Gastrointestinal Nursing Care Scenarios
(Gastrointestinal Nursing Care Scenarios)
Question 1 A 42-year-old man is being treated for a peptic ulcer with ranitidine (Zantac) taken PO at bedtime. Even though few adverse effects are associated with this drug, one common adverse effect that can be severe is
A) headache
B) irritability
C) dry mouth
D) heart palpitations
Question 2 A patient on 5-FU calls the clinic and reports that he has between five and seven loose bowel movements daily. The nurse will instruct the patient to
A) treat the diarrhea with OTC medications
B) avoid protein-rich foods
C) avoid grapefruit and grapefruit juice
D) notify the clinic if the stools are black or if there is evidence of blood
Question 3 A patient has been prescribed a histamine-2 (H2) receptor antagonist for the treatment of GERD. Why are H2RAs more effective than H1 receptor antagonists in the treatment of diseases of the upper GI tract?
A) H2RAs have a longer duration of action and fewer adverse effects than H1RAs
B) The parietal cells of the stomach have H2 receptors but not H1 receptors
C) H2RAs may be administered orally and in an outpatient environment but H1RAs require intravenous administration
D) H2 receptors in the upper GI tract outnumber H1 receptors by a factor of 2:1
Question 4 To maximize the therapeutic effect of diphenoxylate HCl with atropine sulfate, the nurse will instruct the patient to take the medication
A) once a day
B) twice a day
C) every 2 hours
D) four times a day
(Gastrointestinal Nursing Care Scenarios)
Question 5 A 22-year-old male college senior has lived with a diagnosis of Crohn’s disease for several years and has undergone several courses of treatment with limited benefit. Which of the following targeted therapies has the potential to alleviate the symptoms of Crohn’s disease?
A) Tositumomab plus 131I (Bexxar)
B) Muromonab-CD3 (Orthoclone OKT3)
C) Infliximab (Remicade)
D) Eculizumab (Soliris)
Question 6 A patient has been prescribed rabeprazole (Aciphex). It will be important for the nurse to assess the patient’s drug history to determine if the patient is taking which of the following drugs?
A) Levodopa
B) Morphine
C) Digoxin
D) Dicyclomine hydrochloride
Question 7 An adult patient who has been diagnosed with a rectal tumor is scheduled to begin treatment with cisplatin. The nurse has conducted patient teaching about the possibility of nausea and vomiting. In order to reduce the patient’s risk of severe nausea, the nurse should
A) place the patient on a low-residue diet
B) ensure that the patient is NPO from midnight prior to receiving the drug
C) administer a combination of antiemetics prior to the administration of the drug
D) encourage the patient to request antiemetics if the nausea becomes unbearable
Question 8 It is determined that a patient, who is in a hepatic coma, needs a laxative. Lactulose is prescribed. Which of the following should the nurse monitor to assess the efficacy of the lactulose therapy?
A) Water levels in the colon
B) Oncotic pressure in the colon
C) Blood ammonia levels
D) Relief from symptoms
(Gastrointestinal Nursing Care Scenarios)
Question 9 A 60-year-old man has scheduled a follow-up appointment with his primary care provider stating that the omeprazole (Prilosec) which he was recently prescribed is ineffective. The patient states,“I take it as soon as I feel heartburn coming on, but it doesn’t seem to help at all.” How should the nurse best respond to this patient’s statement?
A) “It could be that Prilosec isn’t the right drug for you, so it would be best to talk this over with your care provider.”
B) “Prilosec won’t really decrease the sensation of heartburn, but it is still minimizing the damage to your throat and stomach that can be caused by the problem.”
C) “Prilosec will help your heartburn but it’s not designed to provide immediate relief of specific episodes of heartburn.”
D) “A better strategy is to take a dose of Prilosec 15 to 30 minutes before meals or drinks that cause you to get heartburn.”
Question 10 A 33-year-old woman has irritable bowel syndrome (IBS). The physician has prescribed simethicone (Mylicon) for her discomfort.Which of the following will the nurse monitor most closely during the patient’s drug therapy?
A) Drug toxicity
B) Anorexia
C) Increased abdominal pain and vomiting
D) Increased urine output
Question 11 Mr. Tan is a 69-year-old man who prides himself in maintaining an active lifestyle and a healthy diet that includes adequate fluid intake. However, Mr. Tan states that he has experienced occasional constipation in recent months. What remedy should be the nurse’s first suggestion?
A) Bismuth subsalicylate
B) A bulk-forming (fiber) laxative
C) A stimulant laxative
D) A hyperosmotic laxative
Question 12 A 29-year-old woman has been prescribed alosetron (Lotronex) for irritable bowel syndrome. Before starting the drug therapy, the nurse will advise the patient about which of the following adverse effect(s)?
A) Constipation
B) Breathlessness and hypotension
C) Hyperthyroidism
D) Impaired cardiac function
(Gastrointestinal Nursing Care Scenarios)
Question 13 A 29-year-old female patient has been prescribed orlistat (Xenical) for morbid obesity. The nurse is providing patient education concerning the drug. An important instruction to the patient would be to
A) omit the dose if the meal does not contain fat
B) take orlistat and multivitamins together
C) take orlistat in one dose at breakfast
D) omit the dose if the meal does not contain protein
Question 14 Prior to administering a dose of 5-FU to a patient with pancreatic cancer, the nurse is conducting the necessary drug research. The nurse is aware that 5-FU is a cell cycle–specific chemotherapeutic agent. Which of the following statements best describes cell cycle–specific drugs?
A) They follow a specific sequence of cytotoxic events in order to achieve cell death
B) They affect cancerous cells during a particular phase of cellular reproduction
C) They achieve a synergistic effect when administered in combination with cell cycle–nonspecific drugs
D) They affect cancerous cells and normal body cells in a similar manner
Question 15 A patient with a long history of alcohol abuse has been admitted to an acute medical unit with signs and symptoms of hepatic encephalopathy. His current medication orders include QID doses of oral lactulose. What desired outcomes should the nurse associate with this drug order?
A) Patient will have three to four loose bowel movements each day
B) Patient will express relief from constipation
C) Patient will have formed bowel movements that do not contain frank or occult blood
D) Patient will express an understanding of his current bowel regimen
Question 16 A nurse is assessing a female patient who is taking diphenoxylate HCl with atropine sulfate. Which of the following would lead the nurse to suspect that she is experiencing an allergic reaction?
A) Numbness of extremities
B) Headache and lethargy
C) Toxic megacolon
D) Urticaria
(Gastrointestinal Nursing Care Scenarios)
Question 17 A 73-year-old woman has scheduled an appointment with her nurse practitioner to discuss her recurrent constipation. The woman states that she experiences constipation despite the fact that she takes docusate on a daily basis and performs cleansing enemas several times weekly.How should the nurse best respond to this patient’s statements?
A) “Because we become more prone to constipation as we age, you’ll likely need to increase the number of stool softeners you take.”
B) “I’ll refer you to a specialist because it could be that you have a disease affecting your bowels or stomach.”
C) “Taking too many laxatives can make your bowels dependent on them, making you more susceptible to constipation.”
D) “Try using a different over-the-counter laxative and see that if you resolves your problem.”
Question 18 A patient develops diarrhea secondary to antibiotic therapy. He is to receive two tablets of diphenoxylate HCl with atropine sulfate (Lomotil) orally as needed for each loose stool. The nurse should inform him that he may experience
A) dizziness
B) bradycardia
C) muscle aches
D) increase in appetite
Question 19 A patient who takes aluminum hydroxide with magnesium hydroxide (Mylanta) frequently for upset stomach, heartburn, and sour stomach is seen regularly in the clinic. The nurse should assess which of the following?
A) Blood glucose level
B) Serum phosphate level
C) Urine specific gravity
D) Aspartate transaminase levels
Question 20 A teenage boy has undergone a diagnostic workup following several months of persistent, bloody diarrhea that appears to lack an infectious etiology. The boy has also experienced intermittent abdominal pain and has lost almost 15 pounds this year. Which of the following medications is most likely to treat this boy’s diagnosis?
A) Lubiprostone
B) Mesalamine
C) Docusate
D) Bismuth subsalicylate
Question 21 Mesalamine (Asacol) is prescribed for a 22-year-old woman with Crohn disease. The nurse will discuss with the patient the possibility for which of the following adverse effects related to the new drug therapy?
A) Hair loss
B) Metallic taste
C) Fatigue
D) Increased appetite
(Gastrointestinal Nursing Care Scenarios)
Question 22 A 58-year-old man is prescribed dicyclomine (Bentyl) for irritable bowel syndrome. In which of the following conditions is dicyclomine therapy contraindicated?
A) Hypertension
B) Diabetes mellitus
C) Glaucoma
D) Rheumatoid arthritis
Question 23 A nurse is planning care for a 59-year-old woman who is on ranitidine therapy. The nurse is concerned for the patient’s safety.Which of the following would be an appropriate nursing diagnosis?
A) Diarrhea related to adverse effects of drug therapy
B) Acute Pain related to adverse drug effects, headache
C) Risk for Injury related to drug-induced somnolence, dizziness, confusion, or hallucinations
D) Potential Complication: Electrolyte Imbalance related to hypophosphatemia, secondary to drug therapy
Question 24 A 57-year-old man is to begin 5-FU therapy for colon cancer. It will be most important for the nurse to monitor which of the following during the first 72 hours of the initial treatment cycle?
A) Myelosuppression
B) Cardiac events
C) White blood cell nadir
D) Nausea and vomiting
Question 25 A patient is taking cholestyramine. The nurse will assess for which of the following common adverse effects of the drug?
A) Abdominal pain
B) Headache
C) Constipation
D) Indigestion
Question 26 A patient comes to the clinic asking for help to quit drinking alcohol. She has a 21-year history of heavy drinking and is worried about developing cirrhosis of the liver. The patient agrees to take disulfiram (Antabuse). The nurse will teach the patient that the combination of alcohol and Antabuse will cause which of the following?
A) Bradycardia
B) Diarrhea
C) Nausea
D) Slight headache
Question 27 A 52-year-old man is suffering from a deficiency of exocrine pancreatic secretions and is prescribed pancrelipase (Pancrease MT). Before the medication therapy begins, the nurse will assess for allergies related to
A) ragweed
B) pollen
C) pork
D) shellfish
(Gastrointestinal Nursing Care Scenarios)
Question 28 A nurse is providing discharge instructions to a patient who will be taking fludrocortisone at home. The nurse will encourage the patient to eat a diet that is
A) low in sodium and potassium
B) low in sodium, high in potassium
C) high in iron
D) low in proteins
Question 29 A nurse is aware that diphenoxylate HCl with atropine sulfate is an effective adjunct in the treatment of diarrhea. For which of the following patients could the administration of this drug be potentially harmful?
A) An 80-year-old man who has diarrhea secondary to Clostridium difficile infection
B) A woman who has experienced severe diarrhea associated with influenza
C) A man who has experienced diarrhea shortly after beginning tube feeding through a nasogastric tube
D) A 60-year-old woman who tends to get diarrhea during periods of intense stress
Question 30 A clinic nurse is planning care for a 68-year-old man who has been on omeprazole (Prilosec) therapy for heartburn for some time. Regarding the patient’s safety, which of the following would be a priority nursing action?
A) Teach the patient to take omeprazole 1 hour before meals
B) Emphasize that the drug should not be crushed or chewed
C) Coordinate bone density testing for the patient
D) Monitor the patient for the development of diarrhea
Question 31 A nurse is overseeing the care of a young man whose ulcerative colitis is being treated with oral prednisone. Which of the following actions should the nurse take in order to minimize the potential for adverse drug effects and risks associated with prednisone treatment?
A) Avoid OTC antacids for the duration of treatment
B) Advocate for intravenous, rather than oral, administration
C) Teach the patient strategies for dealing with headaches
D) Carefully assess the patient for infections
Question 32 A woman with numerous chronic health problems has been diagnosed with a benign gastric ulcer has begun treatment with ranitidine (Zantac). Which of the following teaching points should the nurse provide to this patient?
A) “Quitting smoking will significantly increase the chance that this drug will heal your ulcer.”
B) “This drug will help to eliminate the bacteria in your stomach that caused your ulcer.”
C) “You should eat several small meals each day rather than three larger meals.”
D) “Take each dose of ranitidine with an antacid of your choice.”
(Gastrointestinal Nursing Care Scenarios)
Question 33 A patient has GERD and is taking ranitidine (Zantac). She continues to have gastric discomfort and asks whether she can take an antacid. Which of the following is an appropriate response by the nurse?
A) “Sure, you may take an antacid with ranitidine.”
B) “No, the two drugs will work against each other.”
C) “Yes, but be sure to wait at least 2 hours to take the antacid after you take the ranitidine.”
D) “I wouldn’t advise it. You may experience severe constipation.”
Question 34 A woman with an inflammatory skin disorder has begun taking prednisone in an effort to control the signs and symptoms of her disease. The nurse who is providing care for this patient should prioritize which of the following potential nursing diagnoses in the organization of the patient’s care?
A) Fluid Volume Excess
B) Constipation
C) Acute Confusion
D) Impaired Gas Exchange
Question 35 Following an endoscopy, a 66-year-old man has been diagnosed with a duodenal ulcer resulting from Helicobacter pylori infection. Which of the following medications will likely be used in an attempt to eradicate the patient’s H. pylori infection? (Select all that apply.)is situation?
A) A PPI
B) Antibiotics
C) Cisapride (Propulsid)
D) Aluminum hydroxide
