The Nursing Life

Gastro 4

 

 

1.  Digoxin preparations and absorbents should not be given simultaneously. As a nurse, you are aware that if these agents are given simultaneously, which of the following will occur?

  1. Increased absorption of digoxin
  2. Decreased absorption of digoxin
  3. Increased absorption of the absorbent
  4. Decreased absorption of the absorbent

 

2.     When used with hyperacidic disorders of the stomach, antacids are given to elevate the gastric pH to:

  1. 2.0
  2. 4.0
  3. 6.0
  4. >8.0

 

3.     One of your patients is receiving digitalis orally and is also to receive an antacid at the same time. Your most appropriate action, based on the pharmacokinetics of antacids, is to:

  1. Delay the digitalis for 1 to 2 hours until the antacid is absorbed
  2. Give the antacid at least 2 to 4 hours before administering the digitalis
  3. Administer both medications as ordered and document in nurse’s notes
  4. Contact the physician regarding the drug interaction and request a change in the time of dosing of the drugs.

 

4.     The nurse would teach patients that antacids are effective in treatment of hyperacidity because they:

  1. Neutralize gastric acid
  2. Decrease stomach motility
  3. Decrease gastric pH
  4. Decrease duodenal pH

 

5.     The nurse would monitor for which of the following adverse reactions to aluminum-containing antacids such as aluminum hydroxide (Amphojel)?

  1. Diarrhea
  2. Constipation
  3. GI upset
  4. Fluid retention

 

6.     The nurse would question an order for which type of antacid in patients with chronic renal failure?

  1. Aluminum-containing antacids
  2. Calcium-containing antacids
  3. Magnesium-containing antacids
  4. All of the above.

 

7.     The nurse would monitor a patient using sodium bicarbonate to treat gastric hyperacidity for signs and symptoms of:

  1. Metabolic alkalosis
  2. Metabolic acidosis
  3. Hyperkalemia
  4. Hypercalcemia

 

8.     Which of the following nursing diagnoses is appropriate for a patient receiving famotidine (Pepcid)?

  1. Increased risk for infection due to immunosuppresion
  2. Potential risk for bleeding related to thrombocytopenia.
  3. Aleration in urinary elimination related to retention
  4. Alteration in tissue perfusion related to hypertension

 

9.     Histamine2-receptor antagonists:

  1. Compete with histamine for binding sites on the parietal cells
  2. Irreversibly bind to H+/K+ATPase
  3. Cause a decrease in stomach pH
  4. Decrease signs and symptoms of allergies related to histamine release

 

10.  Proton pump inhibitors:

  1. Gastric ulcer formation
  2. GERD
  3. Achlorhydria
  4. Diverticulosis

 

11.  A patient unable to tolerate oral medications may be prescribed which of the following proton pump inhibitors to be administered intravenously?

  1. lansoprazole (Prevacid)
  2. omeprazole (Prilosec)
  3. pantoprazole (Protonix)
  4. esomeprazole (Nexium)

 

12.  When administering sucralfate (Carafate) to a patient with a nasogastric tube, it is important to:

  1. Crush the tablet into a fine powder before mixing with water
  2. Administer with a bolus tube feeding
  3. Allow the tablet to dissolve in water before administering
  4. Administer with an antacid for maximum benefit

 

13.  Sucralfate (Carafate) achieves a therapeutic effect by:

  1. Neutralizing gastric acid
  2. Enhancing gastric absorption
  3. Forming a protective barrier around gastric mucosa
  4. Inhibiting gastric acid secretion

 

14.  To avoid fecal impaction, psyllium (Metamucil) should be administered with at least how many ounces of fluid?

  1. 4
  2. 6
  3. 8
  4. 10

 

15.  Bismuth subsalicylate (Pepto-Bismol), as an absorbent, has which of the following mechanisms of action?

  1. Decreased GI motility
  2. Decreased gastric secretions
  3. Increased fluid absorption
  4. Binding to diarrhea-causing bacteria for excretion

 

16.  Side effects of loperamide (Imodium) include all of the following except?

  1. Diarrhea
  2. epigastric pain
  3. Dry mouth
  4. Anorexia

 

17.  The mechanism of action of diphenoxylate (Lotomil) is:

  1. An increase in intestinal excretion of water
  2. An increase in intestinal motility
  3. A decrease in peristalsis in the intestinal wall
  4. A decrease in the reabsorption of water in the bowel

 

18.  Milk of Magnesium alleviates constipation by:

  1. Increasing water absorption into the colon
  2. Lubricating the passage of stool
  3. Increasing bulk within the colon
  4. Stimulating nerves that regulate defecation

 

19.  Lactulose, a hyperosmotic laxative, also functions to:

  1. Decrease peripheral edema
  2. Correct sodium imbalances
  3. Reduce ammonia levels
  4. Alleviate galactose intolerance

 

  1. 2.
  2. 1.
  3. 4.
  4. 1. Antacids work by neutralizing gastric acid, which would cause an increase in pH. They do not affect gastric motility.
  5. 2. Aluminum- and calcium-containing antacids cause constipation, magnesium-containing antacids cause diarrhea, and sodium-containing antacids cause sodium and fluid retention.
  6. 3. Magnesium-containing antacids can cause hypermagnesemia in patients with chronic renal failure. Aluminum-containing antacids may be used as a phosphate binder in patients with chronic renal failure. Calcium-containing antacids are also appropriate because these patients may be hypocalcemic.
  7. 1. Solutions containing sodium bicarbonate (a base) can cause metabolic alkalosis. Serum K and serum calcium would decrease with alkalosis, not increase.
  8. 2. A serious side effect of famotidine is thrombocytopenia, which is manifested by a decrease in platelet count and an increased risk of bleeding.
  9. 1. Histamine receptor blocking agents decrease gastric acid by competing with histamine for binding sites on the parietal cells.

10.  3. Because the proton pump inhibitors stop the final step of acid secretion, they can block up to 90% of acid secretion, leading to achlorhydria (without acid).

11.  3. Pantoprazole is the only proton pump inhibitor that is available for intravenous administration. The other medications in this category may only be administered orally.

12.  C. It is important to give sucralfate on an empty stomach so that it may dissolve and form a protective barrier over the gastric mucosa. The tablet form will not dissolve in water when crushed; it must be left whole and allowed to dissolve. Crushing the medication so that it will not dissolve could lead to clogging of the nasogastric tube and decreased effectiveness of the drug.

13.  3. Sucralfate has a local effect only on the gastric mucosa. It forms a pastelike substance in the stomach, which adheres to the gastric lining, protecting against adverse effects related to gastric acid. It also stimulates healing of any ulcerated areas of the gastric mucosa.

14.  3. Bulk-forming laxatives must be given with at least 8 ounces of liquid plus additional liquid each day to prevent intestinal obstruction.

15.  4. Absorbent antidiarrheal medications bind to diarrhea-causing bacteria to form a nonabsorbable complex, which is then excreted in the stool.

16.  1. Side effects associated with loperamide include CNS fatigue and dizziness, epigastric pain, abdominal cramps, nausea, dry mouth, vomiting, and anorexia. Diarrhea is an indication, not a side effect.

17.  3. Diphenoxylate acts on the smooth muscle of the intestinal tract to inhibit GI motility and excessive propulsion of the GI tract (peristalsis).

18.  1. Milk of Magnesia is a saline laxative that increases osmotic pressure to draw water into the colon.

19.  3. Lactulose reduces blood ammonia levels by forcing ammonia from the blood into the colon. It is useful in treating patients with hepatic encephalopathy.

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