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Pharm Unit 6 Book Quiz

Unit 6 quiz on GI medications for APNs, covering mechanisms of action for loperamide and best laxative choices post-surgery. Includes rationales for selecting appropriate pharmacologic treatments. Ideal for advanced nursing pharmacology review.

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    UNIT 6 BOOK QUIZ Question 1 . The APN understands that loperamide works by which mechanism? • 1. Supplying missing bacteria to the gastrointestinal (GI) tract . correci2. Decreasing gastric and bowel motility • 3. Coating the w T alls of the gastrointestinal (GI) tract and binding to toxins . 4. Stimulating peristalsis and gastric motility Rationales • Option l:This describes the mechanism of a probiotic. ■ Option 2:Loperamide binds to the opiate receptors of the intestine, leading to a decrease in gastric and intestinal motility. • Option 3:This describes the mechanism of an adsorbent. . Option 4:This describes the mechanism of a stimulant laxative or pro kinetic agent. [Page Reference: 485] Question 2 . A patient underwent sternotomy and coronary artery bypass surgery yesterday. It is important to avoid straining for a bow T el movement postoperative ly. Which laxative would be the best choice for this type of patient? • 1 . Psyllium . 2.Lubiprostone • 3. Methylnaltrexo ne • correct4. Docusate Rationales • Option 1:Bulk-forming laxatives are used for simple, chronic constipation. • Option 2:Lubiprostone is used for women who have irritable bow T el syndrome (IBS) with constipation.

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    Option 3: Methylnaltrexone is used for treating constipation from chronic opioid use. • Option 4: Surfactants. or "stool softeners." are commonly prescribed postoperatively to prevent straining and the resultant pressure on the surgical incision. [Page Reference: 5161 Q u e s t i o n s . Many patients, particularly older adults, take over-the-counter (OTC) laxatives regularly. Which statement about laxative use is accurate? . 1. Patients cannot become dependent on laxatives. • corrects. Fluid and electrolyte imbalances can occur. • 3. Persons with Crohn's disease often abuse laxatives and take too many. • 4. Castor oil is good choice of laxative for a pregnant woman. Rationales • Option l:This is untrue. Many patients become dependent on laxatives for a bowel movement, particularly with the overuse of stimulant laxatives. • Option 2:This is especially true of older adults using bulk-forming laxatives or hyperosmolar agents. ■ Option 3: Laxative abuse is commonly seen in those with personality disorders and women with depression or anorexia nervosa. • Option 4:Castor oil induces uterine contractions and should not be used. [Page Reference: 5 1 6 ] Question 4. A patient with a body mass index (BMI) of 28 has recently been diagnosed with gastroesophageal reflux disease (GERD), and omeprazole has been prescribed. Which advice would the APN give this patient regarding lifestyle changes? • l."You should eat meals high in carbohydrates." • 2. "Small amounts of alcohol are OK."

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    corrects. "Attaining a healthy weight will help reduce symptoms of GERD." 4. "Drinking peppermint tea before bed will help." Rationales « Option l:High-carbohydrate meals will worsen GERD. • Option 2:Alcohol decreases lower esophageal sphincter tone and w T ill make GERD worse. • Option 3: Obesity increases abdominal pressure and will worsen GERD. • Option 4:Peppennint decreases lower esophageal sphincter tone and will make GERD w’orse. [Page Reference: 10581 Question 5 . Prior to initiating therapy with misoprostol for a 30-year-old woman, which question is essential for the APN to ask? • correctl. "Is there any possibility that you might be pregnant?" « 2. "Do you take any other pain medication?" • 3. "Are you taking any antacids or [histamine-2] Hz blockers right now?" . 4."How long have you been suffering from arthritis?" Rationales ■ Option 1: Misoprostol is an abortifacient and is Pregnancy Category X. Determining whether the patient is pregnant is the top priority before prescribing this medication. • Option 2: Misoprostol is a cyto protective agent. Although it is important to evaluate other medications the patient might take, it is not the priority in this instance. • Option 3:Although this is important to evaluate, it is not the priority. ■ Option 4:The diagnosis is not relevant to the safe administration of misoprostol in this instance. [Page Reference: 498]

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    Question 6. A 25-year-old female patient is about to embark on a 2-week cruise for her honeymoon, and she is worried because she experiences seasickness. She asks about using a scopolamine patch. Which advice would the APN provide the patient about this medication? • correct!. "Apply the patch behind your ear 4 hours before getting on the ship." • 2. "Change the patch every morning while on the ship." • 3. "When you change the patch, put it behind the same ear." . 4. "Only apply the patch to your arm if you experience seasickness." Rationales • Option 1 :The patch should be applied behind the ear 4 hours before traveling. . Option 2:The patch can be left in place for up to 3 days. 1 Option 3: If therapy is still needed after 3 days, the new patch should be placed behind the other ear. • Option 4:The patch should be applied behind the ear 4 hours before traveling. [Page Reference: 497] Question 7 . A patient consults the APN because of concerns about experiencing repeated bouts of vertigo and nausea. The patient asks whether anything can be prescribed to help. Which medication would be most appropriate for this patient? . 1. Prochlorperazine 10 mg oral tablet • 2. Apre pitant 40 mg capsule ■ corrects. Meclizine 25 mg oral tablet . 4.Dolasetron 100 mg tablet Rationales ■ Option 1:Prochlorperazine is not usually effective for treating vertigo. Option 2:Aprepitant is used for nausea and vomiting in patients receiving chemotherapy.

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    Option 3: Antihistamines act on the vestibular system and chemo receptor trigger zone (CTZ) and thus are good for vertigo and its associated nausea. • Option 4:Doiasetron is used for preventing nausea and vomiting after surgery or chemotherapy. [Page Reference: 494] Question S. A patient is to start taking esomeprazole for the treatment of gastroesophageal reflux disease (GERD). Which instruction must the APN give the patient regarding this medication? • l.Take this medication with every meal. • correct2 . Take the medication at least 1 hour before a meal. • 3. Take the medication 1 to 3 hours after meals. . 4. Take the medication every time you experience heartbum. Rationales • Option 1: Esomeprazole is most effective when given 1 hour prior to a meat and it is not taken with every meal. • Option 2: Esomeprazole is most effective when given 1 hour prior to a meal. . Option 3: Antacids should be taken 1 to 3 hours after meals and at bedtime. • Option 4: Esomeprazole should be taken daily for several weeks to treat GERD. If the patient has no relief of symptoms, he or she needs further investigation. [Page Reference: 10591 Question 9 . Which medication works by binding to the base of ulcers and gastric erosions, thus forming a protective barrier? • 1 . M etoc lopramide • corrects. Sucralfate • 3. Aluminum carbonate • 4. Bismuth subsalicylate

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    Rationales • Option 1 : Metoclopramide is a prokinetic agent. It does not have the described mechanism of action. • Option 2:Sucralfate is a cyto protective agent and binds to the base of ulcers and erosions. • Option 3:Aluminum carbonate is an antacid. It does not have the described mechanism of action. • Option 4:Bismuth subsalicylate has numerous uses, including the treatment of diarrhea. It does not have the described mechanism of action. [ P a g e Reference: 4 9 1 ] Question 1 0 . A patient comes to the clinic complaining of a 2-day history 7 of diarrhea. He receives two tablets of diphenoxylate HC1 with atropine sulfate to take orally as needed for each loose stool. The APN should inform him that he may experience which symptom(s)? « l . A slower heart rate than normal ■ 2 . The need to urinate frequently • 3 . An increase in appetite . correct!. Drowsiness and dizziness Rationales • Option l:This medication occasionally causes tachycardia. • Option 2 The anticholinergic effects of the medication may cause urinary retention. ■ Option 3:Enhanced appetite is not caused by this medication. • Option 4: Diphenoxylate with atropine may cause sedation and possibly dizziness. [ P a g e Reference: 485] Question 1 1 . When initiating long-term drug therapy with proton pump inhibitors (P Pls) for patients with severe gastroesophageal reflux disease (GERD), which of these is one of the four goals of treatment? • correct!. To reduce symptoms of reflux

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    • 2 . To remove barriers to adherence . 3 .To prevent the development of vitamin B - deficiency • 4.To cure the disorder Rationales • Option 1 :Reducing the symptoms of reflux is one of the four goals of treatment • Option 2:Any disease process where lifestyle modifications are central to management is prone to problems with adherence. • Option 3:Vitamin B :2 deficiency is a potential adverse effect of long- term treatment with PPIs and is not a goal of treatment. • Option 4:GERD is a chronic condition. Patients with GERD must understand the lifelong nature of the disorder and the need to incorporate the treatment regimen into their everyday lives. [Page Reference: 1 0 5 9 ] Question 1 2 . For which patient is docusate contraindicated? « l . A female patient with an 8-w’eek-old baby who is breastfeeding • 2 . A female patient w’ho is 16 w T eeks pregnant « 3.A male patient who has just undergone a thoracotomy • correct4. A male patient complaining of nausea and abdominal pain Rationales • Option 1:Surfactants are safe for pregnant and breastfeeding women. ■ Option 2 : Surfactants are safe for pregnant and breastfeeding women. « Option 3:Surfactants are often prescribed postopera Lively to prevent straining. • Option 4 : Laxatives should not be taken in the presence of nausea, vomiting, o r abdominal pain. The patient needs further investigation to rule out a bow T el obstruction. [Page Reference: 5 1 7 ]

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    Question 1 3 . The APN is writing orders for a patient who is scheduled to have a colonoscopy 3 days from now. Which medication should be prescribed to cleanse the entire gastrointestinal (GI ) tract prior to this procedure? ■ c orre c tl . Po lye thyle ne g lyc o1 ■ 2 . M e thylce llulose • 3 . Lactulose . 4. Doc us ate c alcium Rationales • Option 1: Polyethylene glycol is commonly used as bowel prep before a colonoscopy. » Option 2: Methylcellulose is a bulk-forming laxative used to treat simple, chronic constipation. • Option 3 : Lactulose is most commonly used to treat hepatic encephalopathy. ■ Option 4:Docusate is a surfactant, or "stool softener/ 1 and w T ould not cleanse the colon sufficiently. [ P a g e Reference: 5 0 2 ] Question 1 4 . A 2 2-year-old female patient suffering from irritable bowel syndrome (IBS) with constipation is seen at the clinic. Which medication would be most appropriate for this patient? • 1 . Lactulose • 2 . Mineral oil • corrects. Lubiprostone . 4. Polycarbophil Rationales • Option l:Lactulose is a hyperosmolar laxative frequently prescribed to lower ammonia levels in patients with hepatic failure. . Option 2 : Mineral oil is normally used to lubricate the intestines and is commonly used for fecal impaction. I t may decrease the absorption of fat-soluble vitamins.

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    Option 3:Lubiprostone is a chloride channel activator and is used to treat IBS with constipation in women 18 years and older. • Option 4:Polycarbophil is a bulk-forming laxative used to treat simple, chronic constipation. [Page Reference: 5 0 3 ] Question 1 5 . Considering eradication rates, adverse effects, antimicrobial resistance, and patient compliance, which regimen is most appropriate for treatment ofH. pylon-induced peptic ulcer disease (PUD)? ■ correctl. Clarithromycin, amoxicillin, and a proton pump inhibitor (PPI) • 2 . Tetracycline, metronidazole, and a proton pump inhibitor (PPI) • 3. Clarithromycin, tetracycline, and a histamine-2 (Hi) blocker . 4. Metronidazole, amoxicillin, and a histamine-2 (H 2 ) blocker Rationales « Option l:This regimen has fewer adverse effects, less antibiotic resistance, and good-to-excellent eradication rates. • Option 2 : Metronidazole has numerous adverse effects. • Option 3:Proton pump inhibitors (PPIs) are the standard for treating H. pylori -induced PUD. • Option 4:Proton pump inhibitors (PPIs) are the standard for treating H. py/ori-induced PUD. Metronidazole has numerous adverse effects . [ P a g e Reference: 1 0 6 2 ] Question 1 6 . A 56-year-old male patient with diabetes has been taking a proton pump inhibitor (PPI) daily as prescribed for gastroesophageal reflux disease (GERD) but still experiences significant acid reflux. Which medication could be prescribed to increase gastric emptying and help improve his symptoms? • correctl. Metoclopramide ■ 2 . Famotidine • 3. Prochlorperazine

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