MEDICAL SURGERY NURSING PRACTICE QUESTIONS

1. The nurse is preparing to administer medications and' notes that a patient has sucralfate ordered gid. When is the best time to administer this medication? A. 1 hour before meals Rationale: This medication should be administered on an empty stomach. Taking the medication with meals, 1 hour after meals, or with a bedtime snack does not allow the medication to form its protective coat of the gastric mucosa. B. With meals C. 1 hour after meals D. With a bedtime snack 2. Which drug therapy is aimed at reducing gastric acid secretions? (Select all that apply.) A. Prokinetic agents B. Antacids C. H2 antagonists D. Proton pump inhibitors E. Coating agents Rationale: H2 antagonists and proton pump inhibitors are used to reduce gastric acid secretion. Prokinetic agents are used to hasten emptying of the stomach to reduce reflux. Antacids neutralize gastric acid. Coating agents are given to form a barrier in the stomach. 3. Which is a common adverse effect of magnesium-based antacid preparations? A. Heartburn B. Rebound indigestion C. Constipation D. Diarrhea Rationale: Magnesium oxide, magnesium hydroxide, and magnesium trisilicate are used in antacid preparations. All magnesium products can cause diarrhea. Milk of Magnesia is often taken for constipation. Antacids are given to relieve heartburn. Calciumbased antacids are likely to cause rebound indigestion. Magnesium is often given as a laxative, in antacid form or as magnesium sulfate. 4. Cimetidine (Tagamet) is an example of which class of drug? A. Prokinetic agent B. Proton pump inhibitor C. Histamine (H2) receptor antagonist Rationale: All H2 receptor antagonists end in "dine." Examples in this category include cimetidine, ranitidine, famotidine, and nizatidine. An example of a protokinetic agent is metoclopramide. An example of a proton pump inhibitor is omeprazole.An example of a coating agent is sucralfate. D. Coating agent 5. A postoperative appendectomy patient has a nasogastric tube and wonders why the previous nurse told him that he was receiving an IV "ulcer-preventing" medication called ranitidine. The patient states that he has never had any stomach problems in his life. Which is the best response by the nurse? A. "This medication will cause the pH in your stomach to drop." B. "This medication helps coat your stomach while the nasogastric tube is in place." C. "Because you are not eating after surgery, this medication will help reduce the hydrochloric acid your stomach is still secreting." Rationale: Patients who are not eating still secrete hydrochloric acid from the stomach's parietal cells. H2 receptor antagonists block the H2 receptors, resulting in a decrease in the amount of acid secreted. The pH of the stomach contents then becomes less acidic, which reduces the stress of the mucosal lining of the stomach. Ranitidine causes the stomach contents to become less acidic as the amount of acid secreted decreases; consequently, the pH of the stomach rises. This is not a coating agent, and giving it parenterally will not work to coat the stomach. Increased gastric acid, not nasogastric tubes, causes peptic ulcer disease (PUD). D. "The nasogastric tube will cause peptic ulcer disease. This medication will help prevent that." MEDICAL SURGERY NURSING PRACTICE QUESTIONS 6. The nurse is assessing a patient with constipation. Which situation(s) would cause constipation? (Select all that apply.) A. Diet low in fiber and/or residue B. Excessive fluid intake C. Diet low in cheese and yogurt D. Iron supplements E. Use of morphine Rationale: Constipation can be caused by diets lacking in adequate residue and/or fiber and fluids or the use of constipating medicines (morphine, codeine, anticholinergic agents). Iron has a constipating effect. Fluid intake helps prevent constipation. Constipation can be caused by excessive intake of constipating foods such as cheese or yogurt. 7. Which sign(s) and symptom(s) is/are consistent with dehydration? (Select all that apply.) A. Increased hemoglobin and hematocrit B. Decreased urine specific gravity C. Mental confusion and excessive thirst D. Periorbital edema and increased blood pressure E. Nonelastic skin turgor and delayed capillary filling Rationale: Blood work of dehydrated patients will show falsely elevated hemoglobin and hematocrit levels as a result of decreased capillary fluid. Dehydrated patients may become confused as a result of electrolyte imbalances and often complain of thirst. Older patients may not complain of thirst as a result of perceptual changes. Dehydration is evident by nonelastic skin turgor and delayed capillary filling. 8. A patient who is taking NSAIDs to treat arthritis asks the nurse why misoprostol has also been prescribed. Which explanation by the nurse is accurate? A. NSAIDs often cause GI irritation that can result in peptic ulcers. Rationale: Misoprostol, a GI prostaglandin, is used to prevent and treat gastric ulcers caused by NSAIDs. Prostaglandin inhibition is effective in reducing pain and inflammation, especially in arthritis, but makes the patient more predisposed to peptic ulcers. Prostaglandins are normally present in the GI tract to inhibit gastric acid and pepsin secretion to protect the stomach and duodenal lining against ulceration. NSAIDs inhibit prostaglandin production. Bismuth subsalicylate, metronidazole, and tetracycline combination (Helidac), as well as lansoprazole, clarithromycin, and amoxicillin combination (Prevpac), are used to treat infections caused by Helicobacter pylori. Drug interactions are not prevented by the presence of antiulcer medications. B. NSAIDs promote the production of prostaglandins and reduce the incidence of gastric irritation. C. Antiulcer medications eradicate the presence of bacteria in the stomach that cause ulcers. D. Drug interactions are prevented when antiulcer medications are used in combination with NSAIDs. 9. Which organism or disorder is responsible for many cases of PUD? A. H. pylori Rationale: Various combinations of antibiotics (e.g., amoxicillin, tetracycline, metronidazole, clarithromycin), bismuth, and antisecretory agents (e.g., H2 antagonists, proton pump inhibitors) are used to eradicate H. pylori. C. albicans is the causative agent of candidiasis. E. coli is a normal bowel flora. Herpes zoster is also known as shingles. B. Candida albicans C. Escherichia coli D. Herpes zoster 10. A patient with PUD asks the nurse about the action of prokinetic medications. Which explanation by the nurse is accurate? A. It blocks the formation of hydrochloric acid, reducing irritation of the gastric mucosa. B. It increases the lower esophageal sphincter muscle pressure and peristalsis. Rationale: Prokinetic agents increase the lower esophageal sphincter muscle pressure and peristalsis, hastening emptying of the stomach to reduce reflux. Proton pump inhibitors block the formation of hydrochloric acid, reducing irritation of the gastric mucosa. Antispasmodic agents reduce the secretion of saliva, hydrochloric acid, pepsin, bile, and other enzymatic fluids necessary for digestion and decrease Gl motility and secretions. H2 antagonists decrease the volume of hydrochloric acid produced, increasing the gastric ph, which results in decreased irritation to the gastric mucosa. C. It reduces the secretion of saliva, hydrochloric acid, pepsin, bile, and other enzymatic fluids. D. It decreases the volume of hydrochloric acid produced, increasing the gastric pH. 11. The nurse is instructing a patient recently diagnosed with GED. Which statement by the patient indicates a need for further teaching? A. "I will avoid foods high in fat." B. "I will eat small frequent meals and have a snack at bedtime." Rationale: Late-night snacks need to be avoided to reduce increased gastric secretions. The patient with GERD needs to avoid foods high in fat and should wait 2 hours after eating before lying down. Orange juice may aggravate the symptoms of a patient with GERD. C. "Orange juice may aggravate my symptoms." D. "I will wait 2 hours after eating lunch before lying down for a nap." 12. A nurse is preparing to administer enteric-coated aspirin to an older adult client who had a cerebrovascular accident and has difficulty swallowing medications. The client asks the nurse if she will crush the medication to make it easier to swallow. Which of the following responses should the nurse make? A. "That would release all the medication at once, rather than over time." B."I will crush it and mix it in some ice cream for you." C. "If I crush it you might experience a stomach ache or indigestion." Rationale: The aspirin tablets have an enteric coating that prevents it from dissolving in the stomach but instead passes into the intestine where it dissolves and the client absorbs it. This prevents gastric irritation. Crushing the pill destroys that protection. D. "Stomach acid will inactivate some of the medication if I crush the medication." 13. A nurse is caring for a client who has gastroesophageal disease and a prescription for metoclopramide. For which of the following adverse effects should the monitor? A. Hypertension B. Blurred vision C. Urinary retention D. Sedation Rationale: The nurse should monitor the client for sedation, which is a common adverse effect of metoclopramide. 14. A nurse is reinforcing teaching for a client who has a duodenal ulcer and a new prescription for sucralfate. The client asks the nurse how sucralfate works. Which of the following statements should the nurse make? A. "This medication prevents gastric acid secretion in the stomach." B. "This medication neutralizes gastric acid after it is secreted." C. "This medication kills the bacteria which cause ulcers." D. "This medication adheres to the ulcer and protects it from gastric acid." Rationale: Sucralfate creates a protective coating over the ulcer that lasts about 6 hrs. 15. A nurse is caring for an older adult client who has cancer and is receiving opioids for pain relief. The client has a new prescription for docusate PO daily. When collecting data from the client, which of the following therapeutic effects of docusate should the nurse expect? A. Decreased drowsiness B. Relief from constipation Rationale: Constipation is a serious adverse effect of opioid medications. The intended outcome of docusate therapy is to relieve constipation by producing stool that is softer in consistency and easier for the client to pass.