807 CH 40 Diarrhea drugs - EXAM 3

A nurse is caring for a client prescribed bismuth subsalicylate. What assessment question is most important for the nurse to ask before administering the initial dose of the medication? "Do you have a history of eczema?" "Are you allergic to aspirin?" "Are you visually impaired?" "What do you usually take for diarrhea?"

"Are you allergic to aspirin?" Explanation: It is most important to determine if the client is allergic to aspirin since both aspirin and the medication are salicylates. While all the other questions are legitimate assessment questions, none is directly related to a risk associated with bismuth subsalicylate.

During an assessment of a client experiencing diarrhea, which question is appropriate for the nurse in determining the possible cause of the diarrhea? "Have you recently consumed uncooked ground beef?" "Do you wash your hands after you use the restroom?" "Can you tell me what you ate in the last 24 hours?" "Have you been vaccinated for hepatitis A?"

"Can you tell me what you ate in the last 24 hours?" Explanation: During an assessment, the nurse should ask about food consumed in the last 24 hours. Intestinal infections with viruses, bacteria or protozoa are from uncooked ground beef, poultry, eggs, and dairy products. Asking about consumption of uncooked ground beef does not focus on the other sources of intestinal infections. Asking about washing hands after using the restroom is not appropriate since it is directed towards possible E.coli contamination. Vaccination for hepatitis A is not pertinent for the assessment at this time. Two of the most common viral organisms responsible for diarrhea are rotavirus or Norwalk-like virus.

A nurse is teaching a client about diarrhea. Which statement by the client regarding diarrhea would indicate a need for additional teaching? "More than 3 liquid stools a day is defined as diarrhea." "Diarrhea is a disease that has no cure." "Diarrhea may be acute or chronic." "Some medications may cause diarrhea."

"Diarrhea is a disease that has no cure." Explanation: Diarrhea is an increase in the liquidity of stool or frequency of defecation to more than 3 stools per day. It is a symptom of numerous conditions and not a disease. Diarrhea is a manifestation of basic mechanisms that increase bowel motility, and a variety of toxins and medications can cause the diarrhea. Diarrhea may be acute or chronic and mild or severe.

What should the nurse tell a client who will begin taking rifaximin for traveler's diarrhea? "Do not start taking the drug until the diarrhea has persisted for at least 24 hours." "Start the drug 3 days before leaving for your trip and continue until you return." "Taking the antibiotic will allow you to enjoy the local water and food without concern." "If you notice any blood in your stool, do not take this medication any longer."

"If you notice any blood in your stool, do not take this medication any longer." Explanation: Rifaximin should not be taken if a client has bloody diarrhea or diarrhea that persists for more than 48 hours. It is started after the signs and symptoms of the disease develop and is taken for 3 days. The traveler should still avoid exposure to foreign bacteria by not drinking tap water and by avoiding fruits and vegetables washed in tap water. The client does not need to endure diarrhea for 24 hours before treatment. Antibiotics do not negate the risk of water-borne illness. Rifaximin is not taken prophylactically.

The nurse is about to administer diphenoxylate (Lomotil) to a client for the first time. Which of the following side effects should be included in the teaching about this medication? "Perianal irritation is a side effect of this medication." "This medication may make you feel lightheaded or drowsy." "This medication has few side effects so you may not notice any." "You can expect to feel an increase in energy on this medication."

"This medication may make you feel lightheaded or drowsy." Explanation: Diphenoxylate (Lomotil) is chemically related to opioid drugs; therefore, it may have sedative and euphoric effects as well as a list of other side effects. It does not increase energy or cause perianal irritation, although perianal irritation is often a result of diarrhea.

The nurse is caring for a 2-year-old child who has been having frequent diarrhea. What actions are appropriate? Select all that apply. Monitor the client's electrolyte levels closely. Assess red cell indices. Administer loperamide. Monitor the client's fluid balance. Give bismuth salts.

Administer loperamide. Monitor the client's electrolyte levels closely. Monitor the client's fluid balance. Loperamide may be the antidiarrheal of choice in children older than 2 years of age if such a drug is needed. Bismuth salts are not approved for use in children. The client's electrolyte levels and fluid balance must be closely monitored, but red blood cell indices are less likely to be volatile.

A nurse is caring for a client that has developed diarrhea after antibiotic administration. The client has a BUN of 35 and creatinine of 1.8. The provider has ordered diphenoxylate with atropine for the client. What action should the nurse implement? Discuss the issues with another nurse on the unit. Hold the medication. Administer the medication as prescribed. Call the prescriber about the laboratory tests.

Call the prescriber about the laboratory tests. Explanation: The nurse knows that the use of diphenoxylate with atropine requires caution with clients that have renal or hepatic compromise. The nurse should call the provider and make sure the provider is aware of the laboratory values before administering the medication. Discussing the situation with other nurses is not warranted. The medication does not need to be held at this time as diphenoxylate with atropine is not contraindicated with renal or hepatic compromise but can be administered with caution.

The nurse is assessing a 68-year-old man with chronic diarrhea. The past medical history does not reveal any current conditions that might be contributing. The patient mentions that he used to have a problem with constipation. The nurse is aware that which of the following might be the cause of his diarrhea? Chronic use of antacids Chronic use of laxatives Eating a low-fiber diet Eating a high-fiber diet

Chronic use of laxatives

he nurse is caring for a patient who has finished a course of clindamycin for an infection. Today the patient reports fever, abdominal pain, and loose, watery stools with mucus. The nurse recognizes this patient needs to be screened for which organism? Escherichia coli Clostridium difficile Campylobacter Human immunodeficiency virus

Clostridium difficile Explanation: Antibiotic-associated colitis is a serious condition that results from antibiotic therapy. By suppressing normal flora in the colon, antibiotics allow proliferation of other bacteria, especially C. difficile.

A 29-year-old woman has been prescribed alosetron (Lotronex) for irritable bowel syndrome. Before starting the drug therapy, the nurse will advise the client about which adverse effect(s)? Breathlessness and hypotension Impaired cardiac function Constipation Hyperthyroidism

Constipation Explanation: The primary adverse effect of alosetron is constipation. Clients are also at risk for ischemic colitis, a rare but potentially fatal complication. This drug does not cause breathlessness, hypotension, impaired cardiac function, or hyperthyroidism.

The nurse is teaching the client about alosetron (Lotronex), which has been prescribed to treat chronic diarrhea. The nurse is aware that alosetron has a Black Box Warning. Of which of the following adverse effects does the nurse inform the patient? Select all that apply. Severe constipation Vomiting Possible bowel obstruction Urinary retention Hemorrhage

Severe constipation Possible bowel obstruction Hemorrhage Black Box Warning is designed to alert nurses to the serious GI adverse effects of alosetron, such as severe constipation, with possible bowel obstruction, perforation, and hemorrhage.

A client presents with fever, vomiting, and diarrhea. What should the nurse suspects are possible causes? Select all that apply. chronic pain bacterial toxin laxative abuse irritable bowel syndrome viral infection

bacterial toxin viral infection Fever, vomiting, and diarrhea are frequently found in illnesses caused by ingestion of bacterial toxins or viruses. Chronic pain, laxative abuse, and irritable bowel syndrome do not have symptoms of a fever or vomiting.

A client diagnosed with irritable bowel syndrome has been prescribed alosetron. The nurse should ensure that the client has been made aware of what potentially severe adverse effect? blood dyscrasias diverticulosis bowel obstruction anal fissures

bowel obstruction Explanation: Severe constipation, with possible obstruction, perforation, and hemorrhage, is the most common problem resulting from alosetron. None of the other options are associated with this medication.

Question 8 of 10 A client diagnosed with irritable bowel syndrome has been prescribed alosetron. The nurse should ensure that the client has been made aware of what potentially severe adverse effect? anal fissures diverticulosis blood dyscrasias bowel obstruction

bowel obstruction Explanation: Severe constipation, with possible obstruction, perforation, and hemorrhage, is the most common problem resulting from alosetron. None of the other options are associated with this medication.

The health care provider (HCP) has determined that a client diagnosed with bacterial gastroenteritis following an overseas trip is a candidate for antibacterial drug therapy. The nurse knows that the HCP will select the appropriate drug based on which factor? symptomatology the country from which the client returned causative agent number of days with diarrhea

causative agent Explanation: In bacterial gastroenteritis or diarrhea, the choice of antibacterial drug depends on the causative organism and susceptibility tests. The other information will not influence selection.

A client reports the intention to use an over-the-counter bismuth product. The nurse should inform the client that there is a potential that the medication will cause what side effect? hyperglycemia hypertension dark stool photosensitivity

dark stool Explanation: Bismuth subsalicylate causes a temporary and harmless darkening of the tongue or stool. It is not associated with any of the other options.

What is the priority nursing diagnosis for an 89-year-old client with frequent liquid stools? deficient knowledge related to medications pain related to abdominal cramping imbalanced nutrition: less than body requirements deficient fluid volume

deficient fluid volume Explanation: Fluid volume deficits may develop rapidly in older adults with diarrhea. Older adults are more likely to develop adverse effects associated with the use of these drugs, including sedation, confusion, dizziness, electrolyte disturbances, fluid imbalance, and cardiovascular effects. Although nutrition, pain, and knowledge deficit may be concerns for this client, they are not the priority concern.

The client states that prior to exams at school, the client has abdominal cramping and diarrhea. What does the nurse suspect is the trigger for these signs and symptoms? hyperthyroidism colitis functional diarrhea disorder intestinal neoplasm

functional diarrhea disorder Explanation: The client is describing functional diarrhea disorder where the diarrhea occurs as a result of stress or anxiety. The client does not have hyperthyroid, intestinal neoplasm, or colitis. While all of these conditions can lead to diarrhea, the client's description does not support any of these diagnoses.

The nurse should counsel a client to discontinue use of over-the-counter antidiarrheals and seek treatment from a health care provider if diarrhea persists for how long? 7 days 1 day 2 days 12 hours

2 days Explanation: The nurse should counsel a client to discontinue use of over-the-counter antidiarrheals and seek treatment from a health care provider if diarrhea persists for more than 2 days. Diarrhea lasting more than 2 days can indicate infection or a condition that will require more intense treatment with prescription medication. Dehydration can occur if untreated. Diarrhea of 12 hours to 1 day can be viral. Diarrhea for 7 days can be life threatening.

When describing the drugs used to treat traveler's diarrhea, which would the nurse identify as the most common cause? Pseudomonas Staphylococcus aureus C. difficile E. coli

E. coli Explanation: The most common cause of traveler's diarrhea is E. coli.

At your general medicine practice, your newest patient is a 2-year-old girl from Nigeria whose mother reports the child has excellent health, except for the diarrhea she has demonstrated. Diarrhea started within days of their arrival in the United States 3 weeks ago. History reveals nothing remarkable, but her mother comments on her love of (and continual consumption of) ice cream, something new to her since coming to this country. What would you expect her treatment to involve? Eliminate milk products from her diet Increase fluid intake, especially milk Increase cheese consumption, as cheese can have a constipating effect on many people Eliminate ice cream from her diet, as any new food causes diarrhea

Eliminate milk products from her diet Explanation: Eliminating milk and milk products from her diet will eliminate the cause of her diarrhea.

Nonspecific therapy of diarrhea includes: Loperamide. Bulk laxatives. Psyllium. Fluid and electrolyte replacement.

Fluid and electrolyte replacement. Explanation: A major element of nonspecific therapy is adequate fluid and electrolyte replacement.

A prescriber adds psyllium to the medication administration record for a client experiencing diarrhea. Which is the best rationale for the addition of psyllium? It causes bloating and swells the colon. It binds and expels toxins into the stool. It reduces exchange of proteins and mucus in the stools. It absorbs toxins and water, decreasing fluidity of stools.

It absorbs toxins and water, decreasing fluidity of stools. Explanation: Polycarbophil and psyllium are most often used as bulk-forming laxatives as they absorb toxin and water, decreasing the fluidity of the stools. They do not cause bloating and swell the colon or reduce the exchange of proteins and mucus in the stools.

Which is a common cause of diarrhea in older adults? Laxative overuse The normal aging process Poor muscle tone Glaucoma

Laxative overuse Explanation: Diarrhea in older adults may occur from laxative overuse.

The nurse is teaching a client about diphenoxylate with atropine sulfate which has been prescribed for treatment of acute diarrhea. For which adverse effect should the nurse teach the client to anticipate? Nausea Bradycardia Increased appetite Diaphoresis

Nausea Explanation: Adverse effects of diphenoxylate with atropine sulfate include nausea, vomiting, dizziness, headache, drowsiness, and tachycardia. The incidence and severity of most adverse effects are low when the medication is used appropriately.

he nurse is preparing medications for a client with diarrhea. The nurse will withhold bismuth subsalicylate if the client's record indicates a history of what disorder? lactose intolerance hypertension aspirin allergy type 2 diabetes

aspirin allergy Explanation: Bismuth subsalicylate has antisecretory and possibly anti-inflammatory effects because of its salicylate component. Clients with an allergy to aspirin and aspirin products should not take bismuth subsalicylate. Bismuth subsalicylate is not contraindicated for hypertension, type 2 diabetes, or lactose intolerance.