1. A patient is prescribed an aluminum-containing antacid for hyperacidity.

The nurse
should inform the patient about which possible adverse effect?
a. Diarrhea
b. Flatulence
c. Constipation
d. Muscle twitching
2. After reviewing the prescriptions of a patient with constipation, the nurse advises the patient
to avoid taking a particular medication at bedtime. Which medication did the nurse likely find in
the patient's prescriptions?1
1. Psyllium

2 Castor oil
3 Polyethylene glycol
4. Bismuth subsalicylate

- Castor oil is a purgative with an onset of action of 2 to 6 hours after administration. If the patient
takes this medication before going to bed, the patient may experience sleep disturbance or may
 suffer from fecal incontinence. Therefore, the nurse advises the patient to avoid taking castor oil
at bedtime.

3. Which is the mechanism of action of a proton pump inhibitor?

1. Reacts with gastric acid to form neutral salts
2. Forms a barrier over the ulcer crater to protect it from acid and pepsin
Correct
3. Suppresses acid secretion by inhibiting the enzyme that makes gastric acid
4. Eradicates the H. pylori that is associated with the ulceration of the mucosa
Proton pump inhibitors are antisecretory agents which suppress acid secretion by inhibiting the enzyme
that makes gastric acid. Antacids react with gastric acid to form neutral salts. A mucosal protectant is
prescribed to form a barrier over the ulcer crater to protect it from acid and pepsin. An antibacterial drug is
prescribed to eradicate H. pylori.

4.A patient with renal impairment requires bowel cleansing before a diagnostic procedure. The
nurse prepares to administer which laxative?
a. Mineral oil
b. Docusate sodium
c. magnesium sulfate
d. polyethylene glycol- electrolyte solution
i. Polyethylene glycol electrolyte solution, an osmotic laxative, produces a watery
stool in 2 to 6 hours. It is isosmotic with body fluids so it causes no fluid or
electrolyte imbalance and thus can be used safely in patients with an electrolyte
impairment.

5. A nurse is planning care for a patient who has peptic ulcer disease and is taking amoxicillin.
The nurse is aware that amoxicillin has which mechanism of action?
a. Coating of the ulcer crater as a barrier to acid
b. Inhibition of an enzyme to block acid secretion
c. Selective blockade of parietal cell histamine 2 receptors
d. Disruption of the bacterial cell wall, causing lysis and death

6. The nurse should associate which factor(s) with the pathophysiology of peptic ulcer disease?
Select all that apply.
a. Poor submucosal gastric blood flow
b. Increased synthesis of prostaglandins
c. Presence of Zollinger-Ellison syndrome
d. Reduced stomach production of bicarbonate
e. Haemophilus influenzae
i. Peptic ulcers develop when an imbalance exists between mucosal defensive factors and
aggressive factors. Sufficient blood flow to cells of the gastrointestinal mucosa is needed
to maintain integrity. In Zollinger-Ellison syndrome, hypersecretion of acid alone causes
 ulcers by overcoming mucosal defenses. Bicarbonate is needed to neutralize hydrogen
ions. Prostaglandins are needed to stimulate mucus and bicarbonate to maintain mucosal
blood flow. Helicobacter pylori, not Haemophilus influenzae, is a bacillus that can disrupt
the protective mucosal layer when colonized in the GI tract.
7. A nurse administers which medication to inhibit an enzyme that makes gastric acid in a
patient who has a duodenal ulcer?
a. Ranitidine
b. Famotidine
c. Misoprostol
d. Omeprazole
i. Omeprazole causes irreversible inhibition of the proton pump, the enzyme that
generates gastric acid. It is a powerful suppressant of acid secretion. Famotidine
and ranitidine block histamine 2 receptors on parietal cells. Misoprostol protects
against ulcers caused by nonsteroidal anti-inflammatory drugs by stimulating the
secretion of mucus and bicarbonate to maintain submucosal blood flow.

8.A patient reports abdominal bloating and infrequent, small, hard stools after taking psyllium for
2 weeks. Which is the nurse's priority action?
a. Consult the physician about another laxative choice.
b. Check the dose because an increase may be indicated.
c. Ask whether the patient is toileting at the same time every day.
d. Ask whether the patient is using at least 8 ounces of fluid to prepare the
psyllium.
i. Bulk-forming laxatives, such as psyllium, must be given with at least 8 ounces (240
mL) of liquid, plus additional liquid each day, to prevent intestinal impaction.
Another laxative may not be necessary at this time. A dosage increase and
monitoring are appropriate after proper mixing of the medication has been
validated.

9. A patient going on a vacation cruise is prescribed a scopolamine transdermal patch for motion
sickness. The nurse teaches the patient to recognize which side effect?
a. Irritability
b. Dry mouth
c. Urinary frequency
d. Increased heart rate
i. Scopolamine blocks the binding of acetylcholine with cholinergic receptors in the inner
ear, an imbalance that is a common cause of motion sickness. The most common side
effects are dry mouth, blurred vision, and drowsiness. Urinary retention occurs less
frequently. An increased heart rate and irritability are not associated effects.
10.An elderly, critically ill patient who was hospitalized underwent gastric surgery 1 week ago.
The caregiver reports that the patient has seemed confused for the past 2 to 3 days. Which drug
would most likely have caused this symptom in the patient?
a. Sucralfate
b. Misoprostol
c. Cimetidine
d. Pantoprazole
i. Cimetidine is an H 2 receptor antagonist that is associated with confusion and
disorientation as adverse effects in elderly patients. Sucralfate is an agent that protects
against ulcers. It is not prescribed for critically ill patients. Misoprostol is a prostaglandin
analogue associated with adverse effects such as gastrointestinal distress, bleeding in
the vagina, and headache. Pantoprazole is a proton pump inhibitor associated with
gastric tumors.

11.A patient is prescribed lorazepam and a glucocorticoid during chemotherapy treatments.

What is the nurse's best action?
a. Call the healthcare provider and question the order.
b. Administer the two medications at least 12 hours apart.
c. Administer the medications and assess the patient for relief.
d. Only administer the lorazepam if the patient seems anxious.
i. Drug combination therapy is commonly used to manage chemotherapy-induced nausea
and vomiting. Both lorazepam and the glucocorticoids have been found to be effective
medications to assist in preventing and managing chemotherapy-induced nausea and
vomiting. The nurse should not question the order. The lorazepam is not being
administered for anxiety, and the two medications do not have to be given 12 hours apart.

12.Which increases the concentration of gastric acids?

a. Hypersecretion of parietal cells

b. Inhibition of proton pump activity
c. Inhibition of acetylcholine receptors
d. Hypersecretion of proteolytic enzymes
i. Hydrochloric acid, which is necessary for digestion, is secreted by the parietal cells lining
the stomach. Hypersecretion of these cells causes acidity or more severe disorders.

13.A patient who is hospitalized for a fractured hip develops abdominal pain and is diagnosed
with a gastric ulcer. Which drug will the primary healthcare provider likely order?
 a. Sucralfate
b. Misoprostol
c. Omeprazole
d. Lansoprazole
i. Sucralfate is known to act locally by forming a protective barrier (mucus) against pepsin
on the surface of the ulcer, healing the ulcer. Therefore, the nurse should administer
sucralfate. Since the patient has a fractured hip, misoprostol would not be prescribed
because of probable adverse effects such as diarrhea. Proton pump inhibitors such as
omeprazole and lansoprazole are known to stimulate bone mineral loss and thus may
interfere with the healing of the bone.

14. A patient reports vomiting blood. Upon further analysis, the patient is diagnosed with
increased production of gastric acid. Which drug should the nurse anticipate being included in
the treatment plan?
a. Famotidine
b. Misoprostol
c. Simethicone
d. Lansoprazole
i. Lansoprazole is a proton pump inhibitor that inhibits the proton pump and thereby
decreases the acid levels in the stomach. The proton pump is stimulated by the release
of calcium ions that occurs when gastrin receptors bind to gastrin and inhibits the
production of gastric acid. Misoprostol is a prostaglandin analogue that protects the lining
of the gastrointestinal tract from stomach acids but does not reduce or inhibit the
production of acids. Famotidine is an H 2 receptor antagonist that inhibits the binding of H
2 receptors to histamine, but it has no effect on gastrin receptors. Simethicone is an
antiflatulent drug and has no effect on the secretion of acid in the stomach

15. The use of a sodium-based antacid is contraindicated in which group of patients?

a. Patients with Infections
b. Patient with renal failure
c. patients with heart failure
d. Patient with low bone density
i. Sodium-based antacids have adverse effects on patients with heart failure because the
sodium content in these formulations is very high. Sodium-based antacids can be taken
by patients suffering from renal disorders because they are easily excreted. Patients with
infection can also consume sodium-based antacids in low doses since the acids protect
the system from infection. Patients with a low bone density are advised not to consume
aluminum-based antacids.
16. A patient who has had a pancreatectomy is taking pancrelipase. Which finding would the
nurse use to evaluate the effectiveness of this drug?
a. Increase in flatulence
b. Resolution of jaundice
c. Reduction in fatty stools
d. Decrease in abdominal distention
i. A deficiency of pancreatic enzymes through pancreatectomy or pancreatitis may
compromise digestion, especially the digestion of fats. Fatty stools are characteristic of
 the deficiency. Replacement of pancreatic enzymes with pancrelipase results in a
reduction of fat excretion through the stools. An increase in flatulence, resolution of
jaundice, and a decrease in abdominal distention are not therapeutic effects of
pancrelipase.

17.The nurse reviews the patient's medication record and notes the following: sucralfate 1 gram
orally 4 times daily before meals (7:30 AM, 11:30 AM, and 4:30 PM) and at bedtime (10:00 PM);
phenytoin 200 mg orally daily at 8:00 AM. Which modifications, if any, should be made to the
medication regimen?
a. The medications can be administered as ordered.
b. The nurse should obtain a prescriber order to administer the phenytoin at 9:30 AM daily.
c. The nurse should obtain a prescriber order for intravenous phenytoin to avoid a drug interaction.
d. The nurse should administer the phenytoin with the 7:30 AM dose of sucralfate,
because this is more time efficient.
i. Sucralfate can impede the absorption of phenytoin; therefore, a period of 2 hours should
separate these drugs. The nurse should consult the prescriber for a time administration
change. Based on this information, it is not appropriate to administer the drugs as
ordered, switch the phenytoin to the IV form, or administer the phenytoin with the
sucralfate.

18. A patient is admitted to the intensive care unit after a myocardial infarction. The provider has
ordered drugs to prevent gastrointestinal disorders. Which is a likely reason for administering
acid-controlling drugs?
a. The patient is prone to stress ulcers.
b. The patient's stress levels are treated by these drugs.
c. The general procedures for the treatment include these drugs.
d. The adverse effects of the treatment are treated by these drugs.
i. A critically ill patient is prone to stress-related mucosal damage. Therefore, these patients
should be prescribed a histamine receptor blocker or a proton pump inhibitor. The
patient's stress levels can cause gastrointestinal disorders, but these drugs do not lower
stress levels. The general procedures performed on the patients, such as the use of
nasal tubes or feeding tubes, only increase the chances of gastrointestinal disorders.
Adverse effects are specific to the type of treatment received and can be addressed by
specific drugs.

19. How do H 2 receptor antagonists reduce the secretion of acids?

a. By blocking the H 2 receptors
b. By stimulating gastrin receptors
c. By blocking acetylcholine receptors
d. By stimulating acetylcholine receptors
i. H 2 receptor antagonists block H 2 receptors and stop the secretion of acids by parietal
cells. H 2 receptor antagonists do not block acetylcholine receptors. They make parietal
 cells unresponsive to the stimulation of acetylcholine and gastrin receptors. H 2 receptor
antagonists do not directly affect gastrin and acetylcholine receptors.

20. A patient who has cirrhosis also has severe constipation. The laboratory reports show an
increase in serum ammonia levels. Which medication will most benefit the patient?
a. Bisacodyl
b. Lactulose
c. Magnesium oxide
d. Magnesium citrate
i. Lactulose is an osmotic laxative that causes retention of water in the intestines and
promotes stool softening. It also eliminates excess ammonia through fecal matter.
Therefore, lactulose will benefit the patient by removing excess serum ammonia from the
body. Bisacodyl is a stimulant laxative. It is used to relieve constipation, but does not
affect ammonia levels. Magnesium oxide and magnesium citrate are osmotic laxatives.
These medications are effective in relieving constipation but do not facilitate elimination of
excess ammonia and may temporarily elevate magnesium levels. Therefore, these
medications are not beneficial to patients with increased serum ammonia levels.

21. Which medication, if prescribed for a patient, would prompt the nurse to administer a human
chorionic gonadotropin (hCG) test?
a. Cimetidine
b. Misoprostol
c. Lansoprazole
d. Calcium carbonate

i.
The use of misoprostol is contraindicated for pregnant women because it is classified under
pregnancy category X and is known for its abortifacient property. Therefore, the nurse should verify that
the patient isn't pregnant with an hCG test prior to administration. Cimetidine is an H 2 receptor antagonist,
and lansoprazole is a proton pump inhibitor. Both are classified under pregnancy category B and can be
safely administered to pregnant women. Calcium carbonate is a calcium-containing antacid classified
under pregnancy category A. Drugs that are classified under pregnancy categories A and B are safe for
pregnant woman and cause no adverse effects.

22.An 80-year-old patient with a history of renal insufficiency recently was started on cimetidine.
Which assessment finding indicates that the patient may be experiencing an adverse effect of
the medication?
a. +3 pitting edema
b. Pain with urination
c. New onset of disorientation to time and place
d. Heart rate changes from a baseline of 70 to 80 beats/min to 110 to 120 beats/min
i. Effects on the central nervous system are most likely to occur in elderly patients
who have renal or hepatic impairment. Patients may experience confusion,
hallucinations, lethargy, restlessness, and seizures. Pitting edema, dysuria, and
tachycardia are not adverse effects of cimetidine.

23. The nurse prepares to administer a bisacodyl suppository to a patient who has not had a
bowel movement in several days. When should the nurse administer the PRN medication?
a. In the evening before bed
b. In the afternoon before lunch
c. In the morning after breakfast
d. In the morning before breakfast
i. Bisacodyl suppositories act rapidly (in 15 to 60 minutes). They can be given at any time,
but for patient convenience, they should not be given at bedtime to avoid disrupting
sleep. For convenience and patient ease, a fast-acting laxative should not be given
before a meal, which could cause the urge to have a bowel movement during the meal.

24. After reviewing a patient's medication history, the nurse finds that the patient is at risk for
laxative abuse. Which medication did the nurse likely find in the patient's medication history?
a. Bisacodyl
b. Loperamide
c. Dimenhydrinate
d. Bismuth subsalicylate
i. Bisacodyl is a stimulant laxative that is available over the counter, so it is easily
accessible to patients. If a patient uses it frequently, there is a risk for laxative
abuse. Loperamide, dimenhydrinate, and bismuth subsalicylate are not laxatives.
Loperamide is an antidiarrheal drug that helps in the treatment of diarrhea by
reducing peristalsis. Bismuth subsalicylate is an over-the-counter antidiarrheal drug
that absorbs the bacteria and toxins that cause diarrhea. It is used to alleviate
diarrhea. Dimenhydrinate is an antihistamine that is available over the counter.
 Dimenhydrinate blocks the histamine receptors that trigger vomiting, thereby
reducing nausea. Dimenhydrinate is not used to treat constipation.

e.
25. The nurse is reviewing the prescriber's orders and notes that omeprazole has been ordered
for a patient admitted with acute coronary syndrome. The nurse should be concerned if this
medication is combined with which other medication noted on the patient's record?
a. Aspirin 81 mg daily
b. Clopidogrel 75 mg daily
c. Metoprolol 50 mg every 8 hours
d. Heparin 5000 units subcutaneous every 12 hours
i. For patients who lack risk factors for gastrointestinal (GI) bleeding, combined use
of clopidogrel with a proton pump inhibitor such as omeprazole may reduce the
effects of clopidogrel without offering any real benefits and thus should be avoided.
This is due to inhibition of CYP2C19, which converts the drug to its active form.
Nothing in the question indicates that the patient is at risk for GI bleeding.
Coadministration with aspirin, metoprolol, or heparin is not cause for concern.

26. A patient who was using antacids for a week reports having an upset stomach and liquid
bowel movements. After reviewing the patient's record, the nurse asks the patient to
immediately stop taking the antacid. Which over-the-counter antacid is the patient likely
consuming?
a. Calcium carbonate
b. Aluminum hydroxide
c. Sodium bicarbonate
d. Magnesium hydroxide.
i. Magnesium hydroxide is an antacid that contains magnesium and is known to
cause diarrhea if used over the long term, so the nurse should ask the patient to
immediately stop taking the antacid. Aluminum hydroxide is an aluminum-based
antacid that can cause constipation and other severe conditions such as
hypercalcemia. The combination of magnesium- and aluminum-based antacids can
nullify the adverse effects caused by each. Calcium carbonate is a calcium-based
antacid known to cause nausea and vomiting, as well as severe conditions such as
kidney stones. Sodium bicarbonate is a sodium-based antacid known to cause
metabolic alkalosis if used over the long term. It also causes adverse effects in
patients with cardiac problems.

27. A nurse teaches a patient who has ulcerative colitis about the side effects of the treatment
medication, sulfasalazine. Which statement by the patient would indicate understanding of the
information?
a. "I may have constipation, so I'll increase my fluid intake."
b. "My tongue may become discolored and my taste altered."
c. "I'll report any fatigue or sore throat and fever to my doctor."
d. "I'll immediately report any chest pain or shortness of breath."
i. Sulfasalazine is used to treat ulcerative colitis by suppressing inflammation. It has the
adverse hematologic effects of agranulocytosis, hemolytic anemia, and macrocytic
anemia. Patients should report any signs of infection and/or fatigue. Altered taste, tongue
discoloration, constipation, chest pain, and shortness of breath are not effects associated
with sulfasalazine.
28. Instruction by the nurse regarding alcohol abstinence is essential when a patient will be
discharged taking which medication?
a. Tetracycline
b. Metronidazole
c. Clarithromycin
d. Bismuth subsalicylate
i. A disulfiram-like reaction can occur if metronidazole is used with alcohol; therefore,
alcohol must be avoided during treatment with this drug. Although the use of
alcohol is not promoted in patients who take tetracycline, clarithromycin, or bismuth
subsalicylate, it does not create an adverse reaction.

29. Which instruction should the nurse give a patient who is to take bismuth subsalicylate for
eradication of H. pylori?
a. "Nausea and diarrhea are common side effects."
b. "Do not drink alcohol while taking this medication."
c. "The drug can cause your bowel movements to be black."
d. "Take the medication through a straw to prevent staining of your teeth."
i. Bismuth may impart a harmless black coloration to the tongue and the stool, and
patients should be forewarned of this effect.Nausea and diarrhea are the most
common side effects of clarithromycin, which also is used to treat H. pylori. Alcohol
must be avoided when the patient is treated with metronidazole for H. pylori
infection because it may cause a disulfiram-like reaction. Tetracycline, which is also
highly active against H. pylori, can cause staining of developing teeth.