NUR 316 Exam 3 Question & Answers, All Answers Explained With Rationales

NUR 316 Exam 3 Question & Answers, All Answers Explained With Rationales-A patient who has chronic renal failure wants to self-treat with an antacid for occasional heartburn. Which medication is the best choice for this ...

NUR 316 Exam 3 Question & Answers, All Answers Explained With Rationales-A patient who has chronic renal failure wants to self-treat with an antacid for occasional heartburn. Which medication is the best choice for this patient? A.A magnesium-containing antacid B.A calcium-containing antacid C.An aluminum-containing antacid D.Because of renal problems, the patient should not take antacids for this problem. - ANS: C Aluminum- and sodium-based antacids are recommended for patients with renal compromise because they are more easily excreted. Both calcium- and magnesium-based antacids are more likely to accumulate to toxic levels in patients with renal disease and are often avoided in this patient group. When working with an older patient who has been admitted for a possible GI bleed, the nurse identifies which drug as having the potential to cause confusion and disorientation? A.An antacid B.A PPI C.An H2 antagonist D.A mucosal protectant - ANS: C H2 antagonists may cause confusion and disorientation in older adults. When teaching a patient about sucralfate (Carafate) therapy, which of the following statements will the nurse include? A."Take sucralfate 1 hour before your other medications." B."Sucralfate is administered once daily upon waking up." C."Sucralfate acts systemically to heal gastric ulcers." D."Sucralfate promotes ulcer healing." - ANS: D Sucralfate forms a protective barrier that can be thought of as a liquid bandage, binds to the exposed proteins of ulcers and erosions, and limits the access of pepsin. Pepsin is an enzyme that normally breaks down proteins in food but can have the same effect on GI epithelial tissue, either causing ulcers or making them worse. Sucralfate also binds and concentrates epidermal growth factor, present in the gastric tissues, which promotes ulcer healing. Other drugs should be taken at least 2 hours ahead of sucralfate. Its effects are transient and multiple daily dosing (up to four times daily) is therefore needed. Sucralfate acts locally, not systemically, binding directly to the surface of an ulcer. Simethicone (Mylicon) is often combined with calcium carbonate antacids because of what effect? A.An increased antacid effect will result when these drugs are given in combination. B.Simethicone helps to reduce the gas that is caused by the calcium antacids. C.Simethicone reduces the diarrhea that is caused by the calcium. D.Simethicone improves the taste of the calcium tablets, which must be chewed. - ANS: B Calcium carbonate neutralization will produce gas and possibly belching, so the addition of simethicone is intended to reduce this effect. Simethicone alters elasticity of mucus-coated gas bubbles, breaking them into smaller ones, resulting in decreased gas pain and increased expulsion via mouth or rectum. The antidiarrheal drug Lomotil contains both diphenoxylate, a synthetic opiate agonist, and atropine, an anticholinergic. What is the purpose of the additive, atropine? A.Enhance the effects of the diphenoxylate. B.Discourage recreational use of the opiate diphenoxylate. C.Counteract the adverse effects of the diphenoxylate. D.Act as an adsorbent for bacteria in the bowel. - ANS: B A small dose of atropine, combined with diphenoxylate, discourages recreational use of this drug because if taken in large doses, a person will experience unpleasant anticholinergic effects such as dry mouth, abdominal pain, blurred vision, and tachycardia. A patient is experiencing diarrhea while completing a course of antibiotic therapy. Which of the following agents does the nurse anticipate administering to the patient? A.L. acidophilus B.Bismuth subsalicylate C.Diphenoxylate with atropine D.Loperamide - ANS: A L. acidophilus is a probiotic often used in the treatment of antibiotic-induced diarrhea. The other agents are usually not used in the treatment of antibiotic-induced diarrhea. A patient who takes warfarin has been prescribed an adsorbent for diarrhea. It is important for the nurse to assess the patient for bruising because use of warfarin with adsorbents interferes with the absorption of which vitamin? A.A B.D C.E D.K - ANS: D The oral anticoagulant warfarin is more likely to cause increased bleeding times or bruising when co-administered with adsorbents. This is thought to be because the adsorbents bind to vitamin K, which is needed to make certain clotting factors. Vitamin K is synthesized by the normal bacterial flora in the bowel. Before administering belladonna alkaloids, it is most important for the nurse to assess the patient for a history of which condition? A.Anemia B.Diabetes mellitus C.Myasthenia gravis D.Hypertension - ANS: C Use of the belladonna alkaloid preparations is contraindicated in patients who have shown a hypersensitivity to anticholinergics and in patients with narrow-angle glaucoma, GI obstruction, myasthenia gravis, paralytic ileus, and toxic megacolon. Which antidiarrheal does the nurse associate with the development of adverse effects of urinary retention, headache, confusion, dry skin, rash, and blurred vision? A.Anticholinergics B.Adsorbents C.Probiotics D.Opiates - ANS: A Anticholinergics work by decreasing GI peristalsis through their parasympathetic blocking effects. Adverse effects include urinary retention, headache, confusion, dry skin, rash, and blurred vision. A patient is taking lactulose four times a day but does not have a history of constipation. In fact, he has had bowel movements every day. What is the probable reason for the lactulose? A.Cleansing the bowel before a procedure B.Removal of helminths C.Reduction of high ammonia levels associated with liver failure D.Daily maintenance to prevent constipation - ANS: C Lactulose helps to reduce blood ammonia levels by converting ammonia to ammonium, which can then be eliminated by the body. A hospitalized patient is experiencing diarrhea. Which of the following does the nurse identify as adverse side effects of diphenoxylate with atropine therapy? (Select all that apply.) A.Increased salivation B.Abdominal pain C.Bradycardia D.Blurred vision - ANS: B, D When administering diphenoxylate with atropine, the nurse should assess the patient for adverse effects, including dry mouth, abdominal pain, tachycardia, and blurred vision. A 48-year-old patient has been admitted with abdominal pain, and states that she has not had a bowel movement for 4 days. Her abdomen is distended and slightly tender. Which laxative would be appropriate for this patient? A.Milk of Magnesia B.A bulk-forming laxative C.Mineral oil D.No laxative should be given at this time. - ANS: D These laxatives are contraindicated in the presence of undiagnosed abdominal pain because taking a laxative in cases of intestinal obstruction could be very harmful to the patient. No laxatives should be given if the patient has undiagnosed abdominal pain. The nurse is preparing to administer scopolamine to a patient. It is most important for the nurse to determine if the patient has a history of which condition? A.Cataracts B.Narrow-angle glaucoma C.Presbyopia D.Detached retina - ANS: B The nurse should only administer the anticholinergic drug scopolamine after careful assessment of the patient's health history and medication history. One very important concern to reemphasize with scopolamine, which is commonly administered in patch form to prevent motion sickness, is the contraindication to its use in patients with narrow-angle glaucoma. If the patient has a history of this disorder, then another antiemetic or antinausea drug should be used. A patient is receiving a continuous tube feeding via a percutaneous endoscopic gastrostomy tube. Which drug would most likely be prescribed for this patient? A.Metoclopramide B.Meclizine C.Aprepitant D.Phosphorated carbohydrate solution - ANS: A Metoclopramide is a prokinetic drug that promotes the movement of substances through the GI tract and increases GI motility. This action is helpful in preventing aspiration in those receiving tube feedings. A patient with terminal cancer has not had chemotherapy for a few weeks and has had no nausea or vomiting since then. However, he is taking dronabinol twice a day. What rationale should be considered by the nurse? A.Prevents recurrence of the chemotherapy-induced nausea and vomiting B.Prevents stress ulcers C.Improves his mood D.Stimulate his appetite - ANS: D Dronabinol is used as an appetite stimulant in patients who are experiencing nutritional wasting caused by cancer and cancer treatment. A patient is 2 months pregnant. She comes to the clinic complaining of severe morning sickness. She has tried numerous nonpharmacologic measures to relieve the morning sickness, but they have not worked. The nurse anticipates the use of which antinausea drug? A.Phosphorated carbohydrate solution B.Aprepitant A. Dronabinol C.Dolasetron - ANS: A Phosphorated carbohydrate solution (Emetrol) is a mint-flavored, pleasant-tasting oral solution used to relieve nausea. It works by direct local action on the walls of the GI tract, where it reduces cramping caused by excessive smooth muscle contraction. It can be used to control mild cases of nausea and vomiting. It does not have a pregnancy category rating, but one of its listed unlabeled (not approved by the U.S. Food and Drug Administration) uses is for treatment of morning sickness during pregnancy. The other drugs are not indicated for use in pregnancy. Which group of drugs used to treat nausea does the nurse identify as most likely to cause a prolonged QTc interval? A.Prokinetics B.Antidopaminergics C.Tetrahydrocannabinoids D.Serotonin blockers - ANS: D The serotonin blockers have the potential to cause prolonged QTc interval. A patient tells the nurse that he takes ginger almost every day for nausea. It is most important for the nurse to determine if the patient is taking which medication? A.Furosemide B.Acetaminophen C.Warfarin D.Calcium supplements - ANS: C Use of ginger can increase absorption of all oral medications and may theoretically increase bleeding risk with anticoagulants (e.g., warfarin [Coumadin]) or antiplatelet drugs (e.g., clopidogrel [Plavix]).