Deck 16: Gastrointestinal Drugs

Question 1

A patient reports taking an oral bisacodyl laxative for several years. What instructions will the provider give the patient to guide the discontinuation of the laxative?

A) Stop taking the oral laxative and use a suppository until normal motility resumes.
B) Stop taking the laxative immediately and expect no stool for several days.
C) Switch to a bulk-forming laxative, such as methylcellulose.
D) Withdraw from the laxative slowly to avoid a rebound constipation effect.

Answer 1

Stop taking the laxative immediately and expect no stool for several days.

Question 2

When ordering castor oil for a patient, what guidance will the provider share with the nurse?

A) Administer the medication at bedtime.
B) Chill the medication and mix it with fruit juice.
C) Provide teaching about home use of this medication.
D) Teach the patient that the effects will occur slowly.

Answer 2

Chill the medication and mix it with fruit juice.

Question 3

A patient who has been taking senna for several days notes that the urine is yellowish brown. What response will the prescriber provide when the patient expresses concern about this change?

A) It indicates that renal failure has occurred.
B) It is caused by dehydration, which is a laxative side effect.
C) It is a sign of toxicity; this drug must be discontinued.
D) It is an expected, harmless effect of senna.

Answer 3

It is an expected, harmless effect of senna.

Question 4

A patient diagnosed with renal disease is scheduled for a colonoscopy. What drug will the provider prescribe for administration before the procedure?

A) A glycerin suppository
B) Magnesium hydroxide
C) Polyethylene glycol plus electrolytes (PEG-ELS)
D) Sodium phosphate

Question 5

A patient receives ondansetron and dexamethasone for chemotherapy-induced nausea and vomiting (CINV). The patient states that the drugs provide relief during and immediately after chemotherapy, but that significant nausea and vomiting occur several days after each chemotherapy treatment. What action will the prescriber take to address this outcome?

A) Discuss increasing the dose of ondansetron with the patient.
B) Suggest giving prolonged doses of dexamethasone.
C) Suggest adding aprepitant to the medication regimen.
D) Discontinue the ondansetron and prescribe aprepitant.

Question 6

A patient takes nonsteroidal antiinflammatory drugs (NSAIDs) for arthritis. What can the provider prescribe to prevent ulcers?

A) Antibiotics
B) Histamine-2 receptor antagonists
C) Proton pump inhibitors
D) Mucosal protectants

Question 7

The parent of a child with cerebral palsy reports that the child has pebble-like stools most of the time and seems uncomfortable if several days have passed between stools. Which medication will the provider recommend to the child's parents?

A) Bisacodyl suppositories
B) Magnesium citrate
C) Methylcellulose
D) Polyethylene glycol

Question 8

Which new diagnosis would prompt the provider to discontinue a PRN order for magnesium hydroxide?

A) Renal failure
B) Cirrhosis
C) Hemorrhoids
D) Prostatitis

Question 9

A patient with peptic ulcer disease is otherwise healthy. The patient does not smoke and states drinking 1 or 2 glasses of wine with meals each week. Which drugs will the provider prescribe?

A) Amoxicillin, clarithromycin, and omeprazole
B) Amoxicillin, metronidazole, and cimetidine
C) Clarithromycin, metronidazole, and omeprazole
D) Tetracycline, cimetidine, and lansoprazole

Question 10

A patient with a history of chronic alcohol use has been admitted to the unit with a diagnosis of cirrhosis. Admission laboratory reports show that the patient's ammonia level is elevated at 218 $\mu$ g/dL. What medication will the provider prescribe to address the lab result?

A) 0.9% NS IV
B) Docusate sodium [Colace]
C) Lactulose
D) Polyethylene glycol [MiraLax]

Question 11

A patient newly diagnosed with peptic ulcer disease (PUD) reports taking low-dose aspirin (ASA) for prevention of cardiovascular disease. The medical history determines that the patient drinks 2 to 3 cups of coffee each day, eats three meals a day, and has a glass of wine with dinner 3 or 4 nights per week. The provider will counsel this patient to what lifestyle action?

A) Change the meal pattern to five or six smaller meals per day.
B) Discontinue taking aspirin, because it can irritate the stomach.
C) Stop drinking wine or any other alcoholic beverage.
D) Switch to a decaffeinated coffee and reduce the number of servings.

Question 12

A patient with gastroesophageal reflux disease (GERD) receives a prescription for a proton pump inhibitor (PPI). What information will the provider include when teaching the patient about this drug?

A) "The FDA has determined that there is a gastric cancer risk with this drug."
B) "This drug will be given on a short-term basis only."
C) "You may experience high magnesium levels when taking this drug."
D) "You should report any fever and cough to your provider."

Question 13

A provider has a routine order for sodium phosphate as a bowel cleanser before a patient's colonoscopy. The lab report shows that the patient's creatinine clearance and blood urea nitrogen are both elevated. What will the provider do in response to these lab results?

A) Reduce the amount of fluid given with the laxative to prevent fluid retention.
B) Prescribe polyethylene glycol and electrolytes (PEG-ELS) instead.
C) Suggest that the patient reduce the dietary sodium intake.
D) Prescribe a laxative suppository instead.

Question 14

A patient is diagnosed with Zollinger-Ellison syndrome. Which medication does the provider recognize as most effective for this patient's condition?

A) Cimetidine
B) Esomeprazole
C) Omeprazole
D) Sucralfate

Question 15

An older adult patient takes an opioid analgesic after a right hip open reduction internal fixation (ORIF). Which medication will the provider prescribe to prevent constipation?

A) Docusate sodium
B) GoLYTELY
C) Glycerin suppositories
D) Polyethylene glycol

Question 16

When metronidazole is a component of the H. pylori treatment regimen, what guidance will the prescriber provide to the patient?

A) Avoid any alcoholic beverages.
B) Avoid foods containing tyramine.
C) Take the drug on an empty stomach.
D) Take the drug with food.

Question 17

A patient with lower abdominal pain and nausea is admitted to the hospital. The patient's abdomen is distended and firm with hypoactive bowel sounds. The patient reports of not having a bowel movement for 3 days. What initial action will the provider take?

A) Order a bulk-forming laxative.
B) Order a saline enema.
C) Order diagnostic tests.
D) Prescribe a cathartic laxative.

Question 18

A patient is prescribed ondansetron 30 minutes before initiation of chemotherapy. The patient reports that the ondansetron did not work as well as it had previously. What action will the prescriber take?

A) Order that the ondansetron be given at the same time as the chemotherapy is administered.
B) Prescribe a high dose of intravenous dolasetron.
C) Prescribe dexamethasone to be given with the ondansetron.
D) Prescribe loperamide to be given with the ondansetron.

Question 19

A patient has been taking psyllium two to three times daily for several days but has not passed a stool. What initial action will the prescriber take when the patient reports abdominal pain?

A) Tell the patient to increase water intake.
B) Suggest increasing psyllium intake.
C) Prescribe a bisacodyl suppository.
D) Palpate the patient's abdomen and auscultate for bowel sounds.

Question 20

A patient with a history of peptic ulcer disease takes ranitidine and sucralfate. The patient reports that discomfort is usually controlled but that symptoms occasionally flare up. What action will the provider take to address the patient's concern?

A) Order an endoscopic examination.
B) Discuss testing for H. pylori and an antibiotic.
C) Discuss switching to a proton pump inhibitor.
D) Counsel the patient to avoid caffeine.

Question 21

A patient plans to perform missionary work in a region with poor drinking water. The provider gives the patient a prescription for ciprofloxacin to take on the trip. What instructions will the prescriber discuss with this patient?

A) Combine the antibiotic with an antidiarrheal medication, such as loperamide.
B) Start the ciprofloxacin 1 week before traveling.
C) Take 1 tablet of ciprofloxacin with each meal while living in areas with inadequate water maintenance.
D) Use the drug if symptoms develop and are severe or do not improve in a few days.

Question 22

A patient reports a 6-month history of daily episodes of recurrent, crampy abdominal pain followed by diarrhea that usually relieves the pain. The patient undergoes a colonoscopy, for which the findings are normal. What will the provider discuss with the patient?

A) Prescribing antispasmodic medication
B) Avoiding food containing lactose and gluten
C) Keeping a food, stress, and symptom diary
D) Prescribing antidiarrheal drugs to manage symptoms

Question 23

A patient with Crohn disease will receive an initial infusion of infliximab. The prescriber explains how this drug works to treat this disease. Which statement by the patient indicates a need for further teaching?

A) "I may have an increased risk of infections when taking infliximab."
B) "I should report chills, fever, itching, and shortness of breath while receiving the infusion."
C) "This drug sometimes provides a complete cure of inflammatory bowel disease."
D) "I will take the second dose in 2 weeks, the third dose in 6 weeks, and then a dose every 8 weeks thereafter."

Question 24

A patient who experiences motion sickness plans to go on a cruise. The prescriber orders transdermal scopolamine [Transderm Scop]. The patient asks why an oral agent is not ordered. What response will the provider give to explain that the benefit of a transdermal preparation?

A) The patch can be applied as needed at the first sign of nausea.
B) This form has less intense anticholinergic effects than the oral form.
C) The patch is less sedating than the oral preparation.
D) This method provides direct effects, because it is placed close to the vestibular apparatus of the ear.

Question 25

A provider discusses the use of immunosuppressants for the treatment of inflammatory bowel disease (IBD) with a patient. Which statement by the patient indicates understanding of the teaching?

A) "Azathioprine helps induce rapid remission of IBD."
B) "Cyclosporine can be used to induce remission of IBD."
C) "Cyclosporine does not have serious adverse effects."
D) "Methotrexate is used long term to maintain remission of IBD."