CH58: GI motility drugs

A client develops Clostridium difficile after receiving antibiotic therapy. The client asks the nurse how this occurs. Which is the nurse's best response? "By suppressing normal flora, antibiotics allow proliferation of the organism." "This is common of all antibiotic therapy and hospitalized clients." "The antibiotic decreases the white blood count, which allows for bacteria to invade the body." "The diarrhea is a result of overgrowth of viruses attacking the cells in the bowels."

"By suppressing normal flora, antibiotics allow proliferation of the organism." Antibiotic-associated colitis is a serious condition that results from oral or parenteral antibiotic therapy from any client. By suppressing normal flora in the colon, antibiotics allow proliferation of other bacteria, especially gram-positive anaerobic Clostridium difficile organisms. These organisms cause fever, abdominal pain, and severe diarrhea with stools containing mucus, pus, and sometimes blood. Symptoms may develop within a few days or several weeks after the causative antibiotic is discontinued. C-diff is not common in all antibiotic therapy and hospitalized clients. The antibiotic does not decrease the WBC but decreases the bacteria, allowing the WBC to attack the bacteria. The diarrhea is not a result of overgrowth of viruses.

A caregiver of a 1-year-old asks the nurse if they can give the diphenoxylate that was prescribed for an older sibling to the child. Which is the nurse's best response? "The medication needs to be adjusted for the 1-year-old's weight." "I will call the prescriber to find out if this is safe." "Children younger than 1 year of age should not be given this medication." "There are over-the-counter medications that are better for the 1-year-old."

"Children younger than 1 year of age should not be given this medication." Children younger than 2 years of age should not take this drug, and those from age 2 to less than 13 years should take the liquid preparation to enhance accuracy of the dosage. Calling the prescriber is not necessary. The nurse should not encourage over-the-counter medications for the child.

A caregiver of a 1-year-old asks the nurse if the caregiver can give the diphenoxylate that was prescribed for an older sibling to the child. Which is the nurse's best response? "I will call the prescriber to find out if this is safe." "The medication needs to be adjusted for the 1-year-old's weight." "Children younger than 2 years of age should not be given this medication." "There are over-the-counter medications that are better for the 1-year-old."

"Children younger than 2 years of age should not be given this medication." Children younger than 2 years of age should not take the drugs, and those from age 2 to less than 13 years should take the liquid preparation to enhance accuracy of the dosage. Calling the prescriber is not necessary. The nurse-should not encourage over-the-counter medications for the child.

A client is prescribed polyethylene glycol-electrolyte solution in preparation for a colonoscopy. The nurse would instruct the client to do which of the following? "Mix a packet in a glass of cold water." "Drink 8 ounces every 10 minutes." "Take one glassful of the liquid." "Take one to eight spoonfuls in a day."

"Drink 8 ounces every 10 minutes." Polyethylene glycol-electrolyte solution is dispensed as 4 L of solution, and the client is to take 240 mL (8 ounces) of the solution every 10 minutes until the solution is finished. Mixing a packet in a glass of cold water would be appropriate for psyllium.

A postoperative surgical client, prescribed twice-daily administration of docusate sodium, is concerned about developing diarrhea. What should the nurse teach the client about docusate sodium? "This medication will cause your bowels to contract more strongly than they normally do." "This drug will help you pass regular stools while you're in the hospital, but you should not take it for more than 5 days." "You'll usually have a bowel movement within 2 to 3 hours of taking this." "This medication will only soften your stools over the next couple of days."

"This medication will only soften your stools over the next couple of days." Surfactant laxatives (e.g., docusate calcium or docusate sodium) decrease the surface tension of the fecal mass to allow water to penetrate into the stool. They also act as a detergent to facilitate admixing of fat and water in the stool. As a result, stools are softer and easier to expel. These agents have little, if any, laxative effect. Their main value is to prevent straining while expelling stool. They usually act within 1 to 3 days and should be taken daily.

A client is receiving metoclopramide intravenously prior to cancer chemotherapy. The nurse would expect this drug to begin acting within which time frame? 15 to 30 minutes 1 to 5 minutes 5 to 15 minutes 30 to 45 minutes

1 to 5 minutes When given intravenously, metoclopramide has an onset of action of 1 to 5 minutes.

The nurse administers metoclopramide orally at 9:00 AM to a patient with GERD. The nurse would expect this drug to exert its maximum effectiveness at which time? 1:00 PM to 2:00 PM 11:00 AM to 11:30 AM 12 noon to 12:30 PM 10:00 AM to 10:30 AM

10:00 AM to 10:30 AM Metoclopramide, when administered orally, peaks in 60 to 90 minutes, which in this case would be between 10:00 AM to 10:30 AM.

The nurse is teaching the client how to treat diarrhea and discussing general guidelines. The nurse reminds the client to stop taking the antidiarrheal medication and to call the clinic if fever and abdominal pain become severe, after how many days? 4 1 3 2

2 Clients should consult a health care provider if diarrhea is accompanied by severe abdominal pain or fever, lasts longer than 2 days, or if stools contain blood or mucus.

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? 2 days 7 days 12 hours 1 day

2 days 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.

A client was prescribed a cathartic laxative prior to scheduled sigmoidoscopy. The nurse should inform the client that it will take how long to experience another bowel movement? 2 to 3 days up to 8 days 5 to 7 days 12 to 24 hours

2 to 3 days After taking a strong laxative or cathartic, it takes 2 to 3 days of normal eating to produce enough feces in the bowel for a bowel movement.

A nurse instructs a client taking an antidiarrheal agent to stop the drug and call the health care provider if the client does not experience relief within which time frame? 48 hours 36 hours 72 hours 24 hours

48 hours If the client experiences no response within 48 hours, the client should notify her health care provider to determine a possible underlying medical cause for the diarrhea.

The nurse is seeing a 69-year-old client who is highly physically active and consumes a balanced diet that includes adequate fluid intake. Despite this, the client states experiencing occasional constipation in recent months. What remedy should be the nurse's first suggestion? Bismuth subsalicylate A bulk-forming (fiber) laxative A hyperosmotic laxative A stimulant laxative

A bulk-forming (fiber) laxative Bulk-forming (fiber) laxatives are considered the safest and most physiologic of the laxatives. As such, they are normally preferable to stimulant and hyperosmotic laxatives for occasional relief of constipation. Bismuth subsalicylate does not relieve constipation.

A client's severe diarrhea has necessitated treatment with polycarbophil. The nurse should caution the client about the possibility of what adverse effect? Gastroesophageal reflux Nausea and vomiting Abdominal fullness and bloating Headache and visual disturbances

Abdominal fullness and bloating Polycarbophil may cause abdominal discomfort and bloating and may reduce the absorption of coadministered medications. It is not noted to cause nausea and vomiting, reflux, or headache.

The nurse is assessing a client who reports constipation. The use of a medication to treat this problem is contraindicated if the client reports what symptom? Frequent episodes of flatulence Lack of bowel movement for 5 days Lack of urge to defecate Abdominal pain and fever

Abdominal pain and fever Laxatives and cathartics are contraindicated in clients with abdominal pain. The presence of fever would also be a possible indication of infection.

The nurse is assessing a client who reports constipation. The use of a medication to treat this problem is contraindicated if the client reports what symptom? Lack of bowel movement for 5 days Frequent episodes of flatulence Abdominal pain and fever Lack of urge to defecate

Abdominal pain and fever Laxatives and cathartics are contraindicated in clients with abdominal pain. The presence of fever would also be a possible indication of infection.

Which would the nurse identify as being affected by dexpanthenol? Epinephrine Dopamine Acetylcholine Serotonin

Acetylcholine Dexpanthenol works by increasing acetylcholine levels and stimulating parasympathetic system. Metoclopramide works by blocking dopamine receptors. Dexpanthenol does not affect serotonin. Dexpanthenol does not affect epinephrine.

A nurse is caring for a patient with intestinal stenosis who has been prescribed psyllium. During the course of the treatment, the patient shows the signs of colon obstruction. What intervention should the nurse perform to avoid the occurrence of colon obstruction? Provide foods high in bulk or roughage. Give mineral oil to the patient after meals. Administer the drug with adequate fluid intake. Administer the drug after chilling it.

Administer the drug with adequate fluid intake. The nurse should administer the drug with adequate fluid intake to avoid obstruction of the esophagus, stomach, small intestine, and colon in a patient with intestinal stenosis. Mineral oil is given to the patient as a laxative on an empty stomach in the evening. The nurse should provide foods high in bulk or roughage to avoid constipation in a patient receiving laxatives. The nurse administers a laxative with an unpleasant or salty taste after chilling it to disguise its taste.

The patient has called the office to see if using bismuth subsalicylate will work to treat simple diarrhea. The nurse knows this will be a safe and effective treatment for diarrhea unless the patient has: Hypertension Hypothyroidism Allergy to aspirin Urinary retention

Allergy to aspirin

The nurse is caring for a female client diagnosed with chronic severe diarrhea-predominant irritable bowel syndrome that has not responded to conventional therapy. Which medication should the nurse anticipate being prescribed? Nitazoxanide Alosetron Rifaximin Cholestyramine

Alosetron Alosetron is a selective 5-HT3 receptor antagonist indicated for treating women with chronic severe-predominate irritable bowel syndrome that has not responded to conventional therapy. Rifaximin is a nonsystemic antibiotic that would not be prescribed for this client. Nitazoxanide is an antiprotozoal agent used for Giardia lamblia. Cholestyramine is a bile-binding drug and not the drug of choice for this client.

A client is diagnosed with traveler's diarrhea, and the health care provider prescribes rifaximin. The nurse describes this drug as: Antibiotic GI stimulant Antidiarrheal Opium derivative

Antibiotic Rifaximin is the first antibiotic approved by the Food and Drug Administration specifically for treating traveler's diarrhea, acting against noninvasive strains of Escherichia coli, which is the most common cause of traveler's diarrhea.

The nurse cautions a client with what allergy to avoid the use of bismuth salts in the treatment of diarrhea? Nuts Aspirin Penicillin Eggs

Aspirin

The nurse cautions a client with what allergy to avoid the use of bismuth salts in the treatment of diarrhea? Eggs Aspirin Penicillin Nuts

Aspirin Clients who are allergic to aspirin should not use bismuth salts.

What recommendations should be included in client teaching as a means of avoiding constipation? (Select all that apply.) Be active and exercise daily. Eat foods high in bulk or roughage. Take an opioid pain medication daily. Avoid defecating when the urge occurs. Drink plenty of fluids.

Be active and exercise daily. Eat foods high in bulk or roughage. Drink plenty of fluids.

Cholestyramine and colestipol are useful in treating diarrhea due to which cause? Retroviruses Gram-positive bacterial infection Bile salt accumulation Autoimmune processes

Bile salt accumulation Cholestyramine and colestipol are useful in treating diarrhea due to bile salt accumulation in conditions such as Crohn's disease or surgical excision of the ileum. They would not be used for treatment of diarrhea cause by bacterial infection, retrovirus, or autoimmune processes.

A health care provider prescribes a chemical stimulant laxative. Which would be appropriate? Bisacodyl Polycarbophil Docusate Lactulose

Bisacodyl Bisacodyl is a chemical stimulant laxative. Polycarbophil is a bulk laxative. Docusate is a lubricant laxative. Lactulose is an osmotic laxative.

A client experiencing diarrhea asks the nurse about over-the-counter (OTC) antidiarrheals. Which OTC should not be taken with aspirin? Loperamide Octreotide Polycarbophil Bismuth subsalicylate

Bismuth subsalicylate Bismuth subsalicylate is a commonly used OTC used for diarrhea. It has a salicylate, which is in the family of aspirin. A nurse should teach the client that use of the medication with aspirin can cause an overdose. Octreotide acetate is a synthetic form of somatostatin and is used for diarrhea as it decreases GI secretion and motility. Polycarbophil is a bulk-forming laxative. Loperamide is a synthetic derivative of meperidine that decreases GI motility by its effect on intestinal muscles.

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? Call the prescriber about the laboratory tests. Discuss the issues with another nurse on the unit. Administer the medication as prescribed. Hold the medication.

Call the prescriber about the laboratory tests. 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 caring for a client who has been prescribed a chemical stimulant laxative. This medication may have either a slow, steady effect or may cause severe cramping and rapid evacuation of the contents of the large intestine. What drug would the nurse be teaching this client about? Bismuth salts Bisacodyl Castor oil Cascara

Cascara Special considerations include that the drug may have a slow, steady effect or may cause severe cramping and rapid evacuation of the contents of the large intestine and the client should be advised of the possibilities and need to maintain ready access to bathroom facilities.

The nurse is conducting a pre-colonoscopy class and knows that polyethylene glycol- electrolyte solution will be contraindicated for the client with which condition? Chronic constipation Oral stomatitis Colitis Gastresophageal reflux disease

Colitis Polyethylene glycol-electrolyte solution is contraindicated in clients who have colitis.

Question 20 of 20 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)? Hyperthyroidism Impaired cardiac function Breathlessness and hypotension Constipation

Constipation 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 knows that there are many ways to decrease the risk of constipation. These include which of the following? Select all that apply. Consume food rich in fiber. Drink 64 to 80 ounces of fluids daily. Use a stimulant laxative every day. Partake in daily physical exercise. Set a routine time and place for daily bowel movement.

Consume food rich in fiber. Drink 64 to 80 ounces of fluids daily. Partake in daily physical exercise. Set a routine time and place for daily bowel movement. Stimulant laxatives such as bisacodyl (Dulcolax) should not be used frequently, because long-term use can impede normal bowel function and result in laxative dependence.

An older adult has regularly drunk mineral oil to treat occasional episodes of constipation. The nurse should encourage the client to explore other treatments because the use of oral mineral oil can result in which adverse effect? Decreased absorption of drugs and vitamins Paralytic ileus Rebound constipation Edema from changes in intestinal solute content

Decreased absorption of drugs and vitamins Oral use of mineral oil may cause potentially serious adverse effects, including decreased absorption of fat-soluble vitamins and some drugs and lipid pneumonia if aspirated into the lungs. Thus, mineral oil is not an oral laxative of choice in any condition. It is not noted to cause rebound constipation, paralytic ileus, or edema.

Diphenoxylate with atropine sulfate resolves diarrhea by what mechanism of action? Absorbing toxins Decreasing intestinal motility Binding with fecal material to increase bulk Inhibiting cellular division in causative bacteria

Decreasing intestinal motility Diphenoxylate with atropine sulfate resolves diarrhea by decreasing intestinal motility.

A community health nurse is conducting a health promotion session with a group from a local seniors' center. The nurse has addressed the issue of laxative overuse in this population. The nurse should highlight what consequence of the overuse of laxatives? Fecal incontinence Abdominal pain Dependence Impaired absorption of water-soluble vitamins

Dependence Overuse of laxatives results in dependence. This is a significant problem among older adults and is more common than fecal incontinence, impaired vitamin absorption, or abdominal pain.

The nurse should educate the client prescribed a stimulant cathartic to be alert for which common adverse effect? Diarrhea Vomiting Rectal bleeding Nausea

Diarrhea The stimulant cathartics are the strongest and most abused laxative products. These drugs act by irritating the GI mucosa and pulling water into the bowel lumen. As a result, feces are moved through the bowel too rapidly to allow colonic absorption of fecal water, so a watery stool is eliminated. Nausea, vomiting, and rectal bleeding should not routinely occur.

A nurse is caring for a client who has been diagnosed with constipation. The health care provider has ordered a laxative. What other interventions will the nurse include in the teaching plan? Select all that apply. Diet with fruits, vegetables, and whole grains Decrease stress Smoking cessation Regular aerobic exercise Increase fluid intake

Diet with fruits, vegetables, and whole grains Regular aerobic exercise Increase fluid intake Lifestyle management of a client diagnosed with constipation is to maintain normal bowel function. Interventions include a diet with more fruits, vegetables, and whole grains; increased exercise; and increased fluid intake. Decreasing stress and smoking cessation re not priorities in maintaining normal bowel function; however, they may help improve the client's overall health and should be encouraged when addressing the client's general health status.

The nurse is caring for a client with diarrhea who has been prescribed diphenoxylate with atropine and is observing the client for which adverse effects of this drug? Paleness of the face Polyuria Bradycardia Dizziness

Dizziness Adverse effect of diphenoxylate include tachycardia, urinary retention, flushing, headache, and dizziness as well as nausea and vomiting.

A client reports to the nurse about needing to strain to defecate. The client adds that defecating is very painful. What laxative will the nurse suggest to the prescriber based on the painful defecation? Sorbitol Fiber Psyllium Docusate

Docusate A laxative such as a stool softener like docusate sodium is recommended for clients who are straining or for whom defecation is painful. Sorbitol may be given with activated charcoal to remove toxic substances. Bulk-forming laxatives such as psyllium are used in clients who are debilitated, older, or unable or unwilling to eat an adequate diet. Fluids and fiber are indicated for all clients to encourage a healthy bowel regimen.

A patient who experiences frequent constipation asks the nurse for advice regarding which agent would be best for long-term daily use? The nurse will respond that the best for daily use is which of the following? Mineral oil Bisacodyl (Dulcolax) Docusate (Colace) Milk of magnesia

Docusate (Colace) Docusate, a surfactant that enhances entry of water into fecal material, is safest for daily use. Milk of magnesia, a saline cathartic, should not be used frequently, because it can lead to electrolyte imbalance. Bisacodyl, a stimulant laxative, also can cause electrolyte imbalance. Mineral oil, a lubricant, can interfere with intestinal absorption of fat-soluble vitamins and some orally administered drugs.

The home health nurse is visiting with a client who has been prescribed diphenoxylate with atropine (Lomotil) for chronic diarrhea. Which of the following adverse effects should the nurse be aware of when assessing the client's present condition? Select all that apply. Hypertension Dry mouth Tachypnea Bradycardia Lightheadedness

Dry mouth Lightheadedness Adverse effects include dry skin and mucous membranes, nausea, constipation and lightheadedness.

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

E. coli

What is first-line therapy for infants and children 1 to 4 years of age with diarrhea? Paregoric Difenoxin (Motofen) Bismuth salts (Pepto-Bismol) Electrolyte replacement

Electrolyte replacement Special precautions need to be taken to monitor for electrolyte and fluid disturbances and supportive measures taken as needed. Serious fluid volume deficits may rapidly develop in children with diarrhea. Appropriate fluid replacement should include oral rehydration solutions.

A nurse is completing an admission assessment of a client who is having diarrhea. The client states that the diarrhea started after "abdominal surgery." The client cannot recall the type of surgery. Which does the nurse suspect as the cause of the diarrhea? Skin infection of the surgical site Excision of the small intestine Surgical repair for colon polyps Liver resection

Excision of the small intestine Surgical excision of portions of the intestine, especially the small intestine, can decrease the absorptive area and increase fluidity of stools. Skin infections, surgical repair of colon polyps and liver resection do not cause diarrhea.

An older adult client has received a third dose of diphenoxylate. In addition to monitoring the number and consistency of the client's stools, the nurse should prioritize what assessment? Nutritional status Fluid and electrolyte balance Neurological status Oxygen saturation

Fluid and electrolyte balance After drug administration, the nurse monitors the number and consistency of stools and fluid and electrolyte balance. The client's fluid and electrolyte balance are more vulnerable during prolonged diarrhea than is neurologic, nutritional, or respiratory status.

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? Functional diarrhea disorder Intestinal neoplasm Colitis Hyperthyroidism

Functional diarrhea disorder 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.

An infant is brought to the pediatric clinic. The mother tells the nurse the child is constipated and she doesn't know what to do. What would the nurse tell the mother is the safest and most effective way to treat constipation in children prior to bowel training? Glycerin suppositories Sorbitol Dulcolax suppositories Milk of magnesia

Glycerin suppositories For acute constipation, glycerin suppositories are often effective in infants and small children.

What nonpharmacologic intervention is included in the plan of care for an adult client experiencing diarrhea? Select all that apply. Add weight training exercises Increase fluids intake to 2-3 liters per day. Diet of bland foods such as rice, soup, and applesauce Increase intake of protein Exercise 30 minutes per day

Increase fluids intake to 2-3 liters per day. Diet of bland foods such as rice, soup, and applesauce In most cases of acute, nonspecific diarrhea in adults, fluid losses are not severe, and clients need only simple replacement of fluids and electrolytes to replace those lost in the stool. Acceptable replacement fluids during the first 24 hours include 2 to 3 liters of clear fluids. Also, a diet consisting of bland foods such as rice, soup, salted crackers, cooked cereals, baked potatoes, eggs, and applesauce is best. Increasing the intake of protein is not warranted. Clients should be careful exercising and should not add weight training while experiencing diarrhea.

A group of students are reviewing the actions of laxatives on the GI tract. The students demonstrate understanding when they state what about bulk stimulants? Selectively antagonize opioid binding Increase the fluid in the intestinal contents Allow formation of a slippery coat on the intestinal contents Directly stimulate the nerve plexus in the intestinal wall

Increase the fluid in the intestinal contents Bulk laxatives increase the fluid in the intestinal contents, which enlarges bulk and stimulates local stretch receptor and activates local activity. Chemical stimulant laxatives directly stimulate the nerve plexus in the intestinal wall. Mineral oil, a lubricant, forms a slippery coat on the contents of the intestinal tract. Methylnaltrexone acts as a selective antagonist to opioid binding at the mu receptor.

In pharmacology class the students are learning about the mechanism of action of different laxatives. What would the students learn about the mechanism of action of psyllium hydrophilic mucilloid? Creating a barrier between the colon wall and feces Irritation of the intestinal mucosa Reducing the surface tension of bowel contents Increasing mass and water content of stool

Increasing mass and water content of stool When water is added, the laxative substance swells and becomes gel-like. The added bulk or size of the fecal mass stimulates peristalsis and defecation. The other options are not the mechanism of action of psyllium.

A nurse is completing an assessment on a client experiencing diarrhea. The client states having diarrhea for the past few days, but prior to the diarrhea experienced one week of constipation. Based on the description, what does the nurse suspect? Laxative abuse Irritable bowel syndrome Peripheral vascular disease Ulcerative colitis

Irritable bowel syndrome Irritable bowel syndrome is a functional disorder of intestinal motility with no evidence of inflammation or tissue changes. It can include a change in bowel pattern (constipation, diarrhea, or a combination of both) accompanied by abdominal pain, bloating, and distention or presenting symptoms. Ulcerative colitis is diarrhea with mucus, proteins, and blood. Peripheral vascular disease is pain in the lower extremities. Laxative abuse is characterized by use of laxative, which is not stated by the client.

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 reduces exchange of proteins and mucus in the stools. It absorbs toxins and water, decreasing fluidity of stools. It binds and expels toxins into the stool.

It absorbs toxins and water, decreasing fluidity of stools. 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.

Why is loperamide generally associated with fewer adverse effects than diphenoxylate? It does not affect the central nervous system. It is metabolized by the kidneys rather than the liver. It has a slower onset, later peak, and longer half-life. It is organically derived.

It does not affect the central nervous system. Because loperamide does not penetrate the central nervous system (CNS) well, it does not cause the CNS effects associated with opioids like diphenoxylate. Differences between the adverse effects of these two drugs are not attributable to pharmacokinetics or organic origin.

A client is using psyllium hydrophilic mucilloid to promote evacuation of stool. What is the action of this medication? It reduces the surface tension of bowel contents. It creates a barrier between the colon wall and feces. It irritates the intestinal mucosa, thus increasing intestinal motility. It increases mass and water content of stool, promoting evacuation.

It increases mass and water content of stool, promoting evacuation. Bulk-forming laxatives increase mass and water content of the stool, promoting evacuation. Bulk-forming laxatives do not reduce surface tension of bowel contents. Bulk-forming laxatives do not irritate the intestinal mucosa to increase intestinal motility. Bulk-forming laxatives do not create a barrier between the colon wall and feces.

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

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

What is the correct rationale for why the nurse would administer a laxative at a separate time from the client's other medications? Often laxatives make the client nauseated, which interferes with the ability to take medications. Because a laxative may stimulate a bowel movement, it can interfere with medication administration. They often taste bad and clients are less likely to take other medications. Laxatives may reduce absorption of other drugs present in the GI tract.

Laxatives may reduce absorption of other drugs present in the GI tract. Laxatives may reduce absorption of other drugs present in the GI tract by combining with them chemically, or hastening their passage through the intestinal tract. Nausea, taste, and onset of action have no bearing on administration of laxatives.

A patient is diagnosed with irritable bowel syndrome with constipation as the primary report. Which agent would the nurse expect the health care provider to prescribe? Alosetron Lubiprostone Methylnaltrexone Hyoscyamine

Lubiprostone Lubiprostone is indicated for the treatment of irritable bowel syndrome when constipation is the chief report. Alosetron is indicated for the treatment of irritable bowel syndrome when diarrhea is the chief issue. Hyoscyamine is indicated as adjunct treatment for irritable bowel syndrome. Methylnaltrexone is indicated for the treatment of opioid-induced constipation.

The nurse is teaching a client about loperamide, which the health care provider has prescribed for treatment of chronic diarrhea. Which adverse effects should the nurse be sure to mention? Tremors Disorientation Nausea Flatulence

Nausea Adverse effects of loperamide are few and generally mild, but they include nausea, abdominal pain, constipation, drowsiness, sedation, and vomiting.

The nurse is preparing to administer cascara to a client. The nurse anticipates administering this drug by which route? Intramuscular Rectal, via suppository Rectal, via enema Oral

Oral Cascara is administered orally. Senna may be administered orally or as a rectal suppository. Bisacodyl is given orally or rectally. No laxative is given intramuscularly.

An adult resident of an assisted living facility has not responded appreciably to bulk-forming laxatives, so the primary care provider has prescribed bisacodyl. The nurse who oversees the care at the facility should know that this drug may be administered by what route? Select all that apply. Intramuscular injection Intravenous Oral Subcutaneous injection Suppository

Oral Suppository Bisacodyl can be administered orally or by suppository. Parenteral administration is not possible.

After teaching a group of students about laxatives, the instructor determines that the teaching has been successful when the students identify which agent as an example of a bulk laxative? Bisacodyl Senna Docusate Polycarbophil

Polycarbophil Polycarbophil is an example of a bulk laxative. Bisacodyl and senna are examples of chemical stimulant laxatives. Docusate is an example of a lubricant laxative.

A client is scheduled for a colonoscopy in the morning. What laxative would the nurse expect to be prescribed the evening before the procedure? Psyllium Polyethylene glycol-electrolyte solution Lactulose Castor oil

Polyethylene glycol-electrolyte solution Saline or stimulant cathartics are acceptable as used for occasional bowel preparations for endoscopic or radiologic examinations.

A client is scheduled for a colonoscopy. The nurse knows that the preferred drug for bowel cleansing before this procedure is: Psyllium (Metamucil) Polyethylene glycol-electrolyte solution (NuLYTELY) Polyethylene glycol solution (MiraLAX) Bisacodyl (Dulcolax)

Polyethylene glycol-electrolyte solution (NuLYTELY) Polyethylene glycol-electrolyte solution taken orally will rapidly provoke extensive diarrhea with complete emptying of the lower intestine. Polyethylene glycol solution, bisacodyl, and psyllium work much more slowly and are useful in managing constipation.

The nurse is caring for a client who will need to use a medication to assist in the prevention of constipation for an extended period of time. The nurse is aware that which drug is the most desirable for long-term use? Bisacodyl Lactulose Psyllium Polyethylene glycol-electrolyte solution

Psyllium Psyllium is the best medication for long-term use in the treatment of constipation.

Psyllium (Metamucil) is a bulk-forming laxative available over-the-counter and frequently used. The nurse knows that which of these statements regarding use of psyllium is correct? Laxatives are the preferred method for bowel management in older adults. Psyllium is useful in critically ill patients who experience constipation. Home care nurses should not become involved in their patients' bowel management. Psyllium can be used freely in children.

Psyllium is useful in critically ill patients who experience constipation. Psyllium should be administered to children only under health care provider supervision. In older adults, dietary fiber, adequate fluid consumption, and exercise are the preferred method for bowel management. Critically ill patients often experience constipation from decreased physical activity and, at times, administration of opioid analgesics. Home care nurses should determine patients' risk for constipation and assist in bowel management.

The nurse should know that lactulose achieves a therapeutic effect by which means? Irritating the intestinal mucous membrane Decreasing the viscosity of intestinal contents in the duodenum Pulling water into the intestinal lumen by osmotic pressure Relaxing the muscle tone of the ileocecal valve and anal sphincter

Pulling water into the intestinal lumen by osmotic pressure Lactulose is a disaccharide that is not absorbed from the GI tract. It exerts laxative effects by pulling water into the intestinal lumen. It does not change muscle tone, change the viscosity of bowel contents, or irritate the intestinal epithelium.

Which is an important assessment for the nurse to make before administering a laxative? Question the client regarding the type and intensity of symptoms to provide a baseline evaluation. It is imperative to ask clients whether they are expecting any visitors because the effects of the medication may hinder visitation. Once a medication is ordered by the health care provider, it is unnecessary to make any additional assessments before administering the medication. An abdominal circumference measurement is an important assessment for the nurse to make in order to evaluate medication effectiveness.

Question the client regarding the type and intensity of symptoms to provide a baseline evaluation. It is important to assess the client before giving any medication. Important assessments include a review of the client's chart for the course of treatment, and discovering the reason for administration of the prescribed drug. Question the client regarding the type and intensity of symptoms (e.g., pain, discomfort, diarrhea, or constipation) to provide a baseline for evaluation of the effectiveness of drug therapy. Listen first to bowel sounds and then palpate the abdomen, monitoring the client for signs of guarding or discomfort. An abdominal circumference measurement and the presence of visitors are not critical assessments prior to administration of the medication.

After reviewing information about metoclopramide, the students demonstrate a need for additional teaching when they identify that the drug can be given by which route? Oral Rectal Intramuscular Intravenous

Rectal Metoclopramide can be given orally, intramuscularly, or intravenously but not rectally.

A client who is homeless is admitted with dehydration and diarrhea. The admission interview indicates that the client regularly collects food from dumpsters behind restaurants. What pathogens could be causing diarrhea? Select all that apply. Staphylococcus aureus Salmonella Listeria monocytogenes Shigella Clostridium difficile

Salmonella Listeria monocytogenes Shigella Staph aureus

After describing the drugs used to treat irritable bowel syndrome, the students demonstrate understanding of the information when they identify alosetron as which of the following? Chloride channel activator Serotonin antagonist Selective opioid antagonist Anticholinergic

Serotonin antagonist Alosetron is classified as a serotonin 5-HT antagonist. Hyoscyamine is an anticholinergic agent that may be used to treat irritable bowel syndrome. Lubiprostone is a locally acting chloride channel activator used for treatment of chronic, idiopathic constipation and for treatment of irritable bowel syndrome with constipation in women. Methylnaltrexone is a selective antagonist to opioid binding at the mu-receptors.

The client has been prescribed diphenoxylate with atropine (Lomotil) for diarrhea. The nurse recognizes that this drug is effective against diarrhea because of which action? Antimicrobial effects Anti-inflammatory effects allowing absorption of fluids Slows peristalsis by acting on the smooth muscles of the intestine Decreases GI secretions

Slows peristalsis by acting on the smooth muscles of the intestine Diphenoxylate with atropine is chemically related to opioid drugs; therefore, they decrease intestinal peristalsis, which often is increased when the client has diarrhea.

A nurse is preparing a presentation for a local woman's group about irritable bowel syndrome. Which of the following would the nurse include in the presentation? Select all that apply. Stress may play a role in the cause of this disorder. An underlying anatomical cause has not been identified. It is a relatively rare disorder. Abdominal distress and bouts of diarrhea or constipation are common. It usually affects men 3 to 4 times more often than women.

Stress may play a role in the cause of this disorder. An underlying anatomical cause has not been identified. Abdominal distress and bouts of diarrhea or constipation are common. The underlying cause of the disorder may be related to stress. The disorder is characterized by abdominal distress, bouts of diarrhea or constipation, bloating, nausea, flatulence, fatigue, depression, and anxiety. No anatomical cause has been found for this disorder. Irritable bowel syndrome is a very common disorder. Irritable bowel syndrome typically occurs more commonly in women, affecting women 3 times as often as men.

A client who is taking magnesium citrate experiences sweating, palpitations, and flushing. The nurse understands that this is most likely related to which of the following? Sympathetic stress reaction due to intense GI tract neurostimulation Direct stimulation of the nerve plexus in the abdominal wall Formation of a slippery coat on the contents of the intestinal tract Detergent action on the surface of the intestinal bolus

Sympathetic stress reaction due to intense GI tract neurostimulation The client's symptoms are most likely related to a sympathetic stress reaction due to intense neurostimulation of the GI tract or to the loss of fluid and electrolyte imbalance. Direct stimulation refers to the action of chemical stimulant laxatives. Detergent action is related to the use of docusate. Formation of a slippery coat relates to the use of mineral oil.

A client has been admitted to the hospital with dehydration and hypokalemia secondary to severe diarrhea. Why might the care team be reluctant to aggressively treat a client's diarrhea by slowing gastrointestinal (GI) peristalsis? A rapid cessation of diarrhea can exacerbate electrolyte imbalances. The client's body may be ridding itself of toxins. Rebound bowel obstruction is likely to occur. The client may become fluid overloaded.

The client's body may be ridding itself of toxins. Episodes of acute diarrhea may be defensive mechanisms by which the body tries to rid itself of irritants, toxins, and infectious agents. Consequently, health care providers must be judicious when determining how best to treat diarrhea. Obstruction and fluid overload are unlikely to occur during responsible care, and cessation of diarrhea won't exacerbate imbalances.

An adult client has presented to the emergency department (ED) after 36 hours of severe diarrhea that shows no sign of abating. The ED nurse should be aware that the use of diphenoxylate would be contraindicated in which circumstance? The client has an allergy to aspirin. The client has a documented history of laxative abuse. The client's diarrhea is caused by the ingestion of toxins. The client's diarrhea is attributable to psychosocial stress.

The client's diarrhea is caused by the ingestion of toxins. Contraindications to the use of diphenoxylate with atropine include diarrhea caused by toxic materials, microorganisms that penetrate intestinal mucosa (e.g., pathogenic E. coli, Salmonella, Shigella), and antibiotic-associated colitis. Laxative abuse, allergies to aspirin, and the presence of stress do not contraindicate the safe use of diphenoxylate.

A man with irritable bowel syndrome reports ongoing diarrhea and asks for a prescription for alosetron, which was helpful for his coworker who recently started taking the drug. What is the nurse's best response? This drug is used as a laxative. This drug is only approved for use in women. This drug is no longer on the market. This drug is contraindicated with irritable bowel syndrome.

This drug is only approved for use in women. Alosetron is approved for use in women with irritable bowel syndrome with diarrhea being the predominant concern and should be discontinued immediately if the client develops constipation or symptoms of ischemic colitis. Clients must read and sign a client-provider agreement before it can be prescribed. The drug is not a laxative.

An adult client asks the nurse how many stools per week is considered "normal." The nurse should indicate that there is no fixed number but that functional constipation is diagnosed at what frequency? Six stools per week Three stools per week Four stools per week Five stools per week

Three stools per week Due to variations in diet and other factors, there is no "normal" number of stools, but the traditional medical definition of constipation includes three or fewer bowel movements per week.

A client is taking psyllium hydrophilic mucilloid daily. What information should be included in the discharge plan? Mix the medication with food at the evening meal. Discontinue the mucilloid if you do not have a bowel movement daily. Up to 30 g of fluid with the medication can be divided over several divided doses daily. Take your other medications with the mucilloid.

Up to 30 g of fluid with the medication can be divided over several divided doses daily. The daily dose of up to 30 g can be divided over several doses. The client should not mix the medication with food or other medications. The mucilloid should not be discontinued if the client does not have a bowel movement.

A middle-aged client, frustrated by increasingly frequent episodes of constipation, is highly reluctant to take medications. What nonpharmacologic measure should the nurse recommend? Use of a ginger or ginseng supplement Daily consumption of 6 to 8 L of fluids Adoption of a low-fat diet Use of a fiber supplement

Use of a fiber supplement There is some evidence that fiber supplements improve the frequency and consistency of stools. No effectiveness data support increasing fluids beyond normal intake. Low fat intake, ginger, and ginseng are not noted to benefit clients with constipation.

The nurse is aware that critically ill clients are more at risk for constipation for what reasons? (Select all that apply.) Increased access to a high-fiber diet Use of opioid medications Decreased activity Change in bowel routines Decrease in the amount of family interaction

Use of opioid medications Decreased activity Change in bowel routines Critically ill clients are more at risk for constipation because of decreased activity, decreased access to a high-fiber diet, the use of opioid medications, and changes in usual bowel routines.

Rifaximin has been prescribed for a client diagnosed with traveler's diarrhea. What information should the nurse include in the teaching plan about the medication? Superinfections will not occur with this medication Adverse effects include migraine, joint pain, and nausea The diarrhea is usually associated with fever and bloody stools Used for E. coli infections

Used for E. coli infections Rifaximin is a structural analog of rifampin. Researchers developed is specifically to treat travelers' diarrhea due to noninvasive E. coli in clients older than 12 years of age. Use for diarrhea in the presence of fever or bloody stools is not warranted. Superinfection may occur, requiring termination of rifaximin. Adverse effects include flatulence, headache, stomach pain, urgent bowel movements, nausea, constipation, fever, vomiting, and dizziness.

In what client circumstance would the use of a bulk-forming laxative be contraindicated? acute abdominal pain inability to ambulate independently a history of hemorrhoids currently prescribed vitamin B supplements

acute abdominal pain Laxatives and cathartics should not be used in the presence of undiagnosed abdominal pain or other signs of intestinal obstruction because of the risks of perforation and peritonitis. Vitamin supplements, hemorrhoids, and decreased mobility do not necessarily contraindicate the use of laxatives.

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

bacterial toxin virus 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 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? anal fissures diverticulosis blood dyscrasias bowel obstruction

bowel obstruction 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 parent of an adolescent client reports that the teen has chronic diarrhea and lacks an appetite. Assessment reveals that the client is significantly underweight, has dry hair, and exhibits erosion of tooth enamel. When asked, the client reports occasional laxative use for "constipation." What condition does the nurse consider most likely? bulimia with laxative abuse anorexia nervosa dehydration and hyperkalemia sodium retention

bulimia with laxative abuse Enamel erosion is a hallmark of bulimia. The report of "occasional" laxative use plus the report of chronic diarrhea raises the strong potential for laxative abuse. None of the other options would account for the tooth enamel erosion.

What form of laxative would likely be prescribed to manage long-term constipation? lubricant laxative plus increased water intake bulk-forming laxative plus increased water intake saline laxative plus increased water intake stimulant cathartic plus increased water intake

bulk-forming laxative plus increased water intake Bulk-forming laxatives add mass to the feces, stimulating peristalsis and defecation. They must be taken with water to avoid obstruction. Generally, bulk-forming drugs are the most desirable laxative for long-term use.

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? photosensitivity dark stool hyperglycemia hypertension

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

A nurse is teaching a group of older adults about nonpharmacologic strategies for preventing constipation. The nurse should recommend what practices? Select all that apply. drinking 6 to 10 glasses of fluid each day reserving at least 8 hours nightly to assure adequate sleep consuming a high-fiber diet engaging in frequent physical exercise introducing organic foods into the daily diet

drinking 6 to 10 glasses of fluid each day consuming a high-fiber diet engaging in frequent physical exercise Nonpharmacologic measures for preventing constipation include increased fiber intake, exercise, and adequate fluids. Organic foods do not have any particular benefit in the prevention of constipation. Adequate sleep has multiple benefits, but reduced constipation is not among these.

The nurse working at a long-term care facility frequently screens residents for risk factors for constipation. What common risk factor does the nurse look for? diabetes mellitus impaired mobility active infection hypertension managed by a beta-adrenergic blocker

impaired mobility Several risk factors are associated with the development of constipation, including diet and lifestyle, particularly decreased levels of physical activity. Diabetes, infection, and the use of beta-blockers are not risk factors for this problem.

A 2-year-old child from Nigeria is reported to have excellent health, except for the diarrhea that started within days of the family's arrival in the United States 3 weeks ago. History reveals nothing remarkable, but the mother comments on her child's love of (and continual consumption of) ice cream, something not available in their native country. This history supports what possible cause of the child's diarrhea? irritable bowel syndrome lactase deficiency Clostridium difficile inflammatory bowel disorder

lactase deficiency Deficiency of lactase, which breaks down lactose to simple sugars (i.e., glucose and galactose) that can be absorbed by the gastrointestinal (GI) mucosa, inhibits digestion of milk and milk products. Lactase deficiency commonly occurs among people of African and Asian descent.

The health care provider has prescribed polycarbophil to a client for the treatment of diarrhea. The nurse should teach the client to expect what effect? a cessation of diarrhea and no bowel movements for 2 to 3 days small but firm, formed stools a transition to rectal oozing over the next 12 to 24 hours large stools of a gelatin-like consistency

large stools of a gelatin-like consistency Polycarbophil absorbs large amounts of water and produces stools of gelatin-like consistency. None of the other options are accurate when discussing polycarbophil.

The nurse cautions a woman who is breastfeeding about avoiding the use of magnesium laxatives based on the understanding that the: newborn may experience diarrhea. newborn may experience intestinal rupture. laxative can alter the newborn's electrolyte levels. drug could cause a hypersensitivity reaction in the newborn.

newborn may experience diarrhea. Magnesium laxatives can cause diarrhea in the newborn if the mother uses it when breastfeeding.

A client needing to evacuate the colon for endoscopy would likely be prescribed which medication solution? psyllium methylcellulose polyethylene glycol electrolyte mineral oil

polyethylene glycol electrolyte A client needing to evacuate the colon for endoscopy would likely take polyethylene glycol electrolyte solution as it is a bowel evacuant. Methylcellulose and psyllium are bulk-forming laxatives and will not evacuate the bowel for endoscopy. Mineral oil is an emollient that lubricates the intestinal walls and softens the stool, thereby enhancing passage of fecal material.

A client has just received the initial administration of prescribed diphenoxylate with atropine. The nurse should plan to assess the client for what adverse reactions? Select all that apply. urinary retention dizziness pruritus dyspnea tachycardia

urinary retention dizziness tachycardia Adverse effects of diphenoxylate with atropine include tachycardia, dizziness, headache, flushing, nausea and vomiting, dry skin and mucous membranes, and urinary retention. This drug is not associated with pruritus or dyspnea.