78, 79, 80, 82 GI DRUGS

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The nurse is discussing the mechanism of action of omeprazole (Prilosec) with a group of nursing students. Which statement by a student would best indicate understanding of the mechanism of action of omeprazole?
a. "The duration of action is short, because the drug has a short half-life."
b. "Absorption occurs in the stomach when the pH is greater than 5."
c. "It irreversibly inhibits the enzyme needed to produce stomach acid."
d. "The complete return of acid production occurs 24 hours after discontinuation."

ANS: C
The mechanism of action of omeprazole is that it irreversibly inhibits the enzyme needed to produce stomach acid. Effects persist until new enzyme is synthesized, with partial recovery in 3 to 5 days.
Although the half-life of the drug is short, the effects persist long after the drug has been cleared from the body.
Absorption does not take place in the stomach. The medication is acid labile and would be destroyed in the gut without protection. It is enteric coated and designed to become activated in the alkaline environment of the duodenum.
Partial return of acid production occurs 3 to 5 days after the medication is stopped. Full recovery may take weeks.

The nurse has provided education on factors that contribute to ulcer formation to her patient diagnosed with peptic ulcer disease (PUD). Which of the following statements by the patient indicates a need for further teaching?
a. "I guess I'll have to avoid coffee and cola from now on."
b. "I am surprised to learn that Helicobacter pylori infection can lead to ulcers."
c. "Instead of ibuprofen, I'll take acetaminophen for my arthritis."
d. "I'm going to ask my doctor to order a nicotine patch to help me quit smoking."

ANS: A
No convincing evidence shows that beverages containing caffeine (eg, coffee, tea, and cola) promote ulcer formation or interfere with recovery; this statement indicates a need for further teaching.
The most common cause of PUD is infection with H. pylori; no further teaching is necessary.
The second most common cause of PUD is the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Ibuprofen is an NSAID, but acetaminophen is not; no further teaching is necessary.
Smoking delays ulcer healing and increases the risk of recurrence; no further teaching is necessary.

The health care provider is treating a patient with complaints of severe abdominal pain and confirmed infection with H. pylori. Which of the following medication combinations would the nurse expect the health care provider to order?
a. cimetidine (Tagamet) and metronidazole (Flagyl)
b. cimetidine (Tagamet), tetracycline, and cefuroxime (Ceftin)
c. clarithromycin (Biaxin), amoxicillin (Amoxil), and esomeprazole (Nexium)
d. amphotericin B, cimetidine (Tagamet), and bismuth (Pepto-Bismol)

ANS: C
The antibiotics administered most often are amoxicillin, clarithromycin, bismuth, metronidazole, and tetracycline. None is effective alone, hence the combination of clarithromycin and amoxicillin. The antibacterial activity of amoxicillin is highest at a neutral pH and can be enhanced by reducing gastric acidity with an antisecretory agent, such as esomeprazole. This combination is an appropriate treatment plan.
Metronidazole is very effective against sensitive strains; however, more than 40% of strains are now resistant. One antibiotic alone is not effective in treating H. pylori. Cimetidine promotes healing of ulcers, therefore it would be an important drug to include in the treatment plan.
Although two antibiotics are included, only tetracycline is effective against H. pylori. Cimetidine promotes healing of ulcers, therefore it would be an important drug to include in the treatment plan.
Although cimetidine and bismuth are appropriate in the treatment plan, amphotericin B is an antifungal agent and would have no effect on H. pylori.

A patient is placed on a multidrug regimen that includes bismuth for treatment of peptic ulcer disease (PUD). The nurse should include which of the following points when providing patient education?
a. One week of therapy should heal ulcers, relieve symptoms, and eradicate H. pylori.
b. Resolution of pain indicates that the ulcer has healed.
c. The tongue and stool may turn black.
d. A single-antibiotic regimen is preferable to a multi-antibiotic regimen whenever possible.

ANS: C
Bismuth can impart a harmless black color to the tongue and stool. Patients should be forewarned of this effect.
One week of therapy does not heal ulcers. Eradication rates for H. pylori are consistently higher with a 2-week course of treatment.
Instructing the patient that when symptoms resolve, the ulcer will be healed is incorrect. The cessation of pain and disappearance of the ulcer rarely coincide.
Guidelines recommend that, to minimize the emergence of resistance, at least two antibiotics, and preferably three, should be used to eradicate H. pylori.

When metronidazole (Flagyl) is a component of the H. pylori treatment regimen, the patient must be instructed to
a. avoid foods containing tyramine.
b. take the drug with food.
c. take the drug on an empty stomach.
d. avoid any alcoholic beverages.

ANS: D
The patient should be instructed to avoid alcoholic beverages, because a disulfiram-like reaction can occur if metronidazole is taken with alcohol.
Nothing indicates that the patient should avoid foods containing tyramine.
Metronidazole may be taken with or without food.

A patient on antiulcer therapy complains of reduced libido and impotence. The nurse identifies a knowledge deficit in the patient. During teaching, the nurse informs the patient that _______ has been shown to cause reduced libido and impotence.
a. nizatidine (Axid)
b. cimetidine (Tagamet)
c. ranitidine (Zantac)
d. famotidine (Pepcid)

ANS: B
Cimetidine binds to androgen receptors, causing receptor blockade, which results in gynecomastia, reduced libido, and impotence.
Nizatidine, ranitidine, and famotidine do not bind to androgen receptors and therefore do not affect the libido or cause impotence.

The nurse is providing patient education to an elderly patient being treated for duodenal ulcers. The prescriber has ordered sucralfate (Carafate). The patient asks the nurse how sucralfate helps heal ulcers. Select the correct explanation given by the nurse.
a. "It creates a protective barrier against pepsin and acid."
b. "It irreversibly suppresses gastric acidity."
c. "It inhibits the enzyme that generates gastric acid."
d. "It enhances prostaglandin production."

ANS: A
Sucralfate promotes ulcer healing by creating a protective barrier against acid and pepsin.
Sucralfate does not reduce gastric acid secretion.
Sucralfate does not inhibit the enzyme that generates gastric acid.
Sucralfate does not enhance prostaglandin synthesis.

The nurse is providing education to a patient who has been prescribed both an antacid and ranitidine (Zantac). Which instruction should the nurse give the patient about taking the medications?
a. "Take the antacid 1 hour after the ranitidine."
b. "The antacid and ranitidine should be taken at the same time for better effect."
c. "Take the antacid 15 minutes before the ranitidine."
d. "Take the antacid 30 minutes after the ranitidine."

ANS: A
Because antacids raise gastric pH, they can affect the dissolution and absorption of ranitidine. Therefore, 1 hour should separate administration of antacids and ranitidine.
Antacids and ranitidine should not be taken at the same time, because dissolution and absorption of ranitidine will be reduced.
One hour should separate administration of antacids and ranitidine. These intervals are not enough separation for the drugs.

The nurse is teaching a class to a community group about peptic ulcer disease. Which statement about the use of anticholinergics for PUD is correct?
a. "Because very high doses of these drugs are needed to inhibit acid secretion, the side effects usually are unacceptable to those taking the drug."
b. "Anticholinergics can cause diarrhea, glucose intolerance, and dehydration."
c. "Anticholinergics are the drugs of choice for most patients with peptic ulcer disease."
d. "Anticholinergics can cure PUD when used as single-agent therapy."

ANS: A
The doses of anticholinergics required to inhibit acid secretion are so high they produce muscarinic blockade throughout the body, which leads to dry mouth, constipation, urinary retention, and visual disturbance. These side effects can be very disturbing.
Anticholinergics cause constipation, not diarrhea. Dehydration and glucose intolerance are not side effects of anticholinergics.
Anticholinergics are rarely used for treatment of PUD because of their side effects.
No single agent alone is recommended for the treatment of PUD. In addition, the cause of the ulcer must be identified so that an appropriate treatment plan is selected.

The nurse is preparing to administer medications to a patient taking sucralfate (Carafate) and ciprofloxacin (Cipro). The drugs are ordered for 0900. In what manner should the nurse proceed to administer the drugs?
a. The nurse should administer the drugs with a full glass of water.
b. The nurse should ask the prescriber to change the times to prevent concurrent administration.
c. The nurse should administer the two drugs at same time with food.
d. The nurse should administer the ciprofloxacin 15 minutes before the sucralfate.

ANS: B
The nurse should ask the prescriber to change the times to prevent concurrent administration, because sucralfate may impede the absorption of ciprofloxacin. The interaction can be minimized by administering sucralfate at least 2 hours apart from ciprofloxacin.
Administration with a full glass of water does not address the implications of concurrent administration.
A 2-hour interval is required between these drugs, and sucralfate needs to be taken on an empty stomach.
A 2-hour interval is required between these drugs.

The nurse is preparing to administer cimetidine 300 mg IV per the prescriber's order. Which of the following represents proper administration of the medication?
a. Mix 300 mg with 10 mL of 5% dextrose and water and give IVP over 1 minute.
b. Mix 300 mg with 10 mL of 0.9% sodium chloride and give IVP over 2 minutes.
c. Mix 300 mg in 50 mL of 0.9% sodium chloride and infuse over 15 minutes.
d. Mix 300 mg in 100 mL of 0.9% sodium chloride and infuse over 5 minutes.

ANS: B
Intravenous cimetidine can be administered IVP or by infusion. Mixing 300 mg with 10 mL of 0.9% sodium chloride is correct, and administration over 2 minutes also is correct.
Cimetidine 300 mg should be mixed with 0.9% sodium chloride, not D5W, and should be pushed over 2 minutes.
Cimetidine 300 mg should be mixed with 100 mL of 0.9% sodium chloride, not 50 mL. The rate of infusion is correct.
The dilution is accurate, but the rate of infusion is 15 minutes, not 5 minutes.

A 30-year-old female patient is to be started on misoprostol (Cytotec) for treatment of a gastric ulcer secondary to long-term ibuprofen (Motrin) use. Which of the following must the nurse include in the patient education?
a. "Start taking the drug at the end of your next menstrual period."
b. "Take the medication 1 hour before meals."
c. "Use a reliable method of birth control."
d. "Perform a breast self-examination weekly while on the medication."

ANS: C
Because the patient is of childbearing age, she must be able to comply with birth control measures and use a reliable method. The patient must have a negative serum pregnancy test within 2 weeks of starting therapy. The drug is contraindicated during pregnancy because it can lead to partial or complete expulsion of the fetus.
The medication should be started only on the second or third day of the next normal menstrual cycle.
The medication should be taken with meals (not before) and at bedtime.
There is no basis for performing breast self-examination more often.

A patient comes to the emergency department complaining of nausea, vomiting, and abdominal cramps. The nurse anticipates that the patient should receive
a. a stimulant laxative, such as bisacodyl (Dulcolax).
b. increased fiber and water to promote defecation.
c. an osmotic laxative, such as magnesium citrate (Citro-mag).
d. nothing; further assessment should be performed, given the patient's symptoms.

ANS: D
In patients experiencing abdominal pain, nausea, cramps, and other associated symptoms, further assessment is required. These complaints could be associated with appendicitis, regional enteritis, diverticulitis, ulcerative colitis, or an acute surgical condition of the abdomen. Further and more conclusive information is needed.
No information suggests that the patient is constipated and needs a laxative.

The nurse has admitted a patient to the unit who has been experiencing bowel problems. The patient is to receive a bowel preparation for a radiologic procedure. The nurse would anticipate administration of which of the following medications?
a. Psyllium (Metamucil)
b. Docusate sodium (Colace)
c. Castor oil
d. Bisacodyl (Dulcolax)

ANS: C
Castor oil is the only laxative listed that is indicated for bowel preparation for radiologic procedures.
Psyllium, docusate sodium, and bisacodyl are not indicated for bowel preparation for radiologic procedures.

What information would be most important for the nurse to provide to a patient requesting a prn dose of magnesium hydroxide (Milk of Magnesia)?
a. "You will need to increase your fluid intake."
b. "Avoid drinking milk for an hour after the magnesium hydroxide."
c. "I'll need to get a prescriber's order for mineral oil to avoid irritation."
d. "You can expect immediate results."

ANS: A
The nurse should instruct the patient to increase the fluid intake, because osmotic laxatives, such as magnesium hydroxide, can cause a substantial loss of water.
Magnesium hydroxide does not interact with milk.
There is no basis for administering mineral oil with magnesium hydroxide.
Low doses produce results within 6 to 12 hours, and high doses produce results in 2 to 6 hours.

The nurse is providing education for a patient taking bisacodyl (Dulcolax) tablets daily. Which statement by the patient best demonstrates the need for further teaching?
a. "I should swallow the pill intact."
b. "I should take the pills with milk or dairy products."
c. "The pill will be effective within 6 to 12 hours."
d. "Most people take the pill at bedtime, with good results in the morning."

ANS: B
Milk and antacids accelerate dissolution of the enteric coating on the bisacodyl tablets; this statement indicates a need for further teaching.
Because bisacodyl tablets are enteric coated, they should be swallowed without being chewed or crushed; no further teaching is needed.
Because the action time is 6 to 12 hours, taking the medication at bedtime produces a response the following morning; no further teaching is needed.

The nurse is preparing to administer magnesium hydroxide (Milk of Magnesia) per a patient's request for a laxative. The patient asks the nurse how this medication works. Which of the following would be a correct statement by the nurse?
a. "It draws water into the colon to soften the feces."
b. "It lubricates the passage of stool."
c. "It increases bulk in the colon."
d. "It stimulates the nerves that regulate defecation."

ANS: A
Osmotic laxatives, such as magnesium hydroxide, work by drawing water into the intestinal lumen. Accumulation of water causes the fecal mass to soften and swell, stretching the intestinal wall and stimulating peristalsis.
Osmotic laxatives, such as magnesium hydroxide, do not lubricate the passage of stool, increase bulk in the colon, or stimulate nerves that regulate defecation.

The nurse is preparing to provide the patient with methylcellulose (Citrucel). The patient asks the nurse how this type of laxative works. The nurse correctly states that this laxative is known as a(n) _________________ laxative and works by __________________.
a. bulk-forming; functioning as dietary fiber
b. surfactant; softening the feces
c. stimulant; stimulating peristalsis
d. osmotic; retaining water and softening the feces

ANS: A
Methylcellulose is a bulk-forming laxative, and its actions and effects are much like those of dietary fiber.
Methylcellulose is not a surfactant, stimulant, or osmotic laxative.

A patient admitted to the unit for dehydration tells the nurse that he has not had a bowel movement in 5 days, and he typically has one daily. The nurse administers psyllium (Metamucil) as ordered and should monitor the patient for
a. bright red stools.
b. black, tarry stools.
c. pale, clay-colored stools.
d. intestinal obstruction.

ANS: D
Bulk-forming laxatives can cause an intestinal obstruction or impaction if not enough water is consumed. The patient needs concurrent rehydration to prevent this.
Bright red stools would not be anticipated unless the patient has hemorrhoids, and there is no indication of this.
Black, tarry stools typically are seen if blood is present in the stool, no information suggests that the patient has gastrointestinal bleeding.
Pale, clay-colored stools may be apparent if the patient has a hepatic disorder, but no information suggests this.

For a patient with which of the following would the nurse withhold a prn order for magnesium hydroxide?
a. Hemorrhoids
b. Prostatitis
c. Cirrhosis
d. Chronic renal failure

ANS: D
Magnesium can accumulate to toxic levels in patients with renal dysfunction. The nurse should withhold the medication.
Magnesium hydroxide is not contraindicated for patients with hemorrhoids, prostatitis, or cirrhosis.

The nurse is administering magnesium hydroxide (Milk of Magnesia) to a patient who has been complaining of constipation and has consistently taken the medication every day for a week. The patient has poor skin turgor, BP 90/60, and HR 120. The nurse should further assess the patient for
a. toxicity.
b. dehydration.
c. increased sodium.
d. increased potassium.

ANS: B
Osmotic laxatives can cause a substantial loss of water. The patient is displaying signs and symptoms of dehydration. To prevent dehydration, the patient should increase the water intake.
Nothing indicates toxicity or an increase in sodium or potassium.

The nurse is caring for an elderly patient who is status-post right hip open-reduction internal fixation (ORIF). The patient is taking oxycodone (OxyContin) every 6 hours as needed for pain and chlorpheniramine (Chlor-Trimeton) daily. The nurse discusses obtaining an order from the prescriber for which of the following medications?
a. GoLYTELY
b. Lactulose
c. Docusate sodium (Colace)
d. Polyethylene glycol (MiraLax)

ANS: C
Oxycodone and chlorpheniramine both can be constipating. The patient needs something prophylactically, such as docusate sodium, that can be taken daily to prevent constipation. In addition, the patient's mobility is limited, which can further increase the risk of constipation.
GoLYTELY is not indicated for constipation. It is used for cleansing the bowel prior to diagnostic procedures.
Lactulose is not indicated. It typically is used for reducing ammonia levels in hepatic encephalopathy.
Polyethylene glycol is indicated for occasional constipation. No information suggests that the patient is constipated.

A patient with cirrhosis has begun displaying signs and symptoms of hepatic encephalopathy. The nurse prepares to administer lactulose per the prescriber's order. The nurse understands that this drug has been ordered to
a. reduce cerebral edema.
b. reduce abdominal ascites.
c. lower ammonia levels.
d. reduce the hepatic enzymes.

ANS: C
Lactulose is the only laxative known to lower ammonia levels in patients with portal hypertension and hepatic encephalopathy secondary to liver disease.
Lactulose does not work to reduce cerebral edema, nor is there any indication the patient is experiencing it.
Lactulose does not work to reduce abdominal ascites.
Lactulose does not reduce liver enzymes.

The nurse, who is caring for a patient with constipation, is preparing to administer morning medications. The nurse determines that concurrent drug administration of which of the following medications most likely would contribute to constipation? (Select all that apply.)
a. Oxycodone/acetaminophen (Percocet)
b. Aluminum hydroxide
c. Benztropine (Cogentin)
d. Ranitidine (Zantac)
e. Diazepam (Valium)

ANS: A, B, C
Drugs that most likely would contribute to constipation are the opioids (oxycodone/acetaminophen), anticholinergics (benztropine), and some antacids (aluminum hydroxide).
Ranitidine and diazepam are not associated with constipation.

The nurse administers psyllium (Metamucil) to a patient who has requested a laxative. The nurse should monitor the patient for ____________ and provide ______________ to minimize the effects and risks.
a. nausea and vomiting; an antiemetic
b. abdominal cramps; a K-pad (warming pad)
c. esophageal obstruction; 8 ounces of water
d. watery stools; 30 mL of water

ANS: C
Esophageal obstruction can occur if the psyllium is taken without sufficient fluids. It should be administered with a full glass of water or juice to promote passage.
Nausea, vomiting, and watery stools are not associated with psyllium, therefore intervention is unnecessary.

A patient with a history of chronic alcohol abuse has been admitted to the unit with cirrhosis. Upon review of the patient's laboratory test results, the nurse notes that the ammonia level is 218. What medication should the nurse prepare to administer?
a. 0.9% NS
b. Lactulose
c. Docusate sodium (Colace)
d. Polyethylene glycol (MiraLax)

ANS: B
Lactulose is the only laxative known to lower ammonia levels in patient with portal hypertension and hepatic encephalopathy secondary to liver disease.
No information suggests that the patient needs fluid or electrolyte replacement.
Docusate sodium and polyethylene glycol are not effective at lowering ammonia levels.

The nurse on an oncology unit is caring for a patient with lung cancer. Prior to the next dose of cisplatin (Platinol-AQ), which antiemetic would the nurse most likely administer to the patient?
a. Metoclopramide (Reglan)
b. Droperidol (Inapsine)
c. Ondansetron (Zofran)
d. Prochlorperazine

ANS: C
Serotonin-receptor antagonists, such as ondansetron, are the most effective drugs available for suppressing nausea and vomiting caused by cisplatin and other highly emetogenic anticancer drugs.
Metoclopramide is used to suppress postoperative nausea and vomiting and emesis associated with cancer chemotherapy. However, it would not be the drug of choice in this situation.
Butyrophenones, such as droperidol, are used as antiemetics; however, they are not the most effective antiemetics for cancer patients. They typically are used for postoperative nausea.
Phenothiazines, such as prochlorperazine, may be used with cancer chemotherapy and surgery, but they are not as effective for emesis caused by cisplatin.

The nurse is caring for a patient who is receiving chemotherapy. The patient complains of nausea and begins to vomit. The nurse administers ondansetron (Zofran) to alleviate the nausea. Which medication given concurrently with ondansetron would increase its effectiveness?
a. Dexamethasone (Decadron)
b. Ranitidine (Zantac)
c. Loperamide (Imodium)
d. Alosetron (Lotronex)

ANS: A
Ondansetron is very effective by itself and even more effective when combined with dexamethasone.
Ranitidine and loperamide do not increase the effectiveness of ondansetron.
Alosetron is indicated for irritable bowel syndrome (IBS), not for patients receiving chemotherapy.

The recovery room nurse is caring for a patient status post surgery and administers an antiemetic agent for postoperative nausea and vomiting. The patient is transferred to the unit and beings to display extrapyramidal effects. The nurse suspects that which category of agents is most likely responsible?
a. Phenothiazines
b. Glucocorticoids
c. Cannabinoids
d. Serotonin-receptor antagonists

ANS: A
Side effects of phenothiazines include extrapyramidal reactions, anticholinergic effects, hypotension, and sedation.
Glucocorticoids and cannabinoids do not cause extrapyramidal side effects.
The most common side effects of serotonin-receptor antagonists are headache, diarrhea, and dizziness. They do not cause extrapyramidal side effects.

4. The nurse is preparing to administer dronabinol (Marinol) to a newly admitted patient. Prior to administration, the nurse reviews the patient's health history. For which of the following reasons found in the health history would the nurse clarify the order?
a. The patient has a history of bradycardia.
b. The patient has a history of drug abuse.
c. The patient has acquired immunodeficiency syndrome (AIDS).
d. The patient has a history of psychiatric disorders.

ANS: D
The nurse would clarify the order because of the patient's history of psychiatric disorders. Dronabinol can cause temporal disintegration, dissociation, depersonalization, and dysphoria.
Dronabinol is not contraindicated in patients with bradycardia. The medication actually causes tachycardia.
Nothing indicates that the patient has a history of drug abuse; however, there is a small potential for abuse.
Dronabinol is used in patients with AIDS to stimulate appetite.

The nurse is caring for a psychiatric patient with breast cancer who is just about to receive chemotherapy. What antiemetic would be most appropriate for this patient, who is anticipating nausea?
a. Loperamide (Imodium)
b. Ranitidine (Zantac)
c. Dronabinol (Marinol)
d. Lorazepam (Ativan)

ANS: D
One of the principal affects of lorazepam is its ability to suppress anticipatory nausea. It is used in combination regimens to suppress chemotherapy-induced nausea and vomiting (CINV).
Loperamide and ranitidine do not affect CINV.
Dronabinol is contraindicated in patients with a psychiatric illness.

A patient comes to the clinic for a checkup and shares upcoming plans to go on a vacation cruise. The patient asks for a medication to prevent sea sickness. The nurse practitioner orders scopolamine. The nurse provides education and tells the patient to be aware of the potential side effects, which include
a. nausea and vomiting.
b. blurred vision and drowsiness.
c. itching and diarrhea.
d. hearing loss and salivation.

ANS: B
The most common side effects associated with scopolamine are blurred vision and drowsiness. The drug is given to prevent nausea and vomiting.
Nausea and vomiting are not side effects of the drug.
Constipation, not diarrhea, is a side effect of the drug. Itching is not a side effect.
Dry mouth, not salivation, is a side effect. Hearing loss is not a side effect.

The nurse is reviewing the medication administration record to verify medications at the start of the shift. The nurse notes a new order for diphenoxylate. What assessment finding would cause the nurse to withhold the medication?
a. Dehydration
b. Diarrhea
c. Constipation
d. Dizziness

ANS: C
The assessment finding that would cause the nurse to withhold the medication is constipation because the drug is only given for diarrhea.
Dehydration would not be a contraindication to the use of diphenoxylate, and it may have been precipitated by the underlying problem (ie, diarrhea, which needs to be controlled).
The medication is indicated for the treatment of diarrhea. The nurse would administer the medication.
Dizziness is not a contraindication to the administration of diphenoxylate.

A patient with diarrhea has been prescribed methylcellulose (Citrucel). The patient asks the nurse, "I thought this was for constipation. Why am I getting it?" Select the most appropriate response from the nurse.
a. "Methylcellulose adds bulk to the stool to firm it up."
b. "Methylcellulose acts by reducing the volume of diarrhea."
c. "Methylcellulose reduces intestinal motility, slowing intestinal transit."
d. "Methylcellulose stimulates the bowel to eliminate the diarrhea, leaving only formed stools."

ANS: A
The most appropriate response from the nurse should be that methylcellulose is a bulk-forming agent that acts by giving the stool a more firm, less watery consistency by "bulking it up."
Methylcellulose does not reduce the volume of diarrhea. Loperamide has that action.
Methylcellulose does not reduce intestinal motility, slowing intestinal transit. Opiates have that action.
Methylcellulose does not stimulate the bowel to eliminate diarrhea, leaving only formed stools.

The nurse is preparing to administer diphenoxylate (Lomotil) to a patient who complains of diarrhea. For what side effects would the nurse observe the patient after administration of this medication?
a. Reduced heart rate
b. Salivation
c. Urinary frequency
d. Blurred vision

ANS: D
Diphenoxylate is combined with atropine to discourage abuse of the drug, because it is an opioid. Side effects of atropine include blurred vision, photophobia, dry mouth, urinary retention, and tachycardia.
Because diphenoxylate is formulated with atropine to discourage abuse, the nurse should observe the patient for an increased heart rate from the atropine.
Because diphenoxylate is formulated with atropine to discourage abuse, the nurse should evaluate the patient for complaints of dry mouth, not salivation.
Urinary retention, rather than urinary frequency, is a side effect of atropine, with which diphenoxylate is formulated.

The nurse is caring for a pregnant patient who is suffering from severe traveler's diarrhea. The nurse should prepare to administer
a. azithromycin (Zithromax).
b. ciprofloxacin (Cipro).
c. levofloxacin (Levaquin).
d. doxycycline (Vibramycin).

ANS: A
Severe traveler's diarrhea in a pregnant patient is treated with azithromycin.
Ciprofloxacin and levofloxacin are indicated for traveler's diarrhea but not in pregnant patients.
Doxycycline is not indicated for treatment of traveler's diarrhea.

A patient with irritable bowel syndrome has received a prescription for a tricyclic antidepressant (TCA). When asked about the rationale for this drug, the nurse should explain that
a. TCAs effectively relieve constipation.
b. these agents can effectively reduce abdominal pain.
c. lifting depression is the goal for this condition.
d. TCAs alter the dopaminergic effects in the gastrointestinal (GI) tract.

ANS: B
The nurse should explain that these agents can effectively reduce abdominal pain. Depression is not associated with diarrhea.
TCAs do not relieve constipation.
Lifting depression does not alter the symptoms of IBS (ie, abdominal pain, constipation, and/or diarrhea).
TCAs do not alter dopaminergic effects in the GI tract.

The nurse is teaching a pharmacology refresher class to a group of medical-surgical nurses. The nurse asks "Alosetron (Lotronex) is approved for which patient population?" Which response by one of the nurses best indicates understanding of the use of this drug?
a. "It has been approved for use in women with diarrhea-predominant IBS."
b. "It can be given to men with diarrhea and crampy abdominal pain due to IBS."
c. "It would be indicated for pregnant women with iron-associated constipation."
d. "It is approved for use in children whose growth rate is reduced because of IBS."

ANS: A
Alosetron is approved for use in women only with diarrhea-predominant IBS; this statement indicates understanding.
Alosetron is not approved for symptoms of IBS in men, only women; further teaching is needed.
Alosetron is approved only for use in women with IBS associated with diarrhea. It therefore would be contraindicated in pregnant women with iron-associated constipation and children with IBS; further teaching is needed.

13. The nurse reviews the patient data and health history of a patient who is prescribed tegaserod (Zelnorm) for treatment of IBS. For which of the following patients should the nurse question the order? (Select all that apply.)
a. The patient who is a 56-year-old male.
b. The patient who has irritable bowel syndrome-constipation.
c. The patient who has a history of sulfa allergy.
d. The patient who is a chronic dialysis patient.
e. The patient who is a 40-year-old female.

ANS: A, D
The nurse should question the order for tegaserod for the male patient and also for the chronic dialysis patient. The drug is approved only for use in females under the age of 55. It is contraindicated in severe renal impairment.
Tegaserod is not contraindicated for the patient with constipation, because it is used to treat constipation-predominant IBS.
It is not contraindicated in patients with sulfa allergies.
Tegaserod is approved for use in women under 55.

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."

ANS: B
Sulfasalazine reduces the inflammation. This statement indicates understanding.
Although similar to sulfonamides, sulfasalazine is not used to treat infections; further teaching is needed.
Sulfasalazine does not enhance the immune response or increase the reabsorption of fluid; further teaching is needed.

The nurse is caring for a patient with ulcerative colitis who is being treated with azathioprine. Which laboratory test result should be monitored periodically?
a. Microscopic urine examination
b. Complete blood count (CBC) with differential
c. Immunoglobulin survey
d. Serum albumin

ANS: B
The nurse should monitor the CBC, because neutropenia is a major adverse effect of azathioprine. Another major adverse effect is pancreatitis.
Microscopic urinalysis is not indicated.
The immunoglobulin and serum albumin levels do not require monitoring.

The nurse is caring for a patient with Crohn's disease. The patient has been taking metronidazole (Flagyl) for 6 months. The patient begins to complain of numbness and tingling in the extremities. The nurse should suspect
a. myopathy.
b. peripheral neuropathy.
c. myalgia.
d. extrapyramidal symptoms.

ANS: B
The patient's symptoms correlate with peripheral neuropathy, which is a risk of long-term treatment with metronidazole.
These symptoms do not correlate with peripheral neuropathy. In addition, myopathy, myalgia, and extrapyramidal symptoms are not side effects of metronidazole.

The nurse is caring for a patient with chronic back pain, for which the patient takes opiates daily. To help prevent nausea, the patient also takes metoclopramide (Reglan). For which of the following signs and symptoms would the nurse administer intravenous (IV) diphenhydramine (Benadryl)?
a. Severe spasms of the tongue, face, and neck
b. Dry mouth and urinary retention
c. Diarrhea and abdominal cramps
d. Constipation

ANS: A
The nurse should administer diphenhydramine for extrapyramidal reactions (ie, severe spasms of the tongue, neck, and face), which are caused by long-term use of metoclopramide.
IV diphenhydramine is not indicated for dry mouth, urinary retention, diarrhea, or constipation.

The nurse is caring for a patient with cancer who has been undergoing chemotherapy. The patient now suffers from oral mucositis as a result of the chemotherapy. An order is written for palifermin (Kepivance). The nurse plans to discontinue the dose at least ____ hours prior to the next chemotherapy dose.
a. 8
b. 12
c. 24
d. 72

ANS: C
The nurse should discontinue the palifermin 24 hours prior to the chemotherapy, because palifermin may increase the severity and duration of oral mucositis.
Holding the drug for 8 or 12 hours before chemotherapy is not long enough; this would increase the severity and duration of oral mucositis.
The medication need not be discontinued 72 hours before the chemotherapy. The minimum time is 24 hours in advance.

The nurse would question a prescription for alosetron (Lotronex) for a patient with a history of which health problem or problems? (Select all that apply.)
a. Ulcerative colitis
b. Traveler's diarrhea
c. Intestinal obstruction
d. Diabetes
e. Diverticulitis

ANS: A, C, E
The nurse should question a prescription for patients with a history of ulcerative colitis, intestinal obstruction, and diverticulitis. Alosetron is approved only for diarrhea-predominant IBS in women.
Alosetron is not contraindicated in women with irritable bowel syndrome-diarrhea (IBS-D) who have a history of traveler's diarrhea or diabetes.

A patient with peptic ulcer disease asks about dietary changes that may help relieve symptoms. The nurse's best advice would be to:
1. avoid spicy foods.
2. eat a bland diet.
3. have a serving of milk or cream with each meal.
4. eat small but frequent meals.

4

A patient is placed on a multidrug regimen including bismuth for peptic ulcer disease. The nurse should instruct the patient as follows:
1. "One week of therapy should heal ulcers and relieve symptoms."
2. "When the symptoms resolve, the ulcer will be healed."
3. "The tongue and stool may turn black on bismuth."
4. "Single-drug therapy is preferable."

3

When metronidazole is a component of an H. pylori treatment regimen, the patient must be instructed to:
1. avoid tyramine-containing foods.
2. take the drug with food.
3. take the drug on an empty stomach.
4. avoid alcohol.

4

A man on antiulcer therapy complains of reduced libido and impotence. The nurse informs him that it may be associated with:
1. nizatidine.
2. cimetidine.
3. ranitidine.
4. famotidine.

2

Which statement regarding omeprazole is correct?
1. The duration of action is short because the drug has a short half-life.
2. Absorption occurs in the stomach when the pH is greater than 5.
3. It irreversibly inhibits the enzyme needed to produce stomach acid.
4. The complete return of acid production occurs 24 hours after discontinuation

3

The mechanism by which sucralfate helps to heal ulcers is by:
1. creating a protective barrier against pepsin and acid.
2. suppressing gastric acidity irreversibly.
3. inhibiting the enzyme that generates gastric acid.
4. enhancing prostaglandin production.

1

A woman is prescribed misoprostol to prevent gastric ulcers. An important component of patient education is the:
1. expectation that the menstrual cycle will become irregular.
2. avoidance of pregnancy.
3. prevention of constipation.
4. importance of taking the drug on an empty stomach.

2

To minimize the interaction between antacids and ranitidine, patients with peptic ulcer disease should be instructed to take the antacid:
1. 1 hour before or after the ranitidine.
2. at the same time as the ranitidine.
3. 20-30 minutes after the ranitidine.
4. 2-3 hours after the ranitidine.

1

Which group of patients should use antacids containing sodium with extreme caution?
1. Patients with arthritis
2. Patients with heart failure
3. Hypotensive patients
4. Aspirin-allergic patients

2

Which statement regarding the use of anticholinergics for peptic ulcer disease is correct?
1. Because very high doses are needed to inhibit acid secretion, the side effects are usually unacceptable to patients.
2. In toxic doses they can cause diarrhea and glucose intolerance, eventually producing dehydration.
3. These are the drugs of choice for most patients with peptic ulcer disease.
4. These drugs are capable of curing peptic ulcer disease when used as single-agent therapy

1

Which factor(s) contribute to peptic ulcer formation? You may select more than one answer.
1. Spicy foods
2. H. pylori infection
3. NSAIDs
4. Smoking
5. Decreased gastrin production

2 3 4

. If a patient is experiencing nausea, vomiting, and abdominal cramps, the laxative of choice is:
1. a stimulant laxative such as bisacodyl.
2. an increase of fiber and water.
3. an osmotic laxative such as magnesium citrate.
4. nothing; no laxative should be given under these circumstances.

4

Which laxative would be the best suited for use in preparing the small bowel for surgery?
1. Psyllium
2. Docusate sodium
3. Castor oil
4. Bisacodyl

3

Bulk-forming laxatives:
1. function like dietary fiber.
2. act within 2-6 hours.
3. produce a semifluid stool.
4. are used to prepare the bowel for diagnostic procedures.

1

Esophageal obstruction can occur with:
1. surfactant laxatives.
2. bulk-forming laxatives.
3. osmotic laxatives.
4. stimulant laxatives.

2

Sales of over-the-counter phenolphthalein have been limited because it:
1. is the primary laxative abused by the public.
2. produces a blue-green tint to the urine.
3. may be carcinogenic.
4. interacts harmfully with many prescription drugs.

3

Magnesium hydroxide and sodium phosphate are:
1. bulking agents.
2. stimulants.
3. osmotic laxatives.
4. surfactant laxatives.

3

The nurse counsels a patient preparing to take magnesium hydroxide. What information is the most important for the patient?
1. Increase fluid intake.
2. Restrict liquids after taking the drug.
3. Use with mineral oil to avoid irritation.
4. Expect immediate results.

1

Laxatives with magnesium salts are contraindicated in patients with:
1. hemorrhoids.
2. proctitis.
3. autoimmune disorders.
4. renal dysfunction.

4

A patient is receiving bisacodyl. A component of patient education should include which of the following instructions?
1. Swallow the pills intact.
2. Take pills with milk or dairy products.
3. Use antacids simultaneously.
4. Use daily for best results.

1

. Milk of magnesia alleviates constipation by:
1. increasing water absorption into the colon.
2. lubricating the passage of stool.
3. increasing bulk within the colon.
4. stimulating nerves that regulate defecation

1

To avoid fecal impaction, psyllium should be administered with at least how many milliliters of water?
1. 120
2. 180
3. 240
4. 300

3

Lactulose, a hyperosmotic laxative, also has which function?
1. Decreases peripheral edema
2. Corrects sodium imbalances
3. Reduces ammonia levels
4. Alleviates galactose intolerance

3

Which drug categories are known to exacerbate constipation? You may select more than one answer.
1. Antacids
2. Bulking agents
3. Anticholinergics
4. Opioids
5. B vitamins

3, 4

Which patient meets the criteria for constipation? You may select more than one answer.
1. A patient who has not had a bowel movement in 3 days
2. A patient whose bowel movements are irregular
3. A patient with regular hard and dry stools
4. A patient who has to strain to evacuate a soft stool
5. A patient who strains during more than 25% of bowel movements

3, 5

. The nurse is administering cisplatin to a patient with lung cancer. Which category of antiemetics is the most effective?
1. Motility agents
2. Butyrophenones
3. Serotonin-receptor antagonists
4. Phenothiazines

3

To increase the effectiveness of a 5-HT3 receptor antagonist, the nurse may also administer:
1. dexamethasone.
2. ranitidine.
3. loperamide.
4. hyoscyamine.

1

After an antiemetic is administered to a patient with postoperative nausea and vomiting, the patient develops extrapyramidal effects. Which category of agents is most likely responsible?
1. Phenothiazines
2. Glucocorticoids
3. Cannabinoids
4. Serotonin-receptor antagonists

1

When dronabinol is administered to control nausea and vomiting, which property of the drug should be considered?
1. The potential for the drug to cause bradycardia
2. The potential for abuse
3. The probability of a hypertensive reaction
4. The development of exacerbating psychiatric disorders

4

A cancer patient has developed anticipatory nausea from her chemotherapy for breast cancer. Which drug can help deal with this problem?
1. Loperamide
2. Ranitidine
3. Dronabinol
4. Lorazepam

4

An adult is planning a vacation cruise and has been given a prescription for scopolamine. Which common side effects will the nurse describe?
1. Nausea and vomiting
2. Blurred vision and drowsiness
3. Itching and diarrhea
4. Hearing loss and salivation

2

The medication administration record has an entry for a patient to receive diphenoxylate. Which assessment finding would cause the nurse to question this entry?
1. Dehydration
2. Diarrhea
3. Constipation
4. Dizziness

3

When loperamide is recommended, the nurse should instruct the patient that:
1. this agent has a high potential for abuse.
2. the drug may produce extreme dizziness.
3. the drug may be purchased over the counter as a tablet, capsule, or liquid.
4. this drug will stimulate the bowel and may cause flatulence

3

Anticholinergic antispasmodics may be useful to:
1. firm stool consistency.
2. reduce fluid loss.
3. improve the efficacy of bulking agents.
4. relieve cramping.

4

Which antibiotic would be used in a pregnant woman with severe traveler's diarrhea?
1. Azithromycin
2. Ciprofloxacin
3. Levofloxacin
4. Doxycycline

1

A patient with irritable bowel syndrome has received a prescription for a tricyclic antidepressant (TCA). When asked about the rationale for this drug, the nurse should explain that:
1. TCAs effectively relieve constipation.
2. these agents can effectively reduce abdominal pain.
3. lifting depression is the goal for this condition.
4. TCAs alter the dopaminergic effects in the gastrointestinal tract.

2

Alosetron is approved for which population?
1. Women with diarrhea-predominant IBS
2. Men with constipation and crampy abdominal pain
3. Pregnant women with iron-associated constipation
4. Children whose growth rate is reduced because of IBS

1

Tegaserod should not be administered to patients with:
1. severe renal impairment.
2. constipation.
3. sulfa allergy.
4. weight gain.

1

While teaching an ulcerative colitis patient receiving sulfasalazine, the nurse explains that this medication:
1. treats the infection that triggers the condition.
2. reduces the inflammation.
3. enhances the immune response.
4. increases the reabsorption of fluid.

2

The nurse manages the care of a patient with ulcerative colitis being treated with azathioprine. Which laboratory test result should be monitored periodically?
1. Microscopic urine examination
2. CBC with differential
3. Immunoglobulin survey
4. Serum albumin

2

Patient education for persons who require pancreatic enzyme supplementation includes which instruction?
1. The drugs should be taken with every meal and snack.
2. The drugs are required only if meals are fatty.
3. The drugs should be taken at bedtime.
4. The drugs are used when meals are missed.

1

How does metoclopramide reduce postoperative nausea and vomiting?
1. It decreases mobility in the entire GI tract.
2. It decreases chemoreceptor stimulation.
3. It improves the body's response to analgesic medication.
4. It promotes motility in the small intestine.

2

When planning the administration of antiemetic medications to a patient, the nurse is aware that combination therapy is often preferred because:
1. the risk of constipation is decreased.
2. lower doses of medication are cost-effective.
3. different vomiting pathways are blocked.
4. increased sedation is achieved with higher doses of medication

3

The nurse will question a prescription for alosetron for patients with a history of which health problem(s)? You may select more than one answer.
1. Ulcerative colitis
2. Traveler's diarrhea
3. Intestinal obstruction
4. Diabetes
5. Diverticulitis

1 3 5

A patient has a BMI of 28. Which term accurately applies to this patient?
1. Normal weight
2. Underweight
3. Overweight
4. Obese

3

An obese patient states, "My goal is to reduce my weight from 280 pounds to 230 pounds in the first 6 months." The nurse should respond with which statement?
1. "That is a realistic goal for your weight-reduction program."
2. "Because most weight loss occurs in the first 6 months, you should aim for 200 pounds."
3. "Weight loss of more than 20 pounds in 6 months could be dangerous."
4. "Safe and maintainable weight loss should be about 10% of your body weight in 6 months."

4

. An obese patient comes to the clinic and requests a prescription for diet pills. The nurse should respond with which statement?
1. "Let's begin with a comprehensive diet, exercise, and behavior management program."
2. "Drugs are the cornerstone of an effective weight-loss program for people who are obese rather than just overweight."
3. "Drugs are indicated only for patients who have no health risks from their obesity."
4. "Drugs may produce an excessively rapid weight loss that could be hazardous to your heart."

1

Sibutramine is contraindicated for patients taking:
1. anticoagulants.
2. selective serotonin reuptake inhibitors.
3. nonsteroidal anti-inflammatory agents.
4. beta blockers.

2

How is orlistat different from most drugs for weight loss?
1. It reduces fat absorption in the intestines.
2. It suppresses the appetite center in the brain.
3. It increases metabolism to help burn calories.
4. It increases serotonin levels and improves mood

1

To minimize the risk of vitamin deficiency in patients taking orlistat, the nurse counsels them to:
1. take a daily supplement of fat-soluble vitamins.
2. take a daily multivitamin 2 hours before or after taking orlistat.
3. eat vitamin-rich foods at the same time that they take orlistat.
4. take a daily multivitamin at the same time that they take orlistat.

2

A patient has been prescribed sustained-release diethylpropion for weight loss. The patient asks, "When should I take this medication?" The nurse should respond, "Take the medication:
1. with your dinner."
2. before your largest meal."
3. after 4 PM."
4. during the midmorning."

4

A patient has been taking phentermine for 12 weeks for weight loss. The patient now reports that it no longer produces appetite suppression. The best action would be to:
1. switch to another agent in this class.
2. discontinue the drug.
3. increase the dose.
4. continue the current dosing.

2

An obese adult requests dexfenfluramine for obesity after reading about the drug online. The nurse should provide which information?
1. This drug has been approved for long-term weight control.
2. This drug is indicated only for obese patients with hypertension or heart disease.
3. This drug was removed from the market because of associated heart damage.
4. This drug may help with weight loss, but diet management should be used first.

3

Which statement is correct regarding tagatose?
1. It is an effective fat blocker in the small intestine.
2. It is a sweetener that has only 38% of the calories of sugar.
3. It is a calorie-free fat substitute.
4. It is an over-the-counter stimulant.

2

A patient starting a weight loss session should be counseled that weight loss has which benefit(s)? You may select more than one answer.
1. It reduces blood pressure in hypertensive patients.
2. It prevents type 1 diabetes.
3. It increases high-density lipoproteins.
4. It reduces glucose in persons with type 2 diabetes
5. It increases low-density lipoproteins

1 3 4

The nurse at a public health clinic is assessing a patient's risks for heart disease. A patient who has a BMI of 28 would require which intervention?
a. No intervention is indicated; the patient's BMI is within normal limits.
b. The patient should be instructed in methods for gaining weight
c. The patient should be educated about weight reduction.
d. The patient should be referred for surgical intervention for extreme obesity.

ANS: C
A BMI of 30 or higher indicates obesity. A BMI of 25 to 29.9 indicates that the patient is overweight.
The patient's BMI is within the range of being overweight.
The patient is neither underweight nor obese.

The nurse is working with a group of obese patients. One states, "My goal is to reduce my weight from 280 pounds to 230 pounds in the first 6 months." What response by the nurse would be most appropriate for this patient?
a. "That is a realistic goal for your weight-reduction program."
b. "Because most weight loss occurs in the first 6 months, you should aim for 200 pounds."
c. "Weight loss of more than 20 pounds in 6 months could be dangerous."
d. "Safe and maintainable weight loss should be about 10% of body weight in 6 months."

ANS: D
Safe and maintainable weight loss should be about 10% of body weight in 6 months.
A loss of 50 pounds in 6 months is unrealistic for this patient.
Advising the patient to aim for a weight loss of 200 pounds in the first 6 months is less realistic than a reduction of 50 pounds and may actually harm the patient.
Weight loss of more than 20 pounds in 6 months is not dangerous, because it falls within the guideline of 10% of body fat (ie, 28 pounds for this patient).

The nurse is caring for an obese patient who is tearful and wants diet pills to control the weight. Select the most appropriate response by the nurse.
a. "Let's begin with a comprehensive diet, exercise, and behavior management program."
b. "Drugs are the cornerstone of an effective weight-loss program for people who are obese rather than just overweight."
c. "Drugs are indicated only for patients who have no health risks from their obesity."
d. "Drugs produce an excessively rapid weight loss, which could be hazardous to your heart."

ANS: A
A comprehensive diet, exercise, and behavior management program is most appropriate course. Drugs can be used as an adjunct to diet and exercise, but only for people who have an increased health risk and only after a 6-month program of diet and exercise.
Drugs are not the cornerstone of an effective weight-loss program.
Drugs are not indicated only for patients who have no health risks from obesity.
Drugs do not produce an excessively rapid weight loss in everyone. Everyone reacts to medications differently, and what works for one patient may not work for another.

Candidates for the use of sibutramine (Meridia) who have no other risk factors should have a BMI of at least
a. 25.
b. 27.
c. 30.
d. 35.

ANS: C
In the absence of other risk factors, candidates for the use of sibutramine should have a BMI of 30 or higher.
If other risk factors are present, such as hypertension, diabetes, or hyperlipidemia, candidates for the use of sibutramine should have a BMI of 27 or higher.

The nurse is providing discharge teaching for an obese patient who is going home on sibutramine (Meridia). Which statement by the patient demonstrates a need for further education?
a. "I may experience a headache while taking this drug."
b. "I may experience an increase in my heart rate."
c. "This medication will help me lose weight by suppressing my appetite."
d. "I can expect to have diarrhea while taking this medication."

ANS: D
Diarrhea is not a side effect of sibutramine; this statement indicates a need for further teaching.
About 30% of patients taking sibutramine experience headache and a slight increase in heart rate; no further teaching is required.
The medication does assist in weight loss. Sibutramine works by suppressing appetite and possibly by increasing the metabolic rate; no further teaching is required.

While planning care for obese patients, two nurses are contrasting the differences between orlistat (Xenical) and other weight-loss agents. Which of the following statements best demonstrates how orlistat is different from most weight-loss drugs?
a. It reduces fat absorption in the intestines.
b. It suppresses the appetite center in the brain.
c. It increases the metabolism to help burn calories.
d. It increases serotonin levels and improves mood.

ANS: A
Unlike most other weight-loss drugs, which act in the brain to curb appetite, orlistat acts in the gastrointestinal (GI) tract to reduce absorption of fat.
Orlistat does not act to increase metabolism, suppress appetite, or increase serotonin levels and improve mood.

The nurse is providing patient education to a group of obese patients. To minimize the risk of vitamin deficiency in patients taking orlistat (Xenical), the nurse should instruct the patients to
a. take Metamucil to reduce the GI effects of orlistat.
b. take a daily multivitamin 2 hours before or after taking orlistat.
c. eat vitamin-rich foods at the same time orlistat is taken.
d. take a daily multivitamin at the same time orlistat is taken.

ANS: B
In reducing fat absorption, orlistat can reduce the absorption of fat-soluble vitamins. To avoid deficiency, patients should take a daily multivitamin supplement 2 hours before or after taking orlistat.
The question does not concern minimization of GI effects, and Metamucil will not accomplish this.
If vitamin-rich foods are eaten at the same time orlistat is taken, the drug would also absorb those nutrients.
Taking a daily multivitamin at the same time as orlistat is not appropriate, because it would not be absorbed.

A patient has been prescribed once daily sustained-release diethylpropion (Tenuate) for weight loss. When providing education about the administration of this drug, the nurse should instruct the patient to take the medication
a. just prior to bedtime.
b. once daily before breakfast.
c. 1 hour prior to meals.
d. during the midmorning.

ANS: D
When once daily dosing of sustained-release tablets is used, the patient should be instructed to take the medication in the midmorning.
The medication is not recommended prior to bedtime.
Phentermine is indicated once daily before breakfast.
For a three times a day (TID) dosing schedule with an immediate-release tablet, the medication is taken 1 hour prior to meals.

A patient has been taking phentermine (Adipex-P) for 12 weeks for weight loss. At a follow-up appointment, the patient reports that the medication is no longer causing appetite suppression. The nurse should advise the patient that the prescriber most likely will
a. switch to another agent in this class.
b. discontinue the drug.
c. increase the dosage.
d. continue the current dosage.

ANS: B
Tolerance is common and may be seen in 6 to 12 weeks. The appropriate response is to discontinue the drug rather than increase the dosage.
Switching to another agent in this class will not be effective because of cross-tolerance.
Increasing the dosage is not indicated.
Continuing the medication when it is ineffective is unwise.

The nurse in a clinic is caring for an obese adult patient who requests dexfenfluramine (Redux) after reading about the drug online. The nurse should instruct the patient that this drug
a. has been approved for long-term weight control.
b. is indicated only for obese patients with hypertension or heart disease.
c. was removed from the market because of associated heart damage.
d. may help with weight loss, but diet management should be used first.

ANS: C
Redux was removed from the market because of associated heart damage.
The drug has not been approved for long-term weight control.
These responses are not appropriate, because the drug has been removed from the market.

Which of the following are benefits of a weight-loss program? (Select all that apply.)
a. Reduction of blood pressure in hypertensive patients
b. Prevention of type 1 diabetes
c. Increase in high-density lipoprotein
d. Reduction of glucose in individual with type 2 diabetes
e. Increase in low-density lipoprotein

ANS: A, C, D
The benefits of weight-loss treatment include reduction of blood pressure in hypertensive patients, reduction of glucose in individuals with type 2 diabetes, and an increase in high-density lipoproteins.
Weight-loss treatment does not prevent type 1 diabetes.
Weight-loss treatment does not increase low-density lipoprotein

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