NCLEX Practice Exam for Pharmacology: Gastrointestinal Medications

EXPLANATION

✔ Correct answer:

Vomiting. Ondansetron (Zofran) is an antiemetic medication primarily used to prevent and treat nausea and vomiting. It works by blocking the action of serotonin, a natural substance in the body that can trigger vomiting. Postoperative patients are often at risk of nausea and vomiting due to the effects of anesthesia, opioids, and the surgical procedure itself. Administering Ondansetron can help prevent these symptoms, improving the patient's comfort and reducing the risk of complications such as aspiration.

Imagine your brain has a "vomit button" that gets pushed when certain signals (like serotonin) are too strong. Ondansetron acts like a barrier over that button, preventing it from being pushed and thus stopping you from vomiting.

When administering Ondansetron, Nurse Adams should:

• Monitor the patient’s response to the medication, including the reduction of nausea and vomiting symptoms.
• Assess for potential side effects such as headache, dizziness, or constipation, which are common with Ondansetron.
• Evaluate the patient’s hydration status, especially if vomiting has been severe or prolonged, and ensure adequate fluid intake.
• Educate the patient on the purpose of the medication and the importance of reporting any persistent nausea or vomiting.

✘ Incorrect answer options:

Atelectasis. Atelectasis refers to the collapse of part or all of a lung, which can occur after surgery. It is not treated with antiemetics like Ondansetron but rather with interventions such as deep breathing exercises, incentive spirometry, and ambulation.

Abdominal infection. Ondansetron does not have antibacterial properties and is not used to treat infections. Abdominal infections require appropriate antibiotic therapy and sometimes surgical intervention.

Incisional pain. Pain management typically involves the use of analgesics such as opioids or nonsteroidal anti-inflammatory drugs (NSAIDs), not antiemetics like Ondansetron. Ondansetron would not be effective in treating pain.

EXPLANATION

✔ Correct answer:

Monitoring the frequency and consistency of bowel movements. Infliximab (Remicade) is a monoclonal antibody that targets tumor necrosis factor-alpha (TNF-alpha), a pro-inflammatory cytokine involved in the inflammatory response of autoimmune diseases like Crohn's disease. The primary goal of Infliximab therapy in Crohn's disease is to reduce inflammation in the gastrointestinal tract, which should lead to a reduction in symptoms such as diarrhea, abdominal pain, and bowel urgency. Monitoring the frequency and consistency of bowel movements is crucial because it directly indicates how well the inflammation is being controlled. Improvement in these parameters suggests that the treatment is effective.

Crohn’s disease is a type of inflammatory bowel disease (IBD) characterized by chronic inflammation of the gastrointestinal tract, most commonly affecting the small intestine and the beginning of the colon. The inflammation can involve multiple layers of the bowel wall, leading to symptoms such as persistent diarrhea, abdominal pain, weight loss, and malnutrition. Infliximab helps by neutralizing TNF-alpha, reducing the inflammatory process, and promoting healing of the bowel mucosa.

Imagine a fire (inflammation) burning in your gut, causing damage and chaos (symptoms). Infliximab acts like a firefighter, putting out the fire and allowing the affected area to heal. Monitoring bowel movements is like checking to see if the fire has been successfully put out, ensuring everything is returning to normal.

While the patient is receiving Infliximab, Nurse Carter should prioritize:

• Monitoring the frequency and consistency of bowel movements to assess the therapeutic response to Infliximab.
• Observing for any signs of adverse reactions during the infusion, such as difficulty breathing, rash, or chest pain, which could indicate an infusion-related reaction.
• Educating the patient about potential side effects of Infliximab, including increased risk of infections, and advising them to report any signs of infection, such as fever or sore throat, immediately.
• Coordinating regular follow-ups to assess for long-term efficacy and safety, including monitoring for any signs of disease recurrence.

✘ Incorrect answer options:

Monitoring urine output and orientation. While these are important aspects of overall patient care, they are not specific priorities when monitoring the effectiveness of Infliximab in treating Crohn’s disease.

Checking liver function tests prior to the infusion. Although liver function tests are important in some treatments, routine pre-infusion liver function tests are not specifically required for Infliximab. However, monitoring liver function might be necessary depending on the patient’s overall health and other medications.

Keeping track of vomiting episodes. Vomiting is not a primary symptom associated with Crohn’s disease or a common side effect of Infliximab. Therefore, while it is essential to monitor all aspects of a patient’s condition, this is not the priority in this context.

EXPLANATION

✔Correct answer:

It has an unpleasant taste and can be diluted with 15-30 mL of water. Tincture of opium, also known as laudanum, is a concentrated alcoholic solution of opium. It is used in small doses to treat severe diarrhea by reducing intestinal motility. However, due to its high concentration and bitter taste, it can be unpleasant for patients to take. To make it more palatable, the tincture can be diluted with 15-30 mL of water or another liquid before administration. This not only helps mask the taste but also ensures more accurate dosing.

Imagine needing to take a very bitter medicine that’s only a few drops in volume. If you mix it with a small amount of water, it’s easier to swallow, just like how you might dilute a strong coffee with milk or water to make it less intense.

Nurse Morgan should ensure that the patient understands the importance of accurately measuring the dose and diluting the tincture as needed. The nurse should also monitor the patient for any adverse effects, such as sedation or respiratory depression, given that opium is an opioid.

• Instruct the patient to measure the dose carefully using a calibrated dropper or syringe to avoid overdose.
• Advise the patient to dilute the tincture in water or another liquid to reduce the bitterness and facilitate easier ingestion.
• Monitor the patient for signs of opioid-related side effects, including drowsiness, constipation, and respiratory depression.
• Ensure that the medication is stored safely, as tincture of opium is a controlled substance with a high potential for abuse.

✘Incorrect answer options:

Opium tincture can be safely used with medications like naltrexone and buprenorphine. This statement is incorrect. Naltrexone is an opioid antagonist, and buprenorphine is a partial opioid agonist-antagonist. Both of these medications can interfere with the effects of opium tincture, leading to withdrawal symptoms or reduced efficacy of the tincture. They should not be used concurrently without careful medical supervision.

It increases intestinal motility and peristalsis. This is the opposite of how opium tincture works. Opium tincture decreases intestinal motility and peristalsis by acting on opioid receptors in the gastrointestinal tract. This action helps to reduce the frequency and urgency of diarrhea.

Opium tincture is not classified as a controlled substance. This statement is incorrect. Opium tincture is indeed classified as a Schedule II controlled substance under the Controlled Substances Act in the United States, meaning it has a high potential for abuse and is subject to strict regulation.

EXPLANATION

✔Correct answer:

Docusate Sodium (Colace). Docusate sodium (Colace) is not a bulk-forming laxative; rather, it is a stool softener. Stool softeners work by increasing the amount of water the stool absorbs in the gut, making the stool softer and easier to pass. It does not add bulk to the stool but rather facilitates easier passage by softening it.

The bulk-forming laxatives, such as methylcellulose (Citrucel), polycarbophil (Fibercon), and psyllium (Metamucil), work differently. These agents are fiber supplements that increase the bulk and water content of the stool, which helps to stimulate bowel movements by expanding the stool mass, making it easier to pass through the intestines.

Imagine stool softeners like adding oil to a sticky dough, making it easier to knead and shape. On the other hand, bulk-forming laxatives are like adding more flour to the dough, increasing its size and firmness, which makes it easier to handle and process.

When advising a patient on the use of a stool softener like Docusate sodium, it is crucial to emphasize the importance of staying hydrated, as this medication requires sufficient water intake to be effective. In contrast, for bulk-forming laxatives, the nurse should instruct the patient to also drink plenty of water to avoid the risk of constipation or intestinal blockage.

• Instruct the patient to take the medication with a full glass of water.
• Educate the patient about the importance of maintaining hydration, especially when using stool softeners or bulk-forming laxatives.
• Advise the patient to monitor for signs of dehydration or electrolyte imbalance, which could be exacerbated by improper use of laxatives.
• Encourage a diet high in fiber to complement the effects of bulk-forming laxatives, if prescribed.

✘Incorrect answer options:

Methylcellulose (Citrucel). Methylcellulose is a bulk-forming laxative that increases stool bulk and moisture content, making it easier to pass. It is commonly used to treat constipation and promote regular bowel movements.

Polycarbophil (Fibercon). Polycarbophil is another example of a bulk-forming laxative. It works by absorbing water into the stool, increasing its bulk, and promoting peristalsis, which helps move the stool through the intestines.

Psyllium (Metamucil). Psyllium is a well-known bulk-forming laxative derived from the husks of psyllium seeds. It absorbs liquid in the intestines, swells, and forms a bulky stool, which helps promote bowel movements and relieve constipation.

EXPLANATION

✔ Correct answer:

Patient's blood pressure. Cimetidine (Tagamet) is an H2 receptor antagonist primarily used to reduce stomach acid production in conditions such as ulcers and gastroesophageal reflux disease (GERD). When administered as an IV bolus, Cimetidine can have cardiovascular effects, particularly hypotension (low blood pressure). This is because Cimetidine can cause vasodilation, leading to a drop in blood pressure. Therefore, the patient's blood pressure should be closely monitored following the administration of Cimetidine to ensure that the patient does not develop hypotension, which could lead to dizziness, fainting, or even shock if severe.

Think of blood vessels as a garden hose that needs the right amount of pressure to water plants (body tissues) effectively. If the pressure drops too low, the water won’t reach the plants properly, just as low blood pressure can prevent adequate blood flow to organs.

After administering Cimetidine, Nurse Johnson should:

• Monitor the patient's blood pressure closely to detect any signs of hypotension.
• Assess the patient for any symptoms of dizziness, lightheadedness, or fainting, which may indicate a significant drop in blood pressure.
• Ensure that the patient is in a safe position, such as lying down or sitting, to prevent falls if hypotension occurs.
• Be prepared to manage hypotension by providing IV fluids or other interventions as ordered by the healthcare provider.

✘ Incorrect answer options:

Patient's temperature. While it is important to monitor the patient's temperature, Cimetidine does not typically cause significant changes in body temperature. Thus, it is not the most critical parameter to monitor in this context.

Patient's respiratory rate. Cimetidine is not known to have direct effects on respiratory rate. Although monitoring vital signs is essential, respiratory rate changes are not a primary concern with this medication.

Patient's skin turgor. Skin turgor is a useful assessment for hydration status, but it is not directly affected by the administration of Cimetidine. Monitoring skin turgor is not necessary in the immediate period following Cimetidine administration.

EXPLANATION

✔Correct answer:

"I'll sip the Cholestyramine powder slowly over time to help with faster absorption." This statement indicates that Mr. Anderson needs more education. Cholestyramine (Prevalite) is a bile acid sequestrant used to lower cholesterol levels. The medication comes in powder form and must be mixed with water or another liquid before ingestion. However, it should be consumed immediately after mixing, not sipped slowly over time. Sipping the mixture slowly can reduce its effectiveness and increase the risk of gastrointestinal side effects such as constipation. Furthermore, Cholestyramine binds with bile acids in the intestines, and it does not require "faster absorption" as the statement implies; its primary action occurs within the gastrointestinal tract.

Taking the medication immediately after mixing ensures that it is properly dispersed and can effectively bind to bile acids to lower cholesterol.

Imagine trying to clean up a spill with a sponge. If you wait too long to use the sponge, the spill might spread, and the sponge won’t be as effective. Similarly, Cholestyramine needs to be taken right away to work effectively, much like how a sponge needs to be used immediately to clean up a mess.

✘Incorrect answer options:

"I'll keep taking my multivitamins as usual." This statement does not indicate a need for more education as long as Mr. Anderson is aware that Cholestyramine can interfere with the absorption of fat-soluble vitamins (A, D, E, and K). Therefore, it is generally recommended to take multivitamins either 1 hour before or 4-6 hours after taking Cholestyramine to ensure proper absorption of these vitamins.

"I'll add more high-fiber foods to my diet." Increasing dietary fiber is often recommended for patients taking Cholestyramine to help prevent or manage constipation, a common side effect of the medication. This statement shows an understanding of dietary modifications that can help mitigate side effects.

"This medicine will assist in lowering my cholesterol." This is a correct understanding of the purpose of Cholestyramine. It works by binding bile acids in the intestine, which leads to a decrease in blood cholesterol levels, particularly low-density lipoprotein (LDL) cholesterol.

EXPLANATION

✔Correct answer:

"These medications will reduce acid production and eradicate the bacteria."  This statement accurately describes the purpose of the prescribed medications for Mr. Thompson's duodenal ulcer and H. pylori infection. The combination of Amoxicillin, Clarithromycin, and Pantoprazole is a standard treatment regimen aimed at eradicating H. pylori bacteria and reducing stomach acid production to promote ulcer healing.

• Amoxicillin (Wymox) and Clarithromycin (Biaxin) are antibiotics used to target and eradicate the H. pylori bacteria, which is a common cause of peptic ulcers.
• Pantoprazole (Prevacid) is a proton pump inhibitor (PPI) that works by reducing the amount of acid produced in the stomach, creating a less acidic environment that allows the ulcer to heal and enhances the effectiveness of the antibiotics.

Think of the ulcer as a wound in the lining of the stomach, and H. pylori bacteria as dirt in that wound. The antibiotics (Amoxicillin and Clarithromycin) are like disinfectants that clean out the dirt (bacteria), while Pantoprazole reduces the acidity, similar to how a soothing ointment reduces irritation and promotes healing.

Nurse Laura should ensure Mr. Thompson understands the importance of completing the full course of antibiotics to effectively eradicate the bacteria and prevent recurrence of the ulcer.

• Explain the purpose of each medication and the importance of adherence to the treatment regimen.
• Advise Mr. Thompson to take the medications as prescribed, even if symptoms improve, to ensure complete eradication of H. pylori.
• Monitor for potential side effects, such as gastrointestinal upset from antibiotics or possible decreased stomach acid effects.
• Encourage Mr. Thompson to avoid NSAIDs and other irritants that can exacerbate ulcer symptoms during treatment.

✘Incorrect answer options:

"The ulcer will heal as these drugs will eliminate the bacteria."  While eliminating H. pylori is crucial, this option omits the role of Pantoprazole in reducing stomach acid, which is essential for creating a conducive environment for ulcer healing. Both bacterial eradication and acid reduction are necessary for optimal treatment.

"These medications will manage the ulcer and prevent motion sickness."  This option is incorrect because the prescribed medications are not used for motion sickness. The treatment is specifically targeted at reducing stomach acid and eradicating H. pylori bacteria to heal the ulcer.

"These medications will reduce acid and form a protective layer over the ulcer."  While Pantoprazole does reduce acid, the prescribed regimen does not include a medication like sucralfate, which forms a protective barrier over the ulcer. This statement inaccurately describes the function of the medications.

EXPLANATION

✔Correct answer:

Decreased urine output. Sulfasalazine (Azulfidine) is commonly used to treat ulcerative colitis by reducing inflammation in the colon. However, like many sulfa-based drugs, it carries the risk of nephrotoxicity, which can lead to decreased urine output, signaling potential kidney dysfunction or acute kidney injury. This finding is the most concerning because it may indicate renal impairment, a serious side effect requiring immediate intervention, such as stopping the medication or adjusting the dose. Prolonged kidney dysfunction can lead to complications like electrolyte imbalances, fluid retention, and even chronic kidney disease.

Sulfasalazine is metabolized in the body to its active components, which include sulfapyridine. Sulfapyridine has been associated with crystal formation in the urine, potentially leading to kidney stones, tubular obstruction, or nephritis. These complications can reduce glomerular filtration rate (GFR) and result in decreased urine output, signaling impaired kidney function.

Think of the kidneys as a coffee filter. If the filter becomes clogged (as in nephrotoxicity), less coffee (urine) will drip through. This reduced output is a sign that the filter (kidneys) isn't working properly and needs attention before it gets completely blocked.

Nurse Allen should promptly assess the patient's fluid intake and output, monitor blood urea nitrogen (BUN) and creatinine levels, and notify the healthcare provider. Additionally, ensuring adequate hydration may help prevent the formation of crystals in the urine. The nurse should also educate the patient about the importance of reporting any changes in urine output or other symptoms suggestive of kidney issues.

• Monitor daily urine output and document any significant decrease.
• Check renal function tests (BUN, creatinine) regularly.
• Ensure the patient maintains adequate hydration to prevent crystalluria.
• Educate the patient on recognizing early signs of kidney problems, such as reduced urine output or dark urine.
• Report any concerning changes to the healthcare provider immediately.

✘Incorrect answer options:

Urine discoloration. While urine discoloration can occur with sulfasalazine due to the drug's metabolites, it is generally harmless and expected. This is not typically a cause for concern unless accompanied by other symptoms of renal dysfunction, such as decreased urine output.

Drowsiness. Drowsiness is not a common side effect of sulfasalazine. If present, it is usually mild and not indicative of a serious condition. It could be related to the overall illness or other medications rather than the sulfasalazine itself.

Vomiting. Although vomiting can be an adverse effect of sulfasalazine, it is generally less concerning than signs of nephrotoxicity. Vomiting can lead to dehydration and electrolyte imbalances, but it is not as immediately alarming as decreased urine output, which directly points to potential kidney issues.

EXPLANATION

✔Correct answer:

Reduction of excess fat in the stool. Pancrelipase (Pancreaze) is a pancreatic enzyme replacement therapy used in patients who have conditions like chronic pancreatitis, cystic fibrosis, or other pancreatic disorders that lead to insufficient pancreatic enzyme production. The primary function of Pancrelipase is to assist in the digestion of fats, proteins, and carbohydrates by providing the necessary enzymes (lipase, protease, and amylase) that the pancreas would normally secrete. When these enzymes are insufficient, fat is not properly digested and is excreted in the stool, leading to steatorrhea, which is characterized by bulky, greasy, and foul-smelling stools.

If Pancrelipase is effective, the enzymes help in the proper digestion of fats, resulting in a reduction or absence of steatorrhea. Thus, the correct therapeutic outcome would be a noticeable reduction in excess fat in the stool, signifying that the medication is working effectively.

Imagine trying to clean greasy dishes without soap. The grease would just smear around and not come off properly. Pancrelipase acts like dish soap for your digestive system—it breaks down fats so they can be properly cleaned off (absorbed), rather than left on the plate (passed in the stool).

When administering Pancrelipase, nurses should ensure the medication is taken with meals and snacks to mimic the natural release of pancreatic enzymes. Nurses should also monitor the patient’s stool for signs of improvement in steatorrhea and educate the patient on the importance of adhering to the prescribed dosing schedule.

• Monitor for signs of decreased steatorrhea, such as less frequent bulky or greasy stools.
• Instruct the patient to take Pancrelipase with every meal and snack to optimize digestion.
• Assess for any signs of potential side effects, such as allergic reactions or gastrointestinal upset.

✘Incorrect answer options:

Absence of constipation. While constipation can be a symptom in some digestive disorders, the primary indication of effective Pancrelipase therapy is the reduction of fat in the stool. Constipation relief is not directly related to the action of Pancrelipase.

Relief from abdominal pain. Although Pancrelipase may indirectly help reduce abdominal discomfort related to indigestion, abdominal pain relief is not the primary indicator of this medication's effectiveness. The focus is on the digestion of fats, not pain relief.

Absence of diarrhea. Diarrhea can be associated with many gastrointestinal issues, but like constipation, it is not the main target of Pancrelipase therapy. The reduction of steatorrhea is the more relevant therapeutic outcome to assess.

EXPLANATION

✔Correct answer:

Keep the bed in a low position with side rails up. The priority nursing intervention for a patient receiving an antiemetic is to ensure safety by keeping the bed in a low position with side rails up. Antiemetic medications, such as ondansetron, metoclopramide, or promethazine, can cause drowsiness, dizziness, or sedation as side effects. These effects increase the risk of falls or injuries, especially in a hospitalized patient who may already be weakened or disoriented due to illness. By keeping the bed in a low position and the side rails up, Nurse Parker can reduce the risk of falls and ensure the patient's safety.

If you were feeling sleepy and unsteady on your feet, you would want to make sure you were in a safe, secure spot where you wouldn't accidentally stumble or fall. This is exactly what keeping the bed low and the side rails up does for a patient who might be drowsy from medication.

Beyond ensuring bed safety, it is also important to frequently assess the patient's level of consciousness, monitor for adverse reactions to the antiemetic, and provide assistance with mobility as needed to prevent falls.

• Regularly assess the patient’s level of sedation and orientation.
• Assist the patient with ambulation if necessary, and provide a call light within reach.
• Monitor for other side effects of antiemetics, such as dry mouth or constipation, and manage them appropriately.
• Document all interventions and patient responses to ensure continuity of care.

✘Incorrect answer options:

Give the client privacy by letting them walk around the room. While respecting a patient’s privacy is important, allowing a patient who may be drowsy or unsteady to walk around unsupervised could increase the risk of falls. Supervision and assistance should be provided when necessary.

Monitor intake and output. Monitoring intake and output is a valuable intervention for assessing the patient's hydration status, particularly if the patient is vomiting. However, it is not the priority intervention related to the safety risks posed by antiemetics, such as sedation and dizziness.

Keep items far away from the bed. Keeping items far away from the bed could create unnecessary hazards, as the patient might attempt to reach or walk to them, increasing the risk of falls. Items should be kept within easy reach to prevent accidents.

EXPLANATION

✔ Correct answer:

"I've found relief from my GERD symptoms." Omeprazole (Prilosec) is a proton pump inhibitor (PPI) that works by reducing the production of stomach acid. It is commonly prescribed for conditions like gastroesophageal reflux disease (GERD), peptic ulcer disease, and Zollinger-Ellison syndrome. The primary therapeutic effect of Omeprazole is to alleviate symptoms associated with excessive stomach acid, such as heartburn, acid reflux, and regurgitation. Therefore, a statement by the patient indicating relief from GERD symptoms would demonstrate that the medication is achieving its intended therapeutic effect.

GERD occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of your esophagus. The lower esophageal sphincter (LES) normally acts as a barrier to prevent acid from moving back up, but in GERD, the LES may be weak or relax inappropriately, allowing stomach acid to enter the esophagus. This can cause symptoms such as heartburn, regurgitation, and chest pain.

Omeprazole inhibits the enzyme H+/K+ ATPase, often referred to as the proton pump, which is located in the parietal cells of the stomach lining. This enzyme is responsible for the final step in the production of gastric acid. By inhibiting this enzyme, Omeprazole significantly reduces the amount of acid produced, which helps in healing the esophagus, preventing further damage, and alleviating the symptoms of GERD.

Think of your stomach as a pot of boiling water. GERD symptoms are like the steam escaping from the pot (acid reflux). Omeprazole works like a lid that reduces the steam (acid) being produced, thus preventing it from escaping (reducing GERD symptoms).

When evaluating the effectiveness of Omeprazole, Nurse Harper should:

• Ask the patient about the frequency and severity of GERD symptoms, such as heartburn, to assess the medication’s efficacy.
• Monitor the patient for any adverse effects of Omeprazole, such as headache, abdominal pain, or potential nutrient deficiencies (e.g., vitamin B12), which can occur with long-term use.
• Educate the patient on lifestyle modifications that can complement the effects of Omeprazole, such as avoiding trigger foods, eating smaller meals, and not lying down immediately after eating.
• Ensure the patient understands the importance of taking Omeprazole as prescribed, typically before meals, to maximize its effectiveness.

✘ Incorrect answer options:

"I'm not experiencing constipation anymore." Omeprazole is not primarily used to treat constipation. While constipation is a common issue, relief from constipation is not an indicator of Omeprazole's effectiveness. Constipation may be managed with dietary changes, increased fluid intake, or laxatives, not Omeprazole.

"My nausea and vomiting have subsided." Although Omeprazole can sometimes reduce nausea and vomiting associated with acid-related disorders, these symptoms are more often secondary. The primary therapeutic goal of Omeprazole is to manage acid-related conditions like GERD, not to directly treat nausea and vomiting.

"I'm having fewer episodes of diarrhea." Diarrhea is not a condition that Omeprazole is designed to treat. In fact, Omeprazole can sometimes cause diarrhea as a side effect, particularly in association with Clostridium difficile infection. A reduction in diarrhea episodes would not be considered an indicator of Omeprazole's effectiveness.

EXPLANATION

✔Correct answer:

Tegaserod (Zelnorm). Tegaserod (Zelnorm) is least likely to be included in the medical management plan for a patient with irritable bowel syndrome (IBS) who also has a history of chest pain. Tegaserod is a selective serotonin 5-HT4 receptor agonist that is used to treat IBS with constipation (IBS-C) in women under the age of 65. However, Tegaserod has been associated with an increased risk of cardiovascular events, including chest pain, heart attack, and stroke, particularly in patients with preexisting cardiovascular conditions. Due to these potential risks, it is contraindicated in patients with a history of cardiovascular issues, including chest pain.

Prescribing Tegaserod to someone with a history of chest pain is like giving a race car to someone with a history of heart problems. The added strain could lead to serious complications.

It is crucial for Nurse Harris to carefully review the patient's medical history and assess for any contraindications, especially cardiovascular conditions, before administering or recommending Tegaserod. Alternative medications with a safer profile for patients with cardiovascular risks should be considered.

• Assess the patient's cardiovascular history before starting any new medication for IBS.
• Monitor the patient for any signs of chest pain or cardiovascular symptoms if Tegaserod is considered, and report these symptoms immediately.
• Educate the patient about the importance of reporting any new or worsening chest pain while on IBS medication.

✘Incorrect answer options:

Lubiprostone (Amitiza). Lubiprostone is a chloride channel activator used for treating IBS with constipation (IBS-C) and chronic idiopathic constipation. It has a good safety profile and is not associated with an increased risk of cardiovascular events, making it a safer choice for patients with a history of chest pain.

Loperamide (Imodium). Loperamide is an antidiarrheal medication commonly used to treat IBS with diarrhea (IBS-D). It works by slowing down gut movement, which helps reduce the frequency of diarrhea. It is not associated with significant cardiovascular risks, making it suitable for patients with chest pain.

Alosetron (Lotronex). Alosetron is a selective serotonin 5-HT3 receptor antagonist used to treat IBS with diarrhea (IBS-D), particularly in women who have not responded to conventional therapy. Although Alosetron carries a risk of serious gastrointestinal side effects, such as ischemic colitis, it is not specifically contraindicated in patients with a history of chest pain or cardiovascular issues.

EXPLANATION

✔Correct answer:

Healing of gastric ulcers. Misoprostol (Cytotec) is a synthetic prostaglandin E1 analog that is primarily prescribed to prevent and treat gastric ulcers, particularly those induced by nonsteroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen. NSAIDs inhibit the production of prostaglandins, which protect the gastric lining by promoting the secretion of mucus and bicarbonate. This inhibition can lead to gastric ulcers. Misoprostol works by replacing the protective prostaglandins, thereby reducing acid secretion and promoting the healing of gastric ulcers.

Prostaglandins are compounds in the body that help to protect the stomach lining from acid. When NSAIDs like Ibuprofen are taken long-term, they inhibit the enzyme cyclooxygenase (COX), which is essential for the synthesis of protective prostaglandins in the gastric mucosa. This reduction in prostaglandin production compromises the stomach's protective barrier, making it more susceptible to damage from gastric acid. Misoprostol counteracts this effect by mimicking the action of natural prostaglandins, leading to increased mucus and bicarbonate production, and ultimately facilitating the healing of gastric ulcers.

Think of the stomach lining as a wall that protects your house (the stomach) from rain (acid). NSAIDs act like a substance that erodes the paint on the wall, making it easier for the rain to cause damage. Misoprostol acts like a fresh coat of weatherproof paint, helping to repair the wall and keep the rain out.

Nurses should monitor the patient for signs of ulcer healing, such as a decrease in abdominal pain or discomfort and improvements in endoscopic findings. Additionally, patient education on the importance of adhering to the prescribed medication regimen is crucial for effective ulcer management.

• Encourage patients to take Misoprostol with food to minimize gastrointestinal discomfort.
• Monitor for common side effects such as diarrhea and abdominal cramping, as these can occur with Misoprostol use.
• Educate the patient on the purpose of the medication, emphasizing that its primary function is to protect the stomach lining and promote ulcer healing.
• Ensure regular follow-up appointments for endoscopic evaluation to assess the progress of ulcer healing.

✘Incorrect answer options:

Alleviation of constipation. Misoprostol is not indicated for the treatment of constipation. In fact, one of the more common side effects of Misoprostol is diarrhea, not alleviation of constipation. Therefore, this outcome would not indicate that the medication is working effectively.

Reduction in diarrhea. Misoprostol often causes diarrhea as a side effect, especially when therapy is initiated. A reduction in diarrhea would not indicate therapeutic effectiveness but rather a reduction in one of the drug's side effects.

Decrease in vomiting. While vomiting could be a symptom of gastrointestinal distress, Misoprostol is not primarily used to treat vomiting. Its effectiveness is best measured by its ability to prevent or heal gastric ulcers, not by its effect on vomiting.

EXPLANATION

✔Correct answer:

1 hour before meals. Sucralfate (Carafate) is a medication used primarily to treat gastric ulcers. It works by forming a protective barrier over the ulcer site, which shields it from stomach acid and pepsin, thus allowing the ulcer to heal. For optimal effectiveness, Sucralfate should be taken on an empty stomach, specifically 1 hour before meals. This timing ensures that the medication can coat the ulcer effectively before food intake triggers the release of stomach acid, which could otherwise dilute the medication's protective layer.

Sucralfate acts locally rather than systemically, binding to ulcerated tissue in the stomach and duodenum to create a viscous, adhesive barrier. This barrier is most effective when the stomach is empty, as it can directly adhere to the ulcerated areas without interference from food or digestive processes.

Imagine you need to apply a protective sealant to a crack in a sidewalk. If you do it before it rains (taking Sucralfate before eating), the sealant will adhere well and protect the crack. If you wait until after it rains (taking Sucralfate after eating), the sealant won’t stick as well, and water (stomach acid) might get into the crack and cause more damage.

Nurse Evans should emphasize to the patient the importance of taking Sucralfate as directed—on an empty stomach, typically 1 hour before meals, and at bedtime if prescribed multiple times a day. This ensures the medication can form the protective coating over the ulcer before exposure to food and gastric acid.

• Instruct the patient to take Sucralfate with a full glass of water for better distribution in the stomach.
• Advise the patient to avoid taking Sucralfate simultaneously with other medications or antacids, as it can interfere with their absorption.
• Educate the patient on the importance of adhering to the prescribed timing for the medication to ensure maximum efficacy.
• Encourage the patient to report any persistent symptoms or side effects, such as constipation, which is a common side effect of Sucralfate.

✘Incorrect answer options:

1 hour after meals. Taking Sucralfate 1 hour after meals is not ideal because the presence of food in the stomach can interfere with the medication’s ability to adhere to the ulcer site. This reduces its effectiveness in forming a protective barrier.

At lunchtime. This option is too vague and does not consider the timing relative to meals. Taking Sucralfate at a random time during the day, such as lunchtime, may not provide the necessary ulcer protection if it coincides with or follows food intake.

Simultaneously with an antacid. Taking Sucralfate simultaneously with an antacid is not recommended because antacids can interfere with the effectiveness of Sucralfate. Antacids can raise the pH of the stomach, potentially reducing the binding capacity of Sucralfate to the ulcer site. It is generally advised to take antacids at least 30 minutes before or after Sucralfate.

EXPLANATION

✔Correct answer:

Confusion. Cimetidine (Tagamet) is an H2 receptor antagonist often prescribed to manage heartburn and other acid-related conditions. In elderly patients, one of the most significant concerns with Cimetidine is its potential to cross the blood-brain barrier and cause central nervous system (CNS) side effects, particularly confusion. This is especially relevant in older adults due to changes in drug metabolism and excretion with age, alongside the likelihood of polypharmacy and pre-existing cognitive conditions. Confusion can lead to increased risks such as falls, accidents, and further cognitive decline.

Imagine the brain as a computer. In elderly patients, the computer might already be running many programs at once (due to other medications or conditions). Adding Cimetidine is like installing a new program that’s not fully compatible, causing the computer to slow down or glitch, leading to confusion.

Nurse Simmons should monitor Mr. Reynolds for any signs of cognitive decline or disorientation. Promptly identifying confusion can help prevent serious complications, such as falls or poor judgment, which could endanger the patient’s safety.

• Regularly assess the patient’s cognitive status, focusing on orientation and memory.
• Communicate any signs of new or worsening confusion to the healthcare provider immediately.
• Review the patient’s medication list for potential interactions that might heighten CNS effects.
• Educate the patient and family members about the importance of reporting any changes in mental status.

✘Incorrect answer options:

Agitation: While agitation can occur with certain medications, confusion is the primary CNS side effect of concern with Cimetidine in elderly patients. Agitation may occur secondary to confusion but is not the most immediate risk.

Dizziness: Dizziness, though a common side effect of various drugs, is less specific and concerning than confusion in this context. Confusion directly impacts cognitive functioning and poses a higher risk to patient safety.

Headache: Headaches can be associated with many drugs, but they are not as commonly linked to Cimetidine as confusion. While a headache can be uncomfortable, confusion has a more significant impact on the patient’s overall cognitive health and safety.

EXPLANATION

✔Correct answer:

"I can use mineral oil liquid for an extended period to prevent further damage." This statement indicates a need for further teaching because long-term use of mineral oil is not recommended. Mineral oil is a lubricant laxative that works by coating the stool and the inside of the bowel with a waterproof film, which helps to retain moisture in the stool, making it easier to pass. However, prolonged use of mineral oil can lead to complications such as fat-soluble vitamin deficiencies (e.g., vitamins A, D, E, and K), lipid pneumonia from aspiration, and dependence on laxatives for bowel movements. Nurse Taylor should educate the patient on the risks of extended use and encourage the patient to use mineral oil only for short-term relief of constipation, ideally under medical supervision.

Mineral oil can interfere with the absorption of fat-soluble vitamins by coating the intestinal lining, which can prevent these vitamins from being absorbed properly. Over time, this can lead to deficiencies, particularly if mineral oil is used regularly without adequate intake of these vitamins.

Imagine your intestines as a sponge absorbing nutrients from food. If you soak the sponge in oil (like taking mineral oil), it creates a slippery coating that prevents the sponge from absorbing water (nutrients). Over time, if you keep soaking the sponge in oil, it won’t absorb anything well, leading to nutrient deficiencies. Similarly, prolonged use of mineral oil can coat your intestines and block the absorption of essential vitamins, making it important to use it only for a short time.

Nurse Taylor should emphasize the importance of using mineral oil only as directed and for short periods. The nurse should also discuss alternative methods for managing hemorrhoids and constipation, such as increasing dietary fiber, staying hydrated, and using stool softeners that do not interfere with nutrient absorption.

• Instruct the patient to use mineral oil for short-term relief only and to consult with their healthcare provider if constipation persists.
• Encourage the patient to incorporate dietary changes and other non-pharmacological measures to manage constipation and prevent hemorrhoids.
• Educate the patient on the risks of long-term mineral oil use, including nutrient malabsorption and potential complications like lipid pneumonia.
• Discuss signs of vitamin deficiencies (e.g., night blindness, bone pain, easy bruising) and advise the patient to report any concerning symptoms.

✘Incorrect answer options:

"It can interfere with the absorption of the vitamin E that I am taking." This statement is correct and shows the patient’s understanding of one of the potential side effects of mineral oil. Because mineral oil can inhibit the absorption of fat-soluble vitamins like vitamin E, the patient should be aware of this interaction.

"I can take it at least 2 hours before bedtime." This statement is also correct. Taking mineral oil a few hours before bedtime is advised because it helps reduce the risk of lipid pneumonia from aspiration, which is a concern if the patient lies down too soon after taking the oil.

"If I miss a dose of mineral oil liquid, I’ll take it as soon as I remember." This statement is generally correct. However, if it’s close to the next dose, the patient should skip the missed dose rather than doubling up. The patient should follow specific instructions provided by the healthcare provider regarding missed doses.

EXPLANATION

✔Correct answer:

"It will decrease your diarrhea and allow your bowel to rest." Total Parenteral Nutrition (TPN) is an intravenous method of feeding that bypasses the digestive tract, delivering essential nutrients directly into the bloodstream. This is particularly beneficial for patients with severe malnutrition, gastrointestinal disorders, or other conditions where the bowel requires rest, such as in the case of chronic diarrhea. By avoiding the use of the gastrointestinal (GI) tract for digestion, TPN allows the bowel to rest, thereby potentially decreasing symptoms such as diarrhea and giving the intestines time to heal. This is a critical aspect of managing patients with severe GI disturbances, making this the most appropriate response from Nurse Kelly.

TPN provides complete nutrition intravenously, including carbohydrates, proteins, fats, vitamins, and minerals. For patients with compromised bowel function or severe gastrointestinal issues, oral or enteral feeding may exacerbate symptoms like diarrhea and abdominal pain. By providing nutrition through TPN, the bowel is not stimulated to process food, reducing diarrhea and allowing healing.

Imagine your GI tract is like a busy highway. When it’s overworked or damaged, traffic (digestion) gets backed up, causing issues like diarrhea. TPN is like building a bypass road, diverting the traffic entirely and giving the highway time to be repaired without the strain of ongoing traffic.

Nurses should closely monitor the patient's fluid and electrolyte balance, as well as blood glucose levels, while on TPN. Education should focus on the purpose of TPN, potential side effects, and the importance of maintaining the TPN line to prevent infection.

• Explain the benefits of bowel rest and how TPN supports this process.
• Monitor the patient for signs of infection, particularly at the central line site.
• Ensure accurate administration of the TPN solution, and adjust as needed based on the patient's response.
• Assess for complications such as refeeding syndrome, hyperglycemia, or electrolyte imbalances.
• Provide emotional support and education regarding the temporary nature of TPN and its role in the patient’s recovery.

✘Incorrect answer options:

"You will feel better after receiving TPN." While TPN is an essential part of the patient’s treatment, simply stating that the patient will feel better is overly vague and does not provide specific information on how TPN works or addresses the patient’s concerns. It's important for the patient to understand that while TPN can improve their nutritional status, it may not immediately resolve all symptoms.

"It will shorten your hospital stay." TPN is generally used for patients with severe nutritional deficits or gastrointestinal issues, which often require careful monitoring and gradual recovery. It is not guaranteed to shorten the hospital stay and may sometimes prolong it due to the complexity of care involved with TPN administration and monitoring.

"It will assist in your weight loss." This statement is incorrect because TPN is used to provide adequate nutrition to patients who cannot meet their needs through oral or enteral feeding, not for weight loss. In fact, TPN is designed to help patients regain weight and nutritional status, not to lose weight.

EXPLANATION

✔Correct answer:

Polyethylene glycol and electrolytes (GoLYTELY). Polyethylene glycol (PEG) with electrolytes, commonly known as GoLYTELY, is classified as an osmotic laxative. Osmotic laxatives work by drawing water into the bowel from surrounding body tissues, which helps to soften the stool and stimulate bowel movements. PEG is commonly used for bowel cleansing before procedures such as colonoscopy, where rapid and complete evacuation of the colon is required.

Think of an osmotic laxative like adding water to a dried sponge. The sponge (or stool) absorbs the water, expands, and becomes softer, making it easier to move and squeeze out.

When administering PEG, it is important to ensure that the patient drinks the solution over the recommended period to achieve effective bowel cleansing. The nurse should also monitor the patient for signs of dehydration or electrolyte imbalances, as osmotic laxatives can lead to significant fluid and electrolyte loss.

• Instruct the patient to drink the full amount of the PEG solution as directed for effective bowel cleansing.
• Monitor the patient’s hydration status, and encourage them to drink clear fluids to prevent dehydration.
• Assess for signs of electrolyte imbalances, such as weakness, dizziness, or irregular heartbeats, especially in patients at risk.

✘Incorrect answer options:

Senna (Senokot). Senna is a stimulant laxative, not an osmotic laxative. It works by irritating the bowel tissues, which in turn stimulates bowel movements. While effective, it operates differently than osmotic laxatives, which work primarily by drawing water into the colon.

Mineral Oil. Mineral oil is a lubricant laxative. It coats the stool and the lining of the intestines with a waterproof film, allowing the stool to retain moisture and pass more easily. This mechanism is distinct from the osmotic action seen in PEG.

Bisacodyl (Dulcolax). Bisacodyl is another stimulant laxative, similar to Senna. It works by stimulating the nerves in the colon to induce bowel movements. Like Senna, it does not function by drawing water into the bowel, making it different from osmotic laxatives like PEG.

EXPLANATION

✔ Correct answer:

A patient undergoing radiation therapy. Metoclopramide (Reglan) is a prokinetic and antiemetic medication commonly used to treat nausea and vomiting, especially in patients undergoing chemotherapy or radiation therapy. It works by enhancing gastrointestinal motility and accelerating gastric emptying, as well as by blocking dopamine receptors in the brain, which helps control nausea and vomiting. For patients undergoing radiation therapy, Metoclopramide can help manage the nausea and vomiting that are common side effects of the treatment, making it a safe and appropriate choice in this scenario.

Imagine your stomach is like a conveyor belt that moves food along. Radiation therapy can make that conveyor belt slow down, causing nausea. Metoclopramide helps speed up the conveyor belt, keeping things moving smoothly and reducing the feeling of nausea.

When administering Metoclopramide to a patient undergoing radiation therapy, Nurse Lewis should:

• Monitor the patient for relief of nausea and vomiting, ensuring the medication is effective.
• Be aware of potential side effects such as drowsiness, restlessness, or extrapyramidal symptoms (e.g., involuntary movements, muscle rigidity), and educate the patient on these possible reactions.
• Assess the patient's overall hydration status and ensure adequate fluid intake, as vomiting can lead to dehydration.
• Advise the patient to report any unusual muscle movements or signs of neuroleptic malignant syndrome, a rare but serious side effect of Metoclopramide.

✘ Incorrect answer options:

A patient with bowel obstruction. Metoclopramide is contraindicated in patients with a bowel obstruction because it increases gastrointestinal motility. This can worsen the obstruction and lead to serious complications such as bowel perforation.

A patient with pheochromocytoma. Metoclopramide is contraindicated in patients with pheochromocytoma (a rare adrenal gland tumor) because it can precipitate a hypertensive crisis by releasing catecholamines from the tumor.

A patient with gastrointestinal hemorrhage. Metoclopramide should not be given to patients with gastrointestinal hemorrhage, as increasing gut motility can exacerbate bleeding and lead to further complications.

EXPLANATION

✔ Correct answer:

For patients with an ileostomy. Loperamide hydrochloride (Imodium) is an antidiarrheal medication that works by slowing down gut movement, which allows for more water and electrolytes to be absorbed, thus reducing the frequency of bowel movements. It is often used to manage chronic diarrhea in patients with an ileostomy. An ileostomy is a surgical procedure in which the ileum (the last part of the small intestine) is diverted to an opening in the abdominal wall, creating a stoma. These patients often experience loose stools because the colon (which absorbs water) is bypassed. Loperamide can help thicken the stool and decrease the frequency of bowel movements, improving the patient's quality of life.

Think of the small intestine as a conveyor belt that moves food along. Normally, the belt slows down in the colon, allowing time for water to be absorbed. In ileostomy patients, the colon is bypassed, so the belt moves too fast, leading to watery stools. Loperamide acts like a brake, slowing down the conveyor belt to give more time for water absorption.

When Loperamide is prescribed for a patient with an ileostomy, Nurse Davis should:

• Monitor the patient's stool consistency and frequency to evaluate the effectiveness of the medication.
• Assess for signs of dehydration, as Loperamide decreases fluid loss but dehydration can still occur if fluid intake is not sufficient.
• Educate the patient on the proper use of Loperamide, including not exceeding the recommended dose to avoid constipation or toxic megacolon.
• Advise the patient to report any signs of severe abdominal pain, swelling, or difficulty passing stool, which could indicate an adverse reaction.

✘ Incorrect answer options:

Cases of acute dysentery. Loperamide is not recommended for acute dysentery, which is characterized by severe diarrhea with blood and mucus. Using Loperamide in such cases can worsen the condition by slowing down the expulsion of harmful bacteria or toxins from the gut.

Instances of abdominal pain. Loperamide is not indicated for treating abdominal pain alone. The underlying cause of abdominal pain should be identified and treated accordingly, rather than simply slowing bowel motility.

Presence of bloody diarrhea. Loperamide should not be used in the presence of bloody diarrhea, as it could potentially worsen the condition by slowing down the elimination of the causative agent, which might be an infection or inflammation.