Chapter 80 - GI Medications and Antimetics

Question 1

1. A nurse caring for a patient who is undergoing a third round of chemotherapy is preparing to administer ondansetron [Zofran] 30 minutes before initiation of the chemotherapy. The patient tells the nurse that the ondansetron did not work as well the last time as it had the first time. What will the nurse do?
   a.
   Administer the ondansetron at the same time as the chemotherapy.
   b.
   Contact the provider to suggest using high-dose intravenous dolasetron [Anzemet].
   c.
   Request an order to administer dexamethasone with the ondansetron.
   d.
   Suggest to the provider that loperamide [Lomotil] be given with the ondansetron.

Answer 1

C

Question 2

2. A pregnant patient who is taking ondansetron [Zofran] for morning sickness tells the nurse she is experiencing headache and dizziness. What will the nurse tell her?
   a.
   It is not safe to take this drug during pregnancy.
   b.
   These are common side effects of ondansetron.
   c.
   She should stop taking the ondansetron immediately.
   d.
   She should report these adverse effects to her provider.

Answer 2

B

Question 3

3. A patient is being treated for chemotherapy-induced nausea and vomiting (CINV) with ondansetron [Zofran] and dexamethasone. The patient reports getting relief during and immediately after chemotherapy but has significant nausea and vomiting several days after each chemotherapy treatment. What will the nurse do?
   a.
   Contact the provider to discuss increasing the dose of ondansetron.
   b.
   Suggest giving prolonged doses of dexamethasone.
   c.
   Suggest adding aprepitant [Emend] to the medication regimen.
   d.
   Tell the patient to ask the provider about changing the ondansetron to aprepitant.

Answer 3

C

Question 4

4. A patient is receiving intravenous promethazine [Phenergan] 25 mg for postoperative nausea and vomiting. What is an important nursing action when giving this drug?
   a.
   Giving the dose as an IV push over 3 to 5 minutes
   b.
   Infusing the dose with microbore tubing and an infusion pump
   c.
   Observing the IV insertion site frequently for patency
   d.
   Telling the patient to report dry mouth and sedation

Answer 4

C

Question 5

5. A nursing student is discussing with a nurse the plan of care for a patient about to undergo a third round of chemotherapy with cisplatin. Which statement by the nursing student about the treatment of CINV is correct?
   a.
   “Aprepitant [Emend] will be necessary to treat CINV caused by cisplatin.”
   b.
   “Antiemetics are most effective if given just as the chemotherapy is finished.”
   c.
   “Lorazepam probably would not be helpful for this patient.”
   d.
   “This patient will need intravenous antiemetics for best effects.”

Answer 5

A

Question 6

6.	A patient who is in her first trimester of pregnancy asks the nurse to recommend nonpharmaceutical therapies for morning sickness. What will the nurse suggest?
a.
Avoiding fatty and spicy foods
b.
Consuming extra clear fluids
c.
Eating three meals daily
d.
Taking foods later in the day

Answer 6

A

Question 7

7. A patient who experiences motion sickness is about to go on a cruise. The prescriber orders transdermal scopolamine [Transderm Scop]. The patient asks the nurse why an oral agent is not ordered. The nurse will explain that the transdermal preparation:
   a.
   can be applied as needed at the first sign of nausea.
   b.
   has less intense anticholinergic effects than the oral form.
   c.
   is less sedating than the oral preparation.
   d.
   provides direct effects, because it is placed close to the vestibular apparatus of the ear.

Answer 7

B

Question 8

8. A nurse explains to a nursing student why opioid antidiarrheal medications are classified as drugs with little or no abuse potential. Which statement by the student indicates a need for further teaching?
   a.
   “Formulations for the treatment of diarrhea have very short half-lives.”
   b.
   “Opioid antidiarrheal drugs contain other drugs with unpleasant side effects at higher doses.”
   c.
   “Some opioid antidiarrheal drugs do not cross the blood-brain barrier.”
   d.
   “Some opioid antidiarrheal medications are not water soluble and cannot be given parenterally.”

Answer 8

A

Question 9

9. A patient is taking bismuth subsalicylate [Pepto-Bismol] to prevent diarrhea. The nurse performing an assessment notes that the patient’s tongue is black. What will the nurse do?
   a.
   Assess further for signs of gastrointestinal (GI) bleeding.
   b.
   Reassure the patient that this is an expected side effect of this drug.
   c.
   Request an order for liver function tests to evaluate for hepatotoxicity.
   d.
   Withhold the drug, because this is a sign of bismuth overdose.

Answer 9

B

Question 10

10. A patient is preparing to travel to perform missionary work in a region with poor drinking water. The provider gives the patient a prescription for ciprofloxacin [Cipro] to take on the trip. What will the nurse instruct this patient to do?
    a.
    Combine the antibiotic with an antidiarrheal medication, such as loperamide.
    b.
    Start taking the ciprofloxacin 1 week before traveling.
    c.
    Take 1 tablet of ciprofloxacin with each meal for best results.
    d.
    Use the drug if symptoms are severe or do not improve in a few days.

Answer 10

D

Question 11

11. A nurse is admitting a patient to the hospital who reports having recurrent, crampy abdominal pain followed by diarrhea. The patient tells the nurse that the diarrhea usually relieves the pain and that these symptoms have occurred daily for the past 6 months. The patient undergoes a colonoscopy, for which the findings are normal. The nurse will plan to teach this patient to:
    a.
    use antispasmodic medications.
    b.
    avoid food containing lactose and gluten.
    c.
    keep a food, stress, and symptom diary.
    d.
    use antidiarrheal drugs to manage symptoms.

Answer 11

C

Question 12

12. A nurse is providing teaching to a nursing student about to care for a woman with irritable bowel syndrome with diarrhea (IBS-D) who is receiving alosetron [Lotronex]. Which statement by the student indicates a need for further teaching?
    a.
    “I should evaluate the patient’s abdomen for distension and bowel sounds.”
    b.
    “Patients with diverticulitis and IBS-C may take this drug.”
    c.
    “This drug can cause ischemic colitis in some patients.”
    d.
    “This drug is given only to women with severe IBS-D.”

Answer 12

B

Question 13

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

Answer 13

B

Question 14

14. A nurse is discussing the use of immunosuppressants for the treatment of inflammatory bowel disease (IBD) with a group of nursing students. Which statement by a student indicates understanding of the teaching?
    a.
    “Azathioprine [Imuran] helps induce rapid remission of IBD.”
    b.
    “Cyclosporine [Sandimmune] can be used to induce remission of IBD.”
    c.
    “Cyclosporine [Sandimmune] does not have serious adverse effects.”
    d.
    “Methotrexate is used long term to maintain remission of IBD.”

Answer 14

B

Question 15

15. A patient with Crohn’s disease will begin receiving an initial infusion of infliximab [Remicade]. The nurse explains how this drug works to treat this disease. Which statement by the patient indicates a need for further teaching?
    a.
    “I may have an increased risk of infections, such as tuberculosis, when taking infliximab.”
    b.
    “I should report chills, fever, itching, and shortness of breath while receiving the infusion.”
    c.
    “This drug sometimes provides a complete cure of inflammatory bowel disease.”
    d.
    “I will take the second dose in 2 weeks, the third dose in 6 weeks, and then a dose every 8 weeks thereafter.”

Answer 15

C

Question 16

16. A nurse is caring for a patient with cancer who has been undergoing chemotherapy. The patient has oral mucositis as a result of the chemotherapy, and the provider has ordered palifermin [Kepivance]. Which is an appropriate nursing action when giving this drug?
    a.
    Administering the drug as a slow IV infusion
    b.
    Flushing the IV line with heparin before infusing the drug
    c.
    Giving the drug within 6 hours of the chemotherapy
    d.
    Warning the patient about the potential for distortion of taste

Answer 16

D

Question 17

17. A patient with gastroesophageal reflux disease (GERD) is to begin taking oral metoclopramide [Reglan]. The patient asks the nurse about the medication. Which response by the nurse is correct?
    a.
    “After 3 months, if the drug is not effective, you may need to increase the dose.”
    b.
    “Metoclopramide may cause hiccups, especially after meals.”
    c.
    “Serious side effects may occur but will stop when the drug is discontinued.”
    d.
    “You should take the drug 30 minutes before each meal and at bedtime.”

Answer 17

D

Question 18

18. A patient who has traveler’s diarrhea asks the nurse about using loperamide to stop the symptoms. What will the nurse tell the patient about this drug?
    a.
    “Loperamide is used for moderate to severe symptoms only.”
    b.
    “This drug is useful as prophylaxis to prevent symptoms.”
    c.
    “This drug is only effective to treat certain infectious agents.”
    d.
    “Use of this drug may prolong symptoms by slowing peristalsis.”

Answer 18

D

Question 19

1. Which patients would be candidates for the use of dronabinol [Marinol] to treat nausea and vomiting? (Select all that apply.)
   a.
   A patient with a history of a psychiatric disorder
   b.
   A patient with acquired immunodeficiency syndrome (AIDS)–induced anorexia
   c.
   A patient with chemotherapy-induced nausea and vomiting
   d.
   A patient with nausea who has used marijuana in the past
   e.
   A patient with postoperative nausea and vomiting

Answer 19

B. C. D.

Question 20

2.	Which types of drugs are used to treat inflammatory bowel disease (IBD)? (Select all that apply.)
a.
Aminosalicylates
b.
Glucocorticoids
c.
Immunomodulators
d.
Opioid antidiarrheals
e.
Sulfonamide antibiotics

Answer 20

A. B. C.