NURS 8024 CORE EXAMS 2025 QUESTIONS AND ANSWERS
RATED A+
✔✔Bulk Laxatives - ✔✔• Nondigestible, nonabsorbable, hydrophilic colloids → increase
bulk and moisture content of stool
• Bulk stimulates peristalsis and absorbed water softens stool
• Commonly include natural plant products (psyllium, methylcellulose) synthetic fibers
(polycarbophil)
• Can stimulate colonic bacterial growth
✔✔Stool Surfactants/softeners - ✔✔• Emollients/Fecal Softeners
• MOA - Softens and lubricates stool, allows penetration of fecal mass by intestinal
fluids
• Inhibits fluid and electrolyte reabsorption
• Docusate sodium (Colace), mineral oil
✔✔Osmotic Laxatives - ✔✔• Metabolized into various osmotic substances
MOA
• Osmosis (higher concentration in bowel, causing water to move from tissue into bowel)
• Increased bulk- increases peristalsis
✔✔lactulose (Cephulac) - ✔✔Osmotic laxative: used in chronic constipation
and treatment of hepatic encephalopathy,
Adverse events include: flatulence, nausea, abdominal discomfort or bloating
✔✔Polyethylene Glycol (PEG, Miralax) - ✔✔osmotic laxative: • Powder mixed in 120-
240ml
• Not absorbed systemically or metabolized by colonic bacteria- so ↓ incidence of
adverse effects (nausea, flatulence, cramping) than other osmotic laxatives
• Can be used as low dose daily for 6 months
• Recommended by American College of Gastroenterology for chronic constipation
• Also used as in large dose solutions as bowel prep for GI procedures
✔✔Magnesium Salts - ✔✔Saline Laxative:
• hydroxide, phosphate, citrate, and sodium phosphate → attracts and retain water
(osmotic effect)
• Magnesium hydroxide (Milk of Magnesia- 8% suspension of Mg hydroxide)
• Not for routine use- limited efficacy for occasional constipation
• Used for bowel prep per GI procedure
• Also neutralizes gastric acid
• *ADE*
• Can cause fluid & electrolyte depletion
• ↑ Mg or ↑ Na accumulation in renal dysfunction or heart failure
,✔✔MOA Stimulants/Irritants - ✔✔• Increase peristalsis via several mechanisms
• Stimulants act directly on intestinal mucosa or on nerve plexus, stimulate sensory
nerves in intestinal mucosa and increase intestinal chloride secretion
• May cause cramping
✔✔Examples of stimulants/irritants for constipation - ✔✔Senna, cascara, bisacodyl
(Dulcolax)
✔✔Lubiprostone (Amitiza) - ✔✔Stimulant laxative
• FDA approved for chronic idiopathic constipation
• MOA- acts locally in gut, opens chloride channels on GI luminal epithelium, ↑↑
intraluminal fluid secretion softens stool & accelerates GI transit time
• ADE- nausea, headache, diarrhea
• $$$ - used after failing first-line agents
✔✔Linaclotide (Linzess) - ✔✔• FDA approved for the treatment of constipation and IBS-
C
• MOA- activates a receptor on the intestinal epithelium → increases intestinal fluid
secretion and increases intestinal motility
• ADE- diarrhea, flatulence, abd. pain
• *Black Box warning- avoid in < 18y/o and contraindicated in pediatrics < 6yrs
• $$$ -used after failing first-line agents
✔✔Considerations for geriatric patients when prescribing constipation medications -
✔✔incidence of constipation ↑ w/ age
• 30% of healthy older persons regularly use laxatives; second only to analgesics
• More susceptible to dehydration and electrolyte
imbalance
✔✔Pediatric considerations for constipation medications - ✔✔multifactorial etiologies
• emotional, dietary, environmental - contributing
factors
• Dosage adjustments for specific drugs
• Contraindications and warnings for specific products
✔✔Pregnancy and Lactation considerations for constipation medication - ✔✔• *Bulk
laxatives, stool softeners preferred*
• Limited absorption of most laxatives
• Agents considered safe: lactulose, psyllium,
Polyethylene Glycol (Miralax), methylcellulose
(Citrucel), docusate, senna
• Contraindicated in pregnancy: castor oil, saline
cathartics (improper use can cause electrolyte
imbalance)
,✔✔Considerations for treatment of constipation - ✔✔- Non-pharmacologic: fluids and
fiber,
exercise, patient education
- If possible, treat underlying cause of constipation
- Chronic Laxative Abuse: be aware, Pt. education,
• wean from stimulants and saline laxatives
• add bulk laxatives and stool softeners
✔✔Indications for Antiemetics - ✔✔Nausea, vomiting, motion sickness, vertigo
✔✔Mechanisms that trigger vomiting - ✔✔• Two brainstem sites have key roles in the
vomiting reflex pathway
• Chemoreceptor trigger zone (located outside the blood-brain barrier)
• Responds directly to chemical stimuli in blood or CSF
✔✔Vomiting center located - ✔✔in the medulla, coordinates the motor mechanisms of
vomiting
• also responds to afferent input from the vestibular system, the periphery (pharynx and
gastrointestinal tract) and higher brainstem and cortical structures
✔✔Motion sickness stems from - ✔✔vestibular system
✔✔Antihistamines as an antiemetic - ✔✔meclizine (Antivert), dimenhydrinate
(Dramamine)
• MOA- reduce sensitivity of the labyrinthine apparatus, precise mechanism unknown
✔✔Anticholinergic as an antiemetic - ✔✔scopolamine transdermal
• effective in N/V due to motion sickness
• Inhibition of vestibular input to the CNS
• Resulting in inhibition of vomiting reflex
✔✔Prochlorperazine (Compazine) - ✔✔Antiemetic: dopamine antagonist blocks D2-
receptors in the chemoreceptor trigger zone (CTZ) and other areas of the brain
• ADE- drowsiness, dizziness, constipation, h/a, tardive dyskinesia
• *Black box warning- dementia related psychosis, increased mortality in elderly
dementia patients
✔✔Promethazine (Phenergan) - ✔✔Antiemetic: antagonizes central & peripheral
histamine H1 receptors (po, IV, IM)
• ADE- sedation, dizziness, confusion, photosensitivity
• *Black box warning- respiratory depression, tissue injury/ gangrene from perivascular
extravasation
✔✔Prokinetic Agents - ✔✔Metoclopramide (Reglan)
Trimethobenzamide (Tigan)
, ✔✔Metoclopramide (Reglan) - ✔✔Antiemetic: • Exact MOA unknown, dopamine
antagonist, prevents stimulation of CTZ,
accelerates gastric emptying- enhances acetylcholine in the upper GI tract
• *Contraindications- if GI motility stimulation may be dangerous (hemorrhage,
obstruction, perforation), Epilepsy
• *Warnings: Depression - suicidal ideation in pts w/ and w/o hx of depression
• Caution in Parkinson's Disease
• Tardive dyskinesia (potential dyskinesia)
• *EPS- acute dystonic reaction, usually w/I first 24-48 hrs*
• Seen more frequently in pediatrics, young adults, geriatrics
• Black box warning- tardive dyskinesia- can be irreversible
✔✔Serotonin 5HT3 Receptor Antagonists - ✔✔• Ondansetron HCL (Zofran), dolasetron
(Anzemet)
dolasetron, granisetron, palonosetron
• MOA- 5-HT3 receptor block in GI & CNS
• Clinical used for prevention of chemotherapy-induced &vpostop N/V
• Available orally and parenterally
• ADE- h/a, fatigue, constipation, diarrhea
✔✔Treatment of acute vomiting - ✔✔Non-pharmacologic: sm. amts. clear
liquids, sm. amts. dry food as tolerated
✔✔Pharmacologic treatment of acute vomiting - ✔✔• Initiated if pt unable to keep intake
up w/ fluid
Losses
• Oral vs. parenteral administration
• Monitor dehydration
✔✔Pediatric treatment of vomiting - ✔✔• Discourage use of pharmacologic intervention
in
uncomplicated vomiting
• Anticholinergics/antihistamines- can cause hallucinations, seizure or death
• Dopaminergics: Increased EPS
• Drugs appropriate for use in <12 yrs
• Promethazine - approved for 2 yrs and up- Do not use < 2 yrs
• Ondansetron - Approved for > 4 yrs (used in infants > 6 mon. severe vomiting/chemo)
✔✔Geriatric treatment considerations for vomiting - ✔✔• Increase in adverse effects
• Some drugs require dose reduction
• Increase risk of dehydration
✔✔Pregnancy and lactation considerations in the treatment of vomiting - ✔✔• Any
antiemetic should be approved by OB
RATED A+
✔✔Bulk Laxatives - ✔✔• Nondigestible, nonabsorbable, hydrophilic colloids → increase
bulk and moisture content of stool
• Bulk stimulates peristalsis and absorbed water softens stool
• Commonly include natural plant products (psyllium, methylcellulose) synthetic fibers
(polycarbophil)
• Can stimulate colonic bacterial growth
✔✔Stool Surfactants/softeners - ✔✔• Emollients/Fecal Softeners
• MOA - Softens and lubricates stool, allows penetration of fecal mass by intestinal
fluids
• Inhibits fluid and electrolyte reabsorption
• Docusate sodium (Colace), mineral oil
✔✔Osmotic Laxatives - ✔✔• Metabolized into various osmotic substances
MOA
• Osmosis (higher concentration in bowel, causing water to move from tissue into bowel)
• Increased bulk- increases peristalsis
✔✔lactulose (Cephulac) - ✔✔Osmotic laxative: used in chronic constipation
and treatment of hepatic encephalopathy,
Adverse events include: flatulence, nausea, abdominal discomfort or bloating
✔✔Polyethylene Glycol (PEG, Miralax) - ✔✔osmotic laxative: • Powder mixed in 120-
240ml
• Not absorbed systemically or metabolized by colonic bacteria- so ↓ incidence of
adverse effects (nausea, flatulence, cramping) than other osmotic laxatives
• Can be used as low dose daily for 6 months
• Recommended by American College of Gastroenterology for chronic constipation
• Also used as in large dose solutions as bowel prep for GI procedures
✔✔Magnesium Salts - ✔✔Saline Laxative:
• hydroxide, phosphate, citrate, and sodium phosphate → attracts and retain water
(osmotic effect)
• Magnesium hydroxide (Milk of Magnesia- 8% suspension of Mg hydroxide)
• Not for routine use- limited efficacy for occasional constipation
• Used for bowel prep per GI procedure
• Also neutralizes gastric acid
• *ADE*
• Can cause fluid & electrolyte depletion
• ↑ Mg or ↑ Na accumulation in renal dysfunction or heart failure
,✔✔MOA Stimulants/Irritants - ✔✔• Increase peristalsis via several mechanisms
• Stimulants act directly on intestinal mucosa or on nerve plexus, stimulate sensory
nerves in intestinal mucosa and increase intestinal chloride secretion
• May cause cramping
✔✔Examples of stimulants/irritants for constipation - ✔✔Senna, cascara, bisacodyl
(Dulcolax)
✔✔Lubiprostone (Amitiza) - ✔✔Stimulant laxative
• FDA approved for chronic idiopathic constipation
• MOA- acts locally in gut, opens chloride channels on GI luminal epithelium, ↑↑
intraluminal fluid secretion softens stool & accelerates GI transit time
• ADE- nausea, headache, diarrhea
• $$$ - used after failing first-line agents
✔✔Linaclotide (Linzess) - ✔✔• FDA approved for the treatment of constipation and IBS-
C
• MOA- activates a receptor on the intestinal epithelium → increases intestinal fluid
secretion and increases intestinal motility
• ADE- diarrhea, flatulence, abd. pain
• *Black Box warning- avoid in < 18y/o and contraindicated in pediatrics < 6yrs
• $$$ -used after failing first-line agents
✔✔Considerations for geriatric patients when prescribing constipation medications -
✔✔incidence of constipation ↑ w/ age
• 30% of healthy older persons regularly use laxatives; second only to analgesics
• More susceptible to dehydration and electrolyte
imbalance
✔✔Pediatric considerations for constipation medications - ✔✔multifactorial etiologies
• emotional, dietary, environmental - contributing
factors
• Dosage adjustments for specific drugs
• Contraindications and warnings for specific products
✔✔Pregnancy and Lactation considerations for constipation medication - ✔✔• *Bulk
laxatives, stool softeners preferred*
• Limited absorption of most laxatives
• Agents considered safe: lactulose, psyllium,
Polyethylene Glycol (Miralax), methylcellulose
(Citrucel), docusate, senna
• Contraindicated in pregnancy: castor oil, saline
cathartics (improper use can cause electrolyte
imbalance)
,✔✔Considerations for treatment of constipation - ✔✔- Non-pharmacologic: fluids and
fiber,
exercise, patient education
- If possible, treat underlying cause of constipation
- Chronic Laxative Abuse: be aware, Pt. education,
• wean from stimulants and saline laxatives
• add bulk laxatives and stool softeners
✔✔Indications for Antiemetics - ✔✔Nausea, vomiting, motion sickness, vertigo
✔✔Mechanisms that trigger vomiting - ✔✔• Two brainstem sites have key roles in the
vomiting reflex pathway
• Chemoreceptor trigger zone (located outside the blood-brain barrier)
• Responds directly to chemical stimuli in blood or CSF
✔✔Vomiting center located - ✔✔in the medulla, coordinates the motor mechanisms of
vomiting
• also responds to afferent input from the vestibular system, the periphery (pharynx and
gastrointestinal tract) and higher brainstem and cortical structures
✔✔Motion sickness stems from - ✔✔vestibular system
✔✔Antihistamines as an antiemetic - ✔✔meclizine (Antivert), dimenhydrinate
(Dramamine)
• MOA- reduce sensitivity of the labyrinthine apparatus, precise mechanism unknown
✔✔Anticholinergic as an antiemetic - ✔✔scopolamine transdermal
• effective in N/V due to motion sickness
• Inhibition of vestibular input to the CNS
• Resulting in inhibition of vomiting reflex
✔✔Prochlorperazine (Compazine) - ✔✔Antiemetic: dopamine antagonist blocks D2-
receptors in the chemoreceptor trigger zone (CTZ) and other areas of the brain
• ADE- drowsiness, dizziness, constipation, h/a, tardive dyskinesia
• *Black box warning- dementia related psychosis, increased mortality in elderly
dementia patients
✔✔Promethazine (Phenergan) - ✔✔Antiemetic: antagonizes central & peripheral
histamine H1 receptors (po, IV, IM)
• ADE- sedation, dizziness, confusion, photosensitivity
• *Black box warning- respiratory depression, tissue injury/ gangrene from perivascular
extravasation
✔✔Prokinetic Agents - ✔✔Metoclopramide (Reglan)
Trimethobenzamide (Tigan)
, ✔✔Metoclopramide (Reglan) - ✔✔Antiemetic: • Exact MOA unknown, dopamine
antagonist, prevents stimulation of CTZ,
accelerates gastric emptying- enhances acetylcholine in the upper GI tract
• *Contraindications- if GI motility stimulation may be dangerous (hemorrhage,
obstruction, perforation), Epilepsy
• *Warnings: Depression - suicidal ideation in pts w/ and w/o hx of depression
• Caution in Parkinson's Disease
• Tardive dyskinesia (potential dyskinesia)
• *EPS- acute dystonic reaction, usually w/I first 24-48 hrs*
• Seen more frequently in pediatrics, young adults, geriatrics
• Black box warning- tardive dyskinesia- can be irreversible
✔✔Serotonin 5HT3 Receptor Antagonists - ✔✔• Ondansetron HCL (Zofran), dolasetron
(Anzemet)
dolasetron, granisetron, palonosetron
• MOA- 5-HT3 receptor block in GI & CNS
• Clinical used for prevention of chemotherapy-induced &vpostop N/V
• Available orally and parenterally
• ADE- h/a, fatigue, constipation, diarrhea
✔✔Treatment of acute vomiting - ✔✔Non-pharmacologic: sm. amts. clear
liquids, sm. amts. dry food as tolerated
✔✔Pharmacologic treatment of acute vomiting - ✔✔• Initiated if pt unable to keep intake
up w/ fluid
Losses
• Oral vs. parenteral administration
• Monitor dehydration
✔✔Pediatric treatment of vomiting - ✔✔• Discourage use of pharmacologic intervention
in
uncomplicated vomiting
• Anticholinergics/antihistamines- can cause hallucinations, seizure or death
• Dopaminergics: Increased EPS
• Drugs appropriate for use in <12 yrs
• Promethazine - approved for 2 yrs and up- Do not use < 2 yrs
• Ondansetron - Approved for > 4 yrs (used in infants > 6 mon. severe vomiting/chemo)
✔✔Geriatric treatment considerations for vomiting - ✔✔• Increase in adverse effects
• Some drugs require dose reduction
• Increase risk of dehydration
✔✔Pregnancy and lactation considerations in the treatment of vomiting - ✔✔• Any
antiemetic should be approved by OB
