Certified Gastroenterology RN Gastroenterology Pharmacology Questions and Answers — Questions and Answers
Question 1: A patient with Crohn's disease is scheduled to begin treatment with infliximab. Before administering the first dose, which of the following is the MOST important screening for the nurse to verify has been completed?
- Complete blood count (CBC)
- Tuberculosis (TB) skin test (Correct answer)
- Basic metabolic panel (BMP)
- Liver function tests (LFTs)
Correct answer: Tuberculosis (TB) skin test
Infliximab is a tumor necrosis factor (TNF)-alpha inhibitor, a type of biologic agent that suppresses the immune system. This suppression can reactivate latent tuberculosis. Therefore, it is crucial to screen for TB before initiating therapy to prevent a serious infection.
Question 2: A nurse is educating a patient about long-term use of a proton pump inhibitor (PPI) for GERD. The nurse should include information about an increased risk for which of the following conditions?
- Hypokalemia
- Hypermagnesemia
- Iron deficiency anemia
- Osteoporosis-related fractures (Correct answer)
Correct answer: Osteoporosis-related fractures
Long-term use of PPIs can interfere with calcium absorption, leading to decreased bone density and an increased risk of osteoporosis and fractures, particularly of the hip, wrist, and spine. While micronutrient deficiencies like hypomagnesemia and vitamin B12 deficiency are also risks, osteoporosis is a major concern that requires patient education regarding calcium and vitamin D intake and bone density monitoring.
Question 3: A patient is being treated for a Helicobacter pylori infection. The nurse anticipates the provider will order which combination of medications?
- An H2 receptor antagonist and an antacid
- A proton pump inhibitor and two antibiotics (Correct answer)
- A mucosal protectant and a prokinetic agent
- An anticholinergic and an aminosalicylate
Correct answer: A proton pump inhibitor and two antibiotics
Standard first-line therapy for H. pylori eradication involves a combination of a proton pump inhibitor (PPI) to reduce stomach acid, and at least two antibiotics (e.g., clarithromycin and amoxicillin or metronidazole) to eliminate the bacteria. This multi-drug approach is necessary to achieve high eradication rates and prevent resistance.
Question 4: A patient with ulcerative colitis is prescribed sulfasalazine. Which of the following statements by the patient indicates a need for further teaching?
- "I will take this medication with a full glass of water."
- "I should report any new rash or fever to my doctor immediately."
- "This medication may turn my skin and urine an orange-yellow color."
- "I can crush the enteric-coated tablet to make it easier to swallow." (Correct answer)
Correct answer: "I can crush the enteric-coated tablet to make it easier to swallow."
Sulfasalazine tablets are often enteric-coated to ensure they dissolve in the small intestine and colon where the medication is needed, rather than in the stomach. Crushing the tablet would destroy this coating, leading to premature release, gastric irritation, and reduced efficacy. The other statements are correct patient education points for sulfasalazine.
Question 5: A nurse is administering lactulose to a patient with hepatic encephalopathy. What is the primary therapeutic goal of this medication in this specific condition?
- To prevent gastrointestinal bleeding
- To reduce serum ammonia levels (Correct answer)
- To treat chronic constipation
- To restore normal gut flora
Correct answer: To reduce serum ammonia levels
In patients with hepatic encephalopathy, the liver is unable to metabolize ammonia, leading to toxic buildup in the blood. Lactulose, an osmotic laxative, works by acidifying the colon, which traps ammonia (as ammonium ions) in the stool and promotes its excretion through defecation, thereby lowering serum ammonia levels and improving mental status.
Question 6: A patient is prescribed sucralfate for the treatment of a duodenal ulcer. The nurse's instructions on medication administration should emphasize taking the medication at what time?
- With meals to enhance absorption
- Immediately after meals to neutralize acid
- On an empty stomach, one hour before meals (Correct answer)
- At the same time as an antacid for maximum effect
Correct answer: On an empty stomach, one hour before meals
Sucralfate works by forming a protective barrier over the ulcer crater. This action is most effective when the stomach is empty, allowing the medication to adhere directly to the ulcer site without interference from food. It should be taken on an empty stomach, typically one hour before meals and at bedtime.
Certified Gastroenterology RN Gastroenterology Pharmacology Questions and Answers
A patient with Crohn's disease is scheduled to begin treatment with infliximab.
Before administering the first dose, which of the following is the MOST important screening for the nurse to verify has been completed?