Question 1

A woman has severe IBS and takes hyoscyamine sulfate (Levsin),simethicone (Phazyme),and a TCA.She reports having continued severe diarrhea.The primary care NP should:

Accepted Answer

Alosetron is given only to women with severe chronic diarrhea-predominant IBS and only after anatomic or biochemical abnormalities of the GI tract have been excluded.Because this woman's symptoms are persistent and severe,diphenoxylate and increased dietary fiber are not indicated.

Question 2

A woman with IBS has been taking antispasmodic medications and reports some relief,but she tells the primary care NP that the disease is interfering with her ability to work because of increased pain.The NP should consider prescribing:

Accepted Answer

TCAs and selective serotonin reuptake inhibitors (SSRIs)have been shown to reduce symptoms and are useful for long-term treatment.Alosetron is ordered by a GI specialist if symptoms are resistant to all other interventions and has been shown to be effective in women with diarrhea-predominant IBS.Misoprostol is used to treat NSAID-induced ulcers.Simethicone acts locally to treat symptoms of trapped air and gas.

Question 3

A patient who has diabetic gastroparesis sees a gastroenterology specialist who orders metoclopramide (Reglan).Within 24 hours,the patient describes having extrapyramidal symptoms (EPS)to the primary care NP.The NP will contact the gastroenterologist and should expect to prescribe:

Accepted Answer

Cogentin is indicated to treat EPS side effects of medications such as metoclopramide.The patient should be monitored during the first 24 to 48 hours for any adverse reactions.Should EPS occur,treat with intramuscular diphenhydramine (Benadryl)50 mg or benztropine (Cogentin)1 to 2 mg

Question 4

A patient takes an antispasmodic and an occasional antidiarrheal medication to treat IBS.The patient comes to the clinic and reports having dry mouth,difficulty urinating,and more frequent constipation.The primary care NP notes a heart rate of 92 beats per minute.The NP should:

Accepted Answer

Patients taking antispasmodic medications should be monitored for anticholinergic side effects,such as increased heart rate,dry mouth,difficulty urinating,and constipation.The NP should lower the dose if needed.TCAs are used to treat pain long-term.Because the antidiarrheal medication is used as needed,there is no reason to discontinue it.Increasing water intake may improve symptoms associated with side effects but would not treat the underlying cause of these symptoms.

Question 5

A patient who has IBS experiences diarrhea,bloating,and pain but does not want to take medication.The primary care NP should recommend:

Accepted Answer

A diet with adequate fiber is the cornerstone of treatment,and 25 g per day is recommended.Unless the patient has a documented gluten or lactose malabsorption,avoiding these substances is not recommended.Water intake should be six to eight glasses per day.Regular walking is usually the best exercise.

Question 6

A patient has been diagnosed with IBS and tells the primary care NP that symptoms of diarrhea and cramping are worsening.The patient asks about possible drug therapy to treat the symptoms.The NP should prescribe:

Accepted Answer

Dicyclomine has indirect and direct effects on the smooth muscle of the gastrointestinal (GI)tract.Both actions help to relieve smooth muscle spasm.Mesalamine is used to treat ulcerative colitis.Simethicone acts locally to treat symptoms of trapped air and gas.Metoclopramide is used to increase motility.

Question 7

A patient who has IBS has been taking dicyclomine and reports decreased pain and diarrhea but is now having occasional constipation.The primary care NP should recommend:

Accepted Answer

Patients who experience constipation may use OTC laxatives as needed.Antidepressants,such as SSRIs or TCAs,are used long-term to help with pain.Raw fruits and vegetables can increase the likelihood of bloating.

Question 8

A patient in the clinic reports frequent episodes of bloating,abdominal pain,and loose stools to the primary care nurse practitioner (NP).An important question the NP should ask about the abdominal pain is:

Accepted Answer

The new Rome II guidelines maintain that irritable bowel syndrome (IBS)of any subtype is characterized by a strong relationship between abdominal pain and defecation because of visceral hypersensitivity to gut-related events.The other characteristics of pain may be assessed to help guide management of IBS,but the first is necessary for a correct diagnosis.

Quiz 31: Medications for Irritable Bowel Syndrome and Other Gastrointestinal Problems

A woman has severe IBS and takes hyoscyamine sulfate (Levsin) ,simethicone (Phazyme) ,and a TCA.She reports having continued severe diarrhea.The primary care NP should:

A woman with IBS has been taking antispasmodic medications and reports some relief,but she tells the primary care NP that the disease is interfering with her ability to work because of increased pain.The NP should consider prescribing:

A patient who has diabetic gastroparesis sees a gastroenterology specialist who orders metoclopramide (Reglan) .Within 24 hours,the patient describes having extrapyramidal symptoms (EPS) to the primary care NP.The NP will contact the gastroenterologist and should expect to prescribe:

A patient takes an antispasmodic and an occasional antidiarrheal medication to treat IBS.The patient comes to the clinic and reports having dry mouth,difficulty urinating,and more frequent constipation.The primary care NP notes a heart rate of 92 beats per minute.The NP should:

A patient who has IBS experiences diarrhea,bloating,and pain but does not want to take medication.The primary care NP should recommend:

A patient has been diagnosed with IBS and tells the primary care NP that symptoms of diarrhea and cramping are worsening.The patient asks about possible drug therapy to treat the symptoms.The NP should prescribe:

A patient who has IBS has been taking dicyclomine and reports decreased pain and diarrhea but is now having occasional constipation.The primary care NP should recommend:

A patient in the clinic reports frequent episodes of bloating,abdominal pain,and loose stools to the primary care nurse practitioner (NP) .An important question the NP should ask about the abdominal pain is: