Answer 18

d. Zinc

Patients on long-term parenteral nutrition are at risk for zinc deficiency.

Question 19

A patient who has type 2 diabetes mellitus asks the nurse about taking chromium supplements. The nurse
will tell this patient that taking chromium

a. can increase the risk for ketoacidosis.
b. is not recommended for persons with diabetes.
c. may cause hypoglycemia if taken in large doses.
d. should be taken in doses greater than 200 mcg/day.

Answer 19

c. may cause hypoglycemia if taken in large doses.

Large doses of chromium can cause a hypoglycemic reaction in patients taking insulin or oral antidiabetic
agents. Normal doses are thought to be helpful in diabetic control. It does not increase the risk for ketoacidosis. The normal dose is 50-200 mcg/day.

Question 20

A patient who will begin taking an antibiotic reports taking several vitamin supplements every day. Which
vitamin or mineral will the nurse counsel the patient about during antibiotic therapy?

a. Selenium
b. Vitamin A
c. Vitamin C
d. Zinc

Answer 20

d. Zinc

Zinc can interfere with antibiotic absorption and should be taken at least 2 hours after taking the antibiotic.

Question 21

A patient who experiences motion sickness when flying asks the nurse the best time to take the medication
prescribed to prevent motion sickness for a 0900 flight. The nurse will instruct the patient to take the medication
at which time?

a. As needed, at the first sign of nausea
b. At 0700, before leaving for the airport
c. At 0830, just prior to boarding the plane
d. When seated, just prior to takeoff

Answer 21

c. At 0830, just prior to boarding the plane

Motion sickness medication has its onset in 30 minutes. The patient should be instructed to take the medication
a half hour prior to takeoff. It is not used as needed.

Question 22

The nurse is caring for a patient who has unexplained, recurrent vomiting and who is unable to keep anything
down. Until the cause of the vomiting is determined, the nurse will anticipate administering which medications?

a. Antibiotics and antiemetics
b. Intravenous fluids and electrolytes
c. Non-prescription antiemetics
d. Prescription antiemetics

Answer 22

b. Intravenous fluids and electrolytes

Antiemetics can mask the underlying cause of vomiting and should not be used until the cause is determined
unless vomiting is so severe that dehydration and electrolyte imbalance occurs. Nonpharmacologic measures,
such as fluid and electrolyte replacement, should be used. Antibiotics are only used if an infectious cause is
determined.

Question 23

The parent of an 18-month-old toddler calls the clinic to report that the child has vomited 5 times that day.
The nurse determines that the child has had three wet diapers in the past 6 hours. What will the nurse recommend for this child?

a. Administering an OTC antiemetic medication such as diphenhydramine
b. Giving frequent, small amounts of Pedialyte
c. Keeping the child NPO until vomiting subsides
d. Taking the child to the emergency department for IV fluids

Answer 23

b. Giving frequent, small amounts of Pedialyte

The child is not dehydrated as evidenced by adequate wet diapers, so nonpharmacologic measures, such as
oral fluids, are recommended. Antiemetics are not recommended unless dehydration occurs. Intravenous fluids are given when dehydration is present.

Question 24

The nurse is teaching a patient who is about to take a long car trip about using dimenhydrinate (Dramamine)
to prevent motion sickness. What information is important to include when teaching this patient?

a. “Do not drive while taking this medication.”
b. “Dry mouth is a sign of toxicity with this mediation.”
c. “Take the medication 1 to 2 hours prior to beginning the trip.”
d. “Take 100 mg up to 6 times daily for best effect.”

Answer 24

a. “Do not drive while taking this medication.”

Drowsiness is a common side effect of dimenhydrinate, so patients should be cautioned against driving while
taking this drug. Dry mouth is a common side effect and not a sign of toxicity. The drug should be taken 30
minutes prior to travel. The maximum recommended dose is 400 mg per day.

Question 25

The nurse is caring for a patient who has postoperative nausea and vomiting. The surgeon has ordered
promethazine HCl (Phenergan). Which aspect of this patient’s health history would be of concern?

a. Asthma
b. Diabetes
c. GERD
d. Glaucoma

Answer 25

d. Glaucoma

Promethazine is contraindicated in patients with glaucoma since it is an anticholinergic medication. It should be used with caution in patients with asthma. The other two conditions are not concerning with this
medication.

Question 26

The nurse is teaching a group of nursing students about the use of antipsychotic drugs for antiemetic purposes.
The nurse will explain that, when given as antiemetics, these drugs are given

a. in smaller doses.
b. less frequently.
c. with anticholinergics.
d. with antihistamines.

Answer 26

a. in smaller doses.

Antipsychotic medications have antiemetic properties in smaller doses.

Question 27

A patient who is receiving chemotherapy will be given dronabinol (Marinol) to prevent nausea and vomiting.
The nurse will tell the patient that this drug will be given at which time?

a. Before and after the chemotherapy
b. During chemotherapy
c. Immediately prior to chemotherapy
d. 24 hours prior to chemotherapy

Answer 27

a. Before and after the chemotherapy

Cannabinoids are given prior to chemotherapy and for 24 hours after chemotherapy.

Question 28

A woman who is 2 months pregnant reports having morning sickness every day and asks if she can take any
medications to treat this problem. The nurse will recommend that the patient take which action first?

a. Contact the provider to discuss a possible need for intravenous fluids.
b. Contact the provider to discuss a prescription antiemetic.
c. Use nonpharmacologic measures such as saltines.
d. Take over-the-counter antiemetics such as diphenhydramine.

Answer 28

c. Use nonpharmacologic measures such as saltines.

Pregnant women should avoid antiemetics during the first trimester of pregnancy because of possible teratogenic effects. The nurse should recommend nonpharmacologic measures such as saltines. If this is not effective, intravenous fluids may become necessary. Pregnant women should consult with their provider before taking prescription or over-the-counter antiemetics.

Question 29

The parent of a child who is receiving chemotherapy asks the nurse why metoclopramide (Reglan) is not being
used to suppress vomiting. The nurse will explain that, in children, this drug is more likely to cause which
effect?

a. Excess sedation
b. Extrapyramidal symptoms
c. Paralytic ileus
d. Vertigo

Answer 29

b. Extrapyramidal symptoms

Metoclopramide can cause extrapyramidal symptoms, and these effects are more likely in children. Children
are not more prone to sedative effects, paralytic ileus, or vertigo while taking this drug.

Question 30

The child who is a candidate for treatment with syrup of ipecac after ingestion of a toxic substance or overdose
is the child who has ingested which substance?

a. Acetaminophen elixir
b. Chlorine bleach
c. Kerosene
d. Toilet cleanser

Answer 30

a. Acetaminophen elixir

Ipecac should not be given to patients who have ingested caustic substances or petroleum distillates since regurgitation
carries a risk of aspiration. Acetaminophen is not a caustic substance or a petroleum distillate.
Chlorine bleach and toilet cleanser are caustic substances. Kerosene is a petroleum distillate.

Question 31

The nurse is teaching a group of parents about the use of syrup of ipecac. Which instruction will the nurse
provide?

a. “Do not administer ipecac without consulting a poison control center.”
b. “Expect the onset of emesis to be immediate.”
c. “Give ipecac with a glass of milk to increase its emetic effect.”
d. “Use ipecac fluid extract and not ipecac syrup.”

Answer 31

a. “Do not administer ipecac without consulting a poison control center.”

Ipecac should not be used for caustic substances or petroleum distillates. Ipecac should be given only after
termining whether it is safe. The onset of emesis is in 15 to 30 minutes. Ipecac should not be given with milk or
carbonated beverages. Ipecac syrup should be used.

Question 32

A patient asks the nurse about using loperamide (Imodium) to treat infectious diarrhea. Which response
will the nurse give?

a. “Loperamide results in many central nervous system (CNS) side effects.”
b. “Loperamide has no effect on infectious diarrhea.”
c. “Loperamide is taken once daily.”
d. “Loperamide may prolong the symptoms.”

Answer 32

d. “Loperamide may prolong the symptoms.”

Patients with infectious diarrhea should be cautioned about using loperamide since slowing transit through
the intestines may prolong the exposure to the infectious agent. Loperamide causes less CNS depression than
other antidiarrheals. It is taken after each loose stool.

Question 33

A child is brought to the emergency department after ingestion of a toxic substance. The child is alert and
conscious and is reported to have ingested kerosene 20 minutes prior. The nurse will anticipate administering

a. activated charcoal.
b. an anticholinergic antiemetic.
c. gastric lavage.
d. syrup of ipecac.

Answer 33

a. activated charcoal.

Activated charcoal is used when patients have ingested a caustic substance or a petroleum distillate in a patient
who is alert and awake. Gastric lavage is no longer used as therapy. Syrup of ipecac is not recommended.

Question 34

A patient who is taking diphenoxylate with atropine (Lomotil) to treat diarrhea asks the nurse why it contains
atropine. The nurse will explain that atropine is added to

a. decrease abdominal cramping.
b. increase intestinal motility.
c. minimize nausea and vomiting.
d. provide analgesia.

Answer 34

a. decrease abdominal cramping.

Atropine is added to decrease abdominal cramping and intestinal motility. It does not affect nausea and vomiting
or pain.

Question 35

The nurse is caring for an older adult who is receiving diphenoxylate with atropine (Lomotil) to treat severe
diarrhea. The nurse will monitor this patient closely for which effect?

a. Bradycardia
b. Fluid retention
c. Nervousness and tremors
d. Respiratory depression

Answer 35

d. Respiratory depression

Diphenoxylate is an opium agonist and can cause respiratory depression. Children and older adults are more
susceptible to this effect. It contains atropine, so it will increase heart rate. It does not contribute to fluid retention.
Lomotil causes central nervous system depression and will not cause nervousness and tremors.

Question 36

A patient asks the nurse the best way to prevent traveler’s diarrhea. The nurse will provide which recommendation
to the patient?

a. “Ask your provider for prophylactic antibiotics.”
b. “Drink bottled water and eat only well-cooked meats.”
c. “Eat fresh, raw fruits and vegetables.”
d. “Take loperamide (Imodium) every day.”

Answer 36

b. “Drink bottled water and eat only well-cooked meats.”

Patients traveling to areas with potential traveler’s diarrhea should be taught to drink bottled water and eat
meats that are well-cooked. Prophylactic antibiotics are not recommended. Patients should eat cooked,
washed fruits and vegetables. Loperamide can increase exposure to pathogens by slowing motility.

Question 37

An appropriate goal when teaching a patient who has diarrhea is that the patient

a. will have less frequent, more formed stools.
b. will not have a stool for 1 to 2 days.
c. will receive adequate intravenous fluids.
d. will receive appropriate antibiotic therapy.

Answer 37

a. will have less frequent, more formed stools.

An appropriate goal is that patients will have formed, less frequent stools not an absence of stools. Receiving
adequate intravenous fluids or antibiotic therapy are interventions not goals.

Question 38

A patient reports having three to four stools, which are sometimes hard, per week. The nurse will perform
which action?

a. Recommend increased fluids and dietary fiber.
b. Request an order for a laxative as needed.
c. Request an order for a stool softener.
d. Suggest discussing chronic constipation with the provider.

Answer 38

a. Recommend increased fluids and dietary fiber.

This patient is having stools that are within the normal range for frequency. Nonpharmacologic measures
should be used first to help soften stools.

Question 39

The nurse is instructing a patient who will take psyllium (Metamucil) to treat constipation. What information
will the nurse include when teaching this patient?

a. The importance of consuming adequate amounts of water
b. The need to monitor for systemic side effects
c. The onset of action of 30 to 60 minutes after administration
d. The need to use the dry form of Metamucil to prevent cramping

Answer 39

a. The importance of consuming adequate amounts of water

Insufficient fluid intake can cause the drug to solidify in the gastrointestinal tract. Psyllium is not digestible, so
it does not have systemic side effects. Onset of action for psyllium is between 10 and 24 hours. The dry form
can cause cramping.

Question 40

A patient who has been instructed to use a liquid antacid medication to treat gastrointestinal upset asks the
nurse about how to take this medication. What information will the nurse include when teaching this patient?

a. Take a laxative if constipation occurs.
b. Take 60 minutes after meals and at bedtime.
c. Take with at least 8 ounces of water to improve absorption.
d. Take with milk to improve effectiveness.

Answer 40

b. Take 60 minutes after meals and at bedtime.

Since maximum acid secretion occurs after eating and at bedtime, antacids should be taken 1 to 3 hours after
eating and at bedtime. Taking antacids before meals slows gastric emptying time and causes increased gastrointestinal
(GI) secretions. Patients should not self-treat constipation or diarrhea. Patients should use 2 to 4
ounces of water when taking to ensure that the drug enters the stomach; more than that will increase GI secretions.
Antacids should not be taken with milk or foods high in vitamin D.

Question 41

A patient who has symptoms of peptic ulcer disease will undergo a test that requires drinking a liquid containing
13C urea and breathing into a container. The nurse will explain to the patient that this test is performed to

a. assess the level of hydrochloric acid.
b. detect H. pylori antibodies.
c. measure the pH of gastric secretions.
d. test for the presence of 13CO2.

Answer 41

d. test for the presence of 13CO2.

When H. pylori is suspected, a noninvasive test is performed by administering 13C urea which, in the presence
of H. pylori, will release 13CO2. The test does not measure the amount of HCl acid or the pH and does not detect
H. pylori antibodies.

Question 42

A patient is taking esomeprazole (Nexium) 15 mg per day to treat a duodenal ulcer. After 10 days of treatment,
the patient reports that the pain has subsided. The nurse will counsel the patient to

a. continue the medication for 4 more weeks.
b. reduce the medication dose by half.
c. stop taking the medication.
d. take the medication every other day.

Answer 42

a. continue the medication for 4 more weeks.

With treatment, ulcer pain may subside in 10 days, but the healing process may take 1 to 2 months. Patients
should be counseled to take the drug for the length of time prescribed. Reducing the dose or taking less frequently
is not indicated.

Question 43

A patient with a peptic ulcer has been diagnosed with H. pylori. The provider has ordered lansoprazole (Prevacid),
clarithromycin (Biaxin), and metronidazole (Flagyl). The patient asks the nurse why two antibiotics are
needed. The nurse will explain that two antibiotics

a. allow for less toxic dosing.
b. combat bacterial resistance.
c. have synergistic effects.
d. improve acid suppression.

Answer 43

b. combat bacterial resistance.

The use of two antibiotics when treating H. pylori peptic ulcer disease helps to combat bacterial resistance because
H. pylori develops resistance rapidly. Giving two antibiotics, in this case, is not to reduce the dose or to
cause synergistic effects. Antibiotics do not affect acid production.

Question 44

A patient who takes propantheline bromine (Pro-Banthine) and omeprazole (Prilosec) for an ulcer will begin
taking an antacid. The nurse will give which instruction to the patient regarding how to take the antacid?

a. Take the antacid 2 hours after taking the propantheline.
b. Take the antacid along with a meal.
c. Take the antacid with milk.
d. Take the antacid with the propantheline bromine.

Answer 44

a. Take the antacid 2 hours after taking the propantheline.

Antacids can slow the absorption of anticholinergics and should be taken 2 hours after anticholinergic administration.
Antacids should be given 1 to 3 hours after a meal and should not be given with dairy products.

Question 45

Which antacid is likely to cause acid rebound?

a. Aluminum hydroxide
b. Calcium carbonate
c. Magnesium hydroxide
d. Magnesium trisilicate

Answer 45

b. Calcium carbonate

While calcium carbonate is most effective in neutralizing acid, a significant amount can be systemically absorbed
and can cause acid rebound. The other antacids do not have significant systemic absorption.

Question 46

An elderly patient reports using Maalox frequently to treat acid reflux. The nurse should notify the patient’s
provider to request an order for which laboratory tests?

a. Liver enzymes and serum calcium
b. Liver enzymes and serum magnesium
c. Renal function tests and serum calcium
d. Renal function tests and serum magnesium

Answer 46

d. Renal function tests and serum magnesium

Maalox contains magnesium and carries a risk of hypermagnesemia, especially with decreased renal function.
Older patients have an increased risk of poor renal function, so this patient should especially be evaluated for
hypermagnesemia.

Question 47

The nurse is caring for a patient who has Zollinger-Ellison syndrome. Which medication order would the
nurse question for this patient?

a. Cimetadine (Tagamet)
b. Pantoprazole (Protonix)
c. Rabeprazole (Aciphex)
d. Ranitidine (Zantac)

Answer 47

a. Cimetadine (Tagamet)

Cimetidine is not effective for treating Zollinger-Ellison syndrome. The other medications are used to treat
Zollinger-Ellison syndrome.

Question 48

A patient who is diagnosed with peptic ulcer disease has been started on a regimen that includes ranitidine
(Zantac) 300 mg daily at bedtime. The patient calls the clinic 1 week later to report no relief from discomfort.
What action will the nurse take?

a. Contact the provider to discuss changing to cimetidine (Tagamet).
b. Notify the provider to discuss increasing the dose.
c. Reassure the patient that the drug may take 1 to 2 weeks to be effective.
d. Suggest that the patient split the medication into twice daily dosing.

Answer 48

c. Reassure the patient that the drug may take 1 to 2 weeks to be effective.

Patients taking histamine2 blockers can expect abdominal pain to decrease after 1 to 2 weeks of drug therapy.
Cimetidine is not as potent as ranitidine and interacts with many medications through the cytochrome P450
system. Three hundred milligrams is the maximum dose.

Question 49

A male patient who has been taking a histamine2 blocker for several months reports decreased libido and
breast swelling. What will the nurse do?

a. Contact the provider to report possible drug toxicity.
b. Reassure the patient that these symptoms will stop when the drug is discontinued.
c. Request an order for serum hormone levels.
d. Suggest that the patient see an endocrinologist.

Answer 49

b. Reassure the patient that these symptoms will stop when the drug is discontinued.

Drug-induced impotence and gynecomastia are reversible drug side effects. These signs do not indicate drug
toxicity. Serum hormone levels and endocrinology evaluation are not indicated.

Question 50

A patient who has been taking ranitidine (Zantac) continues to have pain associated with peptic ulcer. A
noninvasive breath test is negative. Which treatment does the nurse expect the provider to order for this patient?
a. Adding an over-the-counter antacid to the patient’s drug regimen

b. A dual drug therapy regimen
c. Amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec)
d. Lansoprazole (Prevacid) instead of ranitidine

Answer 50

d. Lansoprazole (Prevacid) instead of ranitidine

This patient does not have H. pylori ulcer disease, so dual and triple drug therapy with antibiotics is not indicated.
Patients who fail treatment with a histamine2 blocker should be changed to a proton pump inhibitor (PPI)
such as lansoprazole. PPIs tend to inhibit gastric acid secretion up to 90% greater than the histamine
antagonists.

Question 51

A patient has been taking famotidine (Pepcid) 20 mg bid to treat an ulcer but continues to have pain. The
provider has ordered lansoprazole (Prevacid) 15 mg per day. The patient asks why the new drug is necessary,
since it is more expensive. The nurse will explain that lansoprazole

a. can be used for long-term therapy.
b. does not interact with other drugs.
c. has fewer medication side effects.
d. is more potent than famotidine.

Answer 51

d. is more potent than famotidine.

Famotidine is a histamine2 (H2) blocker. When patients fail therapy with these agents, proton pump inhibitors,
which can inhibit gastric acid secretion up to 90% greater than the H2 blockers, are used. Lansoprazole is not
for long-term treatment and has drug interactions and drug side effects as do all other medications.

Question 52

The nurse is caring for a patient who will begin taking omeprazole (Prevacid) 20 mg per day for 4 to 8 weeks
to treat gastroesophageal reflux disease esophagitis. The nurse learns that the patient takes digoxin. The nurse
will contact the provider for orders to

a. decrease the dose of omeprazole.
b. increase the dose of digoxin.
c. increase the omeprazole to 60 mg per day.
d. monitor for digoxin toxicity.

Answer 52

d. monitor for digoxin toxicity.

Proton pump inhibitors can enhance the effects of digoxin, so patients should be monitored for digoxin toxicity.
Changing the dose of either medication is not indicated prior to obtaining lab results that are positive for
digoxin toxicity.

Question 53

A patient reports experiencing flatulence and abdominal distension to the nurse. Which over-the-counter
medication will the nurse recommend?

a. Alka-Seltzer
b. Maalox
c. Mylicon
d. Tums

Answer 53

c. Mylicon

Mylicon is a brand-name simethicone, which is an anti-gas agent. Maalox Gas contains simethicone, while regular
Maalox does not. The other products do not contain simethicone.

Question 54

A patient who recently began having mild symptoms of GERD is reluctant to take medication. What measures
will the nurse recommend to minimize this patient’s symptoms? (Select all that apply.)

a. Avoiding hot, spicy foods
b. Avoiding tobacco products
c. Drinking a glass of red wine with dinner
d. Eating a snack before bedtime
e. Taking ibuprofen with food
f. Using a small pillow for sleeping
g. Wearing well-fitted clothing

Answer 54

ANS: A, B, E

a. Avoiding hot, spicy foods
b. Avoiding tobacco products
e. Taking ibuprofen with food

Hot, spicy foods aggravate gastric upset, tobacco increases gastric secretions, and ibuprofen on an empty
stomach increases gastric secretions, so patients should be taught to avoid these actions. Alcohol should be
avoided since it increases gastric secretions. Eating at bedtime increases reflux, as does laying relatively flat to
sleep, or wearing fitted clothing.