1.

Which of the following antacids may have a laxative effect and should be used
cautiously in clients who have chronic diarrhea? Select all that apply.
A) Calcium carbonate (Mylanta)
B) Magnesium hydroxide (Milk of Magnesia)
C) Magnesium oxide (Mag-Ox)
D) Aluminum hydroxide (ALternaGEL)
E) Sodium bicarbonate (Bell/ans)
Ans: B, C, E
Feedback:
The magnesium- and sodium-containing antacids may have a laxative effect and may
produce diarrhea. Aluminum- and calcium-containing antacids tend to produce
constipation.

2. Which of the following antacids may produce constipation and should be used
cautiously in clients who have chronic constipation? Select all that apply.
A) Calcium carbonate (Mylanta)
B) Magnesium hydroxide (Milk of Magnesia)
C) Magnesium oxide (Mag-Ox)
D) Aluminum hydroxide (ALternaGEL)
E) Sodium bicarbonate (Bell/ans)
Ans: A, D
Feedback:
The aluminum- and calcium-containing antacids may produce constipation.
Magnesium- and sodium-containing antacids tend to have a laxative effect.

3. A nurse educating a client on the antacid aluminum hydroxide (ALternaGEL) should

warn the client about which of the following adverse reactions? Select all that apply.
A) Alopecia
B) Anorexia
C) Diarrhea
D) Tremors
E) Bone pain
Ans: B, D, E
Feedback:
Adverse reactions of aluminum hydroxide (ALternaGEL) include constipation,
intestinal impaction, anorexia, weakness, tremors, and bone pain.

4. A nurse educating a client on the antacid magnesium oxide (Mag-Ox) should warn the
client of which of the following adverse reactions? Select all that apply.
A) Tremors
B) Anorexia
C) Diarrhea
D) Dehydration

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E) Hypotension
Ans: C, D, E
Feedback:
Adverse reactions of magnesium oxide (Mag-Ox) include severe diarrhea, dehydration,
and hypermagnesemia (nausea, vomiting, hypotension, and decreased respirations).

5. A nurse educating a client on the antacid calcium carbonate (Mylanta) should warn the
client of which of the following adverse reactions? Select all that apply.
A) Rebound hyperacidity
B) Anorexia
C) Headache
D) Dehydration
E) Confusion
Ans: A, C, E
Feedback:
Adverse reactions of calcium carbonate (Mylanta) include rebound hyperacidity,
metabolic alkalosis, hypercalcemia, vomiting, confusion, headache, renal calculi, and
neurologic impairment.

6. At a yearly physical examination, a client asks the nurse if it would be okay to take
ginger to aid with digestion. Before telling the client it is okay to take ginger, which
medical conditions should the nurse make sure the client does not have? Select all that
apply.
A) Hypertension
B) Kidney stones
C) Vitamin B12 deficiency
D) Gallstones
E) Liver disease
Ans: A, D
Feedback:
Ginger should be used cautiously in clients with hypertension or gallstones and during
pregnancy and lactation.

7. After teaching a group of nursing students about upper gastrointestinal system drugs, the
instructor determines that the teaching was successful when the students identify which
of the following as a gastrointestinal stimulant?
A) Ranitidine (Zantac)
B) Misoprostol (Cytotec)
C) Omeprazole (Prilosec)
D) Metoclopramide (Reglan)
Ans: D
Feedback:
Metoclopramide (Reglan) is classified as a gastrointestinal stimulant. Ranitidine is a

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 histamine-2 receptor antagonist. Omeprazole is a proton pump inhibitor. Misoprostol is
a miscellaneous acid reducer.

8. A nurse should recognize that administering antacids to clients taking which of the
following medications can result in decreased drug absorption and decreased drug
effects? Select all that apply.
A) Simvastatin (Zocor)
B) Isoniazid (Nydrazid)
C) Digoxin (Lanoxin)
D) Phenytoin (Dilantin)
E) Enalapril (Vasotec)
Ans: B, C, D
Feedback:
Antacids decrease the absorption of digoxin, isoniazid, phenytoin, and chlorpromazine,
leading to decreased effect of those drugs.

9. A client is diagnosed with an infection with H. pylori. Which of the following drugs are
commonly used in combination with certain antibiotics in the treatment of this
infection? Select all that apply.
A) Metoclopramide (Reglan)
B) Omeprazole (Prilosec)
C) Ondansetron (Zofran)
D) Lansoprazole (Prevacid)
E) Promethazine (Phenergan)
Ans: B, D
Feedback:
The proton pump inhibitors, like omeprazole (Prilosec) and lansoprazole (Prevacid), are
commonly used in combination with certain antibiotics in the treatment of H. pylori.

10. The nurse should administer which of the following medications cautiously to clients
with vitamin B12 deficiency as the prolonged use of these drugs decreases the body's
ability to absorb vitamin B12? Select all that apply.
A) Metoclopramide (Reglan)
B) Rabeprazole (AcipHex)
C) Sucralfate (Carafate)
D) Pantoprazole (Protonix)
E) Promethazine (Phenergan)
Ans: B, D
Feedback:
The nurse should administer proton pump inhibitors, like rabeprazole (AcipHex) and
pantoprazole (Protonix), cautiously to clients with vitamin B12 deficiency as the
prolonged use of these drugs decreases the body's ability to absorb vitamin B12.

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 11. A nurse should monitor a client taking which of the following drugs for increased
adverse effects and toxicity if omeprazole (Prilosec) therapy is initiated? Select all that
apply.
A) Phenobarbital (Luminal)
B) Digoxin (Lanoxin)
C) Diazepam (Valium)
D) Warfarin (Coumadin)
E) Ketoconazole (Nizoral)
Ans: B, C, D
Feedback:
The initiation of proton pump inhibitors, like omeprazole (Prilosec), can result in
increased adverse reactions and toxicities of warfarin (Coumadin), benzodiazepines
(diazepam), digoxin (Lanoxin), phenytoin (Dilantin), and clarithromycin (Biaxin).

12. When describing the action of which drug would the nurse explain that it works to
reduce gastric motility and decrease the amount of acid secreted by the stomach via
blockade of cholinergic receptors? Select all that apply.
A) Omeprazole (Prilosec)
B) Ranitidine (Zantac)
C) Propantheline (Pro-Banthine)
D) Sucralfate (Carafate)
E) Glycopyrrolate (Robinul)
Ans: C, E
Feedback:
Propantheline (Pro-Banthine) and glycopyrrolate (Robinul) are anticholinergic drugs
used to reduce gastric motility and decrease the amount of acid secreted by the stomach
via blockade of cholinergic receptors.

13. A nurse is conducting a class for a community group. As part of the class, the nurse is
explaining the use of syrup of ipecac. The nurse would emphasize that this drug is
contraindicated in which of the following cases? Select all that apply.
A) The client is comatose or has altered mental status.
B) The client has erosive esophagitis.
C) The client is having seizures.
D) The substance is a caustic or corrosive agent.
E) The substance is a low-viscosity petroleum distillate.
Ans: A, C, D, E
Feedback:
The use of syrup of ipecac is contraindicated in the following cases: the client is
comatose or has altered mental status, the client is having seizures, the substance is a
caustic or corrosive agent, the substance is a low-viscosity petroleum distillate, or the
substance is capable of also altered mental status or convulsions.

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 14. Before administering a prescribed emetic, which of the following would the nurse need
to assess? Select all that apply.
A) What chemicals or substances were ingested?
B) What are the client's current medications?
C) What time was the substance ingested?
D) What is the client's blood pressure?
E) What symptoms were noted before seeking treatment?
Ans: A, C, E
Feedback:
Before an emetic is given, it is extremely important to know the chemicals or substances
that have been ingested, the time they were ingested, and what symptoms were noted
before seeking medical treatment.

15. A nurse follows a specific protocol when administering which of the following
medications to prevent nausea induced by doxorubicin (Adriamycin) administration?
Select all that apply.
A) Lansoprazole (Prevacid)
B) Ondansetron (Zofran)
C) Metoclopramide (Reglan)
D) Promethazine (Phenergan)
E) Granisetron (Kytril)
Ans: B, E
Feedback:
5-HT3 receptor antagonists, like ondansetron (Zofran) and granisetron (Kytril), are used
in the prevention of chemotherapy-induced nausea and vomiting.

16. A client is administered trimethobenzamide hydrochloride (Tigan) to control nausea and

vomiting. The nurse would assess the client for which of the following?
A) Acid rebound
B) Neurotoxicity
C) Blurred vision
D) Bone softening
Ans: C
Feedback:
The nurse should monitor the client for blurred vision as an adverse reaction to the
trimethobenzamide hydrochloride (Tigan). The nurse need not monitor the client for
acid rebound, neurotoxicity, and bone softening as they are not adverse reactions to
trimethobenzamide hydrochloride (Tigan). Acid rebound is an adverse reaction to
calcium carbonate. Neurotoxicity and bone softening are adverse reactions to aluminum
carbonate gel.

17. A nurse is caring for a client who has been prescribed aluminum carbonate gel (Basaljel)

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 for the relief of an acute peptic ulcer. Which of the following interventions should the
nurse perform to promote an optimal response to therapy?
A) Administer the drug hourly for the first 2 weeks.
B) Administer the drug early in the morning before breakfast.
C) Administer the drug with 40 mL of apple juice.
D) Administer the first dose by IV route and then orally.
Ans: A
Feedback:
The nurse should administer the drug hourly for the first 2 weeks when treating an acute
peptic ulcer. The nurse instructs the client to administer the drug 1 to 2 hours after meals
and at bedtime after the first 2 weeks. The nurse need not suggest to the client to
administer the drug early in the morning before breakfast nor to administer it with apple
juice. The drug is not given intravenously.

18. A 30-year-old nonpregnant client is prescribed misoprostol. Which of the following

should the nurse instruct the client as part of the teaching plan?
A) Swallow the tablet 1 hour before eating.
B) Administer the drug 1 hour before travel.
C) Do not chew, open, or crush the tablet.
D) Use a reliable contraceptive method.
Ans: D
Feedback:
The nurse should instruct the client to use a reliable contraceptive method to avoid
pregnancy during the course of treatment as it can cause spontaneous abortion. The
nurse should instruct the client taking proton pump inhibitors not to chew, open, or
crush the tablet and to swallow the tablet whole at least 1 hour before eating. The nurse
needs to inform the client taking a drug for motion sickness to administer it about 1 hour
before travel.

19. A nurse is caring for a client brought to the health care facility for a drug overdose. In
which of the following cases can the client be administered an emetic?
A) Client's mental status is intact.
B) Client has an existing condition of severe hypertension.
C) Client has a medical history of convulsions.
D) Client has an existing condition of hemorrhagic diathesis.
Ans: A
Feedback:
The client can be administered an emetic only if the client does not have an altered
mental status or is not comatose. A client who is comatose has an increased risk of
aspiration of stomach contents. Clients with an existing condition of severe
hypertension, a medical history of convulsions, or an existing condition of hemorrhagic
diathesis should not be given an emetic as these conditions may be exacerbated by
vomiting.

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 20. A nurse is caring for an elderly client who has received cimetidine. Which of the
following interventions should the nurse perform?
A) Monitor the client for complaints of pain or sour taste.
B) Monitor the client for concentrated urine and restlessness.
C) Closely monitor the client for confusion and dizziness.
D) Report symptoms of tardive dyskinesia to the primary health care provider.
Ans: C
Feedback:
The nurse should closely monitor the elderly client who has been administered
cimetidine for confusion and dizziness. When the client is receiving an antiemetic, the
nurse monitors the client frequently for continued complaints of pain, sour taste, spitting
blood, or coffee-ground-colored emesis. When antacids are given to the client, the nurse
should observe the client for concentrated urine and restlessness. When the client is
administered prolonged doses of metoclopramide, the nurse reports any sign of tardive
dyskinesia or extrapyramidal symptoms to the primary health care provider.

21. A client is receiving an antiemetic. The nurse identifies a nursing diagnosis of

Imbalanced Nutrition: Less Than Body Requirements. Which of the following would
the nurse include in the client's plan of care? Select all that apply.
A) Remove items with strong smells and odors.
B) Use mouthwash or frequent oral rinses.
C) Make the environment as pleasant as possible.
D) Explain that the drug may change the color of the stool.
E) Follow the medication with a small amount of water.
Ans: A, B, C
Feedback:
When caring for a client receiving an antiemetic with a nursing diagnosis of Imbalanced
Nutrition: Less Than Body Requirements, the nurse makes the environment as pleasant
as possible to enhance the client's appetite and removes items with strong smells and
odors. The nurse gives the client mouthwash or frequent oral rinses to remove the
disagreeable taste that accompanies vomiting. Stool color is unaffected. Liquid antacids
could be followed with a small amount of water.

22. A client is taking ginger medicinally for motion sickness. The nurse would urge the
client to use caution if the client has which medical condition?
A) Gallstones
B) Blood dyscrasia
C) Parkinson's disease
D) Severe liver disease
Ans: A
Feedback:
Ginger should be used with caution in clients with hypertension or gallstones and during
pregnancy or lactation. Antiemetic prochlorperazine is contraindicated in clients with

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 blood dyscrasia, Parkinson's disease, and severe liver disease.

23. A nurse is caring for a client who is prescribed omeprazole for a duodenal ulcer. The
client is also taking benzodiazepines for the management of a seizure disorder. The
nurse would assess the client for which of the following?
A) Decreased absorption of the proton pump inhibitor
B) Risk for toxic level of benzodiazepines
C) Increased risk of respiratory depression
D) Increased risk of bleeding
Ans: B
Feedback:
When the proton pump inhibitor is administered with benzodiazepines, there will be a
risk for a toxic level of benzodiazepines. When the client is administered sucralfate with
the proton pump inhibitor, there will be a decrease in absorption of the proton pump
inhibitor. When the client is administered an antacid with opioid analgesics, there will
be an increased risk of respiratory depression. There will be an increased risk of
bleeding when the client is taking oral anticoagulants with the proton pump inhibitor.

24. A nurse in a health care facility is caring for a client who is receiving an antiemetic to
control vomiting related to chemotherapy. Which of the following nursing diagnoses
should the care plan for this client include?
A) Risk for Imbalanced Fluid Volume
B) Disturbed Sensory Perception
C) Impaired Physical Mobility
D) Ineffective Tissue Perfusion
Ans: A
Feedback:
The care plan should include Risk for Imbalanced Fluid Volume for the client receiving
an antiemetic due to the possible fluid losses associated with vomiting as well as the
possible decrease in fluid intake. Disturbed sensory perception, impaired physical
mobility, and ineffective tissue perfusion are not applicable.

25. A client with a nasogastric tube is prescribed therapy to prevent ulcer development.
Which of the following would be the best option for the drug?
A) Tablet that can be crushed
B) Liquid formulation
C) Intravenous administration
D) Intramuscular injection
Ans: B
Feedback:
The nurse should request the liquid form when administration is in a tube to decrease
the chance of a clogged NG tube. Although it is appropriate to crush the tablet and mix
it with apple juice, there is still a risk for clogging. Intravenous or intramuscular

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 administration would be inappropriate. The IV route is typically preferred if the patient
has an existing IV line, because these drugs are irritating, and IM injections need to be
given deep into the muscular tissue to minimize harm.

26. A group of nursing students are reviewing information about upper gastrointestinal
system drugs. The students demonstrate understanding of the material when they
identify which of the following as a proton pump inhibitor?
A) Nizatidine
B) Omeprazole
C) Esomeprazole
D) Sucralfate
E) Misoprostol
Ans: B, C
Feedback:
Omeprazole and esomeprazole are examples of proton pump inhibitors. Nizatidine is a
histamine-2 receptor antagonist. Sucralfate and misoprostol are examples of
miscellaneous acid reducers.

27. A nurse is teaching a client who is prescribed metoclopramide about signs and
symptoms to report to the primary health care provider. The nurse determines that the
teaching was successful when the client states which of the following? Select all that
apply.
A) Difficulty swallowing
B) Uncontrolled tongue movements
C) Muscle laxity
D) Shuffling gait
E) Diarrhea
Ans: A, B, D
Feedback:
When taking metoclopramide, the client should immediately report any of the following
signs: difficulty speaking or swallowing; mask-like face; shuffling gait; rigidity;
tremors; uncontrolled movements of the mouth, face, or extremities; and uncontrolled
chewing or unusual movements of the tongue. Diarrhea does not require the client to
notify the health care provider.

28. A client is prescribed ranitidine. A review of the client's medication history reveals that
she also takes warfarin for treatment of deep vein thrombosis. The nurse would monitor
the client for which of the following?
A) Decreased white blood cell count
B) Increased risk of respiratory depression
C) Increased risk for bleeding
D) Decreased seizure threshold
Ans: C

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Feedback:
Histamine-2 receptor antagonists when given with warfarin place the client at an
increased risk for bleeding. A decreased white blood cell count occurs when histamine-2
receptor antagonists are given with carmustine. An increased risk of respiratory
depression occurs when histamine-2 receptor antagonists are given with opioid
analgesics. This class of drugs does not interact with any antiseizure medications.

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