AGNP BOARD EXAM QUESTIONS Prescription Gastroenterology (85 Questions with Answers and Explanations)
Question:
A 45-year-old woman has been taking oral
... [Show More] omeprazole (Prilosec) 40 mg twice daily for the treatment of gastroesophageal reflux. To discontinue the medication the nurse practitioner would:
advise the patient to stop the medication.
reduce the dose by 50% every other day.
reduce the dose by 50% weekly. Correct
reduce dose by 50% every month.
Explanation:
For patients on a moderate to high dose of a PPI (e.g., omeprazole (Prilosec) 40 mg daily or twice daily), reduce the dose by 50% every week until the patient is on the lowest dose of the medication. For patients on twice daily dosing, the initial reduction can be accomplished by decreasing the dosing to once in the morning before breakfast. Once the patient has completed a week at the lowest dose, the medication can be discontinued.
Question:
Patients receiving long-term proton pump inhibitors (PPIs) are at increased risk for fractures and:
lower extremity edema.
extraesophageal symptoms.
myocardial infarction. Correct
muscle spasms.
Explanation:
Analysis of patients taking PPIs for long periods of time showed an increased risk of myocardial infarctions. This is thought to be related to reduced nitric oxide in the blood vessel walls. The FDA suggests that providers consider periodically obtaining magnesium levels in patients while they are on a PPI. Increased risk of myocardial infarction has not been associated with histamine receptor blockers.
Question:
Ondansetron (Zofran) dosage should be adjusted in patients:
with renal insufficiency.
who are pregnant.
who are > 65 years old.
with hepatic impairment. Correct
Explanation:
Ondansetron (Zofran) is a 5-HT3 receptor antagonist used for the treatment of nausea and vomiting. Dose limitations are recommended for patients with severe hepatic impairment (Child-Pugh class C); use with caution in mild-moderate hepatic impairment; clearance is decreased and half-life increased in hepatic impairment. No dosage adjustment is recommended with renal insufficiency, pregnancy or in advanced age.
Question:
The antiemetic that does NOT have potential to cause QT prolongation is:
promethazine (Phenergan). Correct
chlorpromazine (Thorazine).
ondansetron (Zofran).
prochlorperazine (Compazine).
Explanation:
Antihistamines such as promethazine and diphenhydramine do not cause QT prolongation. Dopamine and serotonin antagonists are both associated with QT prolongation. Chlorpromazine (Thorazine) and prochlorperazine (Compazine) are dopamine antagonists. Ondansetron (Zofran) is a serotonin antagonist. If a patient has suspected QT interval prolongation or is taking other medications with which the QT interval prolongation could be additive, a 12-lead EKG is recommended before treatment is initiated.
Question:
Promethazine (Phenergan), a 1st generation antihistamine, is contraindicated in the presence of:
motion sickness.
sedation.
asthma. Correct
seasonal allergic rhinitis.
Explanation:
Promethazine (Phenergan) is contraindicated in patients with hypersensitivity reaction to promethazine, other phenothiazines, or any component of the formulation; coma; lower respiratory tract symptoms, including asthma; children younger than 2 years of age; intra-arterial or subcutaneous administration.
Question:
Oral metoclopramide is contraindicated in the patient diagnosed with:
migraines.
epilepsy. Correct
diabetes.
renal impairment.
Explanation:
Metoclopramide (Reglan) is contraindicated in situations when gastrointestinal (GI) motility may be dangerous, including mechanical GI obstruction, perforation, or hemorrhage; pheochromocytoma; history of seizure disorder (e.g., epilepsy); and concomitant use with other agents likely to increase extrapyramidal reactions. Caution is advised in patients with renal impairment; dosage adjustment may be needed.
Question:
Hyperosmotic agents and saline laxatives should be avoided or used with caution in patients who have:
chronic constipation.
liver disease.
heart failure. Correct
hypothyroidism.
Explanation:
Hyperosmotic agents and saline laxatives may seriously alter fluid and electrolyte balance. This increases the risk for dehydration and electrolyte disturbances, especially hypokalemia. Therefore, the risks versus the benefits should be considered prior to use in patients with heart failure.
Question:
Corticosteroids, used in the treatment of ulcerative colitis, usually do NOT:
increase the rate of infection.
reduce the effectiveness of vaccines.
increase the effectiveness of antibiotics. Correct
increase the risk of developing osteoporosis.
Explanation:
Corticosteroids usually do NOT increase the effectiveness of antibiotics; they reduce their effectiveness. Because they suppress the immune system, they increase the rate of infection, reduce the effectiveness of vaccines and increase the risk of osteoporosis and fractures due to loss of calcium with corticosteroids.
Question:
The plasma elimination half-life of esomeprazole (Nexium) is:
1-1.5 hours. Correct
2-3 hours.
3.5-5 hours.
6-8 hours.
Explanation:
The plasma elimination half-life of esomeprazole (Nexium) is approximately 1 to 1.5 hours. Less than 1% of the parent drug is excreted in the urine. Approximately 80% of an oral dose of esomeprazole is excreted as inactive metabolites in the urine, and the remainder is found as inactive metabolites in the feces.
Question:
Proton pump inhibitors (PPIs), such as pantoprazole (Protonix), block gastrointestinal acid secretion by:
converting cations to anions and pumping from parietal cell to the secretory canaliculus.
prohibiting the pumping of hydrogen ions into the parietal cell.
inhibiting the hydrogen-potassium ATPase transport enzyme. Correct
inhibiting the sodium-potassium ATPase transport enzyme.
Explanation:
The recognition that H-K-ATPase was the final step of acid secretion culminated in the development of a class of drugs, the proton pump inhibitors (PPIs), which are targeted at inhibiting this enzyme. They are most effective when the parietal cell is stimulated to secrete acid postprandially, a relationship that has important clinical implications for timing of administration. Because the amount of H-K-ATPase present in the parietal cell is greatest after a prolonged fast, PPIs should be administered before the first meal of the day.
Question:
A 7-10 day regimen of ciprofloxacin (Cipro) plus metronidazole (Flagyl) is indicated for the outpatient treatment of:
bacterial vaginosis.
uncomplicated diverticulitis. Correct
Clostridium difficile.
gastroenteritis.
Explanation:
A 7-10 day course of oral ciprofloxacin (Cipro) plus metronidazole (Flagyl) is appropriate for the outpatient management of uncomplicated diverticulitis. This regimen provides adequate coverage of common gastrointestinal flora of gram-negative rods and anaerobes.
Question:
Ranitidine (Zantac), a histamine receptor antagonist, is contraindicated in:
children.
pancreatitis.
phenylketonuria (PKU). Correct
Zollinger-Ellison disease.
Explanation:
Some H2-blockers contain aspartame. Aspartame is converted to phenylalanine and must be used with caution in patients with PKU. The Pepcid AC brand of famotidine chewable tablets contains 1.4 mg of phenylalanine per 10-mg dose. The Pepcid RPD brand of famotidine oral dispersible tablets contains 1.05 mg of phenylalanine per 20-mg dose. The Zantac brand of ranitidine EFFERdose tablets contains 2.81 mg of phenylalanine per 25-mg dose and 16.84 mg of phenylalanine per 150-mg dose.
Question:
A patient who has been taking a proton pump inhibitor for the last 6 months reports persistent diarrhea for the past 3 weeks. The nurse practitioner should consider:
colitis.
gastroparesis.
bacterial gastroenteritis.
Clostridium difficile. Correct
Explanation:
The US Food and Drug Administration (FDA) has issued a safety alert encouraging providers to consider a diagnosis of Clostridium difficile-associated disease in PPI users with persistent diarrhea. Given the potential risk of Clostridium difficile infection, the FDA has also recommended that providers prescribe the lowest dose and shortest duration of PPI therapy appropriate to the condition being treated.
Question:
Histamine receptor antagonists (H2RA), such as famotidine (Pepcid), inhibit acid secretions by:
blocking the parietal cells (acid-producers) from responding to histamine. Correct
blocking transport of histamine across the ATPase Pump.
antagonizing the release of histamine from the enterochromaffin-like cells (ECL cells).
antagonizing hydrogen ions from responding to histamine.
Explanation:
H2 blockers inhibit the parietal cells in the stomach lining from responding to histamine. This reduces the amount of acid produced by the stomach. H2RA blockers include: famotidine (Pepcid); ranitidine (Zantac), and nizatidine (Axid).
Question:
The length of treatment for oral metoclopramide should NOT exceed:
4 weeks.
8 weeks.
10 weeks.
12 weeks. Correct
Explanation:
Avoid treatment with metoclopramide for longer than 12 weeks in all but rare cases in which therapeutic benefit is thought to outweigh the risk of developing tardive dyskinesia. Oral metoclopramide is indicated for adults only.
Question:
A 42-year-old patient is being treated with 40 mg of famotidine (Pepcid) daily for the treatment of duodenal ulcers. The best time for the patient to take this medication is:
on an empty stomach, 1 hour prior to breakfast.
with breakfast.
prior to the largest meal of the day.
at bedtime. Correct
Explanation:
Oral dosage forms of famotidine (suspension, tablets, chewable tablets, and oral disintegrating tablets) used to treat duodenal ulcers are typically administered once a day at bedtime. BID dosing is also accepted.
Question:
Topical steroid cream, used in the treatment of hemorrhoids, should be applied twice daily for no more than:
3 days.
5 days.
7 days. Correct
10 days.
Explanation:
Topical steroid cream may be used to relieve pruritus and reduce the size of hemorrhoids. It should be applied to the site twice daily for no more than 7 days to avoid potential thinning of perianal and anal mucosa and reduce the risk of injury.
Question:
The drug of choice for the prevention of postoperative nausea and vomiting (PONV) is:
droperidol (Inapsine).
chlorpromazine (Thorazine).
ondansetron (Zofran). Correct
promethazine (Phenergan).
Explanation:
Ondansetron (Zofran) has a limited side effect profile and doesn’t adversely affect the postoperative course. The manufacturer recommends administering preoperatively for the prevention of postoperative nausea and vomiting. Although droperidol (Inapsine), chlorpromazine (Thorazine) and promethazine (Phenergan) are indicated for the treatment of nausea and vomiting, they are not indicated for the prevention of post operative nausea and vomiting. Promethazine has a more extensive side effect profile than Zofran.
Question:
Long-term use of histamine receptor antagonists (H2RA), such as ranitidine (Zantac), has been associated with:
hypermagnesemia.
vitamin B12 deficiency. Correct
iron deficiency.
hypocalcemia.
Explanation:
Long-term H2RA use, for the treatment of gastroesophageal reflux, is associated with B12 deficiency. Proton pump inhibitors are associated with hypomagnesemia, calcium malabsorption, vitamin B12 and iron deficiency. H2RA blockers include: famotidine (Pepcid); ranitidine (Zantac), and nizatidine (Axid).
Question:
Due to potential for extrapyramidal symptoms, oral metoclopramide (Reglan) should NOT be administered concomitantly with:
sertraline (Zoloft). Correct
hydralazine (Apresoline).
hydromorphone (Dilaudid).
lamotrigine (Lamictal).
Explanation:
Concomitant use of drugs that can cause extrapyramidal symptoms should be avoided unless absolutely necessary. These drugs include some antipsychotics (Abilify), selective serotonin reuptake inhibitors (i.e. Zoloft), selective norepinephrine reuptake inhibitors (Cymbalta), and norepinephrine-dopamine reuptake inhibitors (Wellbutrin). Hydralazine (Apresoline) is a vasodilator/nitrate; hydromorphone (Dilaudid) is an opioid; lamotrigine (Lamictal) is an antiepileptic.
Question:
Prior to the initiation of long-term treatment with a proton pump inhibitor (PPI) and periodically during therapy, the nurse practitioner should monitor serum:
potassium.
sodium.
magnesium. Correct
calcium.
Explanation:
Hypomagnesemia due to reduced intestinal absorption has been described with PPI use. It is recommended that serum magnesium levels be obtained prior to starting a PPI when patients are expected to be on the medication for long periods of time, or in patients who take PPIs in conjunction with other medications associated with hypomagnesemia (e.g., digoxin or diuretics).
Question:
Drug classes used as antiemetics do NOT include:
benzodiazepines.
glucocorticoids.
antidepressants. Correct
cannabinoids.
Explanation:
As single agents, the benzodiazepines are relatively weak antiemetic agents. Glucocorticoids are effective and well-tolerated antiemetics for chemotherapy-induced emesis. The modest antiemetic activity of this class of agents, combined with their relatively unfavorable side effect profile (vertigo, xerostomia, hypotension, dysphoria), especially in older patients, has limited their clinical utility. Antidepressants are not utilized as antiemetics.
Question:
Patients who take corticosteroids for Crohn's disease should be instructed to notify the nurse practitioner if pain develops in the:
wrist.
elbow.
hip. Correct
lower back.
Explanation:
The long term use of corticosteroids may lead to avascular necrosis of the hip joints that may require surgery. Hip or knee pain in people taking corticosteroids requires prompt medical attention.
Question:
Corticosteroids, used in the treatment of ulcerative colitis, are produced by the:
pituitary gland.
hypothalamus.
adrenal glands. Correct
pancreas.
Explanation:
Corticosteroids are produced by the adrenal glands in the cortex. Oral and parenteral corticosteroids are used to manage more severe exacerbations. These are ineffective as maintenance therapy to keep ulcerative colitis in remission.
Question:
Metoclopramide, for the treatment of gastroesophageal reflux, should be administered orally:
30 minutes after meals and at bedtime.
30 minutes prior to meals and at bedtime. Correct
with meals.
with a full glass of water before bed.
Explanation:
Metoclopramide (Reglan), an antiemetic for the treatment of gastroesophageal reflux and other nausea/vomiting producing diseases, should be administered 30 minutes prior to meals and at bedtime when administered orally in tablet, elixir or orally disintegrating tablets.
Question:
The brand name of omeprazole is:
Prevacid.
Prilosec. Correct
Protonix.
Probenecid.
Explanation:
The brand name for omeprazole is Prilosec. The generic name for Prevacid is lansoprazole. The generic name for Protonix is pantoprazole. Probenecid is used to treat gout.
Question:
Which medication may be used in infants for the treatment of functional constipation?
Senna (Senokot)
Mineral oil
Bisacodyl (Dulcolax)
Polyethylene glycol 3350 (MiraLax) Correct
Explanation:
Polyethylene glycol 3350 (MiraLax) is an osmotic laxative and is considered safe for use in infants. Mineral oil is contraindicated in infants due to an increased risk for aspiration. Senna (Senokot) and bisacodyl (Dulcolax) are stimulant laxatives and not recommended in this age group for the treatment of functional constipation.
Question:
Patients should be advised to remove the scopolamine patch if an adverse reaction occurs, such as:
constipation.
confusion. Correct
drowsiness.
mydriasis.
Explanation:
Confusion may indicate the beginnings of toxic psychosis caused by scopolamine and the drug should be stopped if confusion occurs. Constipation, drowsiness and mydriasis are all side effects of scopolamine. However, they are not considered an adverse reaction. Constipation can be alleviated with increased fluids. Drowsiness and mydriasis usually resolve within a few days.
Question:
For patients who didn’t respond to an initial course of triple therapy for Helicobacter pylori, an alternate regimen should be prescribed. It would include a proton pump inhibitor (PPI) and:
amoxicillin and clarithromycin.
amoxicillin and cephalexin.
metronidazole and clarithromycin.
metronidazole and tetracycline. Correct
Explanation:
For patients who didn’t respond to an initial course of triple therapy for Helicobacter pylori, tetracycline may be more effective than metronidazole. The recommended regimen contains amoxicillin, omeprazole, and bismuth salts plus either metronidazole or tetracycline. Clarithromycin should not be used unless resistance testing confirms the H. pylori strain is susceptible to the drug. Antibiotics previously taken for prior treatment should generally be avoided.
Question:
In the patient with an allergy to penicillin, treatment of Helicobacter pylori would include a proton pump inhibitor plus:
amoxicillin and clarithromycin.
amoxicillin/clavulanate and tetracycline.
metronidazole and clarithromycin. Correct
amoxicillin and cephalexin.
Explanation:
The regimen most commonly recommended for first-line treatment of Helicobacter pylori is triple therapy with a proton pump inhibitor (PPI), amoxicillin (1 g twice daily), and clarithromycin (500 mg twice daily) for 7 to 14 days. In patients with a known allergy to amoxicillin, metronidazole should be prescribed.
Question:
The brand name of pantoprazole is:
Prevacid.
Prilosec.
Protonix. Correct
Probenecid.
Explanation:
The brand name of pantoprazole is Protonix. It is classified as a proton pump inhibitor. The brand name of omeprazole is Prilosec. The generic of Prevacid is lansoprazole. Probenecid is used to treat gout.
Question:
In patients with severe renal failure, the dosage of histamine receptor antagonists (H2RA) should be reduced by:
25%.
30%.
50%. Correct
75%.
Explanation:
The dose of all the H2RAs is generally reduced by 50% in patients with severe renal failure. The plasma half-life is prolonged and total clearance is reduced in the elderly population due to a decrease in renal function. The elimination half-life is 3.1 hours. H2RA blockers include: famotidine (Pepcid); ranitidine (Zantac), and nizatidine (Axid).
Question:
The bioavailability and time to peak of oral ondansetron (Zofran) in the treatment of noncancerous nausea and vomiting are:
30% and 2 hours.
50% and 1 hour.
60% and 2 hours. Correct
80% and 1 hour.
Explanation:
Bioavailability of oral ondansetron (Zofran) is 50% to 70% due to some first-pass metabolism. In cancer patients (adults), it demonstrates 85% to 87% bioavailability possibly related to changes in metabolism. The time to peak is about 2 hours.
Question:
The generic name for Dramamine is:
doxylamine.
diphenhydramine.
brompheniramine.
dimenhydrinate. Correct
Explanation:
The generic name of Dramamine is dimenhydrinate. Dramamine is classified as an antihistamine. It may be used to treat allergies or dizziness. The brand name for doxylamine is Unisom; diphenhydramine is Benadryl; brompheniramine is Bromax.
Question:
Which of the following agents is NOT typically used to treat symptoms of pain and bloating associated with diarrhea-predominant irritable bowel syndrome (IBS)?
Dicyclomine (Bentyl)
Peppermint oil
Linaclotide (Linzess) Correct
Hyoscyamine (Levsin)
Explanation:
Antispasmodics and peppermint oil may be prescribed as needed and/or prophylactically in the event of an anticipated stressor for short-term relief of symptoms associated with diarrhea-predominant irritable bowel syndrome (IBS). While these agents provide relief of symptoms, they typically do not affect disease-induced alterations in bowel patterns. Linaclotide (Linzess) works to increase intestinal fluid secretion and motility. It is indicated for treatment of constipation-predominant IBS, not diarrhea-predominant IBS.
Question:
The duration of action of meclizine (Antivert) is:
2 hours.
4 hours.
6 hours.
8 hours. Correct
Explanation:
Meclizine (Antivert) is a first generation antihistamine, used in the treatment of nausea/vomiting, vertigo and motion sickness. The duration of meclizine (Antivert) is approximately 8-24 hours. The onset of action is about 1 hour with a half-life of 6 hours.
Question:
Quadruple therapy for the treatment of peptic ulcer disease caused by Helicobacter pylori consists of:
reflux precautions, proton pump inhibitor, bismuth subsalicylate and an antibiotic.
bismuth subsalicylate, a proton pump inhibitor and two antibiotics. Correct
an antacid, bismuth subsalicylate, proton pump inhibitor and an antibiotic.
two proton pump inhibitors and two antibiotics.
Explanation:
Bismuth-containing quadruple therapy consists of a proton pump inhibitor (PPI) combined with bismuth subsalicylate (524 mg four times daily) and two antibiotics (e.g., metronidazole 250 mg four times daily and tetracycline 500 mg four times daily) given for 14 days.
Question:
The brand name for esomeprazole is:
Flexium.
Nexavar.
Protonix.
Nexium. Correct
Explanation:
The brand name for esomeprazole is Nexium. Nexium and Protonix are proton pump inhibitors. The generic name for Protonix is pantoprazole. Nexavar is an antiangiogenic agent. Flexium is an OTC gel used for the treatment of muscle and joint pain.
Question:
The brand name of prochlorperazine maleate is:
Cyclivert.
Thorazine.
Phenergan.
Compazine. Correct
Explanation:
The brand name of prochlorperazine maleate is Compazine. The generic name for Cyclivert is cyclizine; Thorazine is chlorpromazine; Phenergan is promethazine.
Question:
Scopolamine (Transderm-Scop) is indicated for the treatment of nausea and vomiting associated with:
chemotherapy.
gastroenteritis.
hyperemesis gravidarum.
motion sickness. Correct
Explanation:
Scopolamine base (Transderm-Scop) is indicated for the treatment of motion sickness and postoperative nausea and vomiting. It has been used in chemotherapy-induced nausea and vomiting, but this is an off-label use. It is not used in hyperemesis gravidarum. The risks versus the benefits must be considered for use in pregnancy. There is no indication for use in gastroenteritis.
Question:
Triple therapy for treatment of peptic ulcer disease caused by Helicobacter pylori consists of:
reflux precautions, proton pump inhibitor and an antibiotic.
dietary modifications, bismuth subsalicylate and two antibiotics.
an antacid, proton pump inhibitor and an antibiotic.
a proton pump inhibitor and two antibiotics. Correct
Explanation:
Triple therapy for the treatment of Helicobacter pylori consists of a proton pump inhibitor (PPI) and two antibiotics. The regimen most commonly recommended for first-line treatment of Helicobacter pylori is triple therapy with a proton pump inhibitor (PPI), amoxicillin (1 g twice daily), and clarithromycin (500 mg twice daily) for 7 to 14 days.
Question:
The brand name of metoclopramide, an antiemetic, is:
Megace.
Renagel.
Reglan. Correct
Metolazone.
Explanation:
The brand name of metoclopramide is Reglan. It is an antiemetic. The brand name of metolazone, a diuretic, is Zaroxolyn. The generic name of Renagel, a phosphate binder, is sevelamer. Megestrol is the generic name of Megace. It is a progestin and is used to stimulate appetite.
Question:
A patient who has failed two courses of therapy for Helicobacter pylori should:
be admitted for intravenous therapy.
receive quadruple therapy for 3 months' duration.
receive reinforced education about compliance with medications. Correct
be considered for enrollment in a trial study.
Explanation:
It is important to reinforce the need for compliance with medications for a patient who has failed two attempts at treatment of Helicobacter pylori. Non-compliance is often the cause of treatment failure. Intravenous therapy and enrollment in a trial study are not recommended. Although quadruple therapy may be a viable option, it would not extend for 3 months.
Question:
Ondansetron (Zofran) is available as:
intramuscular and intravenous solutions only.
oral disintegrating tablets and an intravenous solution only.
oral elixir and disintegrating tablets only.
oral elixir, tablets, soluble film, disintegrating tablets, intramuscular and intravenous solution. Correct
Explanation:
Ondansetron (Zofran) is available in oral elixir, oral tablets, oral soluble film, oral disintegrating tablets, intramuscular and intravenous solution.
Question:
The first-line regimen for the treatment of Helicobacter pylori is a proton pump inhibitor (PPI) plus:
amoxicillin and clarithromycin. Correct
amoxicillin/clavulanate and tetracycline.
clarithromycin and tetracycline.
amoxicillin and cephalexin.
Explanation:
The regimen most commonly recommended for first-line treatment of Helicobacter pylori is triple therapy with a proton pump inhibitor (PPI), amoxicillin (1 g twice daily), and clarithromycin (500 mg twice daily) for 7 to 14 days.
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