Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 047 (edited file)—"Gastrointestinal Medications" 10/14/08, Page 1 of 10, 0 Figure(s), 0 Table(s), 13 Box(es

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47: Gastrointestinal Medications
PRACTICE QUESTIONS
1. A client has been started on psyllium (Metamucil). The nurse would teach the client to take this medication with: 1. Gelatin, applesauce, or pudding 2. A full glass of liquid, followed by a second glass 3. A multivitamin and mineral supplement 4. A dose of antacid Answer: 2 Rationale: Metamucil is a bulk-forming laxative. It should be taken with a full glass of water or juice, followed by another glass of liquid. This will help prevent impaction of the medication in the stomach or small intestine. The other options are incorrect. Test-Taking Strategy: Use the process of elimination. Option 4 can be eliminated first because most medications are not taken with antacids. Eliminate options 1 and 3 next because they have no physiological benefit for medication effect. Review the administration of this medication if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Teaching/Learning Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 908. 2. A nurse teaches a client taking metoclopramide (Reglan) to discontinue the medication immediately and call the physician if which side effect occurs with long-term use? 1. Anxiety or irritability 2. Dry mouth not helped by the use of sugar-free hard candy 3. Excessive excitability 4. Uncontrolled rhythmic movements of the face or limbs Answer: 4 Rationale: If the client experiences tardive dyskinesia (rhythmic movements of the face or limbs), the client should stop the medication and call the physician. These side effects may be irreversible. Excitability is not a side effect of this medication. Anxiety, irritability, and dry mouth are side effects that are not as harmful to the client. Test-Taking Strategy: Use the process of elimination and focus on the issue, to call the physician. Recalling that the medication can cause tardive dyskinesia will direct you to option 4. Review the side effects of this medication if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005.

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Philadelphia: W.B. Saunders, p. 701. 3. A client has just taken a dose of trimethobenzamide (Tigan). The nurse plans to monitor this client for relief of: 1. Nausea and vomiting 2. Abdominal pain 3. Heartburn 4. Constipation Answer: 1 Rationale: Trimethobenzamide is an antiemetic agent that is used in the treatment of nausea and vomiting. The other options are incorrect. Test-Taking Strategy: Use the process of elimination. Recalling that trimethobenzamide is an antiemetic will direct you to option 1. Review the action and use of this medication if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 1081. 4. A client has a PRN order for ondansetron (Zofran). The nurse would administer this medication to the postoperative client for relief of: 1. Urinary retention 2. Incisional pain 3. Nausea and vomiting 4. Paralytic ileus Answer: 3 Rationale: Ondansetron is an antiemetic that is used in the treatment of postoperative nausea and vomiting, as well as nausea and vomiting associated with chemotherapy. The other options are incorrect. Test-Taking Strategy: Use the process of elimination. Recalling that ondansetron is an antiemetic will direct you to option 3. Review the action and use of this medication if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 802. 5. A client has an order to take magnesium citrate to prevent constipation following a barium study of the upper gastrointestinal tract. The nurse plans to administer this medication: 1. With a full glass of water 2. With fruit juice only 3. Chilled

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4. At room temperature Answer: 3 Rationale: Magnesium citrate is available as an oral solution. It is used commonly as a laxative following certain studies of the GI tract. It should be served chilled, and should not be allowed to stand for prolonged periods. This would reduce the carbonation and make the solution even less palatable. Options 1, 2, and 4 are incorrect. Test-Taking Strategy: Use the process of elimination. Eliminate options 1 and 2 first, knowing that magnesium citrate is itself a liquid. From the remaining options, it is necessary to know it should be given cold to enhance palatability. Review this medication if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Pharmacology References: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 660. McKenry, L., & Salerno, E. (2003). Mosby’s pharmacology in nursing (21st ed.). St. Louis: Mosby, p. 218. 6. A nurse is administering a dose of prochlorperazine (Compazine) to a client for nausea and vomiting. The nurse would monitor the client for which frequent side effect of this medication? 1. Diarrhea 2. Drooling 3. Excessive lacrimation 4. Blurred vision Answer: 4 Rationale: The nurse would monitor the client for blurred vision as a frequent side effect of prochlorperazine. Other frequent side effects of this phenothiazine-type antiemetic and antipsychotic are dry eyes, dry mouth, and constipation. Test-Taking Strategy: Focus on the name of the medication. Recalling that this medication is a phenothiazine-type antiemetic and antipsychotic will assist with answering this question. Remember, frequent side effects of this phenothiazine-type antiemetic and antipsychotic are blurred vision, dry eyes, dry mouth, and constipation. Review this medication if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Pharmacology References: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 892. McKenry, L., & Salerno, E. (2003). Mosby’s pharmacology in nursing (21st ed.). St. Louis: Mosby, p. 400. 7. A client has begun medication therapy with pancrelipase (Pancrease). The nurse determines that the medication is having the optimal intended benefit if which effect is observed? 1. Reduction of steatorrhea

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2. Absence of abdominal pain 3. Relief of heartburn 4. Weight loss Answer: 1 Rationale: Pancrelipase is a pancreatic enzyme used in clients with pancreatitis as a digestive aid. The medication should reduce the amount of fatty stools (steatorrhea). Another intended effect could be improved nutritional status. It is not used to treat abdominal pain or heartburn. It could result in weight gain, but should not result in weight loss if it is aiding in digestion. Test-Taking Strategy: Use the process of elimination. The name of the medication gives an indication of the possible uses of this medication. Use knowledge of the physiology of the pancreas to assist in directing you to the correct option. Review this medication if you had difficulty with this question. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Evaluation Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 824. 8. A nurse is giving a client directions for proper use of aluminum hydroxide tablets (Alu-Caps). The nurse tells the client to: 1. Chew the tablets thoroughly and follow with 4 ounces of water. 2. Swallow the tablets whole with a full glass of water. 3. Take the tablets at the same time as other medications. 4. Take each dose with a laxative to prevent constipation. Answer: 1 Rationale: Aluminum hydroxide tablets should be chewed thoroughly before swallowing. This prevents them from entering the small intestine undissolved. They should not be swallowed whole. Antacids should be taken at least 1 hour apart from other medications to prevent interactive effects. Constipation is a side effect of use of aluminum products, but it is not correct for the client to take a laxative with each dose of aluminum hydroxide tablets. This promotes laxative abuse; the client should first try other means to prevent constipation. Test-Taking Strategy: Use the process of elimination. Eliminate option 4 first, because this action does not promote healthy bowel function. Next, eliminate option 3 using general knowledge of antacid interactive effects. Using principles of digestion and medication use, select from the remaining options. Review the administration of this medication if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W. B. Saunders, p. 41. 9. A client with a history of duodenal ulcer is taking calcium carbonate chewable tablets. The nurse determines that the client is experiencing optimal effects of the medication if:

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1. Muscle twitching stops 2. Heartburn is relieved 3. Serum calcium levels rise 4. Serum phosphorus levels decrease Answer: 2 Rationale: Calcium carbonate is used as an antacid for the relief of heartburn and indigestion in a client with a duodenal ulcer. It can also be used as a calcium supplement (option 3) or to bind phosphorus in the gastrointestinal tract with renal failure (option 4). Option 1 is incorrect, although proper calcium levels are needed for proper neurological function. Test-Taking Strategy: Focus on the client’s diagnosis. The key words in the question are duodenal ulcer and optimal effects. Knowledge of the concepts related to duodenal ulcer will direct you to option 2. Review the actions and use of this medication if you had difficulty with this question. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Evaluation Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W. B. Saunders, p. 155. 10. A hospitalized client asks the nurse for sodium bicarbonate to relieve heartburn following a meal. The nurse reviews the client’s medical record, knowing that the medication is contraindicated in which of the following conditions? 1. Urinary calculi 2. Chronic bronchitis 3. Metabolic alkalosis 4. Respiratory acidosis Answer: 3 Rationale: Sodium bicarbonate is an electrolyte modifier and antacid. It would further aggravate metabolic alkalosis. The conditions identified in the other options are not contraindications for the use of sodium bicarbonate. Test-Taking Strategy: Note the key word, contraindicated, and use knowledge of acid-base concepts to answer this question. Focus on the name of the medication to assist in eliminating options 1, 2, and 4. Review the contraindications associated with the use of this medication if you had difficulty with this question. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W. B. Saunders, p. 974. 11. An older client has recently been started on cimetidine (Tagamet). The nurse monitors the client for which frequent central nervous system (CNS) side effect of this medication? 1. Confusion 2. Dizziness

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3. Tremors 4. Hallucinations Answer: 1 Rationale: Older clients are especially susceptible to the central nervous system (CNS) side effects of cimetidine. The most frequent of these is confusion. Less common CNS side effects include headache, dizziness, drowsiness, and hallucinations. Test-Taking Strategy: Use the process of elimination. Note the key words, most frequent. Use knowledge of the concepts related to the older client and medication administration, and knowledge of this medication to answer the question. Review this medication if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 227. 12. A client with a gastric ulcer has an order for sucralfate (Carafate), 1 g orally four times a day. The nurse schedules the medication for which of the following times? 1. With meals and at bedtime 2. One hour before meals and at bedtime 3. Every 6 hours around the clock 4. One hour after meals and at bedtime Answer: 2 Rationale: The medication should be scheduled for administration 1 hour before meals and at bedtime. The medication is timed to allow it to form a protective coating over the ulcer before food intake stimulates gastric acid production and mechanical irritation. The other options are incorrect. Test-Taking Strategy: Use the process of elimination. Focusing on the client’s diagnosis and recalling the action of the medication will direct you to option 2. Review this medication if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 994. 13. A physician has written an order for ranitidine (Zantac), 300 mg once daily. The nurse schedules the medication for which of the following times? 1. Before breakfast 2. After lunch 3. With supper 4. At bedtime Answer: 4 Rationale: A single daily dose of ranitidine is scheduled to be given at bedtime. This allows for

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a prolonged effect, and the greatest protection of the gastric mucosa. The other options are incorrect. Test-Taking Strategy: Specific knowledge of the timing of this medication is needed to answer this question. Also, recalling that ranitidine suppresses secretions of gastric acids will direct you to option 4. If you had difficulty with this question, review this medication. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 926. 14. A client has been taking omeprazole (Prilosec) for 4 weeks. The nurse determines that the client is receiving the optimal intended effect of the medication if the client reports absence of which of the following symptoms? 1. Constipation 2. Heartburn 3. Diarrhea 4. Flatulence Answer: 2 Rationale: Omeprazole is a gastric pump inhibitor and is classified as an antiulcer agent. The intended effect of the medication is relief of pain from gastric irritation, often referred to as heartburn by clients. Options 1, 3, and 4 are incorrect. Test-Taking Strategy: Use the process of elimination. Recalling the action and use of omeprazole will direct you to option 2. Review this medication if you had difficulty with this question. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Evaluation Content Area: Pharmacology References: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 801. McKenry, L., & Salerno, E. (2003). Mosby’s pharmacology in nursing (21st ed.). St. Louis: Mosby, p. 771. 15. A client is taking cascara sagrada and develops abdominal cramps. The nurse determines that the client is most likely experiencing: 1. A common side effect of this medication 2. Partial bowel obstruction 3. A case of influenza 4. Peptic ulcer disease Answer: 1 Rationale: Cascara sagrada is a laxative that causes nausea and abdominal cramps as the most frequent side effects. Other health problems are not determined based on a single symptom. Test-Taking Strategy: Use the process of elimination. Remember that options that are similar are not likely to be correct. This will allow you to eliminate the two gastrointestinal disorders

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(options 2 and 4). From the remaining options, recalling that laxatives can cause abdominal cramping will direct you to option 1. Review the effects of this medication if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 174. 16. A physician prescribes bisacodyl (Dulcolax) for a client in preparation for a diagnostic test and wants the client to achieve a rapid effect from the medication. The nurse then tells the client to take the medication: 1. With a large meal 2. On an empty stomach 3. At bedtime with a snack 4. With two glasses of juice Answer: 2 Rationale: Most rapid results from bisacodyl occur when it is taken on an empty stomach. It will not have a rapid effect if taken with a large meal. If it is taken at bedtime, the client will have a bowel movement in the morning. Taking the medication with two glasses of juice will not add to its effect. Test-Taking Strategy: Use the process of elimination. Focus on the key words, rapid effect. Recalling that food generally slows the absorption of medication will assist in directing you to option 2. Review the administration of laxatives if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 124. 17. A client has a PRN order for loperamide (Imodium). The nurse should plan to administer this medication if the client has: 1. Hematest-positive nasogastric tube drainage 2. Abdominal pain 3. Constipation 4. An episode of diarrhea Answer: 4 Rationale: Loperamide is an antidiarrheal agent. It is commonly administered after loose stools. It is used in the management of acute diarrhea and also in chronic diarrhea, such as with inflammatory bowel disease. It can also be used to reduce the volume of drainage from an ileostomy. The other options are incorrect. Test-Taking Strategy: Use the process of elimination. Knowledge that this medication is an antidiarrheal will direct you to the correct option. Review the action of this medication if you had difficulty with this question.

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Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 647. 18. A nurse has given instructions to the client who just received a prescription for diphenoxylate with atropine (Lomotil). The nurse determines that the client understands the use of the medication and its properties if the client states that he or she will: 1. Stay within the prescribed dose because it can be habit-forming. 2. Take the medication with a bulk-forming laxative. 3. Expect increased salivation while taking the medication. 4. Anticipate side effects related to central nervous system excitability. Answer: 1 Rationale: The client should not exceed the recommended dose because it may be habit-forming. The medication is an antidiarrheal, and therefore should not be taken with a laxative. Side effects of the medication include dry mouth and drowsiness. Test-Taking Strategy: To answer this question accurately, it is necessary to be familiar with this medication and its habit-forming properties. Noting that atropine is an ingredient will help to eliminate options 3 and 4. From the remaining options, recalling that the medication is an antidiarrheal will assist in eliminating option 2. Review this medication if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Teaching/Learning Content Area: Pharmacology References: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 336. McKenry, L., & Salerno, E. (2003). Mosby’s pharmacology in nursing (21st ed.). St. Louis: Mosby, p. 784. 19. A client has received a dose of dimenhydrinate (Dramamine). The nurse determines that the medication has been effective if the client states relief of: 1. Headache 2. Chills 3. Nausea and vomiting 4. Buzzing sound in the ears Answer: 3 Rationale: Dimenhydrinate is used to treat and prevent the symptoms of dizziness, vertigo, nausea, and vomiting that accompany motion sickness. The other options are incorrect. Test-Taking Strategy: Use the process of elimination. Recalling that dimenhydrinate is used to treat motion sickness will direct you to option 3. Review this medication if you had difficulty with this question. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity

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Integrated Process: Nursing Process/Evaluation Content Area: Pharmacology Reference: McKenry, L., & Salerno, E. (2003). Mosby’s pharmacology in nursing (21st ed.). St. Louis: Mosby, p. 741. 20. A client is taking docusate sodium (Colace). The nurse monitors which of the following to determine whether the client is having a therapeutic effect from this medication? 1. Abdominal pain 2. Hematest-negative stools 3. Reduction in steatorrhea 4. Regular bowel movements Answer: 4 Rationale: Docusate sodium is a stool softener that promotes the absorption of water into the stool, producing a softer consistency of stool. The intended effect is relief or prevention of constipation. The medication does not relieve abdominal pain, stop gastrointestinal bleeding, or decrease the amount of fat in the stools. Test-Taking Strategy: Use the process of elimination. Recalling that docusate is a stool softener will direct you to option 4. Review the action of this medication if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W. B. Saunders, p. 346. <AQ>21. The client with esophageal reflex has been given a prescription for metoclopramide (Reglan). The nurse tells the client to take the medication how many minutes before meals? Answer: 30 Rationale: The client should be taught to take this medication 30 minutes before meals. This allows the medication time to begin working before the client takes in food, which requires digestion and movement. A dose is also usually prescribed to be taken at bedtime. Test-Taking Strategy: Focusing on the client’s diagnosis will assist in answering this question. Review administration of this medication if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Teaching/Learning Content Area: Pharmacology Reference: (2005). Mosby’s 2005 drug consult for nurses. St. Louis: Mosby, p. 713.

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