Chapter 19: Drugs for Nausea, Vomiting, Diarrhea, and Constipation Nursing School Test Banks

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Chapter 19: Drugs for Nausea, Vomiting, Diarrhea, and Constipation

Test Bank

MULTIPLE CHOICE

1. Which statement about normal bowel function is true?
a. Bowel movements should occur once a day every day.
b. Frequency of bowel movements is more important than their consistency.
c. Bowel movements are very simple processes.
d. Bowel movements should be soft and easily pass out of the bowel.
ANS: D
Normal bowel function varies from person to person, from several times a day to several times a week. Consistency is more important than frequency. Stool should be soft enough to pass easily from the bowel, but not liquid. Bowel movements are a complex process involving several muscles and nerves located on the pelvic floor.

PTS: 0 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 341 TOP: Nursing Process Step: N/A MSC: Client Needs Category: N/A

2. Which statement about the vomiting reflex is accurate?
a. The vomiting process consists of four phases.
b. Retching precedes vomiting in the process.
c. Nausea usually occurs prior to vomiting.
d. Vomiting may be a reflex or a voluntary action.
ANS: C
The vomiting process involves three phases: nausea, vomiting, and retching. Nausea usually occurs before vomiting, and retching occurs after vomiting. Vomiting is a reflex, not a voluntary action.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 341 TOP: Nursing Process Step: N/A MSC: Client Needs Category: N/A

3. The nurse is instructing a patient on how to prevent constipation. Which point does the nurse plan to include in the teaching plan?
a. Be sure to eat a diet that is low in fiber.
b. Use a laxative on a daily basis to prevent constipation.
c. Physical inactivity will not affect your bowel function.
d. You should drink plenty of fluids every day to prevent constipation.
ANS: D
To prevent constipation, a patient should be taught to consume a diet that is high in fiber, drink plenty of fluids, and be physically active. Misuse of laxatives can cause constipation because the body becomes dependent on these drugs, needing higher and higher doses until the bowel no longer works.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Planning
MSC: Client Needs Category: Health Promotion and Maintenance

4. The nurse is instructing a patient about how to help prevent the spread of diarrhea. Which point does the nurse include in the teaching plan?
a. When travelling internationally it is best to drink bottled water with ice cubes.
b. Be sure to wash your hands after using the bathroom or changing diapers.
c. Always wear clean gloves when handling raw meat or poultry.
d. Cut down on your fluid intake to decrease the number of diarrhea episodes.
ANS: B
While drinking bottled water is good, ice cubes may be made with tap water, which in certain countries may contain bacteria that can cause diarrhea. Washing hands before and after handling raw meat or poultry is important, but it is not necessary to wear gloves. The patient should continue drinking adequate fluids while having diarrhea to prevent dehydration. Washing hands after using the bathroom or changing diapers can prevent the spread of diarrhea.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Planning
MSC: Client Needs Category: Health Promotion and Maintenance

5. A patient receiving chemotherapy and prescribed ondansetron (Zofran) asks the nurse why the drug is given before meals. What is the nurses best response?
a. Ondansetron is given 30 minutes before your meals to prevent nausea.
b. The purpose of this drug is to move food rapidly through your GI tract.
c. This drug works by preventing nausea caused by morphine given for your pain.
d. If this drug were given after your meals, the food would interfere with its absorption.
ANS: A
Ondansetron is an antinausea drug that is given 30 minutes before meals and at bedtime to prevent the nausea that is associated with chemotherapy. Metoclopramide (Reglan) increases peristalsis to help move food through the GI tract. Antihistamines prevent the nausea and vomiting caused by opiate drugs such as morphine. If the drug were given after meals, its purpose would not be met.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

6. A patient prescribed metoclopramide (Reglan) reports having difficulty sleeping, difficulty concentrating, tiredness, and feeling hopeless. What is the nurses best action?
a. Instruct the patient that these are expected side effects of the drug.
b. Document these findings as the only action.
c. Check the patients chart history of depression.
d. Hold the drug and notify the prescriber.
ANS: D
Difficulty sleeping and concentrating, tiredness, and feeling hopeless are signs of depression. Metoclopramide can cause mild to severe depression. The nurse should hold the drug and notify the prescriber. This drug should not be prescribed for patients with a history of depression.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Psychosocial Integrity

7. A patient prescribed metoclopramide (Reglan) tells the nurse that his abdomen is making gurgling sounds. What is the nurses best action?
a. Instruct the patient that this is an expected effect of the drug.
b. Document this finding as the only action.
c. Hold the drug and notify the prescriber.
d. Give the drug and notify the prescriber.
ANS: A
Metoclopramide increases stomach and small intestine contractions (peristalsis) which helps move food through the GI system. Increased peristalsis causes increased and sometimes loud bowel sounds. The patient should be instructed that this is an expected action of the drug.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

8. A 10-year-old child is prescribed cyclizine (Marezine) 25 mg orally for motion sickness. The drug is available as a 50 mg tablet. How many tablets does the nurse instruct the parent to give the child?
a. One fourth
b. One half
c. Two
d. Four
ANS: B
Want 25 mg, Have 50 mg/tablet. 25 mg/50 mg = 1/2 tablet.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

9. The spouse of a patient who is prescribed promethazine (Phenergan) as part of her antiemetic therapy with chemotherapy reports that after the last dose the patient did not remember the drive home. What is the nurses best action?
a. Thank the spouse for reporting the problem, and document the adverse drug reaction.
b. Hold the dose of promethazine for this round of chemotherapy until the patient is seen by the prescriber.
c. Reassure the patient and spouse that this is a normal response to the drug and that the patient should not drive home.
d. Perform a mini-mental status exam and assess the patients pupillary reflexes before administering the promethazine.
ANS: C
Promethazine, a phenothiazine-based drug, induces sedation and confusion in addition to having antiemetic effects. Some patients have reduced memory about events occurring within a few hours after receiving the drug. This is an expected, temporary side effect and does not denote any permanent reduced cognition. Both the patient and the spouse should be aware of this effect so that the patient is not at risk for injury. Driving, cooking, or operating dangerous equipment should not be performed until the drugs effects have worn off.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Psychosocial Integrity

10. What is the most important assessment question for the nurse to ask a patient before administering intravenous metoclopramide (Reglan)?
a. Are you being treated for depression?
b. Is your type 1 diabetes well controlled?
c. Do you have a gastric or duodenal ulcer?
d. Are you taking aspirin or any aspirin-containing products?
ANS: A
Metoclopramide can make depression worse and intensify thoughts of suicide. Patients with a history of depression should not be prescribed this drug.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

11. The nurse is instructing a patient who is experiencing chronic nausea and vomiting about antiemetic therapy. What is the most important precaution the nurse teaches the patient?
a. Rinse your mouth frequently to reduce the unpleasant sensation of dry mouth.
b. Report any constipation lasting two days or longer to your prescriber.
c. Wear sunscreen and protective clothing when going outdoors.
d. Avoid drinking alcoholic beverages while taking this drug.
ANS: D
All of the antiemetic drugs cause some degree of central nervous system depression, although some drugs have a more profound action than others. Alcohol increases CNS depression, increasing the risks for injury, cognitive changes, and respiratory depression. In addition, alcohol may intensify the experience of nausea. Although it is also important to remind patients to avoid sun exposure because of increased sun sensitivity, and to rinse the mouth to reduce dry mouth sensation, alcohol avoidance is the most important precaution because it can lead to more serious complications.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

12. An older male patient with nausea is prescribed scopolamine (L-hyoscine). Which nursing assessment does the nurse perform to determine whether he is experiencing a serious side effect?
a. Checking capillary refill
b. Measuring abdominal girth
c. Evaluating handgrip strength
d. Evaluating daily intake and output
ANS: D
Scopolamine is an anticholinergic drug that can cause urinary retention. Older men often have some degree of prostate enlargement that may be undiagnosed and result in some urinary retention. Scopolamine makes this problem worse and can cause kidney damage. Comparing urine output to fluid intake is important for this patient to determine whether severe urinary retention is occurring.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Physiological Integrity

13. A patient who is prescribed prochlorperazine (Compazine) for postoperative nausea and vomiting has all of the following changes. For which change does the nurse immediately contact the prescriber?
a. Systolic blood pressure decrease of 12 mm Hg
b. Increased sleepiness but arouses with light shaking
c. Oral temperature increase of 2 F
d. Urine color change from yellow to reddish-brown
ANS: C
Prochlorperazine can trigger neuroleptic malignant syndrome, a rare and life-threatening side effect in which dangerously high body temperatures can occur. Without prompt and expert treatment, this condition can be fatal in as many as 20% of those who develop it. One of the first warning signs is increasing body temperature. At this point, steps must be taken quickly to prevent this adverse reaction from becoming worse.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation
MSC: Client Needs Category: Safe and Effective Care Environment

14. The mother of a 9-month-old child reports that the child has a bowel movement only every 2 or 3 days and that the stool is small and hard, like marbles. What does the nurse recommend as starting treatment for this problem?
a. Use castor oil every 3 days
b. Increase the childs fluid intake
c. Ensure that the child gets adequate exercise
d. Mix a bulk-forming laxative in with the childs cereal
ANS: B
The most common cause of constipation in children of this age group is insufficient fluid intake. A 9-month-old does not ask for fluids and is dependent on others to provide them. Increasing fluids is the action least likely to cause problems in this situation, as long as the intake does not exceed 2 L per day.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

15. How do osmotic laxatives reduce constipation?
a. They cause retention of fluid in the bowel, increasing the water content in stool.
b. They add bulk to the stool, which increases stool mass that stimulates peristalsis.
c. They soften stool, allowing the stool to mix with fatty substances, making it easier to eliminate.
d. They cause chemical irritation of nerve receptors in the intestinal lining, which then triggers peristalsis.
ANS: A
Osmotic laxatives pull water from other body areas into the intestinal tract and prevent it from being reabsorbed through intestinal walls. The extra fluid enters stool, keeping it soft and easier to expel.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 348 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

16. Which action is most important for the nurse to perform after giving a patient bisacodyl (Dulcolax)?
a. Comparing daily urine output with fluid intake
b. Assessing pulse rate and regularity every 4 hours
c. Ensuring that the patient complies with a low-sodium diet
d. Testing the patients blood glucose level at least every shift
ANS: B
Bisacodyl may cause hypokalemia, which can lead to life-threatening dysrhythmias. Serum electrolytes may not have been ordered. Checking pulse regularity can help recognize new or worsening dysrhythmias.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Physiological Integrity

17. The mother of a 6-year-old child receiving diphenoxylate (Lomotil) for the last 4 days for diarrhea reports by telephone that the diarrhea has stopped and that the childs pants cannot be zipped or buttoned today. What is the nurses best advice?
a. Give the child only half the dose of the drug today.
b. Do not give the child fluids for the next 24 hours.
c. Stop the drug and go immediately to the prescribers office.
d. When diarrhea is cured the stool enlarges the abdomen.
ANS: C
Increasing abdominal size while taking a drug for diarrhea is an indication of toxic megacolon, a serious complication of this therapy. Children taking diphenoxylate are more sensitive to the side effects and can develop a toxic megacolon quickly. Other signs and symptoms of this condition include fever, abdominal pain, rapid heart rate, and dehydration. A patient with toxic megacolon may go into shock. When this condition is not recognized and treated early, there is a risk for death.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

18. A patient who is prescribed promethazine (Phenergan) currently has a respiratory rate of 8 breaths per minute. What is the nurses best action?
a. Place the patient on oxygen at 2 L per nasal cannula.
b. Document this as an expected side effect of the drug.
c. Hold the drug and notify the prescriber.
d. Raise the head of the bed 90 degrees.
ANS: C
Respiratory depression (decreased drive for breathing) is a life-threatening adverse effect that can occur with several antiemetic drugs, including promethazine. The nurse must be sure to monitor the patients respiratory rate after administering this drug and report a decrease in respiratory rate to the prescriber. The drug should be held because a respiratory rate of 8 breaths per minute is very low.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Assessment MSC: Client Needs Category: Physiological Integrity

19. The nurse is administering a patients first dose of cyclizine (Marezine). What safety action does the nurse take for this patient?
a. Instruct the patient to call for help when getting out of bed.
b. Raise all four side rails to the upright position.
c. Give the patient a full glass of water with the medication.
d. Tell the patient to avoid eating for at least 2 hours.
ANS: A
Cyclizine is an antiemetic drug. Most of these drugs cause drowsiness as a side effect. The nurse must instruct the patient to call for help when getting out of bed and make sure that the call light is within easy reach. This is especially important because this is the patients first dose of the drug and its effects for this patient are unknown.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

20. The wife of an inpatient who is prescribed dexamethasone (Decadron) tells the nurse over the phone that she has developed a cold with a low-grade fever. What is the nurses best advice at this time?
a. If you come in to visit you must wear an isolation gown.
b. Hospital rules do not allow visitors with colds or fevers for any patients.
c. It would be best to speak with your husband by phone and stay home today.
d. You must take care of yourself so that you can take care of your husband when he comes home.
ANS: C
Dexamethasone is a drug that also has an immunosuppression action. Patients taking this drug are at increased risk for infections and should avoid being exposed to any infection. The nurse must monitor patients receiving this drug for any signs of infection.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

21. A patient reports taking an over-the-counter laxative for constipation daily for the past 3 weeks. What is the nurses best action?
a. Remind the patient about the importance of adequate fluid intake and exercise to prevent constipation.
b. Instruct the patient that these drugs should not be used for more than a week without consulting the prescriber.
c. Ask the patient about usual fluid intake, urinary and bowel habits, and have the patient describe the nature of stools.
d. Contact the prescriber about an order for a stronger laxative because the one the patient is taking is not working.
ANS: B
Laxative drugs are not meant for long-term use and should not be used for longer than one week unless following a prescribers advice. The use of laxatives long-term can cause other health problems.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

22. A patient reports taking psyllium (Metamucil) every morning to prevent constipation. What is the nurses best action?
a. Remind the patient that over-the-counter laxatives should not be taken for more than one week.
b. Instruct the patient that long-term use of psyllium can cause health problems.
c. Hold the drug and notify the prescriber immediately.
d. Document this information as the only action.
ANS: D
Psyllium is a bulk-forming laxative and can be used once a day to help prevent constipation. Bulk-forming laxatives are the one exception to the rule that laxatives should not be used long-term. These drugs are not absorbed from the intestines into the body and are safe for long-term use.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Assessment MSC: Client Needs Category: Physiological Integrity

23. Which laboratory value must the nurse monitor after a patient takes bisacodyl (Dulcolax) for constipation?
a. Sodium
b. Potassium
c. Creatinine
d. Blood urea nitrogen
ANS: B
A common side effect of bisacodyl is hypokalemia (low blood potassium). The nurse must monitor this value when a patient is prescribed this drug and report decreased values to the prescriber.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
REF: pp. 349, 350 TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity

24. What primary assessment does the nurse make for a patient who is prescribed loperamide (Immodium)?
a. Tachycardia
b. Abdominal distention
c. Peripheral edema
d. Respiratory crackles
ANS: B
A potential life-threatening adverse effect of anti-motility drugs such a loperamide is toxic megacolon which is characterized by a very inflated colon and abdominal distention. After giving an antimotility drug, the nurse must be sure to check the patients abdomen for distention and report this finding to the prescriber.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Assessment MSC: Client Needs Category: Physiological Integrity

25. A patient reports taking attapulgite (Kaopectate) for diarrhea over the past 4 days. What is the nurses best action?
a. Send a stool specimen to the lab for analysis.
b. Instruct the patient to notify nursing staff about all episodes of diarrhea and save the stool for assessment.
c. Check the patients blood pressure and heart rate.
d. Teach the patient that antidiarrheal drugs should not be taken for more than 2 days unless instructed to by their prescriber.
ANS: D
Antidiarrheal drugs should not be taken for more than two days unless instructed by a prescriber. When a patients diarrhea is not relieved after two days, they should contact his or her prescriber.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

MULTIPLE RESPONSE

1. Which are potential complications of nausea and vomiting? (Select all that apply.)
a. Bleeding
b. Aortic aneurysm
c. Aspiration pneumonia
d. Bowel perforation
e. Reopening of surgical wounds
ANS: A, C, E
Nausea and vomiting create physiological complications which include bleeding, aspiration pneumonia, dehydration, and reopening of surgical wounds. These complications can be very costly and prolong hospital stays.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 342 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

2. Which are symptoms of constipation? (Select all that apply.)
a. Having less than one bowel movement a day
b. Stools that are harder than normal
c. Sudden increase in frequency of bowel movements
d. Bowels that feel full after a bowel movement
e. Sensation of feeling bloated
ANS: B, D, E
Signs and symptoms of constipation include fewer than three bowel movements a week, a sudden decrease in the frequency of bowel movements, stools that are harder than normal, bowels that still feel full after a bowel movement, and feeling bloated.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 346 TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity

3. Which are symptoms of diarrhea? (Select all that apply.)
a. Weight loss
b. Bowels still feeling full after a bowel movement
c. Abdominal pain and cramping
d. Fever, chills, and feeling ill
e. Feeling bloated
ANS: A, C, D
Signs and symptoms of diarrhea include a frequent need to have a bowel movement, abdominal pain and cramping, fever, chills, generally feeling ill, and weight loss. Bowels feeling full after a bowel movement and feeling bloated are symptoms of constipation.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 351 TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity

4. Which teaching points are included in a care plan for a patient who is taking laxatives for constipation? (Select all that apply.)
a. Drink between 1500 and 2000 mL of fluids every day.
b. Avoid bulk foods such as whole grain bread and vegetables.
c. Use the bathroom right away when you feel the urge to have a bowel movement.
d. Try to get some regular exercise each day to prevent constipation.
e. Take your laxative with at least 4 ounces of water so it can be effective.
ANS: A, C, D
Adequate fluid intake (1500 to 2000 mL), bulk foods in the diet, and regular daily exercise are important strategies to prevent constipation. Patients should be taught to use the bathroom right away when the urge to have a bowel movement occurs. At least 9 ounces of fluid should be given with oral laxatives so that they can be safe and effective.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: pp. 347, 350 TOP: Nursing Process Step: Planning
MSC: Client Needs Category: Health Promotion and Maintenance

ESSAY

1. A child is prescribed metoclopramide (Reglan) 8 mg by oral solution. The available drug solution is 5 mg per 5 milliliters of solution. How many milliliters does the nurse administer?
_____ mL

ANS:
8 mL
Want 8 mg/X mL, Have 5 mg/5 mL = 1.6 5 mL = 8 mL.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

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