ATI RN
Gastrointestinal System Nursing Exam Questions
1. Cholestyramine resin (Questran Light) is prescribed for the client with an elevated serum cholesterol level. The nurse would instruct the client to take the medication
- A. After meals.
- B. Mixed with fruit juice.
- C. Via rectal suppository.
- D. At least 3 hours before meals.
Correct answer: B
Rationale: Cholestyramine resin binds with bile salts in the intestines to form a compound that is excreted in the feces. The client should be instructed to mix the medication with 3 to 6 oz of water, milk, fruit juice, or soup. The medication should be administered before meals. The medication is not administered via rectal suppository.
2. A client with active pulmonary tuberculosis (TB) is to be started on intravenous rifampin therapy. The client should be informed by the nurse that this medication can cause which of the following adverse effects?
- A. Constipation
- B. Black-colored stools
- C. Staining of teeth
- D. Body secretions turning a red-orange color
Correct answer: D
Rationale: The correct answer is D: Body secretions turning a red-orange color. Rifampin is known to cause body secretions, such as urine, sweat, tears, and sputum, to turn a harmless red-orange color. This is a common and expected side effect of rifampin therapy. Choices A, B, and C are incorrect. Constipation is not a common adverse effect of rifampin. Black-colored stools and staining of teeth are not associated with rifampin therapy. It is important for the nurse to educate the client about the harmless red-orange discoloration that may occur with this medication.
3. The nurses caring for a child are concerned about the child’s frequent requests for pain medication. During a team conference, a new nurse suggests they consider administering a placebo instead of the usual pain medication to see how the child responds. The team educates the nurse on why this is not appropriate and bases the decision on what knowledge?
- A. This practice is unjustified and unethical.
- B. This practice is effective in determining whether a child’s pain is real.
- C. The absence of a response to a placebo means the child’s pain has an organic basis.
- D. A positive response to a placebo will not occur if the child’s pain has an organic basis.
Correct answer: A
Rationale: The correct answer is A. The use of placebos without the patient’s consent is unethical and goes against the principles of beneficence and autonomy. Choice B is incorrect because using placebos does not provide reliable information about the presence or severity of the pain; it only indicates the response to the placebo itself. Choice C is wrong as the absence of a response to a placebo does not definitively mean that the child’s pain has an organic basis; there could be various reasons for the lack of response. Choice D is also incorrect as individuals may have a positive response to a placebo even if their pain has a significant organic cause. Therefore, the most appropriate response is A, emphasizing the ethical concerns surrounding the use of placebos without informed consent.
4. A nurse is planning an educational program for a group of older adults at a senior living center. Which of the following recommendations should the nurse include?
- A. You should receive a pneumococcal vaccine when you are 65 years old.
- B. You should receive a shingles vaccine when you are 70 years old.
- C. You should receive a tetanus booster every 5 years.
- D. You should have an eye examination every 2 years.
Correct answer: A
Rationale: The correct answer is A. The CDC recommends a pneumococcal vaccine for all adults aged 65 years and older. This vaccine helps protect against serious pneumococcal disease. Choice B is incorrect as the shingles vaccine is recommended for adults aged 50 years and older, not specifically at 70 years. Choice C is incorrect because a tetanus booster is recommended every 10 years, not every 5 years. Choice D is incorrect as the general recommendation for eye examinations in older adults is annually, not every 2 years.
5. A nurse is preparing to administer enoxaparin to a client. Which of the following actions should the nurse take?
- A. Massage the injection site after administration.
- B. Administer the medication intramuscularly.
- C. Inject the medication into the client's abdomen.
- D. Inject the medication into the deltoid muscle.
Correct answer: C
Rationale: The correct answer is to inject the medication into the client's abdomen. Enoxaparin is a medication that should be administered subcutaneously, not intramuscularly. Massaging the injection site after administration is not recommended as it can cause bruising or discomfort. Injecting the medication into the deltoid muscle is also incorrect because enoxaparin should be given in areas of adipose tissue, such as the abdomen, to ensure proper absorption and effectiveness.
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