Gastrointestinal Medications NCLEX Prep II | Q & A (Complete Solutions)

Gastrointestinal Medications NCLEX Prep II | Q & A (Complete Solutions) The nurse is administering senna to an older client. What is the expected result of this medication? 1. It increases peristalsis. 2. It lines the ...

Gastrointestinal Medications NCLEX Prep II | Q & A (Complete Solutions) The nurse is administering senna to an older client. What is the expected result of this medication? 1. It increases peristalsis. 2. It lines the wall of the bowel. 3. It adds fiber and bulk to the stool. 4. It stimulates the vagus nerve to improve bowel tone. Rationale: Senna works by altering the transport of water and electrolytes in the large intestine, which causes accumulation of water in the mass of stool and increased peristalsis. The other options are incorrect actions for this medication. The nurse has given instructions to a client who has just been prescribed cholestyramine. Which statement by the client indicates a need for further instruction? 1."I will continue taking vitamin supplements." 2."This medication will help to lower my cholesterol." 3."This medication should only be taken with water." 4."A high-fiber diet is important while taking this medication." Rationale: Cholestyramine is a bile acid sequestrant used to lower the cholesterol level, and client compliance is a problem because of its taste and palatability. The use of flavored products or fruit juices can improve the taste. Some side effects of bile acid sequestrants include constipation and decreased vitamin absorption. A client admitted to the medical nursing unit has a diagnosis of gastroesophageal reflux disease (GERD). Metoclopramide has been prescribed 4 times a day. When should the nurse schedule administration of the medication? 1.Every 8 hours 2.With meals and at bedtime 3.Right after meals and at bedtime 4.30 minutes before meals and at bedtime Rationale: Metoclopramide is a gastrointestinal stimulant. Administration should be scheduled 30 minutes before meals and at bedtime to allow the medication time to begin working before food intake and digestion. The other options are incorrect. A client taking an oral laxative wants to obtain a rapid effect from the medication. How should the nurse instruct the client to take the medication? 1.At bedtime 2.With breakfast 3.With the noon meal 4.On an empty stomach Rationale: Most rapid results from an oral laxative occur when it is taken on an empty stomach. If taken at bedtime, the client will have a bowel movement in the morning. It will not have a rapid effect if taken with a meal. A client has an as needed prescription for loperamide hydrochloride. For which condition should the nurse administer this medication? 1.Constipation 2.Abdominal pain 3.An episode of diarrhea 4.Hematest-positive nasogastric tube drainage Rationale: Loperamide is an antidiarrheal agent. It is used to manage acute and chronic diarrhea in conditions such as inflammatory bowel disease. Loperamide also can be used to reduce the volume of drainage from an ileostomy. It is not used for the conditions in options 1, 2, and 4. The client with peptic ulcer disease is prescribed medication therapy. The nurse explains the medications to the client and explains that sucralfate will help to heal the ulcer by doing what? 1. Eradicate Helicobacter pylori. 2. Reduce gastric acidity. 3. Treat bacterial infection. 4. Enhance mucosal defenses. Rationale: Medication therapy is used to treat peptic ulcer disease by 3 mechanisms: eradicating H. pylori (or other bacterial infections), reducing gastric acidity, and enhancing mucosal defenses. Sucralfate works by enhancing mucosal defenses. Antibiotics treat infection and eradicate H. pylori. Antisecretory agents, misoprostol, and antacids work by reducing gastric acidity. A client has a new prescription for metoclopramide. On review of the chart, the nurse identifies that this medication can be safely administered with which condition? 1. Intestinal obstruction 2. Peptic ulcer with melena 3. Diverticulitis with perforation 4. Vomiting following cancer chemotherapy Rationale: Metoclopramide is a gastrointestinal stimulant and antiemetic. Because it is a gastrointestinal stimulant, it is contraindicated with gastrointestinal obstruction, hemorrhage, or perforation. It is used in the treatment of vomiting after surgery, chemotherapy, or radiation. The nurse notes that a client is taking lansoprazole. Which question by the nurse helps to determine that this medication is effective? 1."Has your appetite increased?" 2."Are you experiencing any heartburn?" 3."Do you have any problems with vision?" 4."Do you experience any leg pain when walking?" Rationale: Lansoprazole is a gastric acid proton pump inhibitor that is used to treat gastric and duodenal ulcers, erosive esophagitis, and hypersecretory conditions. It also is used to treat gastroesophageal reflux disease (GERD). It is not used to treat problems with appetite, visual problems, or leg pain. The nurse is reviewing a client's medication reconciliation form in the medical record and notes that the client is taking tamsulosin at home. Which medication, if started in the hospital, should the nurse question? 1.Lisinopril 2.Valsartan 3.Metoprolol 4.Cimetidine Rationale: Tamsulosin is used most commonly for the treatment of benign prostatic hyperplasia. This medication should not be used concurrently with cimetidine because of the risk of tamsulosin toxicity. The other medications noted do not cause interactions with this medication. Oral rifaximin has been prescribed for a client with portosystemic encephalopathy. The nurse reviews the health care provider's prescription and determines that this medication has been prescribed for which purpose? 1.Prevent infection. 2.Prevent restlessness in the client. 3.Prevent fluid retention and ascites. 4.Destroy normal bacteria found in the bowel. Rationale: Rifaximin may be prescribed for the client with portosystemic encephalopathy. It is a broad-spectrum antibiotic that destroys normal bacteria found in the bowel, thereby decreasing protein breakdown and ammonia production. The remaining options are not accurate rationales for administration of this medication to this client. The nurse has administered prochlorperazine to a client for relief of nausea and vomiting. The nurse should then assess the client for which frequent side or adverse effect of this medication? 1.Diarrhea 2.Drooling 3.Blurred vision 4.Excessive tearing Rationale: Prochlorperazine is a phenothiazine-type antiemetic and antipsychotic agent. A frequent side or adverse effect is blurred vision. Other frequent side and adverse effects of this medication are constipation, dry mouth, and dry eyes. A client has an as needed prescription for ondansetron. For which condition(s) should the nurse administer this medication? 1.Paralytic ileus 2.Incisional pain 3.Urinary retention 4.Nausea and vomiting Rationale: Ondansetron is an antiemetic used to treat postoperative nausea and vomiting, as well as nausea and vomiting associated with chemotherapy. The other options are incorrect reasons for administering this medication. The nurse is preparing to give a client directions for proper use of aluminum hydroxide tablets. Which instruction should the nurse provide to the client? 1."Take the tablet at the same time as an antacid." 2."Swallow the tablet whole with a full glass of water." 3."Take each dose with a laxative to prevent constipation." 4."Chew the tablet thoroughly and then drink 8 ounces of water." Rationale: Aluminum hydroxide tablets are an antacid and should be chewed thoroughly before swallowing to prevent them from entering the small intestine undissolved. An antacid should not be taken with the medication to prevent additive and interactive effects. Constipation is a side or adverse effect of the use of aluminum products, but the client should not take a laxative with each dose. This would promote laxative abuse and should be avoided if less habit-forming means can be used. A client has been taking omeprazole for 4 weeks. The ambulatory care nurse evaluates that the client is receiving the optimal intended effect of the medication if the client reports the absence of which symptom? 1.Diarrhea 2.Heartburn 3.Flatulence 4.Constipation Rationale: Omeprazole is a proton pump inhibitor classified as an antiulcer agent. The intended effect of the medication is relief of pain from gastric irritation, often called heartburn by clients. Omeprazole is not used to treat the conditions identified in options 1, 3, and 4. The nurse is reviewing the prescriptions for a newly admitted client. The nurse sees a prescription for intravenous pantoprazole but does not see any gastrointestinal conditions in the medical record. How should the nurse interpret this prescription? 1.It is used as a prophylactic measure. 2.It is inaccurate and should be questioned. 3.It is likely that the client has a new gastrointestinal disorder. 4.It is used before surgery, so the client will probably require surgery. Rationale: Pantoprazole is a proton pump inhibitor and is commonly used as a gastrointestinal prophylactic measure to prevent stress ulcers. The other options are incorrect. A client with constipation has been directed to take oral bisacodyl. The nurse instructs the client on how to receive the most rapid effect from the medication. The client demonstrates understanding of use of this medication by stating that which method will produce the most rapid effect? 1."I should take it at bedtime." 2."I will take it with a large meal." 3."I will take it on an empty stomach." 4."I will drink 2 glasses of milk when I take it." Rationale: The most rapid results from bisacodyl occur when it is taken on an empty stomach. If it is taken at bedtime, the client will have a bowel movement in the morning. It will not have a rapid effect if taken with a large meal or with 2 glasses of milk. A client has begun taking a stimulant laxative. In monitoring the client for medication side and adverse effects, the nurse is likely to note which finding? 1.Abdominal cramps 2.Peptic ulcer disease 3.Gastrointestinal bleeding 4.Partial bowel obstruction Rationale: A stimulant laxative causes nausea and abdominal cramps as the most frequent side effects. The incorrect options represent health problems that are not caused by this medication. A client has received a dose of dimenhydrinate. The nurse should observe relief of what sign or symptom to evaluate that the medication has been effective? 1.Chills 2.Headache 3.Nausea and vomiting 4.Buzzing sound in the ears Rationale: Dimenhydrinate is used to prevent and treat the symptoms of dizziness, vertigo, nausea, and vomiting that accompany motion sickness. The other options are incorrect reasons for administering the medication. A hospitalized client asks the nurse for sodium bicarbonate to relieve heartburn after a meal. The nurse reviews the client's medical record, knowing that the medication is contraindicated in which condition? 1.Atelectasis on chest x-ray 2.Hydronephrosis on renal ultrasound 3.Serum pH 7.52 (7.52), bicarbonate 30 mEq/L (30 mmol/L) 4.Serum pH 7.22 (7.22), bicarbonate 29 mEq/L (29 mmol/L) Rationale: Sodium bicarbonate is an electrolyte modifier and antacid, and it would aggravate metabolic alkalosis, which is a difficult acid-base imbalance to correct. Atelectasis, hydronephrosis, and metabolic acidosis are the other conditions noted. The medication is not contraindicated with these conditions. A client with a peptic ulcer is diagnosed with a Helicobacter pylori infection. The nurse is teaching the client about the medications prescribed, including clarithromycin, esomeprazole, and amoxicillin. Which statement by the client indicates the best understanding of the medication regimen?\ 1."My ulcer will heal because these medications will kill the bacteria." 2."These medications are only taken when I have pain from my ulcer." 3."The medications will kill the bacteria and decrease the acid production." 4."These medications will coat the ulcer and decrease the acid production in my stomach." Rationale: Triple therapy for H. pylori infection usually includes 2 antibacterial medications and a proton pump inhibitor. Clarithromycin and amoxicillin are antibacterials. Esomeprazole is a proton pump inhibitor. These medications will kill the bacteria and decrease acid production. A client has a prescription for sucralfate, orally 4 times daily. The nurse writes which schedule for this medication on the medication administration record? 1.Every 6 hours 2.With meals and at bedtime 3.1 hour after meals and at bedtime 4.1 hour before meals and at bedtime Rationale: Sucralfate is prescribed to treat gastric ulcers. It should be scheduled for administration 1 hour before meals and at bedtime to allow it to form a protective coating over the gastric ulcer to prevent irritation by food, gastric acid, and mechanical movement of the stomach. The other options are incorrect. A client is taking docusate sodium. Which finding by the nurse indicates that treatment has been effective? 1.Reduction in steatorrhea 2.Hematest-negative stools 3.Regular bowel movements 4.Absence of abdominal pain Rationale: Docusate sodium is a stool softener that promotes 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 decrease the amount of fat in the stools, stop gastrointestinal bleeding, or relieve abdominal pain. A client reports frequent use of sodium bicarbonate to relieve heartburn after meals. The nurse should monitor the client for which condition that the client is at risk for with long-term frequent use of this medication? 1.Urinary calculi 2.Chronic bronchitis 3.Metabolic alkalosis 4.Respiratory acidosis Rationale: Sodium bicarbonate is an electrolyte modifier and antacid. With large doses or long-term use, it can cause metabolic alkalosis. The other options are incorrect. An older client recently has been taking cimetidine. The nurse monitors the client for which most frequent central nervous system side effect of this medication? 1.Tremors 2.Dizziness 3.Confusion 4.Hallucinations Rationale: Cimetidine is a histamine (H2)-receptor antagonist. Older clients are especially susceptible to central nervous system side effects of cimetidine. The most frequent of these is confusion. Less common central nervous system side effects include headache, dizziness, drowsiness, and hallucinations. The nurse has administered a dose of docusate. The nurse evaluates that the medication has been effective if the client experiences which finding? 1.Decreased heartburn 2.Decrease in fatty stools 3.Relief of sharp abdominal pain 4.Bowel movement with soft, formed stool Rationale: Docusate is a stool softener that relieves constipation because it promotes absorption of water into the stool, producing a softer consistency of stool. The other options are not effects of this medication. Which finding suggests to the nurse that a client with bleeding esophageal varices is experiencing a side or adverse effect of vasopressin therapy? 1.Complaints of chest pain 2.Bounding peripheral pulses 3.Temperature of 102°F (39.8°C) 4.Blood urea nitrogen (BUN) of 20 mg/dL (7.1 mmol/L) Rationale: Vasopressin therapy causes vasoconstriction, and side and adverse effects include myocardial ischemia, which may be evident by the client's complaints of chest pain. Elevated temperature, bounding peripheral pulses, and a BUN of 20 mg/dL (7.1 mmol/L) are not adverse effects. Vasopressin therapy can cause hypothermia. Because vasopressin has potent vasoconstrictive effects on the peripheral arterioles, weak versus bounding pulses may be found. The normal BUN is 10 to 20 mg/dL (3.6 to 7.1 mmol/L). A client is experiencing diarrhea. The nurse reviews the client's "as needed" (PRN) medication prescription sheet and should plan to administer which medication for this problem? 1.Psyllium 2.Bisacodyl 3.Sennosides 4.Loperamide Rationale: Loperamide is an antidiarrheal agent. It inhibits peristalsis in the intestinal wall and inhibits intestinal secretion so that the number of stools and water content are decreased. Psyllium, bisacodyl, and sennosides are laxatives. A client has just been given a prescription for diphenoxylate with atropine. The nurse determines that the client understands important information about this medication if the client makes what statement? 1."It's best to take this medication with a laxative." 2."This medication contains a habit-forming ingredient." 3."I might drool frequently from taking this medication." 4."I will probably become irritable from taking this medication." Rationale: The client should understand that an adverse effect of this medication is that it may be habit forming, so careful adherence to proper dose is important. The medication is an antidiarrheal and therefore should not be taken with a laxative. Side effects of the medication include dry mouth and drowsiness. Drooling and irritability are not associated with the use of this medication. The nurse is caring for a client who has been prescribed intravenous metoclopramide. The nurse determines that the client likely is being treated for which condition? 1.Paralytic ileus 2.Diabetic gastroparesis 3.Gastroesophageal reflux disease 4.Postoperative nausea and vomiting Rationale: Metoclopramide is given either orally or intravenously. Indications for intravenous metoclopramide include postoperative nausea and vomiting, facilitation of small bowel intubation, and facilitation of radiological exams of the gastrointestinal tract. Oral metoclopramide is given for paralytic ileus, diabetic gastroparesis, and gastroesophageal reflux disease. A client with a history of gastroesophageal reflux disease (GERD) is diagnosed with peptic ulcer disease (PUD). The health care provider prescribes sucralfate in addition to the client's other medications. What teaching should the nurse include in this client's instructions? 1.Take the sucralfate once a day at bedtime with food. 2.Take the sucralfate daily with the proton pump inhibitor. 3.Take the sucralfate before meals and at bedtime on an empty stomach. 4.Take the sucralfate immediately after eating and within 30 minutes of an antacid. Rationale: Sucralfate is an antiulcer medication that promotes ulcer healing by creating a protective barrier against acid and pepsin. It should be taken on an empty stomach. The usual recommended adult dosage is 1 gram 4 times a day, taken 1 hour before meals and at bedtime. Options 1, 2, and 4 are incorrect, as sucralfate should be taken on an empty stomach, at least twice a day, and at least 30 minutes apart from an antacid. A client with recurrent constipation has been prescribed psyllium. Teaching provided by the nurse should include which instruction? 1.Take the powder with food. 2.Sprinkle the powder on top of a hot beverage. 3.Mix the powder with warm applesauce. 4.Mix the powder with a full glass of water or juice followed by drinking an additional glass of liquid. Rationale: Metamucil is a bulk-forming laxative. It should be mixed with 8 oz of water or juice, followed by drinking another 8 oz of liquid. This will help prevent impaction of the medication in the stomach or small intestine. The other options are incorrect methods of administration. The nurse reads that metoclopramide is prescribed for a client. Based on this prescription, the nurse expects to note that which diagnosis is documented? 1.Asthma 2.Gastroparesis 3.Allergic rhinitis 4.Chronic kidney disease Rationale: Metoclopramide stimulates motility of the upper gastrointestinal tract. It is used to stimulate gastric emptying, for the treatment of gastroparesis, and to treat gastroesophageal reflux disease. It may also be prescribed to relieve nausea and vomiting. It is not a respiratory medication or a renal/urinary medication and is not used to treat the conditions noted in the incorrect options. The client with gastroesophageal reflux disease (GERD) has a new prescription for pantoprazole. Which instruction should the nurse provide to the client? 1.Chew the pill thoroughly. 2.Swallow the tablet whole. 3.Headache is expected to occur. 4.Crush the pill if it is difficult to swallow. Rationale: Pantoprazole, a proton pump inhibitor, is a delayed-release medication and should be swallowed whole. It should not be chewed or crushed. Headache is a potential side effect of the medication and should be reported to the health care provider if it is troublesome. The client in the preoperative holding area has been given a dose of scopolamine. Which intended effect is this medication likely being used for with this client? 1.Obstetric amnesia 2.Suppression of emesis