Certified Gastroenterology RN Gastroenterology Pharmacology 4 — Questions and Answers
Question 1: A patient scheduled for colonoscopy is prescribed polyethylene glycol solution; which finding warrants holding the prep and calling the provider?
- Severe abdominal distention and inability to pass flatus (Correct answer)
- Mild nausea after the first liter
- Clear yellow liquid stools
- Chills after drinking cold solution
Correct answer: Severe abdominal distention and inability to pass flatus
Distention with obstipation suggests bowel obstruction, a contraindication to osmotic bowel preparation.
Question 2: Which drug interaction is most concerning for a patient taking omeprazole with clopidogrel?
- Reduced antiplatelet effect via CYP2C19 inhibition (Correct answer)
- Increased risk of QT prolongation
- Severe hypoglycemia
- Enhanced clopidogrel absorption causing bleeding
Correct answer: Reduced antiplatelet effect via CYP2C19 inhibition
Omeprazole inhibits CYP2C19, which is required to convert clopidogrel into its active antiplatelet metabolite.
Question 3: A patient with irritable bowel syndrome with constipation (IBS-C) may be prescribed which chloride channel activator?
- Lubiprostone (Correct answer)
- Alosetron
- Dicyclomine
- Rifaximin
Correct answer: Lubiprostone
Lubiprostone activates intestinal chloride channels, increasing fluid secretion and accelerating transit in IBS-C.
Question 4: Alosetron carries a boxed warning for which serious adverse effect in IBS-D patients?
- Ischemic colitis (Correct answer)
- Hepatic necrosis
- Aplastic anemia
- Toxic megacolon from infection
Correct answer: Ischemic colitis
Alosetron can cause ischemic colitis and severe constipation, so it is restricted to women with severe IBS-D under a special program.
Question 5: Which instruction is correct for a patient taking a bile acid sequestrant such as cholestyramine?
- Take other medications 1 hour before or 4-6 hours after the sequestrant (Correct answer)
- Take all medications at the same time to improve adherence
- Take it on an empty stomach with no fluids
- Crush the resin and inhale-free mix into carbonated beverages only
Correct answer: Take other medications 1 hour before or 4-6 hours after the sequestrant
Cholestyramine binds many drugs in the gut, so other medications must be separated to avoid impaired absorption.
Question 6: A patient with chronic hepatitis B on entecavir must be counseled about which risk if the drug is abruptly discontinued?
- Severe hepatitis flare (Correct answer)
- Adrenal crisis
- Rebound hypertension
- Serotonin syndrome
Correct answer: Severe hepatitis flare
Stopping nucleoside analogs can trigger severe acute exacerbation of hepatitis B, so patients need close monitoring after discontinuation.
Question 7: Which agent is administered before endoscopic procedures to reduce gastric motility?
- Glucagon (Correct answer)
- Neostigmine
- Metoclopramide
- Bethanechol
Correct answer: Glucagon
Glucagon relaxes GI smooth muscle, decreasing peristalsis to improve visualization during endoscopy.
Certified Gastroenterology RN Gastroenterology Pharmacology 4
A patient scheduled for colonoscopy is prescribed polyethylene glycol solution; which finding warrants holding the prep and calling the provider?