Acid Control
This drug serves as a replacement for endogenous prostaglandins to promote protection of the GI mucosa and is an old Category X drug
Misoprostol (Cytotec)
A patient arrives at the ED complaining of gastrointestinal distress for 2 days. The physician orders sublingual Ondansetron (Zofran).
The patient asks why the provider prescribed this drug. What is the nurse’s best response?
a) It will increase bowel activity.
b) It will help you sleep.
c) It will help alleviate nausea and vomiting.
d) It will stimulate your appetite.
c. It will help alleviate nausea and vomiting.
Rationale: Ondansetron is an antiemetic agent that blocks serotonin receptors to decrease nausea and vomiting.
What condition would contraindicate the use of Psyllium (Metamucil)?
Heart failure or fluid restriction, due to large fluid intake required for safety.
Which drug blocks H₁ and dopamine receptors in the chemoreceptor trigger zone?
a) Scopolamine (Transderm Scop)
b) Promethazine (Phenergan)
c) Ondansetron (Zofran)
d) Dronabinol (Marinol)
b. b — Promethazine (Phenergan)
Rationale: Promethazine is a phenothiazine derivative that blocks histamine and dopamine receptors, commonly used for nausea and motion sickness.
Which class of medications provides rapid relief of heartburn by neutralizing acid?
a) PPIs
b) H₂ blockers
c) Antacids
d) Mucosal protectants
c — Antacids.
Rationale: Antacids provide immediate but short-term relief by directly neutralizing gastric acid.
Which of the following medications neutralizes stomach acids by providing an alkaline agent?
Aluminum Hydroxide (Maalox)
A patient reports taking Dimenhydrinate (Dramamine).
What would be appropriate indications for this over-the-counter drug
Select all that apply.
a) Motion sickness
b) Nausea
c) Muscle rigidity
d) Anesthesia
e) Seizures
a, b Motion sickness and Nausea
Rationale: Dimenhydrinate is an antihistamine used to prevent motion sickness and nausea by inhibiting vestibular stimulation.
What is the mechanism of action for Bismuth Subsalicylate (Pepto Bismol)?
a) Stimulates peristalsis
b) Decreases GI secretions and binds toxins
c) Lubricates stool to ease passage
d) Neutralizes acid in stomach
Decreases GI secretions, has antimicrobial effects, and binds bacterial toxins.
Which drug selectively blocks the 5-HT₃ serotonin receptors in the GI tract and in the brain?
a) Ondansetron (Zofran)
b) Metoclopramide (Reglan)
c) Promethazine (Phenergan)
d) Scopolamine (Transderm Scop)
a. Ondansetron (Zofran)
Rationale Ondansetron prevents nausea/vomiting by blocking serotonin at the chemoreceptor trigger zone (CTZ) and vagal nerve terminals.
Which antiemetic is a transdermal patch placed behind the ear?
a) Promethazine (Phenergan)
b) Scopolamine (Transderm Scop)
c) Ondansetron (Zofran)
d) Metoclopramide (Reglan)
b — Scopolamine (Transderm Scop).
Rationale: Scopolamine is applied 4 hours before travel to prevent motion sickness by blocking acetylcholine.
A client is taking a proton pump inhibitor (PPI) medication for GERD.
Which of the following medications will the nurse correctly identify is a PPI?
a) Aluminum hydroxide (Maalox)
b) Famotidine (Pepcid)
c) Pantoprazole (Protonix)
d) Sucralfate (Carafate)
Pantoprazole (Protonix)
PPI drugs end in -prazole and suppress gastric acid by inhibiting the hydrogen/potassium ATPase enzyme.
What is the best teaching point for a patient who takes Ondansetron (Zofran) for nausea prevention before chemotherapy?
Take 30 minutes before treatment to allow onset of action and minimize nausea and vomiting.
Your patient is discharged with Psyllium (Metamucil). Which instruction is correct?
a) Take with 8 oz of water or juice.
b) Take without water for better effect.
c) Take before meals only.
d) Avoid fluids to prevent bloating.
a Take with 8 oz of water or juice.
Psyllium absorbs water to form bulk; without fluids, it may solidify and cause obstruction
Which anticholinergic drug is used as a transdermal patch to prevent motion sickness?
a) Promethazine (Phenergan)
b) Scopolamine (Transderm Scop)
c) Dronabinol (Marinol)
d) Metoclopramide (Reglan)
B. Scopolamine (Transderm Scop)
Rationale: Scopolamine blocks acetylcholine in the vestibular system, preventing motion sickness. Apply patch 4 hours before travel.
Which drug is contraindicated in pregnancy because it can induce uterine contractions?
a) Pantoprazole (Protonix)
b) Misoprostol (Cytotec)
c) Sucralfate (Carafate)
d) Famotidine (Pepcid)
b — Misoprostol (Cytotec).
Rationale: Misoprostol can induce labor or miscarriage; contraindicated in pregnancy.
What Suppresses gastric acid by inhibiting hydrogen/potassium ATPase enzyme.
What Alkaline agent that neutralizes stomach acids.
What Combines with proteins to form a viscous coating that protects the GI lining.
What Replaces endogenous prostaglandins to protect GI mucosa
What Blocks histamine 2 receptors to reduce acid secretion
Pantoprazole → Suppresses gastric acid by inhibiting hydrogen/potassium ATPase enzyme.
Maalox → Alkaline agent that neutralizes stomach acids.
Sucralfate → Combines with proteins to form a viscous coating that protects the GI lining.
Misoprostol → Replaces endogenous prostaglandins to protect GI mucosa.
Famotidine → Blocks histamine 2 receptors to reduce acid secretion
You are caring for a patient admitted to the oncology floor for persistent nausea and vomiting. The physician orders Metoclopramide (Reglan).
Which of the following would be a contraindication for this drug?
a) Nausea
b) Vomiting
c) GI perforation
d) Gastroparesis
c. GI perforation
Rationale: Metoclopramide increases GI motility and is contraindicated in obstruction, perforation, or hemorrhage.
What adverse effect is linked to salicylate toxicity from Pepto Bismol overuse?
a) Tinnitus
b) Constipation
c) Dry mouth
d) Diarrhea
a. tinnitus
Which antiemetic suppresses emesis by blocking dopamine receptors and increasing GI motility?
a) Metoclopramide (Reglan)
b) Ondansetron (Zofran)
c) Promethazine (Phenergan)
d) Scopolamine (Transderm Scop)
a. Metoclopramide (Reglan)
Rationale: Metoclopramide blocks dopamine receptors in the CTZ and enhances acetylcholine action to increase gastric emptying.
How do H₂ blockers differ from PPIs?
a) PPIs neutralize acid; H₂ blockers absorb acid.
b) PPIs block the proton pump; H₂ blockers block histamine receptors.
c) H₂ blockers increase acid production.
d) PPIs coat the stomach lining.
b — PPIs block the proton pump; H₂ blockers block histamine receptors.
Rationale: PPIs work later in the acid pathway; H₂ blockers work earlier by reducing stimulation.
A drug that is nonabsorbable and combines with proteins to form a viscous substance that coats the lining of the GI tract is:
Sucralfate (Carafate)
A patient arrives in the emergency department and admits to ingesting 40 “heart medicine” pills about 20 minutes ago.
The provider orders activated charcoal via NG tube.
Why would activated charcoal be helpful in this situation?
a) It lines the GI tract to protect the esophagus.
b) It binds with toxic agents in the GI tract to prevent absorption into the blood.
c) It induces vomiting to clear toxins.
d) It is too late to administer.
b — It binds with toxic agents to prevent absorption.
Teaching for Bismuth Subsalicylate (Pepto Bismol) should include which? Select all that apply.
a) May cause black stools
b) May discolor tongue
c) Avoid extra aspirin
d) May impair absorption of other meds
e) In high doses may cause tinnitus
a) May cause black stools
b) May discolor tongue
c) Avoid extra aspirin
d) May impair absorption of other meds
e) In high doses may cause tinnitus
Which drug’s mechanism is not fully understood but likely involves activation of cannabinoid receptors to decrease nausea?
a) Metoclopramide (Reglan)
b) Promethazine (Phenergan)
c) Scopolamine (Transderm Scop)
d) Dronabinol (Marinol)
d — Dronabinol (Marinol)
Rationale: Dronabinol is a cannabinoid that activates CB₁ receptors in the brain to reduce nausea and vomiting, often used for chemotherapy-induced nausea.
Which antiemetic increases gastric motility and may cause extrapyramidal symptoms (EPS) with long-term use?
a) Ondansetron (Zofran)
b) Dronabinol (Marinol)
c) Metoclopramide (Reglan)
d) Scopolamine (Transderm Scop)
c — Metoclopramide (Reglan).
Rationale: Metoclopramide increases dopamine blockade, leading to risk of tremors, dystonia, and EPS