NURS 317 Unit 2 Chapter 58 Pharm Point Questions Flashcards
By what routes can the nurse administer metoclopramide? Select all that apply.
A) Rectal
B) Intramuscular
C) Intravenous
D) Oral
E) Subcutaneously
B) Intramuscular
C) Intravenous
D) Oral
Rationale:Metoclopramide can be given orally, intramuscularly, or intravenously, but not rectally or subcutaneously.
The nurse administers metoclopramide orally at 9:00 AM to a client with GERD. The nurse would expect this drug to exert its maximum effectiveness at which time?
A) 1:00 to 2:00 PM
B) 12 to 12:30 PM
C) 10:00 to 10:30 AM
D) 11:00 to 11:30 AM
C) 10:00 to 10:30 AM’
Rationale:Metoclopramide, when administered orally, peaks in 60 to 90 minutes, which in this case would be between 10:00 and 10:30 AM.
What drug, if administered by the nurse, would be classified as a chemical stimulant laxative?
A) Docusate
B) Lactulose
C) Bisacodyl
D) Polycarbophil
C) Bisacodyl
Rationale:Bisacodyl is a chemical-stimulant laxative. Polycarbophil is a bulk laxative. Docusate is a lubricant laxative. Lactulose is a bulk laxative.
When describing traveler’s diarrhea, the nurse identifies what as the most common cause?
A) Staphylococcus aureus
B) Clostridium difficile
C) Pseudomonas
D) Escherichia coli
D) Escherichia coli
Rationale:The most common cause of traveler’s diarrhea is E. coli.
What is the best choice of laxative for the nurse to administer to an infant or young child?
A) Mineral oil
B) Glycerin suppositories
C) Paregoric
D) Bismuth subsalicylate
B) Glycerin suppositories
Rationale:If a laxative is needed, glycerin suppositories are the best choice for infants and young children. While other options may be given to children, they are not the drug of choice. Paregoric and bismuth subsalicylate are antidiarrheals.
A client with constipation is diagnosed with irritable bowel syndrome. Which agent would the nurse expect the healthcare provider to prescribe?
A) Methylnaltrexone
B) Alosetron
C) Hyoscyamine
D) Lubiprostone
D) Lubiprostone
Rationale:Lubiprostone is indicated for the treatment of irritable bowel syndrome when constipation is the chief complaint. Alosetron is indicated for the treatment of irritable bowel syndrome when diarrhea is the chief complaint. Hyoscyamine is indicated as adjunct treatment for irritable bowel syndrome. Methylnaltrexone is indicated for the treatment of opioid-induced constipation.
The nurse is preparing a teaching plan for a client who is using mineral oil. What should the nurse describe as possible adverse effects? Select all that apply.
A) Leakage of stool
B) Decreased heart rate
C) Abdominal cramping
D) Chills
E) Dizziness
F) Weakness
A) Leakage of stool
C) Abdominal cramping
E) Dizziness
F) Weakness
Rationale:Abdominal cramping is associated with mineral oil use. Leakage of stool and staining occurs with mineral oil use due to the inability of the stool to be retained by the external sphincter. Dizziness can occur with mineral oil use. Weakness is associated with mineral oil use. Sweating and flushing are seen with mineral oil use. Decreased heart rate is associated with the use of metoclopramide
How does the nurse evaluate the effectiveness of therapy after administering an antidiarrheal to the client?
A) Number of diarrhea stools
B) Severity of abdominal pain
C) Amount of urine output
D) Serum electrolyte levels
A) Number of diarrhea stools
Rationale:The nurse evaluates treatment for diarrhea by the number of stools the client has after receiving medication. A reduction in stools would indicate the drug was effective and an increase or no change in stools would indicate the drug was not effective.
The nurse is teaching the mother of a 20-kg child how to administer paregoric to the child using household measurements. How much would the nurse instruct the mother to administer?
A) 0.5 to 0.75 teaspoon up to four times a day
B) 1 to 2 teaspoons up to four times a day
C) 1 to 2 drops every 1 hour as needed
D) 1 to 2 tablespoons every 4 hours as needed
B) 1 to 2 teaspoons up to four times a day
Rationale:Pediatric dosage is 0.25 to 0.5 mL/kg PO one to four times daily as needed. 0.25 × 20 kg = 5 mL; 0.5 mL × 20 kg = 10 mL. There is 5 mL in a teaspoon so 1 to 2 teaspoons would be appropriate for this child
A client with constipation has been prescribed lactulose 15 to 30 mL PO q.i.d. PRN. The drug is available at a concentration of 10 g/15 mL. How many grams of lactulose will the client be taking if he or she takes the maximum one-time dose?
20 Grams
Rationale:The dose can be calculated by creating a ratio: 10 g/15 mL = X/30 mL. This yields a result of a 20 g
What is the nurse’s priority teaching point when teaching a client about using psyllium?
A) Taking the agent with a large amount of water
B) Supplementing with lubricant laxatives
C) Taking the agent at bedtime to minimize adverse effects
D) Temporarily limiting intake of high-fiber foods
A) Taking the agent with a large amount of water
Rationale:A large amount of water is needed to prevent the laxative from swelling into a gelatin-like mass in the esophagus that could lead to obstruction. Psyllium can be taken any time, one to three times per day. Bulk laxatives, like psyllium, can increase the motility of the GI tract and interfere with the timing or process of absorption. It would be important to encourage the client to ingest high-fiber foods to promote bowel evacuation and reduce the need for psyllium. Combining the drug with other laxatives may cause excessive bowel stimulation.
The nurse is caring for an older adult client who takes laxatives on a daily basis but still experiences occasional episodes of constipation. The nurse should plan interventions related to what problem?
A) Laxative addiction
B) Bowel obstruction
C) Cathartic dependence
D) Irritable bowel syndrome
C) Cathartic dependence
Rationale:A very common adverse effect that is seen with frequent laxative use or laxative abuse is cathartic dependence. This reaction occurs when clients use laxatives over a long period of time and the GI tract becomes dependent on the vigorous stimulation of the laxative. This is not a form of addiction. Irritable bowel syndrome would cause diarrhea, not constipation. A bowel obstruction is an acute problem that would not cause episodes of constipation over time
A client with a history of constipation has begun taking psyllium. The client has not had a bowel movement since beginning the medication and is experiencing severe cramping? What assessment question should the nurse prioritize?
A) “Have you ever taken psyllium before?”
B) “Are you taking other laxatives in addition to this one?”
C) “Have you been taking the medication at bedtime?”
D) “How much fluid have you been drinking.”
D) “How much fluid have you been drinking.
Rationale:The client’s symptoms may be the result of taking the drug with inadequate fluid intake. Additional laxatives would likely resolve the problem, not exacerbate it. The drug should not be taken at bedtime but doing so would not cause these problems. The client’s prior use of psyllium is not a priority.
The nurse appropriately administers a laxative to the client based on what indication?
A) Enhanced nutrient absorption in the small intestine
B) Promotion of bearing down efforts for bowel evacuation
C) Resolution of a large bowel obstruction
D) Adjunct in anthelmintic therapy
D) Adjunct in anthelmintic therapy
Rationale:Laxatives are used as an adjunct in anthelmintic therapy when it is desirable to flush helminthes from the GI tract. Laxatives would exacerbate a client’s distress if given when there is an obstruction. Laxatives do not enhance nutrient absorption. Laxatives are used to prevent straining/bearing down during bowel evacuation when it is clinically undesirable
The nurse explains the action of bulk stimulants as doing what?
A) Allow formation of a slippery coat on the intestinal contents.
B) Increase the fluid in the intestinal contents.
C) Directly stimulate the nerve plexus in the intestinal wall.
D) Selectively antagonize opioid binding.
B) Increase the fluid in the intestinal contents.
Rationale:Bulk laxatives increase the fluid in the intestinal contents, which enlarges bulk and stimulates local stretch receptor and activates local activity. Chemical stimulant laxatives directly stimulate the nerve plexus in the intestinal wall. Mineral oil, a lubricant, forms a slippery coat on the contents of the intestinal tract. Methylnaltrexone acts as a selective antagonist to opioid binding at the mu receptor.
