Certified Gastroenterology RN Gastroenterology Pharmacology 5 — Questions and Answers
Question 1: A patient beginning quadruple therapy for H. pylori with bismuth, metronidazole, tetracycline, and a PPI must avoid which substance?
- Alcohol (Correct answer)
- Grapefruit juice
- Dairy products entirely for the year
- Leafy green vegetables
Correct answer: Alcohol
Metronidazole with alcohol can cause a disulfiram-like reaction with flushing, vomiting, and tachycardia.
Question 2: Which finding indicates a therapeutic response to lactulose in hepatic encephalopathy?
- Improved mental status and decreased serum ammonia (Correct answer)
- Increased urine output
- Resolution of jaundice
- Normalization of INR
Correct answer: Improved mental status and decreased serum ammonia
Effective lactulose therapy lowers ammonia levels, which correlates with improved level of consciousness.
Question 3: A patient on high-dose loperamide abuse is at risk for which cardiac complication?
- QT prolongation and torsades de pointes (Correct answer)
- Complete heart block from vagal tone
- Coronary vasospasm
- Pericardial effusion
Correct answer: QT prolongation and torsades de pointes
Supratherapeutic loperamide blocks cardiac potassium channels, causing QT prolongation and life-threatening arrhythmias.
Question 4: Which baseline test is required before starting a patient on infliximab?
- Tuberculosis screening (Correct answer)
- Pulmonary function tests
- Echocardiogram in all patients
- Colonoscopy within 1 week
Correct answer: Tuberculosis screening
Anti-TNF therapy can reactivate latent tuberculosis, so TB screening is mandatory before initiation.
Question 5: Ursodiol is prescribed for a patient primarily to achieve which therapeutic effect?
- Dissolution of cholesterol gallstones (Correct answer)
- Neutralization of gastric acid
- Eradication of H. pylori
- Stimulation of pancreatic enzyme release
Correct answer: Dissolution of cholesterol gallstones
Ursodiol reduces biliary cholesterol saturation, gradually dissolving small non-calcified cholesterol gallstones.
Question 6: A patient receiving IV erythromycin for gastroparesis benefits from which pharmacologic action?
- Motilin receptor agonism promoting gastric emptying (Correct answer)
- Dopamine receptor blockade
- Acetylcholinesterase inhibition
- Serotonin 5-HT4 antagonism
Correct answer: Motilin receptor agonism promoting gastric emptying
Erythromycin stimulates motilin receptors, triggering migrating motor complexes that accelerate gastric emptying.
Question 7: Which nursing action is priority when administering IV pantoprazole for an acute GI bleed?
- Use a dedicated line or flush before and after with compatible solution (Correct answer)
- Administer rapid IV push over 30 seconds
- Mix in the same line as lactated Ringer's with calcium
- Refrigerate the reconstituted solution for 72 hours before use
Correct answer: Use a dedicated line or flush before and after with compatible solution
IV pantoprazole has compatibility limitations and should be given through a flushed or dedicated line per infusion guidelines.
Certified Gastroenterology RN Gastroenterology Pharmacology 5
A patient beginning quadruple therapy for H. pylori with bismuth, metronidazole, tetracycline, and a PPI must avoid which substance?