Charter College, Anchorage - NURSING NU1005

Chapter 22: Drug Therapy for Gastrointestinal Problems

Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition

MULTIPLE CHOICE

BASIC CONCEPTS

1)What types of drugs prevent or control nausea/vomiting?

1. 1. Antiemetic drugs
   2. Antimotility drugs
   3. Antidiarrheal drugs
   4. Antipropulsion drugs

2. How is retching different from vomiting?
   1. Nausea is not present in retching but is in vomiting.
   2. Nausea is not present in vomiting but is in retching.
   3. With retching, no vomiting occurs.
   4. With vomiting, no retching occurs.

3. Nausea/vomiting from which cause is helped best by antihistamines?
   1. Allergies
   2. Opiate drugs
   3. Cancer chemotherapy
   4. Exposure to bad odors

4. Which common drug for nausea/vomiting is a 5HT₃-receptor antagonist?
   1. Granisetron
   2. Promethazine
   3. Scopolamine

1. 4. Metoclopramide

5. Which drug for nausea/vomiting can cause decreased sweating and increased risk for overheating?
   1. Meclizine (Antivert)
   2. Ondansetron (Zofran)
   3. Trimethobenzamide (Tigan)
   4. Prochlorperazine (Compazine)

6. Which drug for nausea/vomiting can cause muscle spasms of the jaw, neck, and back when given to children?
   1. Meclizine (Antivert)
   2. Metoclopramide (Reglan)
   3. Trimethobenzamide (Tigan)
   4. Prochlorperazine (Compazine)

7. Which drug used to treat constipation is an osmotic laxative?
   1. Methylcellulose
   2. Lubiprostone
   3. Castor oil
   4. Docusate

8. Which drug used to treat constipation is a lubricant?
   1. Bisacodyl
   2. Lubiprostone
   3. Castor oil
   4. Docusate

9. Which problems are the most common side effects of drugs used to treat constipation?
   1. Abdominal cramps and diarrhea
   2. Hypertension and swollen feet
   3. Skin rash and blurred vision
   4. Insomnia and infection

10. Which drug used to treat diarrhea is an antimotility drug?
    1. Bismuth subsalicylate (Pepto-Bismol)
    2. Calcium polycarbophil (FiberCon)
    3. Metoclopramide (Reglan)
    4. Loperamide (Imodium)

11. Which laboratory value must be monitored after a patient takes bisacodyl (Dulcolax) for constipation?
    1. Sodium
    2. Potassium
    3. Creatinine
    4. Blood urea nitrogen

ADVANCED CONCEPTS

12. Which statement about normal bowel function is true?
    1. Bowel movements should occur once a day every day.
    2. Bowel movement frequency is more important than their consistency.
    3. Bowel movements are very simple processes.
    4. Bowel movements should be soft and easily pass out of the bowel.

13. Which statement about the vomiting reflex is accurate?
    1. The vomiting process consists of four phases.
    2. Retching precedes vomiting in the process.
    3. Nausea usually occurs prior to vomiting.
    4. Vomiting may be a reflex or a voluntary action.

14. You are instructing a patient on how to prevent constipation. Which point should you stress?
    1. “Be sure to eat a diet that is low in fiber.”
    2. “Use a laxative on a daily basis to prevent constipation.”
    3. “Physical inactivity will not affect your bowel function.”
    4. “You should drink plenty of fluids every day to prevent constipation.”

15. You are instructing a patient about how to help prevent the spread of diarrhea. Which important point should you stress?
    1. “When travelling internationally it is best to drink bottled water with ice cubes.”
    2. “Be sure to wash your hands after using the bathroom or changing diapers.”
    3. “Always wear clean gloves when handling raw meat or poultry.”
    4. “Cut down on your fluid intake to decrease the number of diarrhea episodes.”

16. A patient receiving chemotherapy and prescribed ondansetron (Zofran) asks why the drug is given before meals. What is your best response?
    1. “Ondansetron is given 30 minutes before your meals to prevent nausea.”
    2. “The purpose of ondansetron is to move food rapidly through your GI tract.”
    3. “Ondansetron works by preventing nausea caused by morphine given for your pain.”
    4. “If ondansetron is given after your meals, food would interfere with its absorption.”

17. A patient prescribed metoclopramide (Reglan) reports having difficulty sleeping, difficulty concentrating, tiredness, and feeling hopeless. What is your best action?
    1. Instruct the patient that these are expected side effects of the drug.
    2. Document these findings as the only action.
    3. Check the patient’s chart history of depression.
    4. Hold the drug and notify the prescriber.

18. A patient prescribed metoclopramide (Reglan) tells you that his abdomen is making gurgling sounds. What is your best action?
    1. Tell the patient that this is an expected effect of the drug.
    2. Document this finding as the only action.
    3. Hold the drug and notify the prescriber.
    4. Listen for bowel sounds in all four quadrants of the abdomen.

19. A 10-year-old child is prescribed cyclizine (Marezine) 25 mg orally for motion sickness. The drug is available as a 50 mg tablet. How many tablets should you instruct the parents to give the child?
    1. One fourth
    2. One half
    3. Two

1. 4. Four

20. The spouse of a patient who is prescribed promethazine (Phenergan) as part of her antiemetic therapy with chemotherapy reports that after the last dose the patient did not remember the drive home. What is your best action?
    1. Thank the spouse for reporting the problem, and document the adverse drug reaction.
    2. Hold the dose of promethazine for this round of chemotherapy until the patient is seen by the prescriber.
    3. Reassure the patient and spouse that this is a normal response to the drug and stress that the patient should not drive.
    4. Perform a mini-mental status examination and assess the patient’s pupillary reflexes before administering the promethazine.

21. What is the most important assessment question to ask a patient before administering intravenous metoclopramide (Reglan)?
    1. “Are you being treated for depression?”
    2. “Is your type 1 diabetes well controlled?”
    3. “Do you have a gastric or duodenal ulcer?”
    4. “Are you taking aspirin or any aspirin-containing products?”

22. You are instructing a patient who is experiencing chronic nausea/vomiting, about antiemetic therapy. What is the most important precaution you must teach the patient?
    1. “Rinse your mouth frequently to reduce the unpleasant sensation of dry mouth.”
    2. “Report any constipation lasting 2 days or longer to your prescriber.”
    3. “Wear sunscreen and protective clothing when going outdoors.”
    4. “Avoid drinking alcoholic beverages while taking this drug.”

23. An older male patient with nausea is prescribed scopolamine (L-hyoscine). Which assessment determines whether he is experiencing a serious side effect?
    1. Checking capillary refill
    2. Measuring abdominal girth
    3. Evaluating handgrip strength
    4. Evaluating daily intake and output

24. A patient who is prescribed prochlorperazine (Compazine) for postoperative nausea/vomiting has all of the following changes. For which change should you immediately contact the prescriber?
    1. Systolic blood pressure decrease of 12 mm Hg
    2. Increased sleepiness but arouses with light shaking
    3. Oral temperature increase of 2° F
    4. Urine color change from yellow to reddish-brown

25. The mother of a 9-month-old child reports that the child has a bowel movement only every 2 or 3 days and that the stool is small and hard, “like marbles.” What should you recommend as a beginning treatment for this problem?
    1. Use castor oil every 3 days.
    2. Increase the child’s fluid intake.
    3. Ensure that the child gets adequate exercise.
    4. Mix a bulk-forming laxative in with the child’s cereal.

26. How do osmotic laxatives reduce constipation?
    1. They cause retention of fluid in the bowel, increasing the water content in stool.
    2. They add bulk to the stool, which increases stool mass that stimulates peristalsis.
    3. They soften stool, allowing the stool to mix with fatty substances, making it easier to eliminate.
    4. They cause chemical irritation of nerve receptors in the intestinal lining, which then triggers peristalsis.

27. Which action is most important after giving a patient bisacodyl (Dulcolax)?
    1. Comparing daily urine output with fluid intake.
    2. Assessing pulse rate and regularity every 4 hours.
    3. Ensuring that the patient complies with a low-sodium diet.
    4. Testing the patient’s blood glucose level at least every shift.

28. The mother of a 6-year-old child receiving diphenoxylate (Lomotil) for the last 4 days for diarrhea reports by telephone that the diarrhea has stopped and that the child’s pants cannot be zipped or buttoned today. What is your best advice?
    1. “Give the child only half the dose of the drug today.”
    2. “Do not give the child fluids for the next 24 hours.”
    3. “Stop the drug and go immediately to the prescriber’s office.”
    4. “This is expected because when diarrhea is cured the stool enlarges the abdomen.”

29. A patient who is prescribed promethazine (Phenergan) currently has a respiratory rate of 8 breaths/min when it is time to give the next dose. What is your most important action?
    1. Apply oxygen at 2 L per nasal cannula.
    2. Check the patient’s oxygen saturation.
    3. Hold the drug and notify the prescriber.
    4. Raise the head of the bed 90 degrees.

30. You are administering a patient’s first dose of cyclizine (Marezine). What safety action should you take to ensure safety for this patient?
    1. Instruct the patient to call for help when getting out of bed.
    2. Raise all four side rails to the upright position.
    3. Give the patient a full glass of water with the medication.
    4. Tell the patient to avoid eating for at least 2 hours.

31. The wife of an inpatient who is prescribed dexamethasone (Decadron) tells you over the phone that she has developed a cold with a low-grade fever. What is your best advice at this time?
    1. “If you come in to visit you must wear an isolation gown.”
    2. “Hospital rules do not allow visitors with colds or fevers for any patients.”
    3. “It would be best to speak with your husband by phone and stay home today.”
    4. “You must take care of yourself to be able to care for your husband after discharge.”

32. A patient reports taking an over-the-counter laxative for constipation daily for the past 3 weeks. What is your best action?
    1. Remind the patient about the importance of adequate fluid intake and exercise to prevent constipation.
    2. Instruct the patient that these drugs should not be used for more than a week without consulting the prescriber.
    3. Ask the patient about usual fluid intake, urinary and bowel habits, and have the patient describe the nature of his or her stools.
    4. Contact the prescriber about an order for a stronger laxative because the one the patient is taking is not working.

33. A patient reports taking psyllium (Metamucil) every morning to prevent constipation. What is your best action?
    1. Teach that over-the-counter laxatives should not be taken for more than 1 week.
    2. Instruct the patient that long-term use of psyllium can cause health problems.
    3. Hold the drug and notify the prescriber immediately.
    4. Document this information as the only action.

34. What problem is most important to assess for in a patient who is prescribed loperamide (Imodium)?
    1. Tachycardia
    2. Abdominal distention
    3. Peripheral edema
    4. Respiratory crackles

35. A patient reports taking attapulgite (Kaopectate) for diarrhea over the past 4 days. What is your best action?
    1. Send a stool specimen to the lab for analysis including culture, sensitivity, and

parasites.

1. 2. Instruct the patient to notify nursing staff for episodes of diarrhea and save the stool for occult blood check.
   3. Check the patient’s blood pressure, heart rate, respiratory rate, and oxygen saturation.
   4. Teach the patient that antidiarrheal drugs should not be taken for more than 2 days unless instructed to by their prescriber.

36. When should metoclopramide (Reglan) be taken?
    1. 1 hour before meals and at bedtime
    2. 30 minutes before meals and at bedtime
    3. 30 minutes after meals and at bedtime
    4. 1 hour after meals and at bedtime

37. A patient prescribed metoclopramide (Reglan) for 15 months develops these findings: uncontrolled rhythmic movement of the face, lip smacking, uncontrolled chewing, and rapid or wormlike movements of the tongue. What is your best action?
    1. Transfer the patient to a critical care bed immediately.
    2. Document the findings and contact the prescriber.
    3. Ask if the patient has any drug, pet or food allergies.
    4. Place the patient on bed rest and keep him or her NPO.

38. A patient prescribed prochlorperazine (Compazine) has reddish-brown urine. What is your best action?
    1. Collect a urine sample and send it for culture and sensitivity.
    2. Check the patient’s vital signs with special emphasis on body temperature.
    3. Assess for signs of bleeding around the urethra.
    4. Teach the patient that this is an expected side effect of the drug.

39. A patient with constipation is prescribed bisacodyl (Dulcolax). The patient also states he has severe abdominal pain. What is your best action?
    1. Administer the drug as prescribed to relieve the constipation.
    2. Ensure that the patient drinks a full glass of water with the drug.
    3. Listen for bowel sounds in all four quadrants before giving the drug.
    4. Hold the drug and contact the prescriber.

40. Which statement by a patient prescribed an antidiarrheal drug indicates the need for additional teaching?
    1. “I will never take a double dose of my medication even if I miss a dose.”
    2. “I will get up slowly when I get out of bed or rise from a chair.”
    3. “I will contact my prescriber if the diarrhea is not relieved within 4 days.”
    4. “I will avoid alcohol while taking my antidiarrheal medication.”

41. Why should bismuth subsalicylate (Pepto-Bismol) be avoided in children?
    1. It contains an aspirin-like drug that may cause Reye’s syndrome.
    2. Safe use of this drug in children has not been researched.
    3. This drug can inhibit the action of growth hormone, stunting a child’s growth.
    4. It can increase the risk for dehydration and diarrhea in children.

42. For which patient should question the order for trimethobenzamide (Tigan)?
    1. 70-year-old who has prostate cancer
    2. 50-year-old who has hypertension
    3. 40-year-old with a seizure disorder

1. 4. 30-year-old with asthma

MULTIPLE RESPONSE

ADVANCED CONCEPTS

1. Which are potential complications of nausea/vomiting? (select all that apply)
   1. Bleeding
   2. Aortic aneurysm
   3. Aspiration pneumonia
   4. Bowel perforation
   5. Reopening of surgical wounds
   6. Respiratory acidosis

2. Which are symptoms of constipation? (select all that apply)
   1. Having less than one bowel movement a day.
   2. Stools that is harder than normal.
   3. Sudden increase in frequency of bowel movements.
   4. Bowels that feel full after a bowel movement.
   5. Sensation of feeling bloated.
   6. Coffee-ground appearance of stools.

3. What are the symptoms of diarrhea? (select all that apply)
   1. Weight loss
   2. Bowels still feeling full after a bowel movement
   3. Abdominal pain and cramping
   4. Fever and chills
   5. Feeling bloated
   6. Feeling ill

4. Which teaching points would you include for a patient who is taking laxatives for constipation? (select all that apply)
   1. Drink between 1500 and 2000 mL of fluids every day.
   2. Avoid bulk foods such as whole-grain bread and vegetables.
   3. Use the bathroom right away when you feel the urge to have a bowel movement.
   4. Try to get some regular exercise each day to prevent constipation.
   5. Take your laxative with at least 4 ounces of water so it can be effective.
   6. Laxatives are usually prescribed for one 2 to 3 weeks.

5. Which are expected and intended responses to antiemetic drugs? (select all that apply)
   1. Vomiting reflex is inhibited.
   2. Vomiting reflex pathway is uninterrupted.
   3. Patient is sedated.
   4. Nausea is relieved.
   5. Retching occurs as expected.
   6. Vomiting is prevented.

COMPLETION

ADVANCED CONCEPTS

1. A child is prescribed metoclopramide (Reglan) 8 mg by oral solution. The available drug solution is 5 mg/5 mL of solution. How many milliliters does the nurse administer?