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Question 1

A patient is receiving an aluminum-containing antacid. The nurse will inform the patient to watch for which possible adverse effect?
a.
Diarrhea
b.
Constipation
c.
Nausea
d.
Abdominal cramping

Answer 1

ANS: B
Aluminum-based antacids have a constipating effect as well as an acid-neutralizing capacity. The other options are incorrect.

Question 2

When reviewing the health history of a patient who will be receiving antacids, the nurse recalls that antacids containing magnesium need to be used cautiously in patients with which condition?
a.
Peptic ulcer disease
b.
Renal failure
c.
Hypertension
d.
Heart failure

Answer 2

ANS: B
Both calcium- and magnesium-based antacids are more likely to accumulate to toxic levels in patients with renal disease and are commonly avoided in this patient group. The other options are incorrect.

Question 3

The nurse is reviewing the medication orders for a patient who will be taking an H2 antagonist. Which drug may have an interaction if taken along with the H2 antagonist?
a.
Ibuprofen (Motrin)
b.
Ranitidine (Zantac)
c.
Tetracycline (Doryx)
d.
Ketoconazole (Nizoral)

Answer 3

ANS: D
All H2 receptor antagonists may inhibit the absorption of certain drugs, such as the antifungal ketoconazole, that require an acidic gastrointestinal environment for gastric absorption. The other options are incorrect.

Question 4

A patient who has been taking cimetidine (Tagamet) for hyperacidity calls the clinic to say that the medication has not been effective. The nurse reviews his history and notes that which factor may be influencing the effectiveness of this drug?
a.
He takes the cimetidine with meals.
b.
He smokes two packs of cigarettes a day.
c.
He drinks a glass of water with each dose.
d.
He takes an antacid 3 hours after the cimetidine dose.

Answer 4

ANS: B

Smoking may impair the absorption of H2 antagonists. The other factors are correct interventions for this medication.

Question 5

A patient is taking omeprazole (Prilosec) for the treatment of gastroesophageal reflux disease (GERD). The nurse will include which statement in the teaching plan about this medication?
a.
“Take this medication once a day after breakfast.”
b.
“You will be on this medication for only 2 weeks for treatment of the reflux disease.”
c.
“The medication may be dissolved in a liquid for better absorption.”
d.
“The entire capsule must be taken whole, not crushed, chewed, or opened.”

Answer 5

ANS: D
Omeprazole needs to be taken before meals, and an entire capsule must be taken whole, not crushed, chewed, opened, or dissolved in liquid when treating GERD. This medication is used on a long-term basis to maintain healing.

Question 6

A patient is complaining of excessive and painful gas. The nurse checks the patient’s medication orders and prepares to administer which drug for this problem?
a.
Famotidine (Pepcid)
b.
Aluminum hydroxide and magnesium hydroxide (Maalox or Mylanta)
c.
Calcium carbonate (Tums)
d.
Simethicone (Mylicon)

Answer 6

ANS: D
Simethicone alters the elasticity of mucus-coated bubbles, causing them to break, and is an over-the-counter antiflatulent. The other options are incorrect.

Question 7

A 75-year-old woman comes into the clinic with complaints of muscle twitching, nausea, and headache. She tells the nurse that she has been taking sodium bicarbonate five or six times a day for the past 3 weeks. The nurse will assess for which potential problem that may occur with overuse of sodium bicarbonate?
a.
Constipation
b.
Metabolic acidosis
c.
Metabolic alkalosis
d.
Excessive gastric mucus

Answer 7

ANS: C

Excessive use of sodium bicarbonate may lead to systemic alkalosis. The other options are incorrect.

Question 8

A patient will be taking a 2-week course of combination therapy with omeprazole (Prilosec) and another drug for a peptic ulcer caused by Helicobacter pylori. The nurse expects a drug from which class to be ordered with the omeprazole?
a.
Antibiotic
b.
Nonsteroidal anti-inflammatory drug
c.
Antacid
d.
Antiemetic

Answer 8

ANS: A
The antibiotic clarithromycin is active against H. pylori and is used in combination with omeprazole to eradicate the bacteria. First-line therapy against H. pylori includes a 10- to 14-day course of a proton pump inhibitor such as omeprazole, plus the antibiotics clarithromycin and either amoxicillin or metronidazole, or a combination of a proton pump inhibitor, bismuth subsalicylate, and the antibiotics tetracycline and metronidazole. Many different combinations are used.

Question 9

A patient is asking advice about which over-the-counter antacid is considered the most safe to use for heartburn. The nurse explains that the reason that calcium antacids are not used as frequently as other antacids is for which of these reasons?
a.
Their use may result in kidney stones.
b.
They cause decreased gastric acid production.
c.
They cause severe diarrhea.
d.
Their use may result in fluid retention and edema.

Answer 9

ANS: A
Calcium antacids are not used as frequently as other antacids because their use may lead to the development of kidney stones; they also cause increased gastric acid production. The other options are incorrect.

Question 10

At 0900, the nurse is about to give morning medications, and the patient has asked for a dose of antacid for severe heartburn. Which schedule for the antacid and medications is correct?
a.
Give both the antacid and medications at 0900.
b.
Give the antacid at 0900, and then the medications at 0930.
c.
Give the medications at 0900, and then the antacid at 1000.
d.
Give the medications at 0900, and then the antacid at 0915.

Answer 10

ANS: C
Medications are not to be taken, unless prescribed, within 1 to 2 hours of taking an antacid because of the impact on the absorption of many medications in the stomach.

Question 11

During an admission assessment, the patient tells the nurse that he has been self-treating his heartburn for 1 year with over-the-counter Prilosec OTC (omeprazole, a proton pump inhibitor). The nurse is aware that this self-treatment may have which result?
a.
No serious consequences
b.
Prevention of more serious problems, such as an ulcer
c.
Chronic constipation
d.
Masked symptoms of serious underlying diseases

Answer 11

ANS: D
Long-term self-medication with antacids may mask symptoms of serious underlying diseases, such as bleeding ulcer or malignancy. Patients with ongoing symptoms need to undergo regular medical evaluations, because additional medications or other interventions may be needed.

Question 12

An older adult patient had gastric surgery due to a gastrointestinal bleed 3 days ago, and he has been stable since the surgery. This evening, his daughter tells the nurse, “He seems to be more confused this afternoon. He’s never been like this. What could be the problem?” The nurse reviews the patient’s medication record and suspects that which drug could be the cause of the patient’s confusion?
a.
Cimetidine (Tagamet)
b.
Pantoprazole (Protonix)
c.
Clarithromycin (Biaxin)
d.
Sucralfate (Carafate)

Answer 12

ANS: A
Sometimes H2 receptor antagonists such as cimetidine may cause adverse effects related to the central nervous system in the older adult, including confusion and disorientation. The nurse needs to be alert for mental status changes when giving these drugs, especially if the changes are new to the patient.

Question 13

The nurse is teaching a patient who will be taking a proton pump inhibitor as long-term therapy about potential adverse effects. Which statement is correct?
a.
Proton pump inhibitors can cause diarrhea.
b.
These drugs can cause nausea and anorexia.
c.
Proton pump inhibitors cause drowsiness.
d.
Long-term use of these drugs may contribute to osteoporosis.

Answer 13

ANS: D
New concerns have arisen over the potential for long-term users of proton pump inhibitors (PPIs) to develop osteoporosis. This is thought to be due to the inhibition of stomach acid, and it is speculated that PPIs speed up bone mineral loss. The other options are incorrect.

Question 14

A patient in the intensive care unit has a nasogastric tube and is also receiving a proton pump inhibitor (PPI). The nurse recognizes that the purpose of the PPI is which effect?
a.
Prevent stress ulcers
b.
Reduce bacteria levels in the stomach
c.
Reduce gastric gas formation (flatulence)
d.
Promote gastric motility

Answer 14

ANS: A
Stress-related mucosal damage is an important issue for critically ill patients. Stress ulcer prophylaxis (or therapy to prevent severe gastrointestinal [GI] damage) is undertaken in almost every critically ill patient in an intensive care unit and for many patients on general medical surgical units. Procedures performed commonly in critically ill patients, such as passing nasogastric tubes, placing patients on ventilators, and others, predispose patients to bleeding of the GI tract. Guidelines suggest that all such patients receive either a histamine receptor-blocking drug or a proton pump inhibitor. The other options are incorrect.

Question 15

The nurse is providing patient teaching about antacids. Which statements about antacids are accurate? (Select all that apply.)
a.
Antacids reduce the production of acid in the stomach.
b.
Antacids neutralize acid in the stomach.
c.
Rebound hyperacidity may occur with calcium-based antacids.
d.
Aluminum-based antacids cause diarrhea.
e.
Magnesium-based antacids cause diarrhea.

Answer 15

ANS: B, C, E
Antacids neutralize acid in the stomach. Magnesium-based antacids cause diarrhea, and aluminum-based antacids cause constipation. Calcium-based antacids often cause rebound hyperacidity.

Question 16

A patient will be receiving pantoprazole (Protonix), 20 mg IV daily every morning. The medication, once reconstituted, has a strength of 40 mg/10 mL. Identify how many milliliters will the nurse draw up for this dose.

Answer 16

ANS: 5 mL
40 mg : 10 mL :: 20 mg : x mL
(40 x x) = (10 x 20), 40x = 200, x = 5 mL

Question 17

The nurse is giving oral mineral oil as an ordered laxative dose. The nurse will take measures to prevent which potential problem that may occur with mineral oil?
a.
Fecal impaction
b.
Electrolyte imbalances
c.
Lipid pneumonia
d.
Esophageal blockage

Answer 17

ANS: C
Lipid pneumonia may occur if the oral mineral oil is accidentally aspirated into the respiratory tract. The other options are incorrect.

Question 18

When administering a bulk-forming laxative, the nurse instructs the patient to drink the medication mixed in a full 8-ounce glass of water. Which statement best explains the rationale for this instruction?
a.
The water acts to stimulate bowel movements.
b.
The water will help to reduce the bulk of the intestinal contents.
c.
These laxatives may cause esophageal obstruction if taken with insufficient water.
d.
The water acts as a lubricant to produce bowel movements.

Answer 18

ANS: C
Bulk-forming drugs increase water absorption, which results in greater total volume (bulk) of the intestinal contents. Bulk-forming laxatives tend to produce normal, formed stools. Their action is limited to the gastrointestinal tract, so there are few, if any, systemic effects. However, they need to be taken with liberal amounts of water to prevent esophageal obstruction and fecal impaction.

Question 19

A patient will be taking bismuth subsalicylate (Pepto-Bismol) to control diarrhea. When reviewing the patient’s other ordered medications, the nurse recognizes that which medication or medication class will interact significantly with the Pepto-Bismol?
a.
Hypoglycemic drugs
b.
Antibiotics
c.
Acetaminophen (Tylenol)
d.
Antidepressants

Answer 19

ANS: A
Taking hypoglycemic drugs with an adsorbent such as bismuth subsalicylate may result in decreased absorption of the hypoglycemic drugs. The other options are incorrect.

Question 20

A patient is about to undergo a diagnostic bowel procedure. The nurse expects which drug to be used to induce total cleansing of the bowel?
a.
Docusate sodium (Colace)
b.
Lactulose (Enulose)
c.
Mineral oil
d.
Polyethylene glycol 3350 (GoLYTELY)

Answer 20

ANS: D
Polyethylene glycol is a very potent laxative that induces total cleansing of the bowel and is most commonly used before diagnostic or surgical bowel procedures. The other options are incorrect.

Question 21

While recovering from surgery, a 74-year-old woman started taking a stimulant laxative, senna (Senokot), to relieve constipation caused by the pain medications. Two weeks later, at her follow-up appointment, she tells the nurse that she likes how “regular” her bowel movements are now that she is taking the laxative. Which teaching principle is appropriate for this patient?
a.
She needs to be sure to take this medication with plenty of fluids.
b.
It is important to have a daily bowel movement to promote bowel health.
c.
Long-term use of laxatives often results in decreased bowel tone and may lead to dependency.
d.
She needs to switch to glycerin suppositories to continue having daily bowel movements.

Answer 21

ANS: C
Long-term use of laxatives may lead to dependency. Patients need to be taught that daily bowel movements are not necessary for bowel health.

Question 22

A patient asks the nurse about the difference between diphenoxylate with atropine (Lomotil) and the over-the-counter drug loperamide (Imodium). Which response by the nurse is correct?
a.
“Lomotil acts faster than Imodium.”
b.
“Imodium does not cause physical dependence.”
c.
“Lomotil is available in suppository form.”
d.
“Imodium is a natural antidiarrheal drug.”

Answer 22

ANS: B
Although the drug exhibits many characteristics of the opiate class, physical dependence on loperamide has not been reported. All antidiarrheal drugs are orally administered. The other options are incorrect.

Question 23

A patient wants to prevent problems with constipation and asks the nurse for advice about which type of laxative is safe to use for this purpose. Which class of laxative is considered safe to use on a long-term basis?
a.
Emollient laxatives
b.
Bulk-forming laxatives
c.
Hyperosmotic laxatives
d.
Stimulant laxatives

Answer 23

ANS: B
Bulk-forming laxatives are the only laxatives recommended for long-term use. Stimulant laxatives are the most likely of all the laxative classes to cause dependence. The other options are incorrect.

Question 24

When administering mineral oil, the nurse recognizes that it can interfere with the absorption of which substance?
a.
Fat-soluble vitamins
b.
Water-soluble vitamins
c.
Minerals
d.
Electrolytes

Answer 24

ANS: A

Mineral oil can decrease the absorption of fat-soluble vitamins (A, D, E, and K). The other options are incorrect.

Question 25

``` The nurse is reviewing the mechanism of action of antidiarrheal drugs. Which type of antidiarrheal medication works by decreasing the intestinal muscle tone and peristalsis of the intestines? a. Adsorbents such as Pepto-Bismol b. Anticholinergics such as belladonna alkaloids c. Probiotics such as Lactinex d. Lubricants such as mineral oil ```

Answer 25

ANS: B Anticholinergic drugs work to slow peristalsis by reducing the rhythmic contractions and the smooth muscle tone of the gastrointestinal tract. The other options are incorrect.

Question 26

``` The nurse is discussing the use of adsorbents such as bismuth subsalicylate (Pepto-Bismol) with a patient who has diarrhea. The nurse will warn the patient about which possible adverse effects? a. Dark stools and blue gums b. Urinary hesitancy c. Drowsiness and dizziness d. Blurred vision and headache ```

Answer 26

ANS: A Dark stools and blue gums are two of the possible adverse effects of bismuth subsalicylate (see Table 51-2). The other adverse effects listed may occur with the use of other antidiarrheal drugs.

Question 27

``` A patient who has been on antibiotic therapy for 2 weeks has developed persistent diarrhea. The nurse expects which medication class to be ordered to treat this diarrhea? a. Lubricants b. Adsorbents c. Anticholinergics d. Probiotics ```

Answer 27

ANS: D Probiotics work by replenishing bacteria that may have been destroyed by antibiotic therapy, thus restoring the balance of normal flora and suppressing the growth of diarrhea-causing bacteria.

Question 28

``` A patient will be taking bismuth subsalicylate (Pepto-Bismol) to control diarrhea. When reviewing the patient’s other ordered medications, the nurse recognizes that which medication will interact significantly with the Pepto-Bismol? a. Acetaminophen (Tylenol), an analgesic b. Levothyroxine (Synthroid), a thyroid replacement drug c. Warfarin (Coumadin), an anticoagulant d. Fluoxetine (Prozac), an antidepressant ```

Answer 28

ANS: C The oral anticoagulant warfarin is more likely to cause increased bleeding times or bruising when co-administered with adsorbents. This is thought to be because the adsorbents bind to vitamin K, which is needed to make certain clotting factors. Vitamin K is synthesized by the normal bacterial flora in the bowel. The other options are incorrect.

Question 29

``` A laxative has been ordered for a patient. The nurse checks the patient’s medical history and would be concerned if which condition is present? a. High ammonia levels due to liver failure b. Diverticulosis c. Abdominal pain of unknown origin d. Chronic constipation ```

Answer 29

ANS: C All categories of laxatives share the same general contraindications and precautions, including avoidance in cases of drug allergy and the need for cautious use in the presence of these: acute surgical abdomen; appendicitis symptoms such as abdominal pain, nausea, and vomiting; fecal impaction (mineral oil enemas excepted); intestinal obstruction; and undiagnosed abdominal pain. The other options are possible indications for laxatives.

Question 30

A patient is severely constipated and needs immediate relief. The nurse knows that which class of laxative will provide the most rapid results? a. Bulk-forming laxative, such as psyllium (Metamucil) b. Stool softener, such as docusate salts (Colace) c. Magnesium hydroxide (MOM) d. Magnesium oxide tablets

Answer 30

ANS: C Saline laxatives such as magnesium hydroxide (MOM) produce a watery stool, usually within 3 to 6 hours of ingestion. Bulk-forming laxatives such as psyllium do not produce a bowel movement rapidly. Stool softeners such as docusate salts do not cause patients to defecate; they simply soften the stool to ease its passage. Magnesium oxide tablets are used as magnesium supplements, not as laxatives.

Question 31

``` A patient is receiving lactulose (Enulose) three times a day. The nurse knows that the patient is not constipated and is receiving this drug for which reason? a. High ammonia levels due to liver failure b. Prevention of constipation c. Chronic renal failure d. Chronic diarrhea ```

Answer 31

ANS: A Lactulose (Enulose) produces a laxative effect but also works to reduce blood ammonia levels by converting ammonia to ammonium. Ammonium is a water-soluble cation that is trapped in the intestines and cannot be reabsorbed into the systemic circulation. This effect has proved helpful in reducing elevated serum ammonia levels in patients with severe liver disease. The other options are incorrect.

Question 32

``` A patient is taking linaclotide (Linzess) to treat irritable bowel syndrome (IBS). The nurse will monitor this patient for which adverse effect? a. Chest pain b. Chronic constipation c. Abdominal pain d. Elevated blood glucose levels ```

Answer 32

ANS: C Common adverse effects of linaclotide (Linzess) are diarrhea, abdominal pain, and flatulence. Elevated blood glucose levels, chest pain, and chronic constipation are not adverse effects of linaclotide.

Question 33

The nurse is preparing to administer methylnaltrexone (Relistor), a peripherally acting opioid antagonist. This drug is appropriate for which patient? a. A patient with diarrhea b. A terminally ill patient who has opioid-induced constipation c. A patient who is scheduled for a colonoscopy d. A patient who will be having colon surgery in the morning

Answer 33

ANS: B Methylnaltrexone is approved only for terminally ill (hospice) patients who have opioid-induced constipation. The other options are incorrect.

Question 34

A patient has been treated with alosetron (Lotronex) for severe irritable bowel syndrome (IBS) for 2 weeks. She calls the clinic and tells the nurse that she has been experiencing constipation for 3 days. The nurse will take which action? a. Advise the patient to increase intake of fluids and fiber. b. Advise the patient to hold the drug for 2 days. c. Instruct the patient to stop taking the drug and to come to the clinic right away to be evaluated. d. Instruct the patient to continue the alosetron and to take milk of magnesia for the constipation.

Answer 34

ANS: C Alosetron must be discontinued immediately if constipation or signs of ischemic colitis occur. The other options are incorrect.

Question 35

``` The nurse is reviewing the uses of oral laxatives. Which conditions are general contraindications to or cautions about the use of oral laxatives? (Select all that apply.) a. Irritable bowel syndrome b. Undiagnosed abdominal pain c. Nausea and vomiting d. Fecal impaction e. Ingestion of toxic substances f. Acute surgical abdomen ```

Answer 35

ANS: B, C, D, F Cautious use of laxatives is recommended in the presence of these: acute surgical abdomen; appendicitis symptoms, such as abdominal pain, nausea, and vomiting; intestinal obstruction; and undiagnosed abdominal pain. Oral laxatives must not be used with fecal impaction; mineral oil enemas are indicated for fecal impaction. The other options are indications for laxative use.

Question 36

A 10-year-old child will be receiving docusate sodium (Colace), 120 mg/day PO, divided into 3 doses. Identify how many milligrams will the child receive per dose.

Answer 36

ANS: 40 mg | 120 mg/day / 3 doses/day = 40 mg

Question 37

A patient is receiving a tube feeding through a gastrostomy. The nurse expects that which type of drug will be used to promote gastric emptying for this patient? a. Prokinetic drugs, such as metoclopramide (Reglan) b. Serotonin blockers, such as ondansetron (Zofran) c. Anticholinergic drugs, such as scopolamine (Transderm-Scop) d. Neuroleptic drugs, such as chlorpromazine (Thorazine)

Answer 37

ANS: A Prokinetic drugs promote the movement of substances through the gastrointestinal tract and increase gastrointestinal motility.

Question 38

A patient who has AIDS has lost weight and is easily fatigued because of his malnourished state. The nurse anticipates an order for which antinausea drug to stimulate his appetite? a. Metoclopramide (Reglan), a prokinetic drug b. Dronabinol (Marinol), a tetrahydrocannabinoid c. Ondansetron (Zofran), a serotonin blocker d. Aprepitant (Emend), a substance P/NK1 receptor antagonist

Answer 38

ANS: B Dronabinol is used for the treatment of nausea and vomiting associated with cancer chemotherapy, generally as a second-line drug after treatment with other antiemetics has failed. It is also used to stimulate appetite and weight gain in patients with AIDS and in patients undergoing chemotherapy. The drugs in the other options are used to reduce or prevent nausea and vomiting but are not used to stimulate appetite.

Question 39

``` A patient on chemotherapy is using ondansetron (Zofran) for treatment of nausea. The nurse will instruct the patient to watch for which adverse effect of this drug? a. Dizziness b. Diarrhea c. Dry mouth d. Blurred vision ```

Answer 39

ANS: B Diarrhea is an adverse effect of the serotonin blockers. The other adverse effects listed may occur with anticholinergic drugs.

Question 40

``` A patient who has severe nausea and vomiting following a case of food poisoning comes to the urgent care center. When reviewing his medication history, the nurse notes that he has an allergy to procaine. The nurse would question an order for which antiemetic drug if ordered for this patient? a. Metoclopramide (Reglan) b. Promethazine (Phenergan) c. Phosphorated carbohydrate solution (Emetrol) d. Palonosetron (Aloxi) ```

Answer 40

ANS: A The use of metoclopramide (Reglan) is contraindicated in patients with a hypersensitivity to procaine or procainamide. There are no known interactions with the drugs listed in the other options.

Question 41

A mother calls the pediatrician’s office to report that her 18-month-old child has eaten half of a bottle of baby aspirin. She says, “I have a bottle of syrup of ipecac. Should I give it to him? He seems fine right now. What do I do?” What is the nurse’s best response? a. “Go ahead and give him the ipecac, and then call 911.” b. “Don’t give him the ipecac. Call the Poison Control number immediately for instructions.” c. “Please come to the office right away so that we can check him.” d. “Go ahead and take him to the emergency room right now.”

Answer 41

ANS: B The American Academy of Pediatrics no longer recommends the use of syrup of ipecac for home treatment for poisoning. Instructions state that if the poison has been ingested, first call the national poison control hotline at 800-222-1222. In all cases of poisoning, if the victim is conscious and alert, call the local poison control center. If the victim has collapsed or stopped breathing, call 911 for emergency transport to a hospital.

Question 42

A patient is taking chemotherapy with a drug that has a high potential for causing nausea and vomiting. The nurse is preparing to administer an antiemetic drug. Which class of antiemetic drugs is most commonly used to prevent nausea and vomiting for patients receiving chemotherapy? a. Prokinetic drugs, such as metoclopramide (Reglan) b. Serotonin blockers, such as ondansetron (Zofran) c. Anticholinergic drugs, such as scopolamine d. Neuroleptic drugs, such as promethazine (Phenergan)

Answer 42

ANS: B Serotonin blockers used to prevent chemotherapy-induced and postoperative nausea and vomiting. The other options are incorrect.

Question 43

A patient who has been newly diagnosed with vertigo will be taking an antihistamine antiemetic drug. The nurse will include which information when teaching the patient about this drug? a. The patient may skip doses if the patient is feeling well. b. The patient will need to avoid driving because of possible drowsiness. c. The patient may experience occasional problems with taste. d. It is safe to take the medication with a glass of wine in the evening to help settle the stomach.

Answer 43

ANS: B Drowsiness may occur because of central nervous system (CNS) depression, and patients should avoid driving or working with heavy machinery because of possible sedation. These drugs must not be taken with alcohol or other CNS depressants because of possible additive depressant effects. The medication should be taken as instructed and not skipped unless instructed to do so.

Question 44

A patient with motion sickness is planning a cross-country car trip and has a new prescription for a scopolamine transdermal patch (Transderm-Scop). The nurse provides teaching for the use of this patch medication. The patient shows a correct understanding of the teaching with which statement? a. “I will change the patch every day.” b. “I will change the patch every other day.” c. “I will change the patch every 3 days.” d. “I will remove the patch only if it stops working.”

Answer 44

ANS: C | Scopolamine patches are 72-hour doses and are changed every 3 days. The other options are incorrect.

Question 45

A woman who is in the first trimester of pregnancy has been experiencing severe morning sickness. She asks, “I’ve heard that ginger tablets may be a natural way to ease the nausea and vomiting. Is it okay to try them?” What is the nurse’s best response? a. “They are a safe and natural remedy for nausea when you are pregnant.” b. “Go ahead and try them, but stop taking them once the nausea is relieved.” c. “Some health care providers do not recommend ginger during pregnancy. Let’s check with your provider.” d. “You will need to wait until after the first trimester to try them.”

Answer 45

ANS: C There is some anecdotal evidence that ginger may have abortifacient properties, and for this reason some clinicians do not recommend its use during pregnancy.

Question 46

The nurse is reviewing new postoperative orders and notes that the order reads, “Give hydroxyzine (Vistaril) 50 mg IV PRN nausea or vomiting.” The patient is complaining of slight nausea. Which action by the nurse is correct at this time? a. Hold the dose until the patient complains of severe nausea. b. Give the dose orally instead of intravenously. c. Give the patient the IV dose of hydroxyzine as ordered. d. Call the prescriber to question the route that is ordered.

Answer 46

``` ANS: D The nurse needs to question the route. Hydroxyzine (Vistaril) is an antihistamine-class antiemetic that is only to be given either by oral or intramuscular routes. It may be easy to make the mistake of giving hydroxyzine intravenously because many other antiemetics are given by that route. It is important to note that intravenous, intra-arterial, or subcutaneous administration of hydroxyzine may result in significant tissue damage, thrombosis, and gangrene. The nurse cannot change the route of an ordered medication without a prescriber’s order. Antiemetic drugs are best given before the patient’s nausea become severe. ```

Question 47

A patient is on a chemotherapy regimen in an outpatient clinic and is receiving a chemotherapy drug that is known to be highly emetogenic. The nurse will implement which interventions regarding the pharmacologic management of nausea and vomiting? (Select all that apply.) a. Giving antinausea drugs at the beginning of the chemotherapy infusion b. Administering antinausea drugs 30 to 60 minutes before chemotherapy is started c. For best therapeutic effects, medicating for nausea once the symptoms begin d. Observing carefully for the adverse effects of restlessness and anxiety e. Instructing the patient that the antinausea drugs may cause extreme drowsiness f. Instructing the patient to rise slowly from a sitting or lying position because of possible orthostatic hypotension

Answer 47

ANS: B, E, F Antiemetics should be given before any chemotherapy drug is administered, often 30 to 60 minutes before treatment, but not immediately before chemotherapy is administered. Do not wait until the nausea begins. Most antiemetics cause drowsiness, not restlessness and anxiety. Orthostatic hypotension is a possible adverse effect that may lead to injury.

Question 48

An adult patient is about to receive intravenous (IV) ondansetron (Zofran) during a chemotherapy treatment. A dose of 0.15 mg/kg IV 30 minutes before chemotherapy is ordered. The patient weighs 140 pounds. The medication is supplied in a vial marked 2 mg/mL for IV administration. Identify how many milliliters will the nurse administer for this dose. (record answer to one decimal place)

Answer 48

ANS: 4.8 mL Convert pounds to kilograms: 140 / 2.2 = 63.6 kg. Calculate milligrams per dose: 0.15 mg/kg x 63.6 kg = 9,54 = 9.5 mg/dose Calculate milliliters to be given: 2 mg : 1 mL :: 9.5 mg : x mL (2 x x) = (1 x 9.5); 2x = 9.5, x = 4.75, which rounds to 4.8 mL