Adams4e Tif Ch41

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/EChapter 41Question 1Type: MCSA

The nursing instructor is teaching student nurses about lower gastrointestinal (GI) functioning and the large intestine. The nursing instructor evaluates that learning has occurred when the students make which statement?

1. "The large intestine contains host flora that manufacture vitamin E."

2. "The large intestine absorbs most of the nutrients from food."

3. "The large intestine absorbs water and eliminates stool."

4. "Food travels through the large intestine for 3 to 6 hours."

Correct Answer: 3

Rationale 1: The large intestine contains host flora that manufacture B-complex vitamins and vitamin K, not vitamin E.

Rationale 2: The small intestine, not the large intestine, absorbs most of the nutrients from food.

Rationale 3: Major functions of the large intestine include absorption of water and elimination of stool.

Rationale 4: Food travels through the large intestine for 12 to 24 hours, not for 3 to 6.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 41-1

Question 2Type: MCSA

An elderly client has constipation. He asks the nurse the reason for this. What is the best response by the nurse?

1. "You could have a serious illness, and should check with your doctor."

2. "You probably drink too much alcohol, and end up constipated."

3. "You probably don't eat enough fiber, so the stool stays in your intestine too long."Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

4. "Your large intestine is old and does not work as well as it used to."

Correct Answer: 3

Rationale 1: The client could have a serious illness, but constipation in the elderly is more likely related to dietary habits.

Rationale 2: Alcohol can be a contributing factor to constipation, but the nurse should first assess alcohol intake and not just assume excessive alcohol intake.

Rationale 3: If the waste material remains in the intestine too long due to lack of fiber, too much water is reabsorbed leading to small, hard stools.

Rationale 4: Telling an elderly client that his intestine is old is very non-therapeutic.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 41-2


The nurse designs a teaching plan for the client with chronic pancreatitis who receives pancrelipase (Pancreaze). What will the best plan by the nurse include as it relates to the rationale for the client to receive this drug?

1. "These enzymes replace what your ineffective pancreas cannot make."

2. "These enzymes will help promote healing of your pancreas."

3. "These enzymes promote digestion of starches and fats."

4. "These enzymes will help digest all of the food you eat."

Correct Answer: 1

Rationale 1: Chronic pancreatitis eventually leads to pancreatic insufficiency that may necessitate replacement of pancreatic enzymes.

Rationale 2: Pancreatitis enzymes do not help heal the pancreas.

Rationale 3: Pancreatic enzymes will help digest food, but this is not the reason the client is receiving them.

Rationale 4: Pancreatic enzymes will help digest food, but this is not the reason the client is receiving them.Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 41-6

Question 4Type: MCMA

The nurse is planning care for the client who experiences frequent constipation. What will the best plan by the nurse include?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Increase protein in the diet.

2. Drink a glass of water every hour.

3. Increase dairy products in the diet.

4. Increase dietary fiber in the diet.

5. Increase daily physical exercise.

Correct Answer: 4,5

Rationale 1: Increasing protein in the diet will not help prevent constipation.

Rationale 2: Drinking a glass of water every hour is too much fluid and can result in hyponatremia.

Rationale 3: Dairy products in the diet will lead to, not prevent, constipation.

Rationale 4: Increasing fiber in the diet will help prevent constipation.

Rationale 5: Increasing exercise will help prevent constipation.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: Planning

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Learning Outcome: 41-9


The client is scheduled for bowel surgery. What medications are appropriate for the cleansing the bowel “bowel prep” prior to this procedure?



1. Docusate sodium (Colace)

2. Bisacodyl (Dulcolax)

3. Methylcellulose (Citrucel)

4. Sodium phosphate (Fleet Phospho-Soda)

5. Mineral oil

Correct Answer: 2,4

Rationale 1: Docusate sodium (Colace) is a stool softener, and is not appropriate for a "bowel prep."

Rationale 2: Bisacodyl (Dulcolax) is a stimulant laxative and appropriate for a "bowel prep."

Rationale 3: Methylcellulose (Citrucel) is a bulk forming laxative and is not appropriate for a “bowel prep.”

Rationale 4: Sodium phosphate (Fleet Phospho-Soda) is an osmotic saline laxative and appropriate for a "bowel prep."

Rationale 5: Mineral oil is not appropriate for a “bowel prep.”

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 41-7



The client has been vomiting for several days. The nurse would assess the client for which acid–base disturbance?

1. Metabolic acidosis

2. Respiratory alkalosis

3. Metabolic alkalosis

4. Respiratory acidosis

Correct Answer: 3

Rationale 1: Metabolic acidosis will not occur as a result of vomiting.

Rationale 2: Respiratory alkalosis will not occur as a result of vomiting.

Rationale 3: Metabolic alkalosis will result from excessive loss of hydrochloric acid from the stomach brought on by prolonged vomiting.

Rationale 4: Respiratory acidosis will not occur as a result of vomiting.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 41-9


The client takes a stool softener on a regular basis and now reports a change in bowel patterns. Which assessment finding is the priority for the nurse to discuss with the physician?

1. Stools that are smaller in size

2. An increase in bowel frequency

3. A decrease in bowel frequency

4. Cramping with each stool passed

Correct Answer: 4

Rationale 1: Stools that are smaller in size are a concern, but are not the priority concern.


Rationale 2: An increase in bowel frequency does not need to be reported at this time.

Rationale 3: A decrease in bowel frequency does not need to be reported at this time.

Rationale 4: Cramping could indicate a serious condition that should be reported to the physician.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 41-9


The nurse has completed medication education for the client who takes psyllium mucilloid (Metamucil). The nurse recognizes that additional teaching is indicated when the client makes which statement?

1. "I don't need to drink extra fluids while I take this medication."

2. "My cholesterol level will be reduced somewhat with this medication."

3. "This medication is a lot more natural than other laxatives."

4. "This medication takes several days to work."

Correct Answer: 1

Rationale 1: Fluids must be increased when clients use psyllium mucilloid (Metamucil).

Rationale 2: Psyllium mucilloid (Metamucil) does help to reduce cholesterol levels.

Rationale 3: Psyllium mucilloid (Metamucil) is more natural than other laxatives.

Rationale 4: Psyllium mucilloid (Metamucil) does take several days to work.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 41-8



Which client is most at risk to develop constipation?

1. The pediatric client who takes antibiotics for ear infections

2. The elderly client who routinely takes a stimulant laxative twice daily.

3. The young client in the hospital for an appendectomy

4. The middle-aged client who uses an enema when he travels

Correct Answer: 2

Rationale 1: The pediatric client is at low risk to develop constipation.

Rationale 2: Elderly clients who abuse laxatives are at risk for constipation.

Rationale 3: The young client is at low risk to develop constipation.

Rationale 4: The middle-aged client is at low risk to develop constipation.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 41-19


The client takes diphenoxylate with atropine (Lomotil) for diarrhea. The client asks the nurse why he does not experience pain relief since this drug is an opioid. What is the best response by the nurse?

1. "This drug is not an opioid; did your doctor tell you that?"

2. "You would really have to take a lot to experience pain relief."

3. "It does provide some relief from the pain associated with diarrhea."

4. "Because this opioid does not have analgesic properties."

Correct Answer: 4


Rationale 1: Diphenoxylate with atropine (Lomotil) is an opioid.

Rationale 2: The amount of diphenoxylate with atropine (Lomotil) is not the issue; this opioid does not have analgesic properties.

Rationale 3: Diphenoxylate with atropine (Lomotil) does not have analgesic properties, and will not provide any pain relief associated with diarrhea.

Rationale 4: Unlike most opioids, diphenoxylate with atropine (Lomotil) does not have analgesic properties.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 41-8


The client receives prochlorperazine (Compazine) for nausea and vomiting. The nurse notices that the client is exhibiting a stiff neck, turned to the side. What is the best action by the nurse?

1. Administer the client’s as needed analgesic immediately.

2. Contact the physician immediately.

3. Hold the next dose and observe the client.

4. Ask the client if she has ever experienced this before.

Correct Answer: 2

Rationale 1: Giving an analgesic is not the priority intervention.

Rationale 2: Prochlorperazine (Compazine) is a phenothiazine drug; the client is experiencing an extrapyramidal side effect known as dystonia. The nurse should immediately alert the physician and prepare to administer an antidote.

Rationale 3: The client needs an antidote; holding the next dose will not relieve the symptoms.

Rationale 4: Assessment is good, but the client needs an antidote.

Global Rationale:

Cognitive Level: AnalyzingAdams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Client Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 41-8


The primary role of the large intestine is to

1. excrete fecal matter.

2. absorb nutrients.

3. excrete enzymes.

4. control peristalsis.

Correct Answer: 1

Rationale 1: The large intestine is responsible for reabsorption of water and for fecal excretion.

Rationale 2: The small intestine absorbs nutrients and drugs.

Rationale 3: The stomach and small intestine excrete enzymes for digestion.

Rationale 4: Peristalsis is controlled by the autonomic nervous system.

Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 41-1


Which statement best describes the pathogenesis of diarrhea?

1. It is infrequent passage of stool.

2. It occurs when the large intestine reabsorbs water.

3. It is caused by lack of fiber in the diet.


4. It is an increase in frequency of stool.

Correct Answer: 4

Rationale 1: Constipation is the infrequent passage of hard stools.

Rationale 2: Diarrhea occurs when the large intestine fails to reabsorb water.

Rationale 3: Constipation is caused by lack of exercise and fiber.

Rationale 4: Diarrhea is an increase in the frequency and fluidity of bowel movements.

Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 41-3


After a client begins pancreatic enzyme replacement therapy, the nurse will assess for

1. headache.

2. dry mouth.

3. nausea and vomiting.

4. falls.

Correct Answer: 3

Rationale 1: Some anorexiants can cause headache.

Rationale 2: Antidiarrheal therapy can cause dry mouth.

Rationale 3: The most frequent adverse effects are GI symptoms of nausea, vomiting, and diarrhea.

Rationale 4: Antiemetic therapy can cause sedation and falls.

Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityAdams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Client Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 41-6


The mechanism of action of the antidiarrheal atropine (Lomotil) is to

1. promote stool passage.

2. block dopamine receptors in the brain.

3. increase stool formation.

4. slow peristalsis.

Correct Answer: 4

Rationale 1: Laxatives promote stool passage and increase size of stool.

Rationale 2: Antiemetics block dopamine and inhibit vomiting centers.

Rationale 3: Laxatives increase stool.

Rationale 4: Antidiarrheals such as atropine slow peristalsis and allow water reabsorption.

Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Learning Outcome: 41-3


A client has been prescribed prochlorperazine (Compazine) for nausea. Possible adverse effects would include

1. diarrhea.

2. dry mouth.

3. hypertension.


4. bradycardia.

Correct Answer: 2

Rationale 1: Diarrhea is not an adverse effect of prochloperazine.

Rationale 2: Phenothiazines block dopamine, and can cause dry mouth.

Rationale 3: Hypotension, not hypertension, can occur.

Rationale 4: Tachycardia, not bradycardia, can occur.

Global Rationale:

Cognitive Level: UnderstandingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 41-8


Stool softeners

1. break up fecal material.

2. decrease peristalsis.

3. promote water absorption in the intestine.

4. increase peristalsis.

Correct Answer: 3

Rationale 1: Stimulate laxatives break up fecal material.

Rationale 2: None cause decrease in peristalsis.

Rationale 3: Stool softeners cause more water and fat to be absorbed.

Rationale 4: Stimulant laxatives increase peristalsis.

Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityAdams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Client Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Learning Outcome: 41-3


A client who was diagnosed with clostridium difficile calls the clinic and says, “I’m still having diarrhea so I started taking an over-the-counter medication to stop it.” How should the nurse respond?

1. “Which antidiarrheal are you taking?”

2. “How many doses have you taken?”

3. “Stop taking the medicine and come to the clinic.”

4. “Is it stopping your diarrhea?”

Correct Answer: 3

Rationale 1: The identity of the antidiarrheal is not the priority.

Rationale 2: The number of doses taken is not the priority.

Rationale 3: Antidiarrheal use is contraindicated in cases of clostridium difficile.

Rationale 4: The effectiveness of the antidiarrheal is not the priority.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 41.3


A client has been prescribed sulfasalazine (Azulfidine) for treatment of ulcerative colitis. Which nursing assessment question is essential?

1. “How long have you had ulcerative colitis?”

2. “What are you allergic to?”


3. “Are you lactose intolerant?”

4. “Do you have to stand in one place for long periods of time at your work?”

Correct Answer: 2

Rationale 1: This is not the most important assessment data.

Rationale 2: The client who is allergic to sulfa drugs should not take sulfasalazine.

Rationale 3: Lactose intolerance is not a significant assessment finding for this client.

Rationale 4: Standing in one spot for long periods of time is not a significant issue with sulfasalazine.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 41.4


A client has developed nausea and vomiting. What is the nurse’s primary treatment?

1. Replacement of fluids

2. Identifying and eliminating the cause

3. Encouraging the client to lie still

4. Providing the client with soft foods

Correct Answer: 2

Rationale 1: Replacement of fluids is essential, but not the primary treatment.

Rationale 2: Nausea and vomiting are often due to modifiable conditions. Eliminating the conditions is the primary treatment.

Rationale 3: If the client is vomiting, lying still is difficult and may be dangerous if aspiration is a potential.

Rationale 4: The client should not eat while nauseated and vomiting.

Global Rationale: Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Cognitive Level: UnderstandingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 41.5


A client asks if he could use an over-the-counter bulk-type laxative. Which assessment finding would cause the nurse to tell the client not to use this drug?



1. The client is over age 60.

2. The client takes warfarin every other day.

3. The client has type 2 diabetes.

4. The client has a history of fecal impaction.

5. The client is allergic to penicillin.

Correct Answer: 2,4

Rationale 1: There is no contraindication for use of this laxative class in clients over 60.

Rationale 2: Bulk-type laxatives may decrease the absorption and effects of warfarin.

Rationale 3: Bulk-type laxatives may decrease serum glucose levels in clients with type 2 diabetes. This is not an adverse outcome.

Rationale 4: If there is a chance that the client has a fecal impaction, bulk-type laxative should not be used.

Rationale 5: Allergy to penicillin is not a contraindication for use of bulk-type laxatives.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: Implementation


Learning Outcome: 41.7


A client calls the clinic and says, “I have been taking Imodium (loperamide) for diarrhea, but it isn’t helping.” How should the nurse respond?



1. “Are you taking it after every episode of diarrhea?”

2. “Imodium is not effective against diarrhea.”

3. “This medication may make you sleepy.”

4. “You may have to take the maximum dose for 2 or 3 days before diarrhea slows.”

5. “You should come in for assessment.”

Correct Answer: 1,3,5

Rationale 1: Loperamide (Imodium) is taken as a 4 mg single dose, followed by 2 mg after each diarrhea episode up to 16 mg/day.

Rationale 2: Imodium is indicated for diarrhea.

Rationale 3: Imodium has the adverse effect of drowsiness.

Rationale 4: Diarrhea should slow within a few hours of doses.

Rationale 5: If over-the-counter medications are not effective, prescription medications may be necessary. The client should be seen in the clinic.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 41.7



While a nurse is collecting medical history the client says, “I was diagnosed with a spastic colon.” How should the nurse interpret this statement?



1. The client has ulcerative colitis.

2. The client has had recurrent abdominal pain for at least 3 months.

3. The client has irritable bowel syndrome.

4. The client’s disease is psychosomatic.

5. The client has Crohn’s disease.

Correct Answer: 2,3

Rationale 1: Typically, the diagnosis of spastic colon is not the same as ulcerative colitis.

Rationale 2: The diagnostic criterion for this disorder is recurrent abdominal pain for at least 3 days per month during the previous 3 months.

Rationale 3: Irritable bowel syndrome is also known as spastic colon.

Rationale 4: While there is often no organic disease found in this disorder, the pain and other findings are real.

Rationale 5: Irritable bowel syndrome is not the same as Crohn’s disease.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 41.4


A nurse would question a prescription for sulfasalazine (Azulfidine) if the client is also taking which medication?




1. Insulin

2. Digoxin

3. Warfarin

4. Penicillin

5. Vitamin C

Correct Answer: 1,2,3

Rationale 1: Clients with diabetes may experience hypoglycemia if sulfasalazine is taken concurrently.

Rationale 2: Absorption of digoxin may be decreased.

Rationale 3: Anticoagulation effects may be increased.

Rationale 4: There is no drug–drug interaction with penicillin.

Rationale 5: There is no drug–drug interaction with vitamin C.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 41.8


A client says she would like to control her nausea with natural products instead of drugs. What education should the nurse provide?



1. “Peppermint may be effective.”

2. “Some people believe ginger ale is effective against nausea.”

3. “Vitamin E oil is sometimes effective for nausea.”

4. “Milk is usually an effective anti-nausea treatment.”Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

5. “There are no natural remedies for nausea.”

Correct Answer: 1,2

Rationale 1: Peppermint is effective for treatment of nausea in some people.

Rationale 2: Ginger ale is sometimes effective for nausea treatment.

Rationale 3: There is no evidence that vitamin E oil is effective as treatment for nausea.

Rationale 4: Milk is not an anti-nausea treatment.

Rationale 5: Natural remedies for nausea do exist.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 41.5


Adams4e Tif Ch41

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