A patient with Parkinson's disease is prescribed metoclopramide for nausea. Why should the nurse question this order?
It can worsen tremor, rigidity and slowed movement
✓
It speeds the liver breakdown of levodopa
It causes a hypertensive crisis with levodopa
It blocks the absorption of levodopa
Correct Answer
It can worsen tremor, rigidity and slowed movement
Metoclopramide blocks dopamine receptors, and its labeling advises avoiding it in Parkinson's disease and in patients taking antiparkinsonian drugs because it can worsen parkinsonian symptoms. It speeds the liver breakdown of levodopa is incorrect; metoclopramide does not induce levodopa metabolism. It causes a hypertensive crisis with levodopa is not the concern; the problem is opposing effects on dopamine. It blocks the absorption of levodopa is incorrect; metoclopramide speeds gastric emptying rather than blocking absorption.
Category: Dopamine Blocking Antiemetics
Question 2
How does metoclopramide relieve nausea and speed gastric emptying?
It blocks histamine H1 receptors
It blocks dopamine receptors
✓
It activates cannabinoid receptors
It blocks acetylcholine receptors
Correct Answer
It blocks dopamine receptors
Metoclopramide blocks dopamine D2 receptors in the chemoreceptor trigger zone and in the gut, which reduces nausea and increases upper GI motility. It blocks histamine H1 receptors describes antihistamine antiemetics such as meclizine. It activates cannabinoid receptors describes dronabinol. It blocks acetylcholine receptors describes scopolamine, which slows rather than speeds the gut.
Category: Dopamine Blocking Antiemetics
Question 3
Promethazine carries a boxed warning against use in very young children because of which risk?
Severe hypoglycemia
Acute liver failure
Fatal respiratory depression
✓
Malignant hyperthermia
Correct Answer
Fatal respiratory depression
Promethazine labeling warns that it can cause fatal respiratory depression in very young children, so it is contraindicated in that age group and used with caution in older children. Severe hypoglycemia is not a boxed-warning risk of promethazine. Acute liver failure is the major danger of acetaminophen overdose, not of promethazine. Malignant hyperthermia is triggered by certain anesthetic gases and succinylcholine.
Category: Dopamine Blocking Antiemetics
Question 4
Aprepitant prevents chemotherapy-induced nausea and vomiting by blocking the receptors for which signaling molecule?
Serotonin
Dopamine
Histamine
Substance P
✓
Correct Answer
Substance P
Aprepitant is a neurokinin-1 receptor antagonist that blocks substance P in the brain and gut, and it is combined with a serotonin blocker and a corticosteroid. Serotonin is blocked by 5-HT3 antagonists such as ondansetron. Dopamine is blocked by phenothiazines and metoclopramide. Histamine is blocked by antihistamines such as meclizine.
Category: Serotonin and NK1 Antagonists
Question 5
A patient receiving promethazine through a peripheral IV line reports burning pain at the site during the injection. What should the nurse do?
Stop the injection and notify the provider
✓
Slow the injection and finish the dose
Apply a warm compress and finish the dose
Flush the line and give the rest of the dose
Correct Answer
Stop the injection and notify the provider
Injectable promethazine carries a boxed warning for severe tissue injury, including gangrene, from leakage into tissue or injection into an artery, and deep intramuscular injection is the preferred route; pain or burning means the injection is stopped at once and the injury is evaluated. Slow the injection and finish the dose keeps delivering an irritant drug. Apply a warm compress and finish the dose ignores a warning sign of tissue damage. Flush the line and give the rest of the dose also continues the injection into a possibly damaged site.
Category: Dopamine Blocking Antiemetics
Question 6
Shortly after receiving IV prochlorperazine, a patient develops sustained twisting of the neck and upward rolling of the eyes. Which adverse effect is this?
Tardive dyskinesia
Acute dystonia
✓
Absence seizure
Serotonin syndrome
Correct Answer
Acute dystonia
Acute dystonia is an early extrapyramidal reaction to dopamine-blocking drugs such as prochlorperazine and is treated with an anticholinergic or antihistamine such as diphenhydramine. Tardive dyskinesia appears after long-term use rather than soon after a dose. Absence seizure causes brief staring spells without sustained muscle spasm. Serotonin syndrome causes agitation, fever and hyperreflexia.
Category: Dopamine Blocking Antiemetics
Question 7
After applying a scopolamine patch, a patient rubs one eye and notices blurred vision and a widely dilated pupil in that eye. Which teaching addresses this problem?
Apply the patch to the upper arm instead
Remove the patch each night at bedtime
Wash hands after touching the patch
✓
Cover the patch with a heating pad
Correct Answer
Wash hands after touching the patch
Scopolamine is an anticholinergic, and drug left on the fingers can dilate the pupil and blur vision if it reaches the eye, so hands are washed well after handling the patch. Apply the patch to the upper arm instead is incorrect because the patch is placed on clean, hairless skin behind the ear. Remove the patch each night at bedtime would interrupt its continuous release. Cover the patch with a heating pad could increase drug absorption.
Category: Other Antiemetics
Question 8
Which antiemetic is also used to stimulate appetite in patients with weight loss related to AIDS?
Ondansetron
Meclizine
Metoclopramide
Dronabinol
✓
Correct Answer
Dronabinol
Dronabinol is a synthetic form of the main active cannabinoid in marijuana; it treats chemotherapy-induced nausea and vomiting and stimulates appetite in AIDS-related anorexia. Ondansetron is a 5-HT3 antagonist without an appetite indication. Meclizine treats motion sickness and vertigo. Metoclopramide speeds gastric emptying and is not used to stimulate appetite.
Category: Other Antiemetics
Question 9
Why is a small amount of atropine combined with diphenoxylate?
To discourage misuse at high doses
✓
To strengthen the antidiarrheal effect
To prevent nausea
To speed absorption from the gut
Correct Answer
To discourage misuse at high doses
Diphenoxylate is related to opioids, and the small dose of atropine causes unpleasant anticholinergic effects such as dry mouth and flushing if a person takes large amounts, which discourages misuse. To strengthen the antidiarrheal effect is not the reason, because the atropine dose is too small to add meaningfully. To prevent nausea is incorrect, since atropine is not added as an antiemetic. To speed absorption from the gut is incorrect; atropine slows gut activity rather than aiding absorption.
Category: Antidiarrheals
Question 10
A patient with fever, severe abdominal pain and bloody diarrhea asks for loperamide. What should the nurse do?
Give the drug and recheck the temperature later
Withhold the drug and contact the provider
✓
Give the drug with an antiemetic
Give the drug and encourage caffeinated drinks
Correct Answer
Withhold the drug and contact the provider
Fever, severe pain and bloody stool suggest an infectious or inflammatory cause, and slowing motility can keep the organism or its toxins in the bowel, so antidiarrheals are withheld and the provider is contacted. Give the drug and recheck the temperature later ignores signs that the drug may be harmful. Give the drug with an antiemetic still gives a motility-slowing drug. Give the drug and encourage caffeinated drinks adds caffeine, which increases gut motility and fluid loss.
Category: Antidiarrheals
Question 11
Bismuth subsalicylate should be avoided in a child or teenager recovering from influenza or chickenpox because of the risk of which condition?
Stevens-Johnson syndrome
Gray baby syndrome
Reye syndrome
✓
Red man syndrome
Correct Answer
Reye syndrome
Bismuth subsalicylate contains a salicylate, and salicylates given during or after viral illnesses in children and teens are linked to Reye syndrome, which damages the liver and brain. Stevens-Johnson syndrome is a severe skin reaction linked to drugs such as sulfonamides. Gray baby syndrome is linked to chloramphenicol in newborns. Red man syndrome is an infusion reaction to vancomycin.
Category: Antidiarrheals
Question 12
Long-term use of mineral oil as a laxative can impair absorption of which vitamins?
Vitamin C and the B vitamins
Folic acid and vitamin B12
Thiamine and niacin
Vitamins A, D, E and K
✓
Correct Answer
Vitamins A, D, E and K
Mineral oil is a lubricant laxative that dissolves fat-soluble vitamins and carries them out in the stool, so frequent use can cause deficiencies. Vitamin C and the B vitamins are water soluble and are not trapped by the oil. Folic acid and vitamin B12 are water soluble B vitamins. Thiamine and niacin are also water soluble B vitamins.
Category: Laxatives
Question 13
A patient has taken bisacodyl every day for years and now cannot have a bowel movement without it. Which problem does this describe?
Laxative dependence
✓
Fecal impaction
Paralytic ileus
Bowel obstruction
Correct Answer
Laxative dependence
Regular long-term use of a stimulant laxative can leave the bowel dependent on it, which is why laxatives are meant for short-term use along with fiber, fluids and activity. Fecal impaction is a hardened mass of stool that cannot be passed. Paralytic ileus is a loss of bowel movement that can follow abdominal surgery or some drugs. Bowel obstruction is a physical blockage and is a contraindication to laxatives.
Category: Laxatives
Question 14
For which patient is a stool softener such as docusate given mainly to prevent straining?
A patient with a suspected bowel obstruction
A patient recovering from a myocardial infarction
✓
A patient with frequent watery stools
A patient needing bowel cleansing before colonoscopy
Correct Answer
A patient recovering from a myocardial infarction
Straining at stool causes a Valsalva maneuver that strains the heart, so stool softeners are given prophylactically after a myocardial infarction or surgery. A patient with a suspected bowel obstruction should not receive laxatives. A patient with frequent watery stools does not need softer stool. A patient needing bowel cleansing before colonoscopy needs a rapid osmotic or stimulant preparation, which a stool softener cannot provide.
Category: Laxatives
Question 15
A patient taking enteric-coated bisacodyl tablets should be taught not to take them close to which of these?
Water
A meal containing fiber
Milk or antacids
✓
Fruit juice
Correct Answer
Milk or antacids
Milk and antacids raise stomach pH, which can dissolve the enteric coating early and let bisacodyl irritate the stomach and cause cramping. Water is an appropriate fluid for swallowing the tablets. A meal containing fiber does not break down the coating and supports bowel regularity. Fruit juice is acidic and does not dissolve the enteric coating early.
Category: Laxatives
Question 16
A patient taking sulfasalazine for ulcerative colitis reports that the urine has turned orange-yellow. What should the nurse explain?
It means the dose is too high
It signals that kidney stones are forming
It is a sign of acute liver failure
It is a harmless color change caused by the drug
✓
Correct Answer
It is a harmless color change caused by the drug
Sulfasalazine can tint the urine, and sometimes the skin, orange-yellow; the change is harmless, although the patient still keeps up fluid intake and reports rash, sore throat, fever or yellowing of the whites of the eyes. It means the dose is too high is incorrect, because the color appears with ordinary use. It signals that kidney stones are forming is incorrect; stones cause flank pain and blood in the urine rather than an orange tint. It is a sign of acute liver failure is incorrect; liver injury shows as jaundice of the skin and eyes with other symptoms, not an isolated urine color change.
Category: IBS and IBD Drugs
Question 17
To reduce nausea from lubiprostone, the patient should take each dose with which of these?
Food and water
✓
An antacid
Grapefruit juice
A dose of loperamide
Correct Answer
Food and water
Nausea is a common adverse effect of lubiprostone, and taking it with food and water lessens it. An antacid has no role in preventing lubiprostone nausea. Grapefruit juice does not reduce nausea and is not part of lubiprostone teaching. A dose of loperamide would counteract the drug's purpose of relieving constipation.
Category: IBS and IBD Drugs
Question 18
Linaclotide relieves constipation by activating which target in the intestinal lining?
Serotonin 5-HT3 receptors
Guanylate cyclase-C
✓
Mu-opioid receptors
Histamine H2 receptors
Correct Answer
Guanylate cyclase-C
Linaclotide stimulates guanylate cyclase-C, which increases chloride and bicarbonate secretion into the bowel, drawing in fluid and speeding transit. Serotonin 5-HT3 receptors are blocked by alosetron and ondansetron, which slow the bowel. Mu-opioid receptors in the gut slow motility when stimulated and are blocked by drugs for opioid-induced constipation. Histamine H2 receptors control stomach acid secretion, not bowel fluid.
Category: IBS and IBD Drugs
Question 19
Why does methylnaltrexone relieve opioid-induced constipation without reversing pain control?
It blocks only kappa opioid receptors
It speeds the liver metabolism of opioids
It does not cross the blood-brain barrier
✓
It is a weak opioid agonist
Correct Answer
It does not cross the blood-brain barrier
Methylnaltrexone is a peripherally acting mu-opioid antagonist that blocks opioid receptors in the gut but cannot enter the brain, so central analgesia is preserved. It blocks only kappa opioid receptors is incorrect; it acts mainly on mu receptors. It speeds the liver metabolism of opioids is incorrect; it does not change opioid levels. It is a weak opioid agonist is incorrect; it is an antagonist.
Category: Laxatives
Question 20
A patient with Crohn's disease is prescribed budesonide in an ileal-release oral form. What advantage does this form offer over prednisone?
No need to taper when stopping
Cure of the underlying disease
Antibacterial action in the bowel
Fewer systemic corticosteroid effects
✓
Correct Answer
Fewer systemic corticosteroid effects
Budesonide is released near the ileum and colon and is largely inactivated on its first pass through the liver, so it acts locally with less systemic exposure than prednisone. No need to taper when stopping is incorrect because adrenal suppression can still occur and the dose is tapered. Cure of the underlying disease is incorrect; corticosteroids control inflammation but do not cure Crohn's disease. Antibacterial action in the bowel is incorrect; budesonide is an anti-inflammatory steroid.
Category: IBS and IBD Drugs