NCLEX Practice Exam for Pharmacology: Gastrointestinal Medications

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1. The nurse is giving instructions to a client receiving Cholestyramine (Prevalite). Which statement made by the client indicates a need for further teachings?

  1. “I will include a high fiber rich food in my diet”.
  2. “I will continue taking my multivitamins”.
  3. “This medication will help lower my cholesterol”.
  4. “I will sip the cholestyramine powder for a long time for faster absorption”.

2. Which of the following condition can you safely administer Metoclopramide (Reglan)?

  1. Patient with bowel obstruction.
  2. Patient with gastrointestinal hemorrhage.
  3. Patient undergoing radiation.
  4. Patients with pheochromocytoma.

3. A client has been taking Ibuprofen for some quite time and was given Misoprostol (Cytotec). Which of the following is exhibiting the therapeutic effect of Cytotec?

  1. Relief of gastric ulcer.
  2. Relief of diarrhea.
  3. Relief of vomiting.
  4. Relief of constipation.

4. A geriatric patient is prescribed with Cimetidine (Tagamet) for the treatment of heartburn. Which of the following is the most frequent CNS side effect?

  1. Agitation.
  2. Drowsiness.
  3. Headache.
  4. Somnolence.

5. A nurse is administering an IV bolus of Cimetidine (Tagamet). Which of the following should the nurse monitor closely follow the administration?

  1. Respiratory rate.
  2. Skin turgor.
  3. Blood pressure.
  4. Temperature.

6. A client has been given Loperamide hydrochloride (Imodium). Which of the following situation is the medication indicated to?

  1. Abdominal pain.
  2. Patients with an ileostomy.
  3. Bloody Diarrhea.
  4. Acute dysentery.

7. A client has been given Ondansetron (Zofran). For which condition should the nurse administer this medication to the postoperative patient?

  1. Vomiting.
  2. Incisional pain.
  3. Abdominal infection.
  4. Atelectasis.

8. A client with a duodenal ulcer is diagnosed with H. pylori infection. The physician prescribed Amoxicillin (Wymox), Pantoprazole (Prevacid), and Clarithromycin (Biaxin). Which statement made by the nurse correctly explains the purpose of these medications?

  1. “These medicines will minimize acid production and will coat the ulcer”.
  2. “These medicines will stop the acid production and will kill the bacteria”.
  3. “The ulcer will heal because the medications will kill the bacteria”.
  4. “These medicines will control the ulcer and motion sickness”.

9. A client is prescribed with Omeprazole (Prilosec). The nurse determines that the client is receiving its therapeutic effect if which of the following is stated by the client:

  1. Relief of nausea and vomiting.
  2. Decrease diarrheal episodes.
  3. The absence of constipation.
  4. Relief from GERD.

10. A patient with Chron’s disease is receiving an infusion therapy of Infliximab (Remicade). Which of the following should the nurse do while the patient is on this medication?

  1. Monitoring liver function test prior the infusion.
  2. Monitoring the vomiting episodes.
  3. Monitoring the frequency and consistency of bowel movements.
  4. Monitoring urine output and orientation.

11. A client has been prescribed with Pancrelipase (Pancrease). Which of the following symptoms would prompt the nurse that the medication is having its therapeutic effect if which of the following is noted?

  1. Negative abdominal pain.
  2. An absence of constipation.
  3. An absence of diarrhea.
  4. Reduction of excess fat in feces.

12. A nurse is giving a nothing per orem instructions to a malnourished client with diarrhea and frequent abdominal pain episodes which is about to receive a Total Parenteral Nutrition. Which statement made by the nurse is the most appropriate?

  1. “It will help in your weight loss”.
  2. “It can assure you that you feel better after receiving TPN”.
  3. “It will decrease your diarrhea and your bowel can rest”.
  4. “It will give you less time in the hospital”.

13. A client is receiving Sulfasalazine (Azulfidine) for the treatment of ulcerative colitis. Which of the following assessment finding will concern the nurse most?

  1. Drowsiness.
  2. Decreased urine output.
  3. Urine discoloration.
  4. Vomiting.

14. A client has been prescribed with Sucralfate (Carafate) for the treatment of gastric ulcer. The nurse instruct the client that this medication is taken?

  1. 1 hour before meals.
  2. 1 hour after meals.
  3. At the same time with an antacid.
  4. Lunch time.

15. Tincture of opium is given to a patient who is having diarrheal episodes. Which of the following is true regarding this medication?

  1. Opium tincture is not a controlled substance.
  2. Opium tincture can be used with medications like naltrexone and buprenorphine.
  3. It can be diluted with 15-30 ml of water.
  4. It increases intestinal motility and peristalsis.

16. A nurse is giving medicine instructions to a client with hemorrhoids who is receiving a Mineral oil. Which of the following statements made by the client indicates a further teaching?

  1. “I can take it at least 2 hours before bedtime”.
  2. “It can interfere with the absorption of the vitamin E that I am taking”.
  3. “If I miss a dose of mineral oil liquid, I’ll take it as soon as I remember”.
  4. “I can use mineral oil liquid for an extended period to prevent further damage”.

17. A nurse is giving discharge instructions to a client who is receiving a bulk-forming laxative as part of the home medications. All of which are examples of bulk-forming laxative, except?

  1. Docusate Sodium (Colace).
  2. Methylcellulose (Citrucel).
  3. Polycarbophil (Fibercon).
  4. Psyllium (Metamucil).

18. A client with a history of chest pain is admitted to irritable bowel syndrome. As a nurse, which of the following medicines will you least expect to be a part of the medical management? 

  1. Alosetron (Lotronex).
  2. Tegaserod (Zelnorm).
  3. Lubiprostone (Amitiza).
  4. Loperamide (Immodium).

19. What is the priority nursing intervention for a client receiving an antiemetic?

  1. Monitor intake and output.
  2. Keep items far away from the bed.
  3. Give the client privacy by letting him walking around the room.
  4. Keep bed in low position with side rails up.

20. An osmotic laxative will be prescribed for a client. The nurse understands that which medications are osmotic laxative? Select all that apply

  1. Senna (Senokot).
  2. Mineral Oil.
  3. Polyethylene glycol and electrolytes (GoLYTELY).
  4. Sodium Phosphate (Fleet enema).
  5. Bisacodyl (Dulcolax).
 Answers and Rationale

1. Answer: D. “I will sip the cholestyramine powder for a long time for faster absorption”. Cholestyramine is a bile acid sequestrant. It works by helping the body remove bile acids, which can lower cholesterol levels in the blood. A powder form of this medication can cause tooth problems such as discoloration, erosion of enamel, or decay. Other side effects of this medication are decreased vitamin absorption and constipation.

2. Answer: C. Patient undergoing radiotherapy. Metoclopramide can be safely administered to patients having vomiting episodes following radiation, chemotherapy, and surgery.

  • Options A and B: It is contraindicated in patients with conditions where stimulation of gastrointestinal motility might be harmful, such as mechanical bowel obstruction, bowel perforation, or gastrointestinal hemorrhage.
  • Option D:  Hypertensive crises may occur in patients with pheochromocytoma due to induction of catecholamine release from the tumor.

3. Answer: A. Relief of gastric ulcer.  Misoprostol (Cytotec) is a synthetic (man-made) prostaglandin that is used to reduce the risk of stomach ulcers in patients treated with nonsteroidal antiinflammatory drugs (NSAIDs, for example, aspirin, ibuprofen, etc.).

  • Option B: Although a side effect, but it is not the intended therapeutic effect.
  • Options C and D are not related to the medication.

4. Answer: A. Agitation.  Cimetidine an H2-receptor antagonist passes the blood brain barrier, and central nervous system side effects can happen. Most common serious side effects are confusion, agitation, depression, and disorientation.

  • Options B, C, and D: They are considered as the less common side effect.

5. Answer: C. Blood pressure.  Intravenous administration of Cimetidine causes hypotension.

  • Options A, B, and D are not related to this medication.

6. Answer: B. Patients with an ileostomy. Loperamide hydrochloride is an antidiarrheal agent. It can also be used to reduce the volume of drainage from an ileostomy.

  • Options A, C, and D: It is contraindicated in patients with abdominal pain in the absence of diarrhea, and in patients with acute dysentery, which is characterized by blood in stools and high fever.

7. Answer: A. Vomiting. Ondansetron is used to prevent nausea and vomiting that may be caused by surgery or by medicine to treat cancer (chemotherapy or radiation).

  • Options B, C, and D, are not related to this medication.

8. Answer: B. “These medicines will stop the acid production and will kill the bacteria”. The triple therapy treatment of H-pylori infection is the includes 2 antibiotics (Clarithromycin and Amoxicillin) and one proton pump inhibitor such as omeprazole, lansoprazole, pantoprazole, or esomeprazole.

9. Answer: D. Relief from GERD. Omeprazole is used to treat symptoms of gastroesophageal reflux disease (GERD) and other conditions caused by excess stomach acid. It is also used to promote healing of erosive esophagitis (damage to your esophagus caused by stomach acid).

  • Options A, B, and C are not related to this medication.

10. Answer: C. Monitoring the frequency and consistency of bowel movements. Crohn’s disease is a condition in which the body attacks the lining of the digestive tract, causing pain, diarrhea, weight loss, and fever. Infliximab works by reducing the inflammation in the colon, thereby decreasing diarrhea.

  • Options A, B, and D are not related to this medication.

11. Answer: D. Reduction of excess fat in feces. Pancrelipase is used to help improve food digestion in certain conditions (cystic fibrosis, pancreatitis) where the pancreas is not working properly. This medicine minimizes the amount of steatorrhea (fatty stools).

  • Options A, B, and C are not related to this medication.

12. Answer: C. “It will decrease your diarrhea, and your bowel can rest”. The priority in this kind of situation is to stop diarrhea and to provide fluids and electrolyte thru the use of TPN. The bowel is rested so that the abdominal cramping will also stop.

13. Answer: B. Decreased urine output. Sulfasalazine is used to treat bowel inflammation, diarrhea (stool frequency), rectal bleeding, and abdominal pain in patients with ulcerative colitis. It is nephrotoxic, so a decrease in urine output is the most serious concern.

  • Options A, C, and D are also side effects but are less serious.

14. Answer: A. 1 hour before meals. Sucralfate is a gastric protective agent. It works by forming a protective layer on the ulcer to serve as a barrier against acid, bile salts, and enzymes in the stomach. Taken by mouth on an empty stomach at least 1 hour before or 2 hours after eating.

  • Options B and D are incorrect.
  • Option C: Do not take an antacid for at least 30 minutes before or after taking sucralfate.

15. Answer: C. Has an unpleasant taste and can be diluted with 15-30 ml of water. Opium tincture is an oral liquid medication used to control diarrhea. It has an unpleasant taste so it should be diluted with 15-30 ml of water.

  • Option A: Opium tincture contains morphine which is a controlled substance.
  • Option B: Opium tincture should not be used with medications like naltrexone and buprenorphine because they increase sedation and lower beneficial effect of opium tincture.
  • Option D: It is an antidiarrheal, so a decrease motility and peristalsis is expected.

16. Answer: D. “I can use mineral oil liquid for an extended period to prevent further damage”. Mineral oil liquid is a lubricant laxative that works by slowing the absorption of water from the bowel, which softens the stool. The use of mineral oil liquid for a long time may result in loss of normal bowel function.

  • Options A, B, and C are true regarding mineral oil.

17. Answer: A. Docusate Sodium (Colace).

  • Option A is an example of surfactant laxative.

18. Answer: B. Tegaserod (Zelnorm). The use of tegaserod is restricted to patients with IBS due to the serious cardiovascular adverse effect that may happen such as heart attack and stroke.

19. Answer: D. Keep bed in low position with side rails up. Antiemetics can cause drowsiness; hence the priority nursing intervention is to protect the client from injury such as raising the side rails and keeping the bed in low position.

  • Option A is not the most priority intervention.
  • Options B and C will risk the client for fall.

20. Answers: C. Polyethylene glycol and electrolytes (GoLYTELY)., D. Sodium Phosphate (Fleet enema). Osmotics are used to attract water into the large intestines to produce bulk and stimulate peristalsis. Other osmotic are Magnesium hydroxide (Milk of Magnesia) and Magnesium citrate (Citrate of Magnesia).

  • Options A and E are stimulants.
  • Option B is a lubricant.

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