GI + Liver

Question 1

Sodium bicarbonate

Answer 1

Question 2

Cimetidine

Answer 2

Question 3

Omeprazole

Answer 3

Question 4

Sucralfate

Answer 4

Question 5

Ondansetron

Answer 5

Question 6

Docusate

Answer 6

Question 7

Bisacodyl

Answer 7

Question 8

Polyethylene glycol

Answer 8

Question 9

Loperamide

Answer 9

Question 10

Lactulose

Answer 10

Question 11

What are common disorders of the upper GI?

Answer 11

— heartburn
— GERD
— peptic ulcer disease
— duodenal ulcer

Question 12

Which drugs are for upper GI secretions?

Answer 12

— sodium bicarbonate
— cimetidine
— Omeprazole
— Sucralfate

Question 13

Drugs used for GI motility:

Answer 13

— docusate
— Bisacodyl
— polyethylene glycol
— loperamide

Question 14

What do you focus on with assessment?

Answer 14

Baseline hx and prognosis including allergies and medications
— FOCUS: GI and abdominal assessment related to disorder/AE

FOLLOW ADMIN PROTOCOL

Question 15

Education:

Answer 15

— non-pharm interventions
— proper admin
— shortest duration to reduce risk of AE

Question 16

What are examples of non-pharm interventions?

Answer 16

Eating small meals
Sitting up after admin of drug + meals

Question 17

What are common adverse affects with your GI secretion drugs?

Answer 17

— nausea
— vomiting
— diarrhea
— constipation
— abd discomfort
— rash

Question 18

When reviewing the health hx of a pt prescribed an antacid, the nurse knows that antacids containing magnesium need to be used cautiously in patients with which condition?

A. HTN
B. Renal failure
C. Peptic ulcer disease
D. HF

Answer 18

B. Renal failure

Both calcium and magnesium based antacids are more likely to accumulate to toxic levels in pts with renal disease. Pts with renal failure cannot regulate electrolytes

Question 19

A client has taken Omeprazole for many years; which test should the nurse anticipate the HCP will order to assess for a potential complication?

A. EGD
B. Creatinine
C. Bone density scan
D. H. Pylori test

Answer 19

C. Bone density scan

Long term use of PPIs have a potential to develop osteoporosis

Question 20

Nursing assessment with laxatives:

Answer 20

Baseline
Focused: bowel sounds, I&O, electrolytes

CONTRAINDICATED IN ACUTE BOWEL DISORDERS such as lieu’s, obstruction, ischemia, perforation
*laxatives will not help these issues

Question 21

What are some adverse effects with laxatives? What is the therapeutic effect?

Answer 21

— LOOSE STOOLS (diarrhea); hold medication if pt is having frequent BM
— nausea
— vomiting
— abd pain
— DEHYDRATION
— ELECTROLYTE IMBALANCE

Therapeutic effect:
Achievement of soft BM within 24hr of admin of laxative

Question 22

Implementation and teaching of laxatives:

Answer 22

Implementation:
— HOLD if loose stool
— encourage 3L water daily, high fiber diet, increase activity
— if multiple laxative orders: admin Docusate FIRST (most gentle); use Bisacodyl next then polyethylene

Teaching:
— do not take laxative if experiencing nausea, vomiting, abd pain
— contact provider if experiencing SEVERE abd pain, muscle weakness, cramps, dizziness
— do not use laxative for more than 7 days; can develop dependency

Question 23

What are contraindications for anti-diarrheals?

Answer 23

— diarrhea caused by poisoning or by bacterial toxins
— acute abd disorders including GI obstructions

Question 24

What is the therapeutic effect for anti-diarrheals?

Answer 24

Decrease number of BM

Question 25

Teaching for anti-diarrheal

Answer 25

— take as prescribed; overuse can lead to constipation — notify HCP is symptoms persist after 2 days or experiencing signs of dehydration (may need fluids to replace from diarrhea) — DO NOT USE FOR INFECTIOUS DIARRHEA can make it worse — keep hydrated: 3L water/day

Question 26

The nurse is reviewing the uses of oral laxatives. Which conditions are general contraindications or cautions for the use of oral laxatives? A. Nausea + vomiting B. Ingestion of toxic substances C. Undiagnosed abdominal pain D. Fecal impaction E. Acute surgical abdomen F. Irritable bowel syndrome

Answer 26

A, C, D, E Mineral oil enemas are used for fecal impaction

Question 27

Assessment with antiemetics:

Answer 27

Focus: GI, I&O, neuro/LOC — s/s of dehydration, electrolyte imbalance from vomiting — fall risk — drug-drug: CNS DEPRESSANTS

Question 28

Implementation of antiemetic drugs:

Answer 28

Give PRN medication as appropriate (Ondansetron is first line tx) — use least invasive — VERIFY ROUTE Preventative therapy: admin 30-60 min prior to chemo dose or end of surgery

Question 29

What are the different routes for antiemetic drugs? What route with you use if the pt is vomiting?

Answer 29

— oral — oral disintegrating tablet — transdermal patch — suppository — IM — IV Oral preffered; if pt is vomiting used alternative route — suppository used in hospice

Question 30

Teaching and therapeutic effect:

Answer 30

Teach: — timing of admin; take before other medications for antiemetic to have effect — do not operate heavy machinery; sedation FALL RISK Therapeutic effect: Absence of nausea/vomiting AE: drowsiness, dizziness, CV FALL RISK

Question 31

What is hepatic encephalopathy?

Answer 31

Liver cirrhosis, increase in ammonia levels Tx: Lactulose — excretes ammonia in stool — loose stools are expected in therapeutic effect Liver metabolizes ammonia to urea — Ammonia stays in blood stream, going to the brain leading to toxicity; confusion

Question 32

The nurse is teaching a client who has been prescribed an antiemetic. What should the nurse include in the teaching? A. Occasional problems with taste may be experienced B. It is safe to take med with glass of wine C. Avoid driving as medication can cause drowsiness D. Periodic monitor BP

Answer 32

C

Question 33

The nurse is caring for a client prescribed Ondansetron and baclofen. The nurse should prioritize which assessment? A. Bowel sounds B. LOC C. Intake and output D. ROM

Answer 33

B. LOC Combo of these drugs = drowsiness; fall risk. Bowel sounds and I&O are a priority with Ondansetron, but not with baclofen.