LEHNE’S
PHARMACOTHERAPEUTICS FOR
ADVANCED PRACTICE NURSES
AND PHYSICIAN ASSISTANTS 2ND
EDITION ROSENTHAL TEST BANK
WITH CORRECT ANSWERS
An infant who receives a drug that does not produce CNS side effects in
adults exhibits drowsiness and sedation. The nurse understands that this is
because of differences in which physiologic system in infants and adults?
a. Blood-brain barrier
b. First-pass effect
c. Gastrointestinal absorption
d. Renal filtration
ANS: A
The blood-brain barrier is not fully developed at birth, making infants much
more sensitive to CNS drugs than older children and adults. CNS symptoms
may include sedation and drowsiness. The first-pass effect and GI absorption
affect metabolism and absorption of drugs, and renal filtration affects
elimination of drugs, all of which may alter drug levels.
A patient with renal disease is scheduled for a colonoscopy. Before the
procedure, the nurse will
anticipate administering:
a. glycerin suppository.
,b. magnesium hydroxide (MOM).
c. polyethylene glycol and electrolytes.
d. sodium phosphate.
ANS: C
Polyethylene glycol (PEG) plus electrolytes (ELS) is one of two bowel
cleansers used before colonoscopy to clear the bowel. PEG-ELS products are
preferred, because unlike sodium phosphate, they are isotonic and do not
increase the likelihood of dehydration and electrolyte imbalance. Glycerin
suppositories and magnesium hydroxide are not used for bowel cleansing.
The parent of a child with cerebral palsy reports that the child has pebble-like
stools most of the time and seems uncomfortable if several days have
passed between stools. The nurse will suggest that the parent discuss which
medication with the child's provider?
a. Bisacodyl [Dulcolax] suppositories
b. Magnesium citrate
c. Methylcellulose [Citrucel]
d. Polyethylene glycol [MiraLax]
ANS: D
Polyethylene glycol is an osmotic laxative widely used for chronic
constipation, which this child has, because it provides relief from abdominal
discomfort, improves stool consistency, and increases frequency. Bisacodyl is
not recommended for long-term use. Magnesium citrate causes increased
water loss, and methylcellulose can also cause impaction.
A patient will undergo a colonoscopy, and the provider has ordered sodium
phosphate as a
bowel cleanser before the procedure. The nurse reviews the patient's chart
and notes that the
,patient's creatinine clearance and blood urea nitrogen are both elevated.
What will the nurse
do?
a. Reduce the amount of fluid given with the laxative to prevent fluid
retention.
b. Request an order to give polyethylene glycol and electrolytes (PEG-ELS)
instead.
c. Suggest that the patient reduce the dietary sodium intake.
d. Suggest using a suppository laxative instead.
ANS: B
PEG-ELS solutions provide an isosmotic solution and do not cause
dehydration or electrolyte imbalance. They are safe to use in patients with
renal impairment or cardiovascular disease. This patient's laboratory values
suggest renal impairment. Sodium phosphate products can cause kidney
damage; giving them with less fluid only increases this possibility. Reducing
the dietary intake of sodium is not recommended. Suppositories are not
effective bowel cleansing agents.
The nurse is caring for an older adult patient after a right hip open reduction
internal fixation (ORIF). The patient is taking an opioid every 6 hours as
needed for pain. The nurse discusses obtaining an order from the prescriber
for which medication?
a. Docusate sodium [Colace]
b. GoLYTELY
c. Lactulose
d. Polyethylene glycol [MiraLax]
ANS: A
Oxycodone can be constipating. The patient needs something
prophylactically, such as docusate sodium, that can be taken daily to prevent
constipation. In addition, the patient's mobility is limited, which can further
increase the risk of constipation. GoLYTELY is not indicated for constipation; it
, is used for cleansing the bowel before diagnostic procedures. Lactulose is not
indicated; it typically is used for reducing ammonia levels in hepatic
encephalopathy. Polyethylene glycol is indicated for occasional constipation;
no information suggests that the patient is constipated.
A nurse is taking a history on a clinic patient who reports being constipated.
Upon further
questioning, the nurse learns that the patient's last stool was 4 days ago,
that it was of normal,
soft consistency, and that the patient defecated without straining. The
patient's abdomen is not
distended, and bowel sounds are present. The patient reports usually having
a stool every 1 to 2 days. What will the nurse do?
a. Ask about recent food and fluid intake.
b. Discuss the use of polyethylene glycol [MiraLax].
c. Recommend a bulk laxative.
d. Suggest using a bisacodyl [Dulcolax] suppository.
ANS: A
Constipation cannot necessarily be defined by the frequency of bowel
movements, because this varies from one individual to another. Constipation
is defined in terms of a variety of symptoms, including hard stools,
infrequent stools, excessive straining, prolonged effort, and unsuccessful or
incomplete defecation. A common cause of constipation is diet, especially
fluid and fiber intake; therefore, when changes in stool patterns occur,
patients should be questioned about food and fluid intake. Because this
patient has only more infrequent stools and is not truly constipated, laxatives
are not indicated.
A nurse receives an order to administer castor oil to a patient. Which action
by the nurse is correct?
PHARMACOTHERAPEUTICS FOR
ADVANCED PRACTICE NURSES
AND PHYSICIAN ASSISTANTS 2ND
EDITION ROSENTHAL TEST BANK
WITH CORRECT ANSWERS
An infant who receives a drug that does not produce CNS side effects in
adults exhibits drowsiness and sedation. The nurse understands that this is
because of differences in which physiologic system in infants and adults?
a. Blood-brain barrier
b. First-pass effect
c. Gastrointestinal absorption
d. Renal filtration
ANS: A
The blood-brain barrier is not fully developed at birth, making infants much
more sensitive to CNS drugs than older children and adults. CNS symptoms
may include sedation and drowsiness. The first-pass effect and GI absorption
affect metabolism and absorption of drugs, and renal filtration affects
elimination of drugs, all of which may alter drug levels.
A patient with renal disease is scheduled for a colonoscopy. Before the
procedure, the nurse will
anticipate administering:
a. glycerin suppository.
,b. magnesium hydroxide (MOM).
c. polyethylene glycol and electrolytes.
d. sodium phosphate.
ANS: C
Polyethylene glycol (PEG) plus electrolytes (ELS) is one of two bowel
cleansers used before colonoscopy to clear the bowel. PEG-ELS products are
preferred, because unlike sodium phosphate, they are isotonic and do not
increase the likelihood of dehydration and electrolyte imbalance. Glycerin
suppositories and magnesium hydroxide are not used for bowel cleansing.
The parent of a child with cerebral palsy reports that the child has pebble-like
stools most of the time and seems uncomfortable if several days have
passed between stools. The nurse will suggest that the parent discuss which
medication with the child's provider?
a. Bisacodyl [Dulcolax] suppositories
b. Magnesium citrate
c. Methylcellulose [Citrucel]
d. Polyethylene glycol [MiraLax]
ANS: D
Polyethylene glycol is an osmotic laxative widely used for chronic
constipation, which this child has, because it provides relief from abdominal
discomfort, improves stool consistency, and increases frequency. Bisacodyl is
not recommended for long-term use. Magnesium citrate causes increased
water loss, and methylcellulose can also cause impaction.
A patient will undergo a colonoscopy, and the provider has ordered sodium
phosphate as a
bowel cleanser before the procedure. The nurse reviews the patient's chart
and notes that the
,patient's creatinine clearance and blood urea nitrogen are both elevated.
What will the nurse
do?
a. Reduce the amount of fluid given with the laxative to prevent fluid
retention.
b. Request an order to give polyethylene glycol and electrolytes (PEG-ELS)
instead.
c. Suggest that the patient reduce the dietary sodium intake.
d. Suggest using a suppository laxative instead.
ANS: B
PEG-ELS solutions provide an isosmotic solution and do not cause
dehydration or electrolyte imbalance. They are safe to use in patients with
renal impairment or cardiovascular disease. This patient's laboratory values
suggest renal impairment. Sodium phosphate products can cause kidney
damage; giving them with less fluid only increases this possibility. Reducing
the dietary intake of sodium is not recommended. Suppositories are not
effective bowel cleansing agents.
The nurse is caring for an older adult patient after a right hip open reduction
internal fixation (ORIF). The patient is taking an opioid every 6 hours as
needed for pain. The nurse discusses obtaining an order from the prescriber
for which medication?
a. Docusate sodium [Colace]
b. GoLYTELY
c. Lactulose
d. Polyethylene glycol [MiraLax]
ANS: A
Oxycodone can be constipating. The patient needs something
prophylactically, such as docusate sodium, that can be taken daily to prevent
constipation. In addition, the patient's mobility is limited, which can further
increase the risk of constipation. GoLYTELY is not indicated for constipation; it
, is used for cleansing the bowel before diagnostic procedures. Lactulose is not
indicated; it typically is used for reducing ammonia levels in hepatic
encephalopathy. Polyethylene glycol is indicated for occasional constipation;
no information suggests that the patient is constipated.
A nurse is taking a history on a clinic patient who reports being constipated.
Upon further
questioning, the nurse learns that the patient's last stool was 4 days ago,
that it was of normal,
soft consistency, and that the patient defecated without straining. The
patient's abdomen is not
distended, and bowel sounds are present. The patient reports usually having
a stool every 1 to 2 days. What will the nurse do?
a. Ask about recent food and fluid intake.
b. Discuss the use of polyethylene glycol [MiraLax].
c. Recommend a bulk laxative.
d. Suggest using a bisacodyl [Dulcolax] suppository.
ANS: A
Constipation cannot necessarily be defined by the frequency of bowel
movements, because this varies from one individual to another. Constipation
is defined in terms of a variety of symptoms, including hard stools,
infrequent stools, excessive straining, prolonged effort, and unsuccessful or
incomplete defecation. A common cause of constipation is diet, especially
fluid and fiber intake; therefore, when changes in stool patterns occur,
patients should be questioned about food and fluid intake. Because this
patient has only more infrequent stools and is not truly constipated, laxatives
are not indicated.
A nurse receives an order to administer castor oil to a patient. Which action
by the nurse is correct?
