NCLEX Questions: GI - counter medications. For which medication, if t...

NCLEX Questions: GI

A 74-year-old female patient with gastroesophageal reflux disease (GERD) takes over-the- counter medications. For which medication, if taken long-term, should the nurse teach about an increased risk of fractures?

• Sucralfate (Carafate)
• Cimetidine (Tagamet)
• Omeprazole (Prilosec)
• Metoclopramide (Reglan) - c. Omeprazole (Prilosec)

There is a potential link between proton pump inhibitors (PPIs) (e.g., omeprazole) use and bone metabolism. Long-term use or high doses of PPIs may increase the risk of fractures of the hip, wrist, and spine. Lower doses or shorter duration of therapy should be considered.

Following administration of a dose of metoclopramide (Reglan) to the patient, the nurse determines that the medication has been effective when what is noted?

• Decreased blood pressure
• Absence of muscle tremors
• Relief of nausea and vomiting
• No further episodes of diarrhea - c. Relief of nausea and vomiting

Metoclopramide is classified as a prokinetic and antiemetic medication. If it is effective, the patient's nausea and vomiting should resolve. Metoclopramide does not affect blood pressure, muscle tremors, or diarrhea.

The patient receiving chemotherapy rings the call bell and reports the onset of nausea. The nurse should prepare an as-needed dose of which medication?

• Morphine sulfate
• Zolpidem (Ambien)
• Ondansetron (Zofran)
• Dexamethasone (Decadron) - c. Ondansetron (Zofran)*

Ondansetron is a 5-HT3 receptor antagonist antiemetic that is especially effective in reducing cancer chemotherapy-induced nausea and vomiting. Morphine sulfate may cause nausea and vomiting. Zolpidem does not relieve nausea and vomiting. Dexamethasone is usually used in combination with ondansetron for acute and chemotherapy-induced emesis.

The patient who is admitted with a diagnosis of diverticulitis and a history of irritable bowel disease and gastroesophageal reflux disease (GERD) has received a dose of Mylanta 30 mL PO.The nurse should evaluate its effectiveness by questioning the patient as to whether which symptom has been resolved?

• Diarrhea
• Heartburn
• Constipation
• Lower abdominal pain - b. Heartburn

Mylanta is an antacid that contains both aluminum and magnesium. It is indicated for the relief of GI discomfort, such as heartburn associated with GERD. Mylanta can cause both diarrhea and constipation as a side effect. Mylanta does not affect lower abdominal pain.

A patient complains of nausea. When administering a dose of metoclopramide (Reglan), the nurse should teach the patient to report which potential adverse effect?

• Tremors
• Constipation
• Double vision
• Numbness in fingers and toes - a. Tremors

Extrapyramidal side effects, including tremors and tardive dyskinesias, may occur as a result of metoclopramide (Reglan) administration. Constipation, double vision, and numbness in fingers and toes are not adverse effects of metoclopramide.

The nurse determines that a patient has experienced the beneficial effects of therapy with famotidine (Pepcid) when which symptom is relieved?

• Nausea
• Belching
• Epigastric pain
• Difficulty swallowing - c. Epigastric pain

Famotidine is an H2-receptor antagonist that inhibits parietal cell output of HCl acid and minimizes damage to gastric mucosa related to hyperacidity, thus relieving epigastric pain.Famotidine is not indicated for nausea, belching, and dysphagia.

A patient with a history of peptic ulcer disease has presented to the emergency department reporting severe abdominal pain and has a rigid, boardlike abdomen that prompts the health care team to suspect a perforated ulcer. What intervention should the nurse anticipate?

• Providing IV fluids and inserting a nasogastric (NG) tube
• Administering oral bicarbonate and testing the patient's gastric pH level
• Performing a fecal occult blood test and administering IV calcium gluconate
• Starting parenteral nutrition and placing the patient in a high-Fowler's position - a. Providing

IV fluids and inserting a nasogastric (NG) tube

A perforated peptic ulcer requires IV replacement of fluid losses and continued gastric aspiration by NG tube. Nothing is given by mouth, and gastric pH testing is not a priority. Calcium

gluconate is not a medication directly relevant to the patient's suspected diagnosis, and parenteral nutrition is not a priority in the short term.

The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD).Which teaching point should the nurse provide to the patient based on this new diagnosis?

• "You'll need to drink at least two to three glasses of milk daily."
• "It would likely be beneficial for you to eliminate drinking alcohol."
• "Many people find that a minced or pureed diet eases their symptoms of PUD."
• "Your medications should allow you to maintain your present diet while minimizing

symptoms." - b. "It would likely be beneficial for you to eliminate drinking alcohol."

Alcohol increases the amount of stomach acid produced so it should be avoided. Although there is no specific recommended dietary modification for PUD, most patients find it necessary to make some sort of dietary modifications to minimize symptoms. Milk may exacerbate PUD.

A female patient has a sliding hiatal hernia. What nursing interventions will prevent the symptoms of heartburn and dyspepsia that she is experiencing?

• Keep the patient NPO.
• Put the bed in the Trendelenberg position.
• Have the patient eat 4 to 6 smaller meals each day.
• Give various antacids to determine which one works for the patient. - c. Have the patient eat 4

to 6 smaller meals each day.

Eating smaller meals during the day will decrease the gastric pressure and the symptoms of hiatal hernia. Keeping the patient NPO or in a Trendelenberg position are not safe or realistic for a long period of time for any patient. Varying antacids will only be done with the care provider's prescription, so this is not a nursing intervention.

A 72-year-old patient was admitted with epigastric pain due to a gastric ulcer. Which patient assessment warrants an urgent change in the nursing plan of care?

• Chest pain relieved with eating or drinking water
• Back pain 3 or 4 hours after eating a meal
• Burning epigastric pain 90 minutes after breakfast
• Rigid abdomen and vomiting following indigestion - d. Rigid abdomen and vomiting

following indigestion

A rigid abdomen with vomiting in a patient who has a gastric ulcer indicates a perforation of the ulcer, especially if the manifestations of perforation appear suddenly. Midepigastric pain is relieved by eating, drinking water, or antacids with duodenal ulcers, not gastric ulcers. Back pain 3-4 hours after a meal is more likely to occur with a duodenal ulcer. Burning epigastric pain 1-2 hours after a meal is an expected manifestation of a gastric ulcer related to increased gastric secretions and does not cause an urgent change in the nursing plan of care.

The patient with chronic gastritis is being put on a combination of medications to eradicate H.pylori. Which drugs does the nurse know will probably be used for this patient?

• Antibiotic(s), antacid, and corticosteroid
• Antibiotic(s), aspirin, and antiulcer/protectant
• Antibiotic(s), proton pump inhibitor, and bismuth

d.Antibiotic(s) and nonsteroidal antiinflammatory drugs (NSAIDs) - c. Antibiotic(s), proton pump inhibitor, and bismuth

To eradicate H. pylori, a combination of antibiotics, a proton pump inhibitor, and possibly bismuth (for quadruple therapy) will be used. Corticosteroids, aspirin, and NSAIDs are drugs that can cause gastritis and do not affect H. pylori.

The patient is having a gastroduodenostomy (Billroth I operation) for stomach cancer. What long-term complication is occurring when the patient reports generalized weakness, sweating, palpitations, and dizziness 15 to 30 minutes after eating?

• Malnutrition
• Bile reflux gastritis
• Dumping syndrome
• Postprandial hypoglycemia - c. Dumping syndrome

After a Billroth I operation, dumping syndrome may occur 15 to 30 minutes after eating because of the hypertonic fluid going to the intestine and additional fluid being drawn into the bowel.Malnutrition may occur but does not cause these symptoms. Bile reflux gastritis cannot happen when the stomach has been removed. Postprandial hypoglycemia occurs with similar symptoms, but 2 hours after eating.

The nurse is admitting a 68-year-old man with severe dehydration and frequent watery diarrhea.He just completed a 10-day outpatient course of antibiotic therapy for bacterial pneumonia. It is most important for the nurse to take which action?

• Wear a mask to prevent transmission of infection.
• Wipe equipment with ammonia-based disinfectant.
• Instruct visitors to use the alcohol-based hand sanitizer.
• Don gloves and gown before entering the patient's room - d. Don gloves and gown before

entering the patient's room

Clostridium difficile is an antibiotic-associated diarrhea transmitted by contact, and the spores are extremely difficult to kill. Patients with suspected or confirmed infection with C. difficile should be placed in a private room and gloves and gowns should be worn by visitors and health care providers. Alcohol-based hand cleaners and ammonia-based disinfectants are ineffective and do not kill all of the spores. Equipment cannot be shared with other patients, and a disposable stethoscope and individual patient thermometer are kept in the room. Objects should be disinfected with a 10% solution of household bleach.