Question

A nurse is taking a health history of a client who reports occasionally taking several over-the-counter medications, including an H₂ receptor antagonist (H₂RA). Which of the following outcomes indicates the H₂RA is therapeutic?

Answer 1

Correct Answers:

Relief of heartburn

Rationale :

💠 Mechanism of Action: H₂ receptor antagonists (like ranitidine, famotidine, cimetidine) block histamine receptors in gastric parietal cells, reducing gastric acid secretion.

💠 Therapeutic Goal: The main indication is to relieve symptoms of gastroesophageal reflux disease (GERD), peptic ulcers, and heartburn.

💠 Expected Outcome: Decreased epigastric pain and burning after meals or at night indicates effective therapy.

💠 Clinical Monitoring: Symptom relief without rebound acidity suggests optimal dosing and compliance.

💠 Other Effects: They do not affect bowel motility or gas passage, ruling out the other choices.

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Answer 2

Correct Answers:

"I will take this medication 1 hour before meals and at bedtime."

Rationale :

🔷 Mechanism: Sucralfate forms a protective barrier over ulcers, shielding them from acid and pepsin.

🔷 Timing: It must be taken before meals and at bedtime to ensure it coats the stomach lining during peak acid secretion.

🔷 Administration Rule: Should be taken on an empty stomach; concurrent antacid use reduces effectiveness.

🔷 Client Education: Encourage adequate fluid intake to prevent constipation, a possible side effect.

🔷 Therapeutic Effect: Promotes ulcer healing and pain relief by creating a protective mucosal film.

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Answer 3

Correct Answers:

Constipation

Rationale :

💎 Action: Aluminum hydroxide neutralizes stomach acid and binds phosphate in the gut.

💎 Adverse Effect: Aluminum compounds slow intestinal motility, leading to constipation.

💎 Prevention: Encourage high-fiber diet and hydration to minimize this effect.

💎 Combination Therapy: Often combined with magnesium hydroxide, which causes diarrhea, to balance bowel effects.

💎 Monitoring: Persistent constipation should be reported, as it may indicate electrolyte imbalance..

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Answer 4

Correct Answers:

"Your doctor might need to reduce your theophylline dose while taking this medication."

Rationale :

♦ Mechanism: Cimetidine inhibits cytochrome P450 enzymes, affecting metabolism of several drugs including theophylline, warfarin, and phenytoin.

♦ Clinical Importance: Concurrent use increases plasma concentrations, risking toxicity.

♦ Teaching: Advise clients to report signs of theophylline toxicity—nausea, tremor, restlessness, or tachycardia.

♦ Administration Tip: Take with meals or at bedtime, not with antacids, to avoid interference with absorption.

♦ Duration: Usually prescribed for 4–6 weeks, not months, unless clinically indicated.

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Answer 5

Correct Answers:

30 minutes before breakfast

Rationale :

🟣 Mechanism: Lansoprazole is a proton pump inhibitor (PPI) that suppresses gastric acid secretion by inhibiting the H⁺/K⁺ ATPase pump.

🟣 Timing: PPIs are most effective when gastric proton pumps are most active, typically before the first meal of the day.

🟣 Administration: Take 30–60 minutes before breakfast, swallowed whole (do not crush or chew).

🟣 Expected Outcome: Relief of GERD symptoms, healing of ulcers, and prevention of acid reflux.

🟣 Education: Long-term use may require monitoring of magnesium and vitamin B₁₂ levels

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Answer 6

Correct Answers:

Prolonged QT interval

Rationale :

💠 Mechanism: Ondansetron is a serotonin (5-HT₃) receptor antagonist used to prevent nausea and vomiting.

💠 Cardiac Risk: It can prolong the QT interval, increasing the risk for torsades de pointes and life-threatening arrhythmias.

💠 Contraindication: Avoid use in clients with existing QT prolongation or electrolyte imbalances (e.g., hypokalemia, hypomagnesemia).

💠 Monitoring: ECG monitoring is recommended in cardiac, elderly, or high-risk patients.

💠 Other Effects: Common mild effects include headache and constipation, not cardiac rhythm changes.

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Answer 7

Correct Answers:

Glucose 175 (70-100)

Rationale :

🔷 Drug Effect: Glucocorticoids (e.g., dexamethasone) raise blood glucose levels by increasing gluconeogenesis.

🔷 At-Risk Clients: Diabetic or immunocompromised patients are particularly vulnerable to hyperglycemia complications.

🔷 Critical Lab: A glucose of 175 mg/dL exceeds normal range (70–100) and must be reported for dose adjustment.

🔷 Other Labs: Leukopenia or anemia may reflect chemotherapy effects, not directly caused by glucocorticoids.

🔷 Nursing Care: Monitor blood sugar, infection signs, and weight during corticosteroid therapy.

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Answer 8

Correct Answers:

Send stool specimen to lab

Rationale :

♦ Priority: Identify the cause of diarrhea before initiating medication or dietary restriction.

♦ Diagnostic Purpose: Stool specimens detect infection (e.g., C. difficile), parasites, or bleeding.

♦ Nursing Safety: Giving antidiarrheals before identifying the cause could worsen infection by delaying toxin elimination.

♦ Hydration: Assess fluid and electrolyte status concurrently to prevent dehydration.

♦ Rationale for NPO: Not a first priority unless bowel rest is specifically ordered for severe conditions.

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Answer 9

Correct Answers:

"I can still drink my morning coffee"

Rationale :

💎 Absorption Fact: Coffee, tea, and dairy inhibit iron absorption due to tannins and calcium.

💎 Timing: Iron is best absorbed on an empty stomach or with vitamin C–rich juice to enhance absorption.

💎 Side Effects: Dark stools and constipation are expected, harmless findings.

💎 Drug Interactions: Antacids and calcium supplements reduce effectiveness.

💎 Education: Encourage increased fiber and fluids to prevent constipation from oral iron therapy.

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Answer 10

Correct Answers:

Respirations of 8

Rationale :

🟣 Toxicity Sign: A respiratory rate below 12/min indicates magnesium toxicity causing respiratory depression.

🟣 Therapeutic Range: Serum Mg: 1.5–2.5 mEq/L (toxic > 4–5).

🟣 Other Symptoms: Hypotension, decreased deep tendon reflexes, and cardiac arrhythmias accompany toxicity.

🟣 Intervention: Stop infusion immediately and administer calcium gluconate, the antidote.

🟣 Monitoring: Regularly assess respiratory rate, reflexes, and urine output during magnesium therapy.

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EXAM THREE FA25

No.

1 :
A nurse is taking a health history of a client who reports occasionally taking several over-the-counter medications, including an H₂ receptor antagonist (H₂RA). Which of the following outcomes indicates the H₂RA is therapeutic?

2 :
A nurse is teaching a client who has a new prescription for sucralfate to treat a gastric ulcer. Which of the following statements by the client indicates an understanding of the teaching?

3 :
A nurse is teaching a client who has a new prescription for aluminum hydroxide to treat heartburn. The nurse should instruct the client to monitor for and report which of the following adverse reactions?

4 :
A nurse is teaching a client who has a duodenal ulcer about his new prescription for cimetidine. The nurse should include which of the following instructions in the teaching?

5 :
A client is prescribed lansoprazole 15 mg PO once a day. At which of the following times should the nurse administer the medication?

6 :
Ondansetron would be contraindicated in a client who presents with what clinical manifestation?

7 :
A client with cancer is prescribed a glucocorticoid medication to help treat chemotherapy induced nausea and vomiting. Which of the following lab values would need to be reported to the physician?

8 :
A patient presents to the ER with multiple loose stools. Which priority action would be indicated by the nurse?

9 :
A nurse is preparing to administer an iron supplement to a client. Which of the following statements made by the client would indicate a need for further instruction?

10 :
A client is receiving a magnesium sulfate replacement intravenously. Which of the following would need to be reported to the provider immediately.

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EXAM THREE FA25

No.

1 : A nurse is taking a health history of a client who reports occasionally taking several over-the-counter medications, including an H₂ receptor antagonist (H₂RA). Which of the following outcomes indicates the H₂RA is therapeutic?

2 : A nurse is teaching a client who has a new prescription for sucralfate to treat a gastric ulcer. Which of the following statements by the client indicates an understanding of the teaching?

3 : A nurse is teaching a client who has a new prescription for aluminum hydroxide to treat heartburn. The nurse should instruct the client to monitor for and report which of the following adverse reactions?

4 : A nurse is teaching a client who has a duodenal ulcer about his new prescription for cimetidine. The nurse should include which of the following instructions in the teaching?

5 : A client is prescribed lansoprazole 15 mg PO once a day. At which of the following times should the nurse administer the medication?

6 : Ondansetron would be contraindicated in a client who presents with what clinical manifestation?

7 : A client with cancer is prescribed a glucocorticoid medication to help treat chemotherapy induced nausea and vomiting. Which of the following lab values would need to be reported to the physician?

8 : A patient presents to the ER with multiple loose stools. Which priority action would be indicated by the nurse?

9 : A nurse is preparing to administer an iron supplement to a client. Which of the following statements made by the client would indicate a need for further instruction?

10 : A client is receiving a magnesium sulfate replacement intravenously. Which of the following would need to be reported to the provider immediately.

1 :
A nurse is taking a health history of a client who reports occasionally taking several over-the-counter medications, including an H₂ receptor antagonist (H₂RA). Which of the following outcomes indicates the H₂RA is therapeutic?

2 :
A nurse is teaching a client who has a new prescription for sucralfate to treat a gastric ulcer. Which of the following statements by the client indicates an understanding of the teaching?

3 :
A nurse is teaching a client who has a new prescription for aluminum hydroxide to treat heartburn. The nurse should instruct the client to monitor for and report which of the following adverse reactions?

4 :
A nurse is teaching a client who has a duodenal ulcer about his new prescription for cimetidine. The nurse should include which of the following instructions in the teaching?

5 :
A client is prescribed lansoprazole 15 mg PO once a day. At which of the following times should the nurse administer the medication?

6 :
Ondansetron would be contraindicated in a client who presents with what clinical manifestation?

7 :
A client with cancer is prescribed a glucocorticoid medication to help treat chemotherapy induced nausea and vomiting. Which of the following lab values would need to be reported to the physician?

8 :
A patient presents to the ER with multiple loose stools. Which priority action would be indicated by the nurse?

9 :
A nurse is preparing to administer an iron supplement to a client. Which of the following statements made by the client would indicate a need for further instruction?

10 :
A client is receiving a magnesium sulfate replacement intravenously. Which of the following would need to be reported to the provider immediately.