Exam2

Which of the following symptoms suggests the presence of a hiatal hernia?
a. Nausea
b. Heartburn
c. Diarrhea
d. Abdominal cramps

b. Heartburn

Epigastric pain that is relieved by food is suggestive of
a. pancreatitis.
b. cardiac angina.
c. gastric ulcer.
d. dysphagia.

c. gastric ulcer.

Histamine antagonists may be used in the management of peptic ulcer disease to
a. increase gastric motility.
b. inhibit secretion of pepsinogen.
c. neutralize gastric acid.
d. decrease hydrochloric acid (HCl) secretion.

d. decrease hydrochloric acid (HCl) secretion.

PUD

Peptic Ulcer Disease

The most common cause of mechanical bowel obstruction is
a. volvulus.
b. intussusception.
c. adhesions.
d. fecal impaction.

c. adhesions.

Acute right lower quadrant pain associated with rebound tenderness and systemic signs of inflammation are indicative of
a. appendicitis.
b. peritonitis.
c. cholecystitis.
d. gastritis.

a. appendicitis.

A silent abdomen 3 hours after bowel surgery most likely indicates
a. peritonitis.
b. mechanical bowel obstruction.
c. perforated bowel.
d. functional bowel obstruction.

d. functional bowel obstruction.

Functional bowel obstruction.

Functional obstructions are due to conditions that inhibit peristalsis, such as narcotics, anesthesia, surgical manipulation, peritonitis, hypokalemia, and spinal cord injuries. Functional obstructions are characterized by the absence of bowel sounds.

Mechanical bowel obstruction

Mechanical obstructions are due to adhesions, hernia, tumors, impacted feces, volvulus (twisting), or intussusception (telescoping). Mechanical obstructions are characterized by increased bowel sounds initially, accompanied by abdominal pain, nausea, and vomiting.

Ulcerative colitis is commonly associated with
a. bloody diarrhea.
b. malabsorption of nutrients.
c. fistula formation between loops of bowel.
d. inflammation and scarring of the submucosal layer of the bowel.

a. bloody diarrhea.

An early indicator of colon cancer is
a. rectal pain.
b. bloody diarrhea.
c. a change in bowel habits.
d. jaundice.

c. a change in bowel habits.

A patient who should be routinely evaluated for peptic ulcer disease is one who is
a. taking 6 to 8 tablets of acetaminophen per day.
b. being treated with high-dose oral glucocorticoids.
c. experiencing work-related stress.
d. routinely drinking alcoholic beverages.

b. being treated with high-dose oral glucocorticoids.

Celiac sprue is a malabsorptive disorder associated with
a. inflammatory reaction to gluten-containing foods.
b. megacolon at regions of autonomic denervation.
c. ulceration of the distal colon and rectum.
d. deficient production of pancreatic enzymes.

a. inflammatory reaction to gluten-containing foods.

Which of the following clinical findings would suggest an esophageal rather than an oropharyngeal cause of dysphagia?
a. Nasal regurgitation
b. Airway obstruction with swallowing
c. Chest pain during meals
d. Coughing when swallowing

c. Chest pain during meals

Combined dysphagia with both solids and liquids is typical of
a. esophageal stricture.
b. achalasia.
c. esophageal tumors.
d. Mallory-Weiss syndrome.

b. achalasia.

In which of the following cases would it be inappropriate to manage dyspepsia with an empiric trial of an H2 blocker?
a. Concomitant dysphagia
b. Chronic use of nonsteroidal antiinflammatory drugs
c. Dyspepsia occurring after meals
d. Dyspepsia relieved by meals

a. Concomitant dysphagia

Achalasia

Achalasia

A disorder of esophageal smooth muscle function resulting in difficulty in swallowing both liquids and solids.

A Barrett esophagus is
a. best managed with H2 antagonists.
b. a preneoplastic lesion.
c. a benign condition.
d. a gastrin-secreting tumor.

a preneoplastic lesion

Barrett esophagus

Barrett esophagus

A complication of chronic gastroesophageal reflux disease that represents replacement of the normal squamous epithelium of the distal esophagus by columnar tissue. Considered to be a preneoplastic condition.

Which of the following findings should prompt further diagnostic testing in a child presenting with diarrhea?
a. Periumbilical discomfort
b. Greenish, watery diarrhea
c. Frequent, large-volume diarrhea
d. Blood and mucus in the stools

d. Blood and mucus in the stools

Fecal leukocyte screening would be indicated in a patient with suspected
a. lactose intolerance.
b. inflammatory bowel disease.
c. laxative abuse.
d. giardiasis.

b. inflammatory bowel disease.

Which of the following findings would rule out a diagnosis of irritable bowel syndrome in a patient with chronic diarrhea?
a. Negative stool leukocytes
b. Intermittent constipation
c. Abdominal pain and distention
d. Bloody stools

d. Bloody stools

An urgent surgical consult is indicated for the patient with acute abdominal pain and
a. vomiting.
b. CVA tenderness.
c. absent bowel tones.
d. borborygmi.

c. absent bowel tones.

borborygmi

stomach growling

Dysphagia

Difficulty swallowing

Achalasia

Absence of peristalsis in a portion of the esophagus

Encopresis

Stasis and involuntary leakage of stool

Odynophagia

Painful swallowing

Diverticulosis

Herniations in the bowel wall

Causative factors in peptic ulcer disease

Long-term use of nonsteroidal antiinflammatory medications and infection with Helicobacter pylori are causative factors in peptic ulcer disease.

True or False: Esophagitis pain is similar in location and pattern to myocardial chest pain.

True. Esophagitis pain is similar in location and pattern to myocardial chest pain.

True or False: The exocrine pancreas is stimulated to secrete in response to secretin and cholecystokinin.

The exocrine pancreas is stimulated to secrete in response to secretin and cholecystokinin.

Cholelithiasis is present in ____ % of patients who have acute cholecystitis

90%

cholecystitis

cholecystitis refers to inflammation of the gallbladder wall

Cholelithiasis

cholesterol stones in the gallbladder

chronic cholelithiasis symptoms

The chief complication of chronic cholelithiasis is biliary colic, a persistent epigastric or right upper abdominal pain. Often the pain radiates to the back and is accompanied by nausea, vomiting, sweating, and flatus.

Primary risk factor for chronic pancreatitis?

ETOH abuse

A deficiency of lipid digestion or absorption commonly results in
a. steatorrhea.
b. constipation.
c. hyperlipidemia.
d. cholelithiasis.

a. steatorrhea

steatorrhea

fatty stools

Patients with acute pancreatitis are generally not allowed to eat and may require continuous gastric suctioning to
a. prevent abdominal distention.
b. remove the usual stimuli for pancreatic secretion.
c. prevent hyperglycemia associated with loss of insulin secretion.
d. prevent mechanical obstruction of the intestine.

b. remove the usual stimuli for pancreatic secretion.

Most gallstones are composed of
a. bile.
b. cholesterol.
c. calcium.
d. uric acid salts.

b. cholesterol.

Elevated serum lipase and amylase levels are indicative of
a. gallbladder disease.
b. appendicitis.
c. pancreatitis.
d. peritonitis.

c. pancreatitis.

The definitive treatment for cholecystitis is
a. lithotripsy of stones.
b. chemical dissolution of stones.
c. antibiotics and antiinflammatories.
d. cholecystectomy.

d. cholecystectomy.

A biliary cause of acute pancreatitis is suggested by which of the following laboratory results?
a. Elevated serum lipase
b. Elevated serum amylase
c. Elevated serum glucose
d. Elevated serum alkaline phosphatase

Elevated serum alkaline phosphatase

A patient with pancreatitis may experience muscle cramps and laryngospasm secondary to
a. alkalosis.
b. hyperglycemia.
c. hypocalcemia.
d. hypermagnesemia.

c. hypocalcemia.

Chronic pancreatitis may lead to
a. diabetes mellitus.
b. Crohn disease.
c. gallstones.
d. celiac sprue.

a. diabetes mellitus

The usual treatment for chronic pancreatitis includes
a. pancreatectomy.
b. strict dietary avoidance of fats.
c. abstinence from alcohol.
d. long-term narcotic administration for pain.

c. abstinence from alcohol.

The finding of hypotension, rigid abdomen, and absent bowel sounds in a patient with pancreatitis
a. is an expected finding and requires no specific intervention.
b. indicates peritonitis with substantial risk for sepsis and shock.
c. requires immediate surgical intervention.
d. is an unusual finding in pancreatitis and indicates misdiagnosis.

b. indicates peritonitis with substantial risk for sepsis and shock.

The nerves that carry pain sensations from the kidney enter the cord at T___ to L___

T10, L1

True or False: Colicky, spasmodic pains in the flank area are likely to occur with ureteral irritation

True

True or False: The presence of white blood cell casts in the urine is indicative of pyelonephritis

true

Most renal calculi are composed of: _____________

calcium crystals.

Wilms tumor is a ________ that primarily affects ________.

Wilms tumor is a renal cancer that primarily affects children.

True or False: the presence of red blood cell casts in the urine is indicative of glomerulonephritis.

True

Which of the following is not usually associated with nephrosis?
a. Hyperlipidemia
b. Proteinuria
c. Hematuria
d. Generalized edema

c. Hematuria

A person with acute pyelonephritis would most typically have
a. fever.
b. oliguria.
c. edema.
d. hypertension.

a. fever.

The organism most commonly associated with acute pyelonephritis is
a. Streptococcus.
b. Escherichia coli.
c. Klebsiella.
d. Enterobacter.

b. Escherichia coli.

Polycystic kidney disease is
a. always rapidly fatal.
b. due to a streptococcal infection.
c. associated with supernumerary kidney.
d. genetically transmitted.

d. genetically transmitted.

The pathophysiologic basis of acute glomerulonephritis is
a. renal ischemia.
b. bacterial invasion of the glomerulus.
c. an anaphylactic reaction.
d. an immune complex reaction.

d. an immune complex reaction.

Which of the following signs is consistent with a diagnosis of glomerulonephritis?
a. Pyuria
b. Proteinuria
c. White blood cell casts in the urine
d. Foul-smelling urine

b. Proteinuria

7. Z.C. is a 49-year-old man with autosomal dominant polycystic kidney disease (ADPKD). His kidneys are enlarged with multiple urine-filled cystic lesions. Z.C. is currently in a stage of renal insufficiency with a GFR of about 20% of normal. He suffers from recurrent urinary tract infections and chronic anemia. In counseling Z.C. about the risk of transmitting the disorder to his offspring, which of the following statements would be correct?
a. Each offspring has a 50% chance of developing the disease.
b. Each offspring has a 25% chance of developing the disease.
c. Each offspring has a 50% chance of being a carrier.
d. Only boys are affected, whereas girls are carriers.

a. Each offspring has a 50% chance of developing the disease.

The pain that accompanies kidney disorders is called
a. nephritic.
b. nephralgia.
c. nephrotic.
d. nephronitis.

b. nephralgia.

Which of the following findings should prompt an evaluation for renal cancer?
a. Bacteria and protein in the urine
b. Intermittent urinary colic
c. Painless hematuria
d. Red blood cell casts in the urine

c. Painless hematuria

A patient with gouty arthritis develops renal calculi. The composition of these calculi is most likely to be
a. calcium oxalate.
b. struvite.
c. cysteine.
d. uric acid crystals.

d. uric acid crystals.

a. Nephrotic syndrome
b. Uremic syndrome

1. Proteinuria

2. Azotemia

3. Oliguria

4. Hyperlipidemia

a. Nephrotic syndrome
b. Uremic syndrome

1. Proteinuria

2. Azotemia

3. Oliguria

4. Hyperlipidemia

1. ANS: A

2. ANS: B

3. ANS: B

4. ANS: A

True or False: Prerenal acute renal failure occurs when kidney perfusion is impaired.

True

True or False: Prerenal oliguria is a reversible stage of acute renal failure.

True

True or False: Patients with end-stage renal disease are at a high risk of developing hypocalcemia.

True

True or False: Signs and symptoms of end-stage renal disease begin to appear when approximately 75% of nephrons have been lost.

true

True or False: Patients with acute renal failure commonly develop metabolic acidosis because of impaired kidney secretion of H+.

True

The best indicator of renal function:

The glomerular filtration rate (GFR)

A high urine sodium and a fractional sodium excretion greater than 1 is associated with
a. hypovolemia.
b. acute tubular necrosis.
c. prerenal oliguria.
d. activation of the renin-angiotensin-aldosterone cascade.

b. acute tubular necrosis.

The oliguric phase of acute tubular necrosis is characterized by
a. polyuria and nocturia.
b. rapidly developing uremia.
c. inability to concentrate urine.
d. enhanced glomerular filtration.

b. rapidly developing uremia.

The stage of “renal insufficiency” of chronic kidney disease is associated with
a. destruction of more than 90% of total nephrons.
b. uremic syndrome.
c. polyuria and nocturia.
d. proteinuria and hypoproteinemia.

c. polyuria and nocturia.

Osteodystrophy commonly occurs in patients with end-stage renal disease because of
a. hypoparathyroidism.
b. hypercalcemia.
c. insufficient active vitamin D.
d. phosphate deficiency.

c. insufficient active vitamin D.

Renal artery stenosis, hypertension, and nephrosclerosis may all contribute to renal failure by causing
a. hydronephrosis.
b. renal ischemia.
c. nephrosis.
d. renal inflammation.

b. renal ischemia.

Appropriate therapy for prerenal oliguria includes
a. fluid administration.
b. potassium supplementation.
c. fluid restriction.
d. protein restriction.

a. fluid administration.

A patient with renal disease is at risk for developing uremia as his nephrons progressively deteriorate because
a. the basement membrane becomes increasingly permeable.
b. filtration exceeds secretory and reabsorptive capacity.
c. excessive solute and water are lost in the urine.
d. GFR declines.

d. GFR declines.

uremia

renal failure

The most likely cause of anemia in a patient with end-stage renal disease is
a. insufficient erythropoietin.
b. blood loss secondary to hematuria.
c. vitamin B12 deficiency secondary to deficient intrinsic factor.
d. iron deficiency.

a. insufficient erythropoietin.

The most likely cause of compensated acidosis in a patient with end-stage renal disease is
a. insufficient filtration of bicarbonate ions at the glomerulus.
b. excessive production of respiratory and metabolic acids.
c. insufficient metabolic acid excretion due to nephron loss.
d. hypoventilation secondary to uremic central nervous system depression.

c. insufficient metabolic acid excretion due to nephron loss.

The most helpful laboratory value in monitoring the progression of declining renal function is
a. serum creatinine.
b. serum potassium.
c. blood urea nitrogen.
d. mental status changes.

a. serum creatinine.

Appropriate management of end-stage renal disease includes
a. potassium supplementation.
b. a high-protein diet.
c. erythropoietin administration.
d. a high-phosphate diet.

c. erythropoietin administration.

What problem(s) is a patient likely to experience in end-stage renal disease?
a. Proteinuria
b. Polyuria and nocturia
c. Uremia
d. Hematuria

c. Uremia

Which of the following interventions has been found to retard the advancement of chronic kidney disease?
a. Calcium supplementation
b. Erythropoietin
c. Insulin
d. ACE inhibitors or A-II receptor blockers

d. ACE inhibitors or A-II receptor blockers

In patients with polycystic kidney disease, renal failure is expected to progress over time as the cystic process destroys more nephrons. At what point will a patient reach end-stage renal disease?
a. Not possible to predict based on nephron loss
b. Greater than 50% nephron loss
c. Greater than 75% nephron loss
d. Greater than 90% nephron loss

d. Greater than 90% nephron loss

At his most recent clinic visit, a patient with end-stage renal disease is noted to have edema, congestive signs in the pulmonary system, and a pericardial friction rub. Appropriate therapy at this time would include
a. initiation of dialysis.
b. fluid restriction.
c. antibiotics.
d. phlebotomy.

a. initiation of dialysis.

Match the following predisposing factors with the types of acute renal failure below.
a. Nephrotoxic antibiotic
b. Shock
c. Prostatic hyperplasia

1. Prerenal

2. Intrarenal

3. Postrenal

Match the following predisposing factors with the types of acute renal failure below.
a. Nephrotoxic antibiotic
b. Shock
c. Prostatic hyperplasia

1. Prerenal

2. Intrarenal

3. Postrenal

1. ANS: B

2. ANS: A

3. ANS: C

The nurse is discussing the mechanism of action of omeprazole (Prilosec) with a group of nursing students. Which statement by a student would best indicate understanding of the mechanism of action of omeprazole?
a. “The duration of action is short, because the drug has a short half-life.”
b. “Absorption occurs in the stomach when the pH is greater than 5.”
c. “It irreversibly inhibits the enzyme needed to produce stomach acid.”
d. “The complete return of acid production occurs 24 hours after discontinuation.”

c. “It irreversibly inhibits the enzyme needed to produce stomach acid.”

The mechanism of action of omeprazole is that it irreversibly inhibits the enzyme needed to produce stomach acid. Effects persist until new enzyme is synthesized, with partial recovery in 3 to 5 days.
Although the half-life of the drug is short, the effects persist long after the drug has been cleared from the body.
Absorption does not take place in the stomach. The medication is acid labile and would be destroyed in the gut without protection. It is enteric coated and designed to become activated in the alkaline environment of the duodenum.
Partial return of acid production occurs 3 to 5 days after the medication is stopped. Full recovery may take weeks.

The nurse has provided education on factors that contribute to ulcer formation to her patient diagnosed with peptic ulcer disease (PUD). Which of the following statements by the patient indicates a need for further teaching?
a. “I guess I’ll have to avoid coffee and cola from now on.”
b. “I am surprised to learn that Helicobacter pylori infection can lead to ulcers.”
c. “Instead of ibuprofen, I’ll take acetaminophen for my arthritis.”
d. “I’m going to ask my doctor to order a nicotine patch to help me quit smoking.”

a. “I guess I’ll have to avoid coffee and cola from now on.”

No convincing evidence shows that beverages containing caffeine (eg, coffee, tea, and cola) promote ulcer formation or interfere with recovery; this statement indicates a need for further teaching.
The most common cause of PUD is infection with H. pylori; no further teaching is necessary.

The health care provider is treating a patient with complaints of severe abdominal pain and confirmed infection with H. pylori. Which of the following medication combinations would the nurse expect the health care provider to order?
a. cimetidine (Tagamet) and metronidazole (Flagyl)
b. cimetidine (Tagamet), tetracycline, and cefuroxime (Ceftin)
c. clarithromycin (Biaxin), amoxicillin (Amoxil), and esomeprazole (Nexium)
d. amphotericin B, cimetidine (Tagamet), and bismuth (Pepto-Bismol)

c. clarithromycin (Biaxin), amoxicillin (Amoxil), and esomeprazole (Nexium)

The antibiotics administered most often are amoxicillin, clarithromycin, bismuth, metronidazole, and tetracycline. None is effective alone, hence the combination of clarithromycin and amoxicillin. The antibacterial activity of amoxicillin is highest at a neutral pH and can be enhanced by reducing gastric acidity with an antisecretory agent, such as esomeprazole. This combination is an appropriate treatment plan.
Metronidazole is very effective against sensitive strains; however, more than 40% of strains are now resistant. One antibiotic alone is not effective in treating H. pylori. Cimetidine promotes healing of ulcers, therefore it would be an important drug to include in the treatment plan.

A patient is placed on a multidrug regimen that includes bismuth for treatment of peptic ulcer disease (PUD). The nurse should include which of the following points when providing patient education?
a. One week of therapy should heal ulcers, relieve symptoms, and eradicate H. pylori.
b. Resolution of pain indicates that the ulcer has healed.
c. The tongue and stool may turn black.
d. A single-antibiotic regimen is preferable to a multi-antibiotic regimen whenever possible.

c. The tongue and stool may turn black.

Bismuth can impart a harmless black color to the tongue and stool. Patients should be forewarned of this effect.
One week of therapy does not heal ulcers. Eradication rates for H. pylori are consistently higher with a 2-week course of treatment.
Instructing the patient that when symptoms resolve, the ulcer will be healed is incorrect. The cessation of pain and disappearance of the ulcer rarely coincide.
Guidelines recommend that, to minimize the emergence of resistance, at least two antibiotics, and preferably three, should be used to eradicate H. pylori.

When metronidazole (Flagyl) is a component of the H. pylori treatment regimen, the patient must be instructed to
a. avoid foods containing tyramine.
b. take the drug with food.
c. take the drug on an empty stomach.
d. avoid any alcoholic beverages.

D avoid any alcoholic beverages.

The patient should be instructed to avoid alcoholic beverages, because a disulfiram-like reaction can occur if metronidazole is taken with alcohol.
Nothing indicates that the patient should avoid foods containing tyramine.
Metronidazole may be taken with or without food.

A patient on antiulcer therapy complains of reduced libido and impotence. The nurse identifies a knowledge deficit in the patient. During teaching, the nurse informs the patient that _______ has been shown to cause reduced libido and impotence.
a. nizatidine (Axid)
b. cimetidine (Tagamet)
c. ranitidine (Zantac)
d. famotidine (Pepcid)

ANS: B cimetidine (Tagamet)

Cimetidine binds to androgen receptors, causing receptor blockade, which results in gynecomastia, reduced libido, and impotence.
Nizatidine, ranitidine, and famotidine do not bind to androgen receptors and therefore do not affect the libido or cause impotence.

The nurse is providing patient education to an elderly patient being treated for duodenal ulcers. The prescriber has ordered sucralfate (Carafate). The patient asks the nurse how sucralfate helps heal ulcers. Select the correct explanation given by the nurse.
a. “It creates a protective barrier against pepsin and acid.”
b. “It irreversibly suppresses gastric acidity.”
c. “It inhibits the enzyme that generates gastric acid.”
d. “It enhances prostaglandin production.”

ANS: A “It creates a protective barrier against pepsin and acid.”

Sucralfate promotes ulcer healing by creating a protective barrier against acid and pepsin.
Sucralfate does not reduce gastric acid secretion.
Sucralfate does not inhibit the enzyme that generates gastric acid.
Sucralfate does not enhance prostaglandin synthesis.

The nurse is providing education to a patient who has been prescribed both an antacid and ranitidine (Zantac). Which instruction should the nurse give the patient about taking the medications?
a. “Take the antacid 1 hour after the ranitidine.”
b. “The antacid and ranitidine should be taken at the same time for better effect.”
c. “Take the antacid 15 minutes before the ranitidine.”
d. “Take the antacid 30 minutes after the ranitidine.”

ANS: a. “Take the antacid 1 hour after the ranitidine.”

Because antacids raise gastric pH, they can affect the dissolution and absorption of ranitidine. Therefore, 1 hour should separate administration of antacids and ranitidine.
Antacids and ranitidine should not be taken at the same time, because dissolution and absorption of ranitidine will be reduced.
One hour should separate administration of antacids and ranitidine. These intervals are not enough separation for the drugs.

The nurse is teaching a class to a community group about peptic ulcer disease. Which statement about the use of anticholinergics for PUD is correct?
a. “Because very high doses of these drugs are needed to inhibit acid secretion, the side effects usually are unacceptable to those taking the drug.”
b. “Anticholinergics can cause diarrhea, glucose intolerance, and dehydration.”
c. “Anticholinergics are the drugs of choice for most patients with peptic ulcer disease.”
d. “Anticholinergics can cure PUD when used as single-agent therapy.”

ANS: a. “Because very high doses of these drugs are needed to inhibit acid secretion, the side effects usually are unacceptable to those taking the drug.”

The doses of anticholinergics required to inhibit acid secretion are so high they produce muscarinic blockade throughout the body, which leads to dry mouth, constipation, urinary retention, and visual disturbance. These side effects can be very disturbing.
Anticholinergics cause constipation, not diarrhea. Dehydration and glucose intolerance are not side effects of anticholinergics.
Anticholinergics are rarely used for treatment of PUD because of their side effects.
No single agent alone is recommended for the treatment of PUD. In addition, the cause of the ulcer must be identified so that an appropriate treatment plan is selected.

The nurse is preparing to administer medications to a patient taking sucralfate (Carafate) and ciprofloxacin (Cipro). The drugs are ordered for 0900. In what manner should the nurse proceed to administer the drugs?
a. The nurse should administer the drugs with a full glass of water.
b. The nurse should ask the prescriber to change the times to prevent concurrent administration.
c. The nurse should administer the two drugs at same time with food.
d. The nurse should administer the ciprofloxacin 15 minutes before the sucralfate.

ANS: b. The nurse should ask the prescriber to change the times to prevent concurrent administration.

The nurse should ask the prescriber to change the times to prevent concurrent administration, because sucralfate may impede the absorption of ciprofloxacin. The interaction can be minimized by administering sucralfate at least 2 hours apart from ciprofloxacin.
Administration with a full glass of water does not address the implications of concurrent administration.
A 2-hour interval is required between these drugs, and sucralfate needs to be taken on an empty stomach.
A 2-hour interval is required between these drugs

The nurse is preparing to administer cimetidine 300 mg IV per the prescriber’s order. Which of the following represents proper administration of the medication?
a. Mix 300 mg with 10 mL of 5% dextrose and water and give IVP over 1 minute.
b. Mix 300 mg with 10 mL of 0.9% sodium chloride and give IVP over 2 minutes.
c. Mix 300 mg in 50 mL of 0.9% sodium chloride and infuse over 15 minutes.
d. Mix 300 mg in 100 mL of 0.9% sodium chloride and infuse over 5 minutes.

b. Mix 300 mg with 10 mL of 0.9% sodium chloride and give IVP over 2 minutes.

ANS: B
Intravenous cimetidine can be administered IVP or by infusion. Mixing 300 mg with 10 mL of 0.9% sodium chloride is correct, and administration over 2 minutes also is correct.
Cimetidine 300 mg should be mixed with 0.9% sodium chloride, not D5W, and should be pushed over 2 minutes.
Cimetidine 300 mg should be mixed with 100 mL of 0.9% sodium chloride, not 50 mL. The rate of infusion is correct.
The dilution is accurate, but the rate of infusion is 15 minutes, not 5 minutes.

A 30-year-old female patient is to be started on misoprostol (Cytotec) for treatment of a gastric ulcer secondary to long-term ibuprofen (Motrin) use. Which of the following must the nurse include in the patient education?
a. “Start taking the drug at the end of your next menstrual period.”
b. “Take the medication 1 hour before meals.”
c. “Use a reliable method of birth control.”
d. “Perform a breast self-examination weekly while on the medication.”

ANS: c. “Use a reliable method of birth control.”

Because the patient is of childbearing age, she must be able to comply with birth control measures and use a reliable method. The patient must have a negative serum pregnancy test within 2 weeks of starting therapy. The drug is contraindicated during pregnancy because it can lead to partial or complete expulsion of the fetus.
The medication should be started only on the second or third day of the next normal menstrual cycle.

A patient comes to the emergency department complaining of nausea, vomiting, and abdominal cramps. The nurse anticipates that the patient should receive
a. a stimulant laxative, such as bisacodyl (Dulcolax).
b. increased fiber and water to promote defecation.
c. an osmotic laxative, such as magnesium citrate (Citro-mag).
d. nothing; further assessment should be performed, given the patient’s symptoms.

ANS: d. nothing; further assessment should be performed, given the patient’s symptoms.

In patients experiencing abdominal pain, nausea, cramps, and other associated symptoms, further assessment is required. These complaints could be associated with appendicitis, regional enteritis, diverticulitis, ulcerative colitis, or an acute surgical condition of the abdomen. Further and more conclusive information is needed.
No information suggests that the patient is constipated and needs a laxative.

The nurse has admitted a patient to the unit who has been experiencing bowel problems. The patient is to receive a bowel preparation for a radiologic procedure. The nurse would anticipate administration of which of the following medications?
a. Psyllium (Metamucil)
b. Docusate sodium (Colace)
c. Castor oil
d. Bisacodyl (Dulcolax)

ANS: C Castor oil is the only laxative listed that is indicated for bowel preparation for radiologic procedures.
Psyllium, docusate sodium, and bisacodyl are not indicated for bowel preparation for radiologic procedures.

What information would be most important for the nurse to provide to a patient requesting a prn dose of magnesium hydroxide (Milk of Magnesia)?
a. “You will need to increase your fluid intake.”
b. “Avoid drinking milk for an hour after the magnesium hydroxide.”
c. “I’ll need to get a prescriber’s order for mineral oil to avoid irritation.”
d. “You can expect immediate results.”

ANS: A “You will need to increase your fluid intake.”

The nurse should instruct the patient to increase the fluid intake, because osmotic laxatives, such as magnesium hydroxide, can cause a substantial loss of water.
Magnesium hydroxide does not interact with milk.
There is no basis for administering mineral oil with magnesium hydroxide.
Low doses produce results within 6 to 12 hours, and high doses produce results in 2 to 6 hours.

The nurse is providing education for a patient taking bisacodyl (Dulcolax) tablets daily. Which statement by the patient best demonstrates the need for further teaching?
a. “I should swallow the pill intact.”
b. “I should take the pills with milk or dairy products.”
c. “The pill will be effective within 6 to 12 hours.”
d. “Most people take the pill at bedtime, with good results in the morning.”

ANS: b. “I should take the pills with milk or dairy products.”
Milk and antacids accelerate dissolution of the enteric coating on the bisacodyl tablets; this statement indicates a need for further teaching.
Because bisacodyl tablets are enteric coated, they should be swallowed without being chewed or crushed; no further teaching is needed.
Because the action time is 6 to 12 hours, taking the medication at bedtime produces a response the following morning; no further teaching is needed.

The nurse is preparing to administer magnesium hydroxide (Milk of Magnesia) per a patient’s request for a laxative. The patient asks the nurse how this medication works. Which of the following would be a correct statement by the nurse?
a. “It draws water into the colon to soften the feces.”
b. “It lubricates the passage of stool.”
c. “It increases bulk in the colon.”
d. “It stimulates the nerves that regulate defecation.”

ANS: A “It draws water into the colon to soften the feces.”

Osmotic laxatives, such as magnesium hydroxide, work by drawing water into the intestinal lumen. Accumulation of water causes the fecal mass to soften and swell, stretching the intestinal wall and stimulating peristalsis.
Osmotic laxatives, such as magnesium hydroxide, do not lubricate the passage of stool, increase bulk in the colon, or stimulate nerves that regulate defecation.

The nurse is preparing to provide the patient with methylcellulose (Citrucel). The patient asks the nurse how this type of laxative works. The nurse correctly states that this laxative is known as a(n) _________________ laxative and works by __________________.
a. bulk-forming; functioning as dietary fiber
b. surfactant; softening the feces
c. stimulant; stimulating peristalsis
d. osmotic; retaining water and softening the feces

ANS: a. bulk-forming; functioning as dietary fiber
Methylcellulose is a bulk-forming laxative, and its actions and effects are much like those of dietary fiber.
Methylcellulose is not a surfactant, stimulant, or osmotic laxative.

A patient admitted to the unit for dehydration tells the nurse that he has not had a bowel movement in 5 days, and he typically has one daily. The nurse administers psyllium (Metamucil) as ordered and should monitor the patient for
a. bright red stools.
b. black, tarry stools.
c. pale, clay-colored stools.
d. intestinal obstruction.

ANS: d. intestinal obstruction.
Bulk-forming laxatives can cause an intestinal obstruction or impaction if not enough water is consumed. The patient needs concurrent rehydration to prevent this.
Bright red stools would not be anticipated unless the patient has hemorrhoids, and there is no indication of this.
Black, tarry stools typically are seen if blood is present in the stool, no information suggests that the patient has gastrointestinal bleeding.
Pale, clay-colored stools may be apparent if the patient has a hepatic disorder, but no information suggests this

For a patient with which of the following would the nurse withhold a prn order for magnesium hydroxide?
a. Hemorrhoids
b. Prostatitis
c. Cirrhosis
d. Chronic renal failure

ANS: d. Chronic renal failure

Magnesium can accumulate to toxic levels in patients with renal dysfunction. The nurse should withhold the medication.
Magnesium hydroxide is not contraindicated for patients with hemorrhoids, prostatitis, or cirrhosis.

The nurse is administering magnesium hydroxide (Milk of Magnesia) to a patient who has been complaining of constipation and has consistently taken the medication every day for a week. The patient has poor skin turgor, BP 90/60, and HR 120. The nurse should further assess the patient for
a. toxicity.
b. dehydration.
c. increased sodium.
d. increased potassium.

ANS: b. dehydration.

Osmotic laxatives can cause a substantial loss of water. The patient is displaying signs and symptoms of dehydration. To prevent dehydration, the patient should increase the water intake.
Nothing indicates toxicity or an increase in sodium or potassium

The nurse is caring for an elderly patient who is status-post right hip open-reduction internal fixation (ORIF). The patient is taking oxycodone (OxyContin) every 6 hours as needed for pain and chlorpheniramine (Chlor-Trimeton) daily. The nurse discusses obtaining an order from the prescriber for which of the following medications?
a. GoLYTELY
b. Lactulose
c. Docusate sodium (Colace)
d. Polyethylene glycol (MiraLax)

ANS: c. Docusate sodium (Colace)

Oxycodone and chlorpheniramine both can be constipating. The patient needs something prophylactically, such as docusate sodium, that can be taken daily to prevent constipation. In addition, the patient’s mobility is limited, which can further increase the risk of constipation.
GoLYTELY is not indicated for constipation. It is used for cleansing the bowel prior to diagnostic procedures.
Lactulose is not indicated. It typically is used for reducing ammonia levels in hepatic encephalopathy.
Polyethylene glycol is indicated for occasional constipation. No information suggests that the patient is constipated.

A patient with cirrhosis has begun displaying signs and symptoms of hepatic encephalopathy. The nurse prepares to administer lactulose per the prescriber’s order. The nurse understands that this drug has been ordered to
a. reduce cerebral edema.
b. reduce abdominal ascites.
c. lower ammonia levels.
d. reduce the hepatic enzymes.

ANS: c. lower ammonia levels.

Lactulose is the only laxative known to lower ammonia levels in patients with portal hypertension and hepatic encephalopathy secondary to liver disease.
Lactulose does not work to reduce cerebral edema, nor is there any indication the patient is experiencing it.
Lactulose does not work to reduce abdominal ascites.
Lactulose does not reduce liver enzymes.

The nurse, who is caring for a patient with constipation, is preparing to administer morning medications. The nurse determines that concurrent drug administration of which of the following medications most likely would contribute to constipation? (Select all that apply.)
a. Oxycodone/acetaminophen (Percocet)
b. Aluminum hydroxide
c. Benztropine (Cogentin)
d. Ranitidine (Zantac)
e. Diazepam (Valium)

ANS: A, B, C
a. Oxycodone/acetaminophen (Percocet)
b. Aluminum hydroxide
c. Benztropine (Cogentin)

Drugs that most likely would contribute to constipation are the opioids (oxycodone/acetaminophen), anticholinergics (benztropine), and some antacids (aluminum hydroxide).
Ranitidine and diazepam are not associated with constipation.

The nurse administers psyllium (Metamucil) to a patient who has requested a laxative. The nurse should monitor the patient for ____________ and provide ______________ to minimize the effects and risks.
a. nausea and vomiting; an antiemetic
b. abdominal cramps; a K-pad (warming pad)
c. esophageal obstruction; 8 ounces of water
d. watery stools; 30 mL of water

ANS: c. esophageal obstruction; 8 ounces of water

Esophageal obstruction can occur if the psyllium is taken without sufficient fluids. It should be administered with a full glass of water or juice to promote passage.
Nausea, vomiting, and watery stools are not associated with psyllium, therefore intervention is unnecessary.

A patient with a history of chronic alcohol abuse has been admitted to the unit with cirrhosis. Upon review of the patient’s laboratory test results, the nurse notes that the ammonia level is 218. What medication should the nurse prepare to administer?
a. 0.9% NS
b. Lactulose
c. Docusate sodium (Colace)
d. Polyethylene glycol (MiraLax)

ANS: b. Lactulose

Lactulose is the only laxative known to lower ammonia levels in patient with portal hypertension and hepatic encephalopathy secondary to liver disease.
No information suggests that the patient needs fluid or electrolyte replacement.
Docusate sodium and polyethylene glycol are not effective at lowering ammonia levels.

The nurse on an oncology unit is caring for a patient with lung cancer. Prior to the next dose of cisplatin (Platinol-AQ), which antiemetic would the nurse most likely administer to the patient?
a. Metoclopramide (Reglan)
b. Droperidol (Inapsine)
c. Ondansetron (Zofran)
d. Prochlorperazine

ANS: c. Ondansetron (Zofran)

Serotonin-receptor antagonists, such as ondansetron, are the most effective drugs available for suppressing nausea and vomiting caused by cisplatin and other highly emetogenic anticancer drugs.
Metoclopramide is used to suppress postoperative nausea and vomiting and emesis associated with cancer chemotherapy. However, it would not be the drug of choice in this situation.
Butyrophenones, such as droperidol, are used as antiemetics; however, they are not the most effective antiemetics for cancer patients. They typically are used for postoperative nausea.
Phenothiazines, such as prochlorperazine, may be used with cancer chemotherapy and surgery, but they are not as effective for emesis caused by cisplatin.

The nurse is caring for a patient who is receiving chemotherapy. The patient complains of nausea and begins to vomit. The nurse administers ondansetron (Zofran) to alleviate the nausea. Which medication given concurrently with ondansetron would increase its effectiveness?
a. Dexamethasone (Decadron)
b. Ranitidine (Zantac)
c. Loperamide (Imodium)
d. Alosetron (Lotronex)

ANS: a. Dexamethasone (Decadron)

Ondansetron is very effective by itself and even more effective when combined with dexamethasone.
Ranitidine and loperamide do not increase the effectiveness of ondansetron.
Alosetron is indicated for irritable bowel syndrome (IBS), not for patients receiving chemotherapy.

The recovery room nurse is caring for a patient status post surgery and administers an antiemetic agent for postoperative nausea and vomiting. The patient is transferred to the unit and beings to display extrapyramidal effects. The nurse suspects that which category of agents is most likely responsible?
a. Phenothiazines
b. Glucocorticoids
c. Cannabinoids
d. Serotonin-receptor antagonists

ANS: a. Phenothiazines

Side effects of phenothiazines include extrapyramidal reactions, anticholinergic effects, hypotension, and sedation.
Glucocorticoids and cannabinoids do not cause extrapyramidal side effects.
The most common side effects of serotonin-receptor antagonists are headache, diarrhea, and dizziness. They do not cause extrapyramidal side effects.

The nurse is preparing to administer dronabinol (Marinol) to a newly admitted patient. Prior to administration, the nurse reviews the patient’s health history. For which of the following reasons found in the health history would the nurse clarify the order?
a. The patient has a history of bradycardia.
b. The patient has a history of drug abuse.
c. The patient has acquired immunodeficiency syndrome (AIDS).
d. The patient has a history of psychiatric disorders.

ANS: d. The patient has a history of psychiatric disorders.

The nurse would clarify the order because of the patient’s history of psychiatric disorders. Dronabinol can cause temporal disintegration, dissociation, depersonalization, and dysphoria.
Dronabinol is not contraindicated in patients with bradycardia. The medication actually causes tachycardia.
Nothing indicates that the patient has a history of drug abuse; however, there is a small potential for abuse.
Dronabinol is used in patients with AIDS to stimulate appetite.

The nurse is caring for a psychiatric patient with breast cancer who is just about to receive chemotherapy. What antiemetic would be most appropriate for this patient, who is anticipating nausea?
a. Loperamide (Imodium)
b. Ranitidine (Zantac)
c. Dronabinol (Marinol)
d. Lorazepam (Ativan)

ANS: D Lorazepam (Ativan)

One of the principal affects of lorazepam is its ability to suppress anticipatory nausea. It is used in combination regimens to suppress chemotherapy-induced nausea and vomiting (CINV).
Loperamide and ranitidine do not affect CINV.
Dronabinol is contraindicated in patients with a psychiatric illness.

A patient comes to the clinic for a checkup and shares upcoming plans to go on a vacation cruise. The patient asks for a medication to prevent sea sickness. The nurse practitioner orders scopolamine. The nurse provides education and tells the patient to be aware of the potential side effects, which include
a. nausea and vomiting.
b. blurred vision and drowsiness.
c. itching and diarrhea.
d. hearing loss and salivation.

ANS: b. blurred vision and drowsiness.

The most common side effects associated with scopolamine are blurred vision and drowsiness. The drug is given to prevent nausea and vomiting.
Nausea and vomiting are not side effects of the drug.
Constipation, not diarrhea, is a side effect of the drug. Itching is not a side effect.
Dry mouth, not salivation, is a side effect. Hearing loss is not a side effect.

The nurse is reviewing the medication administration record to verify medications at the start of the shift. The nurse notes a new order for diphenoxylate. What assessment finding would cause the nurse to withhold the medication?
a. Dehydration
b. Diarrhea
c. Constipation
d. Dizziness

c. Constipation

ANS: C
The assessment finding that would cause the nurse to withhold the medication is constipation because the drug is only given for diarrhea.
Dehydration would not be a contraindication to the use of diphenoxylate, and it may have been precipitated by the underlying problem (ie, diarrhea, which needs to be controlled).
The medication is indicated for the treatment of diarrhea. The nurse would administer the medication.
Dizziness is not a contraindication to the administration of diphenoxylate.

A patient with diarrhea has been prescribed methylcellulose (Citrucel). The patient asks the nurse, “I thought this was for constipation. Why am I getting it?” Select the most appropriate response from the nurse.
a. “Methylcellulose adds bulk to the stool to firm it up.”
b. “Methylcellulose acts by reducing the volume of diarrhea.”
c. “Methylcellulose reduces intestinal motility, slowing intestinal transit.”
d. “Methylcellulose stimulates the bowel to eliminate the diarrhea, leaving only formed stools.”

ANS: a. “Methylcellulose adds bulk to the stool to firm it up.”

The most appropriate response from the nurse should be that methylcellulose is a bulk-forming agent that acts by giving the stool a more firm, less watery consistency by “bulking it up.”
Methylcellulose does not reduce the volume of diarrhea. Loperamide has that action.
Methylcellulose does not reduce intestinal motility, slowing intestinal transit. Opiates have that action.
Methylcellulose does not stimulate the bowel to eliminate diarrhea, leaving only formed stools.

The nurse is preparing to administer diphenoxylate (Lomotil) to a patient who complains of diarrhea. For what side effects would the nurse observe the patient after administration of this medication?
a. Reduced heart rate
b. Salivation
c. Urinary frequency
d. Blurred vision

ANS: d. Blurred vision

Diphenoxylate is combined with atropine to discourage abuse of the drug, because it is an opioid. Side effects of atropine include blurred vision, photophobia, dry mouth, urinary retention, and tachycardia.
Because diphenoxylate is formulated with atropine to discourage abuse, the nurse should observe the patient for an increased heart rate from the atropine.
Because diphenoxylate is formulated with atropine to discourage abuse, the nurse should evaluate the patient for complaints of dry mouth, not salivation.
Urinary retention, rather than urinary frequency, is a side effect of atropine, with which diphenoxylate is formulated.

The nurse is caring for a pregnant patient who is suffering from severe traveler’s diarrhea. The nurse should prepare to administer
a. azithromycin (Zithromax).
b. ciprofloxacin (Cipro).
c. levofloxacin (Levaquin).
d. doxycycline (Vibramycin).

ANS: A. azithromycin (Zithromax).
Severe traveler’s diarrhea in a pregnant patient is treated with azithromycin.
Ciprofloxacin and levofloxacin are indicated for traveler’s diarrhea but not in pregnant patients.
Doxycycline is not indicated for treatment of traveler’s diarrhea.

A patient with irritable bowel syndrome has received a prescription for a tricyclic antidepressant (TCA). When asked about the rationale for this drug, the nurse should explain that
a. TCAs effectively relieve constipation.
b. these agents can effectively reduce abdominal pain.
c. lifting depression is the goal for this condition.
d. TCAs alter the dopaminergic effects in the gastrointestinal (GI) tract.

ANS: b. these agents can effectively reduce abdominal pain.

The nurse should explain that these agents can effectively reduce abdominal pain. Depression is not associated with diarrhea.
TCAs do not relieve constipation.
Lifting depression does not alter the symptoms of IBS (ie, abdominal pain, constipation, and/or diarrhea).
TCAs do not alter dopaminergic effects in the GI tract.

The nurse is teaching a pharmacology refresher class to a group of medical-surgical nurses. The nurse asks “Alosetron (Lotronex) is approved for which patient population?” Which response by one of the nurses best indicates understanding of the use of this drug?
a. “It has been approved for use in women with diarrhea-predominant IBS.”
b. “It can be given to men with diarrhea and crampy abdominal pain due to IBS.”
c. “It would be indicated for pregnant women with iron-associated constipation.”
d. “It is approved for use in children whose growth rate is reduced because of IBS.”

ANS: a. “It has been approved for use in women with diarrhea-predominant IBS.”

Alosetron is approved for use in women only with diarrhea-predominant IBS; this statement indicates understanding.
Alosetron is not approved for symptoms of IBS in men, only women; further teaching is needed.
Alosetron is approved only for use in women with IBS associated with diarrhea. It therefore would be contraindicated in pregnant women with iron-associated constipation and children with IBS; further teaching is needed

The nurse reviews the patient data and health history of a patient who is prescribed tegaserod (Zelnorm) for treatment of IBS. For which of the following patients should the nurse question the order? (Select all that apply.)
a. The patient who is a 56-year-old male.
b. The patient who has irritable bowel syndrome–constipation.
c. The patient who has a history of sulfa allergy.
d. The patient who is a chronic dialysis patient.
e. The patient who is a 40-year-old female.

a. The patient who is a 56-year-old male.
d. The patient who is a chronic dialysis patient.

ANS: A, D
The nurse should question the order for tegaserod for the male patient and also for the chronic dialysis patient. The drug is approved only for use in females under the age of 55. It is contraindicated in severe renal impairment.
Tegaserod is not contraindicated for the patient with constipation, because it is used to treat constipation-predominant IBS.
It is not contraindicated in patients with sulfa allergies.
Tegaserod is approved for use in women under 55.

The nurse is providing education to a patient with ulcerative colitis who is being treated with sulfasalazine (Azulfidine). What statement by the patient best demonstrates understanding of the action of sulfasalazine?
a. “It treats the infection that triggers the condition.”
b. “It reduces the inflammation.”
c. “It enhances the immune response.”
d. “It increases the reabsorption of fluid.”

ANS: b. “It reduces the inflammation.”

Sulfasalazine reduces the inflammation. This statement indicates understanding.
Although similar to sulfonamides, sulfasalazine is not used to treat infections; further teaching is needed.
Sulfasalazine does not enhance the immune response or increase the reabsorption of fluid; further teaching is needed

The nurse is caring for a patient with ulcerative colitis who is being treated with azathioprine. Which laboratory test result should be monitored periodically?
a. Microscopic urine examination
b. Complete blood count (CBC) with differential
c. Immunoglobulin survey
d. Serum albumin

ANS: B. CBC
The nurse should monitor the CBC, because neutropenia is a major adverse effect of azathioprine. Another major adverse effect is pancreatitis.
Microscopic urinalysis is not indicated.
The immunoglobulin and serum albumin levels do not require monitoring.

The nurse is caring for a patient with Crohn’s disease. The patient has been taking metronidazole (Flagyl) for 6 months. The patient begins to complain of numbness and tingling in the extremities. The nurse should suspect
a. myopathy.
b. peripheral neuropathy.
c. myalgia.
d. extrapyramidal symptoms.

ANS: b. peripheral neuropathy.

The patient’s symptoms correlate with peripheral neuropathy, which is a risk of long-term treatment with metronidazole.
These symptoms do not correlate with peripheral neuropathy. In addition, myopathy, myalgia, and extrapyramidal symptoms are not side effects of metronidazole.

The nurse is caring for a patient with chronic back pain, for which the patient takes opiates daily. To help prevent nausea, the patient also takes metoclopramide (Reglan). For which of the following signs and symptoms would the nurse administer intravenous (IV) diphenhydramine (Benadryl)?
a. Severe spasms of the tongue, face, and neck
b. Dry mouth and urinary retention
c. Diarrhea and abdominal cramps
d. Constipation

ANS: a. Severe spasms of the tongue, face, and neck

The nurse should administer diphenhydramine for extrapyramidal reactions (ie, severe spasms of the tongue, neck, and face), which are caused by long-term use of metoclopramide.
IV diphenhydramine is not indicated for dry mouth, urinary retention, diarrhea, or constipation.

The nurse is caring for a patient with cancer who has been undergoing chemotherapy. The patient now suffers from oral mucositis as a result of the chemotherapy. An order is written for palifermin (Kepivance). The nurse plans to discontinue the dose at least ____ hours prior to the next chemotherapy dose.
a. 8
b. 12
c. 24
d. 72

ANS: C 24
The nurse should discontinue the palifermin 24 hours prior to the chemotherapy, because palifermin may increase the severity and duration of oral mucositis.
Holding the drug for 8 or 12 hours before chemotherapy is not long enough; this would increase the severity and duration of oral mucositis.
The medication need not be discontinued 72 hours before the chemotherapy. The minimum time is 24 hours in advance.

The nurse would question a prescription for alosetron (Lotronex) for a patient with a history of which health problem or problems? (Select all that apply.)
a. Ulcerative colitis
b. Traveler’s diarrhea
c. Intestinal obstruction
d. Diabetes
e. Diverticulitis

a. Ulcerative colitis
c. Intestinal obstruction
e. Diverticulitis

ANS: A, C, E
The nurse should question a prescription for patients with a history of ulcerative colitis, intestinal obstruction, and diverticulitis. Alosetron is approved only for diarrhea-predominant IBS in women.
Alosetron is not contraindicated in women with irritable bowel syndrome–diarrhea (IBS-D) who have a history of traveler’s diarrhea or diabetes.

Which of the following are benefits of a weight-loss program? (Select all that apply.)
a. Reduction of blood pressure in hypertensive patients
b. Prevention of type 1 diabetes
c. Increase in high-density lipoprotein
d. Reduction of glucose in individual with type 2 diabetes
e. Increase in low-density lipoprotein

a. Reduction of blood pressure in hypertensive patients
c. Increase in high-density lipoprotein
e. Increase in low-density lipoprotein

ANS: A, C, D

The benefits of weight-loss treatment include reduction of blood pressure in hypertensive patients, reduction of glucose in individuals with type 2 diabetes, and an increase in high-density lipoproteins.
Weight-loss treatment does not prevent type 1 diabetes.
Weight-loss treatment does not increase low-density lipoprotein.

The nurse in a clinic is caring for an obese adult patient who requests dexfenfluramine (Redux) after reading about the drug online. The nurse should instruct the patient that this drug
a. has been approved for long-term weight control.
b. is indicated only for obese patients with hypertension or heart disease.
c. was removed from the market because of associated heart damage.
d. may help with weight loss, but diet management should be used first.

ANS: C
Redux was removed from the market because of associated heart damage.
The drug has not been approved for long-term weight control.
These responses are not appropriate, because the drug has been removed from the market.

A patient has been taking phentermine (Adipex-P) for 12 weeks for weight loss. At a follow-up appointment, the patient reports that the medication is no longer causing appetite suppression. The nurse should advise the patient that the prescriber most likely will
a. switch to another agent in this class.
b. discontinue the drug.
c. increase the dosage.
d. continue the current dosage.

ANS: b. discontinue the drug

Tolerance is common and may be seen in 6 to 12 weeks. The appropriate response is to discontinue the drug rather than increase the dosage.
Switching to another agent in this class will not be effective because of cross-tolerance.
Increasing the dosage is not indicated.
Continuing the medication when it is ineffective is unwise.

A patient has been prescribed once daily sustained-release diethylpropion (Tenuate) for weight loss. When providing education about the administration of this drug, the nurse should instruct the patient to take the medication
a. just prior to bedtime.
b. once daily before breakfast.
c. 1 hour prior to meals.
d. during the midmorning.

ANS: D during the midmorning.

When once daily dosing of sustained-release tablets is used, the patient should be instructed to take the medication in the midmorning.
The medication is not recommended prior to bedtime.
Phentermine is indicated once daily before breakfast.
For a three times a day (TID) dosing schedule with an immediate-release tablet, the medication is taken 1 hour prior to meals

The nurse is providing patient education to a group of obese patients. To minimize the risk of vitamin deficiency in patients taking orlistat (Xenical), the nurse should instruct the patients to
a. take Metamucil to reduce the GI effects of orlistat.
b. take a daily multivitamin 2 hours before or after taking orlistat.
c. eat vitamin-rich foods at the same time orlistat is taken.
d. take a daily multivitamin at the same time orlistat is taken.

ANS: B take a daily multivitamin 2 hours before or after taking orlistat.

In reducing fat absorption, orlistat can reduce the absorption of fat-soluble vitamins. To avoid deficiency, patients should take a daily multivitamin supplement 2 hours before or after taking orlistat.
The question does not concern minimization of GI effects, and Metamucil will not accomplish this.
If vitamin-rich foods are eaten at the same time orlistat is taken, the drug would also absorb those nutrients.
Taking a daily multivitamin at the same time as orlistat is not appropriate, because it would not be absorbed.

While planning care for obese patients, two nurses are contrasting the differences between orlistat (Xenical) and other weight-loss agents. Which of the following statements best demonstrates how orlistat is different from most weight-loss drugs?
a. It reduces fat absorption in the intestines.
b. It suppresses the appetite center in the brain.
c. It increases the metabolism to help burn calories.
d. It increases serotonin levels and improves mood.

ANS: A It reduces fat absorption in the intestines.

Unlike most other weight-loss drugs, which act in the brain to curb appetite, orlistat acts in the gastrointestinal (GI) tract to reduce absorption of fat.
Orlistat does not act to increase metabolism, suppress appetite, or increase serotonin levels and improve mood.

The nurse is providing discharge teaching for an obese patient who is going home on sibutramine (Meridia). Which statement by the patient demonstrates a need for further education?
a. “I may experience a headache while taking this drug.”
b. “I may experience an increase in my heart rate.”
c. “This medication will help me lose weight by suppressing my appetite.”
d. “I can expect to have diarrhea while taking this medication.”

ANS: d. “I can expect to have diarrhea while taking this medication.”

Diarrhea is not a side effect of sibutramine; this statement indicates a need for further teaching.
About 30% of patients taking sibutramine experience headache and a slight increase in heart rate; no further teaching is required.
The medication does assist in weight loss. Sibutramine works by suppressing appetite and possibly by increasing the metabolic rate; no further teaching is required.

Candidates for the use of sibutramine (Meridia) who have no other risk factors should have a BMI of at least
a. 25.
b. 27.
c. 30.
d. 35.

ANS: C 30

In the absence of other risk factors, candidates for the use of sibutramine should have a BMI of 30 or higher.
If other risk factors are present, such as hypertension, diabetes, or hyperlipidemia, candidates for the use of sibutramine should have a BMI of 27 or higher.

The nurse is caring for an obese patient who is tearful and wants diet pills to control the weight. Select the most appropriate response by the nurse.
a. “Let’s begin with a comprehensive diet, exercise, and behavior management program.”
b. “Drugs are the cornerstone of an effective weight-loss program for people who are obese rather than just overweight.”
c. “Drugs are indicated only for patients who have no health risks from their obesity.”
d. “Drugs produce an excessively rapid weight loss, which could be hazardous to your heart.”

ANS: A
A comprehensive diet, exercise, and behavior management program is most appropriate course. Drugs can be used as an adjunct to diet and exercise, but only for people who have an increased health risk and only after a 6-month program of diet and exercise.
Drugs are not the cornerstone of an effective weight-loss program.
Drugs are not indicated only for patients who have no health risks from obesity.
Drugs do not produce an excessively rapid weight loss in everyone. Everyone reacts to medications differently, and what works for one patient may not work for another.

The nurse is working with a group of obese patients. One states, “My goal is to reduce my weight from 280 pounds to 230 pounds in the first 6 months.” What response by the nurse would be most appropriate for this patient?
a. “That is a realistic goal for your weight-reduction program.”
b. “Because most weight loss occurs in the first 6 months, you should aim for 200 pounds.”
c. “Weight loss of more than 20 pounds in 6 months could be dangerous.”
d. “Safe and maintainable weight loss should be about 10% of body weight in 6 months.”

ANS: d. “Safe and maintainable weight loss should be about 10% of body weight in 6 months.”

Safe and maintainable weight loss should be about 10% of body weight in 6 months.
A loss of 50 pounds in 6 months is unrealistic for this patient.
Advising the patient to aim for a weight loss of 200 pounds in the first 6 months is less realistic than a reduction of 50 pounds and may actually harm the patient.
Weight loss of more than 20 pounds in 6 months is not dangerous, because it falls within the guideline of 10% of body fat (ie, 28 pounds for this patient).

The nurse at a public health clinic is assessing a patient’s risks for heart disease. A patient who has a BMI of 28 would require which intervention?
a. No intervention is indicated; the patient’s BMI is within normal limits.
b. The patient should be instructed in methods for gaining weight
c. The patient should be educated about weight reduction.
d. The patient should be referred for surgical intervention for extreme obesity.

ANS: C
A BMI of 30 or higher indicates obesity. A BMI of 25 to 29.9 indicates that the patient is overweight.
The patient’s BMI is within the range of being overweight.
The patient is neither underweight nor obese.

The nurse is providing patient education to a patient who has been diagnosed with scurvy. The nurse would be correct to tell the patient that she is deficient in
a. folic acid.
b. ascorbic acid.
c. nicotinic acid.
d. riboflavin.

ANS: B
A deficiency of vitamin C can lead to scurvy.
A folic acid deficiency leads to neural tube defects in the fetus.
A nicotinic acid deficiency leads to pellagra.
A deficiency of riboflavin results in angular stomatitis and sore throat.

The nurse is working with a group of obese patients. One states, “My goal is to reduce my weight from 280 pounds to 230 pounds in the first 6 months.” What response by the nurse would be most appropriate for this patient?
a. “That is a realistic goal for your weight-reduction program.”
b. “Because most weight loss occurs in the first 6 months, you should aim for 200 pounds.”
c. “Weight loss of more than 20 pounds in 6 months could be dangerous.”
d. “Safe and maintainable weight loss should be about 10% of body weight in 6 months.”

ANS: D
Safe and maintainable weight loss should be about 10% of body weight in 6 months.
A loss of 50 pounds in 6 months is unrealistic for this patient.
Advising the patient to aim for a weight loss of 200 pounds in the first 6 months is less realistic than a reduction of 50 pounds and may actually harm the patient.
Weight loss of more than 20 pounds in 6 months is not dangerous, because it falls within the guideline of 10% of body fat (ie, 28 pounds for this patient).

The nurse is providing patient education about the use of vitamins. Which statement by the patient demonstrates a need for further teaching?
a. “Night blindness may indicate a vitamin A deficiency.”
b. “I take vitamin E for its antioxidant effects.”
c. “Scurvy is caused by excess vitamin C.”
d. “Deficiency of folic acid may lead to birth defects.”

ANS: C
Scurvy is the result of a vitamin C deficiency; this statement indicates that further teaching is needed.
Vitamin A deficiency can cause night blindness; no further teaching is needed.
Vitamin E is know for its antioxidant effects; no further teaching is needed.
Folic acid deficiency may lead to birth defects; no further teaching is needed.

The nurse, who is teaching a class at a local community center, explains to the audience that more patients are using vitamins to supplement their dietary intake. The nurse correctly tells the audience that the role of vitamins in metabolism is that
a. large amounts are required to meet the metabolic needs of an active individual.
b. vitamins are inorganic compounds.
c. vitamins are needed for energy transformation and to regulate metabolic processes.
d. vitamins serve as an energy source, along with proteins, carbohydrates, and fats.

ANS: C
Vitamins are needed for energy transformation and to regulate metabolic processes.
Large amounts of vitamins are not required to meet the metabolic need of an active individual.
Vitamins are organic compounds.
Vitamins do not serve as an energy source, along with proteins, carbohydrates, and fats, but they are essential for energy transformation and regulation of metabolic processes.

A patient inadvertently took an excessive dose of warfarin (Coumadin) and was immediately treated with IV vitamin K (Phytonadione). The symptoms that would most concern the nurse after administration of vitamin K are
a. mild pruritus, pulse of 92.
b. respirations of 32, bronchoconstriction, O2 sats of 83%.
c. prolonged sensitization to warfarin (Coumadin).
d. blood pressure of 107/52 and bleeding gums.

ANS: B
The patient is experiencing a hypersensitivity reaction to the phytonadione, which is manifested by impending respiratory distress associated with IV administration of the drug.
Mild pruritus may be significant, but the pulse is within normal limits. The greatest concerns are the low O2 sats and bronchoconstriction.
There is no indication of how long the patient was exposed to warfarin, therefore sensitization is not a correct choice.
A blood pressure of 107/52 is not significant, because it may be baseline for the patient. Bleeding gums are an anticipated effect of excessive warfarin and would not be a significant finding after administration of the vitamin K.

People with alcoholism and those who take isoniazid should be monitored for which vitamin B6–related complications? (Select all that apply.)
a. Sprue
b. Glossitis
c. Microcytic anemia
d. Seborrheic dermatitis
e. Changes in neurologic function

c. Microcytic anemia
d. Seborrheic dermatitis
e. Changes in neurologic function

ANS: C, D, E
Vitamin B6 deficiency likely is related to alcoholism or the use of isoniazid, which prevents conversion of the vitamin to its active form and may induce symptoms of deficiency, such as seborrheic dermatitis, microcytic anemia, peripheral neuritis, convulsions, depression, and confusion.
Vitamin B6 deficiency does not induce sprue or glossitis.

A patient is being discharged from the hospital and is receiving patient education about medications, including vitamin C (ascorbic acid). Which symptom would indicate excessive doses of vitamin C?
a. Constipation
b. Seizure activity
c. Excessive bleeding tendencies
d. Gastrointestinal disturbances

ANS: d. Gastrointestinal disturbances

Excessive doses of vitamin C can cause gastrointestinal disturbances, such as nausea, abdominal cramps, and diarrhea.
Constipation is not a symptom of vitamin C excess or any other vitamin excess.
Seizure activity is not a symptom of vitamin C excess or any other vitamin excess.
Excessive bleeding is not associated with vitamin C excess but is related to vitamin K deficiency.

A patient comes to the clinic, worried that he may have contracted a sexually transmitted disease. He complains that his lips are cracked, and he has a “thick” tongue and an itchy scrotum. Upon further assessment, the nurse finds cheilosis, glossitis, vascularization of the cornea, and irritated dermatitis of the scrotum. The nurse suspects that these signs and symptoms are consistent with which vitamin deficiency?
a. Riboflavin
b. Thiamin
c. Pyridoxine
d. Niacin

ANS: A Riboflavin

Symptoms consistent with riboflavin deficiency include cheilosis, glossitis, vascularization of the cornea, and itchy dermatitis of the scrotum.
Symptoms of thiamin deficiency include neurologic and motor deficits, (eg, anesthesia of the feet, ataxic gait, footdrop, and wristdrop).
Symptoms of pyridoxine deficiency include seborrheic dermatitis, microcytic anemia, peripheral neuritis, convulsions, depression, and confusion.
Symptoms of niacin deficiency are scaling and cracking of the skin in areas exposed to the sun.

A patient who is a known chronic alcoholic is admitted to the emergency department. Upon assessment, the nurse notes nystagmus, diplopia, and ataxia. The nurse is correct to suspect
a. dry beriberi.
b. hepatic encephalopathy.
c. riboflavin deficiency.
d. Wernicke-Korsakoff

d. Wernicke-Korsakoff syndrome.

ANS: D
Severe thiamin deficiency occurs most commonly among alcoholics and, in this population, manifests as Wernicke-Korsakoff syndrome. Symptoms include nystagmus, diplopia, and ataxia.
Severe thiamin deficiency produces dry beriberi, which is manifested by anesthesia of the feet, ataxic gait, footdrop, and wristdrop.
Hepatic encephalopathy is manifested by neurologic responses such as loss of concentration and confusion.
Riboflavin deficiency is associated with sore throat and angular stomatitis.

An adult who has been self-medicating, using nutritional therapy for elevated cholesterol, complains of repeated episodes of flushing. The nurse suspects that the patient has been taking
a. niacin.
b. thiamin.
c. riboflavin.
d. pyridoxine.

ANS: A
Niacin is used to reduce cholesterol levels. When taken in large doses, nicotinic acid can cause vasodilation, with resultant flushing, dizziness, and nausea.
Flushing is not a side effect of thiamine, because it does not cause vasodilation.
Flushing is not a side effect of riboflavin, because it does not cause vasodilation.
Flushing is not a side effect of pyridoxine, because it does not cause vasodilation.

The nurse is caring for a patient who has celiac disease with malabsorption. The nurse should monitor for which sign of possible vitamin deficiency?
a. Bleeding
b. Sore tongue
c. Hypercalcemia
d. Hypokalemia

ANS: A Bleeding

Natural forms of vitamin K require bile salts for their uptake. Any condition that reduces the availability of these salts, such as sprue and celiac disease, can reduce vitamin K uptake, leading to a diminished clotting ability and thus bleeding. Deficiencies in celiac disease are associated with the fat-soluble vitamins.
Sore tongue is associated with a lack of B vitamins.
Calcium loss, not calcium excess, would be a problem in this patient.
Hypokalemia does not occur with celiac disease.

The first indication of vitamin A deficiency is
a. easy bruising.
b. sore tongue.
c. poor night vision.
d. sore, bleeding gums.

ANS: C
Vitamin A is needed for dark adaptation; night blindness often is the first indication of deficiency.
Easy bruising is a sign of clotting abnormalities and would be related to a deficiency of vitamin K.
Sore tongue is a sign of niacin deficiency.
Sore, bleeding gums are a sign of vitamin C deficiency.

A pregnant woman tells the nurse that she takes daily vitamin supplements. Since learning of her pregnancy, she has increased her vitamin A supplement to 1200 RAEs per day. The nurse should
a. confirm that this dose is appropriate during pregnancy.
b. encourage the patient to increase the dose to 1500 RAEs to promote the development of the central nervous system of the fetus.
c. recommend that the patient reduce the dose to less than 700 RAEs, because higher doses may be teratogenic.
d. inform the patient that because vitamin A is water soluble, large doses are needed to maintain the vitamin in the system.

ANS: C
Vitamin A is highly teratogenic. An excessive intake during pregnancy can cause malformation of the fetal heart, skull, and other structures. Pregnant women should not exceed the upper limit for vitamin A and should not exceed the recommended dietary allowance (RDA).
The dose is not appropriate during pregnancy.
Vitamin A is not water soluble.

The patient has an order for vitamin K, to be given intravenously (IV) now. The nurse would suspect that the patient most likely has been taking which medication?
a. Heparin
b. Aspirin
c. Warfarin (Coumadin)
d. Enoxaparin (Lovenox)

ANS: C Warfarin/Coumadin

The primary indication for IV vitamin K is to correct a warfarin overdose.
Protamine sulfate is indicated for heparin overdose.
No true antidote exists for aspirin overdose
Vitamin K would not treat an overdose of enoxaparin.

The nurse is teaching a nutrition class to a group of nursing students. The nurse asks, “Which vitamin cannot be stored in large amounts in the body and requires frequent ingestion for replacement?” The students would be correct to respond vitamin
a. A.
b. B.
c. D.
d. E.

ANS: B Vit B

Minimal storage of the B vitamins occurs in the body, therefore frequent ingestion is needed to replenish them.
Vitamins A, D, and E are fat soluble and are stored in the body.