NUR 316- Prep u GI motility
The nurse may advise a patient to take what after a myocardial infarction to prevent straining during defecation? Docusate (Colace) Psyllium (Metamucil) Lubiprostone (Amitiza) Lactulose (Cephulac)
Docusate (Colace) Explanation: The nurse may advise a patient to get docusate (Colace) after a myocardial infarction to prevent straining during defecation.
An older patient is experiencing diarrhea. Which is a likely cause of diarrhea? Diabetes Antihypertensive agents Laxative abuse Glaucoma
Laxative abuse Explanation: Laxative abuse is associated with diarrhea. Diabetes, antihypertensive agents, and glaucoma are not associated with diarrhea.
While discussing the use of laxatives a student, asks the nursing instructor what the best indication of normal bowel elimination is. What would be the best response by the instructor? "One bowel movement daily in the morning." "One bowel movement daily after dinner." "A soft, formed stool." "A semi-formed stool."
"A soft, formed stool." Explanation: Normal bowel elimination should produce a soft, formed stool without pain.
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? "Take one glassful of the liquid." "Mix a packet in a glass of cold water." "Take one to eight spoonfuls in a day." "Drink 8 ounces every 10 minutes."
"Drink 8 ounces every 10 minutes." Explanation: 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.
The nurse has just finished client education with someone who is going home on bulk-forming laxatives. What statement by the client would lead the nurse to believe that the client has understood how to use the medication? "I will mix the medication with 4 to 8 ounces of liquid and follow it by an additional 4 to 8 ounces." "I will mix the dry medication with applesauce." "I will use milk of magnesia in conjunction with this medication until I am having daily bowel movements." "I will decrease the roughage in my diet while I am using this medication."
"I will mix the medication with 4 to 8 ounces of liquid and follow it by an additional 4 to 8 ounces." Explanation: Bulk-forming laxatives need to be taken with at least 8 oz of water or other liquid. The other options are incorrect statements and would indicate further need for teaching.
The nurse is about to administer a laxative to a client for the first time. What should be included in client education? "Laxatives may cause diarrhea, abdominal discomfort, nausea, vomiting, perianal irritation, and flatulence." "It is good to take this medication daily. It is safe and non-habit forming." "It is important to avoid a large intake of fluids when taking this medication." "If you are allergic to red dye number 5, you may have an allergic reaction to this medication."
"Laxatives may cause diarrhea, abdominal discomfort, nausea, vomiting, perianal irritation, and flatulence." Explanation: Laxatives may cause diarrhea, abdominal discomfort, nausea, vomiting, perianal irritation, and flatulence, as well as a number of other side effects. Prolonged use of a laxative can result in a "laxative habit," or dependence on a laxative to have a bowel movement. Some laxatives contain tartrazine (a yellow food dye), which may cause allergic-type reactions (including bronchial asthma) in susceptible individuals. Obstruction of the esophagus, stomach, small intestine, and colon has occurred when bulk-forming laxatives are administered without adequate fluid intake, or in clients with intestinal stenosis.
The nurse is teaching the patient how to treat diarrhea and discussing general guidelines. The nurse reminds the patient to stop taking the antidiarrheal medication and to call the clinic if (1) the medicine does not appear to be working, and/or (2) if fever and abdominal pain become severe, after how many days? 2 1 3 4
2 Explanation: Patients 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 patient to discontinue use of over-the-counter antidiarrheals and seek treatment from a physician if diarrhea persists for how long? 2 days 1 day 12 hours 7 days
2 days Explanation: The nurse should counsel a patient to discontinue use of over-the-counter antidiarrheals and seek treatment from a physician if diarrhea persists for more than 2 days.
Recovering from laxative abuse takes time and patience. After using laxatives to stimulate defecation, approximately how long will it take for the fecal column to re-establish with normal food intake? 2 to 3 days 1 to 2 days 3 to 4 days 1 week
2 to 3 days Explanation: After the colon empties with defecation, it takes 2 to 3 days with normal food intake for the fecal column to re-establish.
The nurse understands that the drug docusate sodium (Colace) would be most appropriate for what client? A 46-year-old client who has not had a bowel movement in 4 days A 74-year-old client who takes bisacodyl daily at home A 66-year-old client who is recovering from a heart attack A 52-year-old client who is preparing for a colonoscopy
A 66-year-old client who is recovering from a heart attack Explanation: Docusate sodium is a stool softener that decreases the surface tension of the fecal mass to allow water to penetrate into the stool. Stools are softer and easier to pass. Its main value is to prevent straining at the stool. This makes the drug most appropriate for the client who has had a heart attack who should avoid straining at the stool.
Mr. Tan is a 69-year-old man who prides himself in maintaining an active lifestyle and a healthy diet that includes adequate fluid intake. However, Mr. Tan states that he has experienced occasional constipation in recent months. What remedy should be the nurse's first suggestion? Bismuth subsalicylate A bulk-forming (fiber) laxative A stimulant laxative A hyperosmotic laxative
A bulk-forming (fiber) laxative Explanation: 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.
Which method is used to discourage the patient from taking an excessive dosage of diphenoxylate HCl? A small amount of atropine sulfate is combined with diphenoxylate HCl. The drug is not available over the counter. The patient is advised to strictly adhere to the prescriber's instructions. The taste of the drug is unpleasant.
A small amount of atropine sulfate is combined with diphenoxylate HCl. Explanation: A small amount of atropine sulfate is combined with diphenoxylate HCl to discourage the patient from taking an excessive dosage of diphenoxylate HCl. Atropine sulfate causes dry mouth and tachycardia, which are quite unpleasant. Advising the patient to strictly adhere to the prescriber's instructions is not always an effective deterrent. The taste and limited availability of the drug do not act as deterrents either.
A patient is being sent home with orders for a laxative PRN. The nurse is conducting patient teaching on the use of a laxative. What will the nurse inform the patient is one of the most common adverse effects of a laxative? Abdominal cramping Dizziness Headache Weakness
Abdominal cramping Explanation: Common adverse effects of laxatives are diarrhea, abdominal cramping, and nausea. CNS effects such as dizziness, headache, and weakness can occur. However, these adverse effects usually relate to the loss of fluid and electrolyte imbalance associated with laxative use and are not the most common adverse effects.
The nurse is preparing a teaching plan for a patient who is using mineral oil. Which would the nurse include as a possible adverse effect? (Select all that apply.) Abdominal cramping Leakage of stool Dizziness Weakness Chills Decreased heart rate
Abdominal cramping Leakage of stool Dizziness Weakness Explanation: Abdominal cramping is associated with mineral oil use. Leakage of stool and staining occur with mineral oil use due to the inability of the stool to be retained by the external sphincter. Dizziness can occur with mineral oil use. Weakness is associated with mineral oil use. Sweating and flushing are seen with mineral oil use. Decreased heart rate is associated with the use of metoclopramide.
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 urge to defecate Abdominal pain and fever Lack of bowel movement for 5 days Frequent episodes of flatulence
Abdominal pain and fever Explanation: 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? Acetylcholine Dopamine Serotonin Epinephrine
Acetylcholine Explanation: 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 should screen a client for signs of which of the following medical conditions as the use of laxatives in these clients is contraindicated? Select all that apply: Chronic hepatitis Type 1 diabetes Acute appendicitis Intestinal obstruction Fecal impaction
Acute appendicitis Intestinal obstruction Fecal impaction Explanation: Laxatives are contraindicated in clients with known hypersensitivity and those with persistent abdominal pain, nausea, vomiting, or unknown cause or signs of acute appendicitis, fecal impaction, intestinal obstruction, or acute hepatitis.
An instructor is preparing a teaching plan for a group of students about the usual indications for laxatives. Which would the instructor include as an indication? Adjunct in anthelmintic therapy Long-term relief of constipation Improved overall activity of the GI tract Promotion of bearing down efforts for bowel evacuation
Adjunct in anthelmintic therapy Explanation: Laxatives are used as an adjunct in anthelmintic therapy when it is desirable to flush helminthes from the GI tract. Laxatives are indicated for the short-term relief of constipation. GI stimulants, not laxatives, are indicated to promote an overall increase in activity of the GI tract. Laxatives are used to prevent straining/bearing down during bowel evacuation when it is clinically undesirable.
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? Administer the drug with adequate fluid intake. Give mineral oil to the patient after meals. Administer the drug after chilling it. Provide foods high in bulk or roughage.
Administer the drug with adequate fluid intake. Explanation: 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.
A woman is seen in the primary care provider's office with chronic severe diarrhea-predominant irritable bowel syndrome, which has not responded to conventional therapy. Which medication is the drug of choice? Rifaximin (Xifaxan) Nitazoxanide (Alinia) Alosetron (Lotronex) Cholestyramine (Questran)
Alosetron (Lotronex) Explanation: Alosetron (Lotronex) 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 (Xifaxan) is a nonsystemic antibiotic that would not be prescribed for this patient. Nitazoxanide (Alinia) is an antiprotozoal agent used for Giardia lamblia. Cholestyramine (Questran) is not the drug of choice for this patient.
Diphenoxylate with atropine sulfate resolves diarrhea by what mechanism of action? Decreasing intestinal motility Absorbing toxins Binding with fecal material to increase bulk Inhibiting cellular division in causative bacteria
Decreasing intestinal motility Explanation: Diphenoxylate with atropine sulfate resolves diarrhea by decreasing intestinal motility.
A client is diagnosed with traveler's diarrhea, and the health care provider prescribes rifaximin. The nurse describes this drug as: Antidiarrheal GI stimulant Antibiotic Opium derivative
Antibiotic Explanation: 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.
A client is taking bisacodyl to treat constipation. The nurse suggests that the client take the drug at which time? In the morning before breakfast After eating lunch At any time during the day Before going to bed
Before going to bed Explanation: Although bisacodyl can be taken at any time, the drug has an onset of action of 6 to 8 hours, making it preferable for the drug to work overnight and seeing the effects in the morning.
A nurse is caring for a client with cancer regularly administered opioids. The client tells you she needs a laxative. What would be the best laxative? Docusate sodium Inulin Bisacodyl Mineral oil
Bisacodyl Explanation: Stimulant laxatives (eg, a senna preparation, bisacodyl) increase intestinal motility, which is the action that opiates suppress. These drugs may cause abdominal cramping, which may be lessened by giving small doses three or four times daily. The other options do not stimulate intestinal function.
Which of the following would the nurse expect to administer to a client with traveler's diarrhea? Metoclopramide Loperamide Bismuth subsalicylate Opium derivative
Bismuth subsalicylate Explanation: Bismuth subsalicylate is indicated for the treatment of traveler's diarrhea and in preventing cramping and distention associated with dietary excess and some viral infections. Loperamide is indicated for the short-term treatment of diarrhea associated with dietary problems and some viral infections. Opium derivatives are indicated for the short-term treatment of cramping and diarrhea.
A 36-year-old pregnant woman is visiting the OB office for her monthly prenatal visit. She is at 36 weeks' gestation. She reports continual constipation, which is causing major discomfort with her hemorrhoids. Which substance would the nurse expect the obstetrician to recommend to relieve her constipation? Bulk-forming laxative plus increased water intake Saline laxative plus increased water intake Stimulant cathartic plus increased water intake Lubricant laxative plus increased water intake
Bulk-forming laxative plus increased water intake Explanation: Bulk-forming laxatives are the most physiologic laxatives because their effect is similar to that of increased intake of dietary fiber. They usually act within 12 to 24 hours but may take as long as 2 to 3 days to exert their full effects.
A nurse is teaching a 24-year-old female patient about her prescription for diphenoxylate with atropine (Lomotil). The nurse asks the patient if she is pregnant to evaluate the safety of taking this drug. The nurse is aware that diphenoxylate with atropine is categorized in which pregnancy category? C X D N
C Explanation: Lomotil is a pregnancy category C medication.
Mr. Jones is prescribed loperamide for diarrhea. Loperamide can be used for which type of diarrhea? Chronic diarrhea Diarrhea caused by pseudomembranous colitis Diarrhea caused by gastroenteritis Diarrhea caused by ingestion of Salmonella organisms
Chronic diarrhea Explanation: Unlike diphenoxylate, loperamide may be used for chronic as well as acute diarrhea. Loperamide is contraindicated for diarrhea related to infections and pseudomembranous colitis. Salmonellosis and gastroenteritis are both infectious diseases and should not be treated with loperamide.
The client asks the nurse why he cannot remain on a laxative indefinitely. Which of the following is the correct response? The client is incorrect and can remain on a laxative. Overuse of a laxative can lead to chronic diarrhea. Chronic use of laxatives can lead to constipation. Chronic use of a laxative can lessen its effects.
Chronic use of laxatives can lead to constipation. Explanation: Overuse of laxatives can lead to chronic constipation. While initial effects may lead to diarrhea, long-term use leads to constipation and should be avoided.
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 Colitis Gastroesophageal reflux disease Oral stomatitis
Colitis Explanation: Polyethylene glycol-electrolyte solution is contraindicated in clients who have colitis.
A 29-year-old woman has been prescribed alosetron (Lotronex) for irritable bowel syndrome. Before starting the drug therapy, the nurse will advise the patient about which of the following adverse effect(s)? Constipation Breathlessness and hypotension Hyperthyroidism Impaired cardiac function
Constipation Explanation: The primary adverse effect of alosetron is constipation. Patients 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. Reference:
When reviewing the medical record of a client who is to receive a chemical stimulant laxative, the nurse would monitor the client closely if he had which condition? Appendicitis Diverticulitis Coronary artery disease Ulcerative colitis
Coronary artery disease Explanation: Chemical stimulant laxatives are used cautiously in clients with coronary artery disease and heart block because these conditions could be affected by the decrease in absorption and changes in electrolytes that can occur. Acute abdominal disorders such as appendicitis, diverticulitis, and ulcerative colitis would be contraindications to the use of chemical stimulants.
The nurse is aware that critically ill clients are more at risk for constipation for what reasons? (Select all that apply.) Decreased activity Decrease in the amount of family interaction Increased access to a high-fiber diet Use of opioid medications Change in bowel routines
Decreased activity Use of opioid medications Change in bowel routines Explanation: 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.
A nurse is caring for a patient with pseudomembranous colitis. The physician has prescribed loperamide HCl to the patient. How does the nurse know that the drug has been effective? Elevation in temperature is noted. Rectal bleeding is noted. Diarrhea is resolved. Nausea and vomiting are resolved
Diarrhea is resolved. Explanation: Loperamide HCl (Lomotil) is an antidiarrheal medication. The nurse will know that the medication is effective if the diarrhea is resolved in the patient. The nurse should monitor the patient for an elevation in body temperature, severe abdominal pain, abdominal rigidity, or distention because these are the indicators of intestinal perforation. The nurse should monitor for rectal bleeding when laxatives are administered.
A nurse is caring for a patient with pseudomembranous colitis. The physician has prescribed loperamide HCl to the patient. How does the nurse know that the drug has been effective? Elevation in temperature is noted. Rectal bleeding is noted. Diarrhea is resolved. Nausea and vomiting are resolved.
Diarrhea is resolved. Explanation: Loperamide HCl (Lomotil) is an antidiarrheal medication. The nurse will know that the medication is effective if the diarrhea is resolved in the patient. The nurse should monitor the patient for an elevation in body temperature, severe abdominal pain, abdominal rigidity, or distention because these are the indicators of intestinal perforation. The nurse should monitor for rectal bleeding when laxatives are administered.
A patient who experiences frequent constipation will use psyllium (Metamucil). The nurse knows which of the following are contraindications to psyllium? Select all that apply. Difficulty swallowing Gastrointestinal obstruction Fecal impaction Undiagnosed abdominal pain Use of herbal preparations
Difficulty swallowing Gastrointestinal obstruction Fecal impaction Undiagnosed abdominal pain Explanation: Difficulty swallowing and gastrointestinal obstruction contraindicates psyllium. Fecal impaction and undiagnosed abdominal pain are contraindications to all orally administered laxatives. Use of herbal preparations is not a contraindication. There are no interactions reported with psyllium.
The nurse receives a phone call from a client who has been out of the country and is now experiencing diarrhea. The nurse knows that the physician will order what medication for relief of the symptoms of this disorder? (Select all that apply.) Diphenoxylate with atropine Psyllium Metronidazole Loperamide
Diphenoxylate with atropine Loperamide Explanation: For symptomatic treatment of diarrhea, diphenoxylate with atropine or loperamide is probably the drug of choice for most people.
The nurse is caring for a new mother who had to have an episiotomy during the birth of her baby. Two days after delivery the client is in need of a laxative. What will the nurse administer? Bisacodyl Castor oil Magnesium citrate Docusate
Docusate Explanation: A mild laxative may be used after delivery with care that it not enter breast milk and affect the newborn if the mother is nursing. Docusate would be the drug of choice from this list because it is mild and will produce a soft stool and decrease the need to strain. The other options would not be appropriate for this client.
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? Docusate (Colace) Milk of magnesia Bisacodyl (Dulcolax) Mineral oil
Docusate (Colace) Explanation: 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.
Which should be included in client teaching as a means of avoiding constipation? (Select all that apply.) Drink plenty of fluids. Take an opioid pain medication daily. Be active and exercise daily. Avoid defecating when the urge occurs. Eat foods high in bulk or roughage.
Drink plenty of fluids. Be active and exercise daily. Eat foods high in bulk or roughage. Explanation: Measures to prevent constipation include: drink plenty of fluids, get exercise, and eat foods high in bulk or roughage. Opioid medications can cause constipation and are therefore not a means of prevention. Avoiding the need to defecate when the urge occurs can lead to constipation.
When describing the drugs used to treat traveler's diarrhea, which would the nurse identify as the most common cause? E. coli Pseudomonas C. difficile Staphylococcus aureus
E. coli Explanation: The most common cause of traveler's diarrhea is E. coli
The nurse is conducting a class on nonpharmacologic treatment for occasional constipation. Which treatments will the nurse recommend? (Select all that apply.) Eat more high-fiber foods Decrease fluid intake Use of prebiotics Use of probiotics Decrease the amount of daily exercise
Eat more high-fiber foods Use of prebiotics Use of probiotics Explanation: Nonpharmacologic treatments for constipation include an increase in the use of high fiber foods, an adequate fluid intake of at least 2 L, the use of both prebiotics and probiotics, and regular daily exercise.
Which of the following are effects that a client might experience while taking diphenoxylate (Lomotil)? Select all that apply: Euphoric effects Analgesic effects Anti-inflammatory effects Sedative effects Slowed GI effects
Euphoric effects Sedative effects Slowed GI effects Explanation: Because diphenoxylate (Lomotil) is opioid-related, it may have sedative, slowed GI, and euphoric effects but no analgesic or anti-inflammatory activity.
A patient reports frequent constipation. The nurse knows that risk factors for constipation include which of the following? Select all that apply. Female gender Physical activity Use of anticholinergic drugs High-fiber diet Advanced age
Female gender Use of anticholinergic drugs Advanced age Explanation: Constipation is more frequent in women and older adults than in men and younger adults. Drugs with anticholinergic action decrease gastrointestinal motility and increase risk for constipation, because fecal matter moves slowly through the large intestine. Many drugs have anticholinergic side effects. Physical activity and high-fiber diets will decrease risk for constipation.
The nurse is educating new parents on treatment of infants with constipation. What is the most effective and safest way to treat constipation in infants prior to bowel training? Milk of magnesia Sorbitol Dulcolax suppositories Glycerin suppositories
Glycerin suppositories Explanation: Glycerin suppositories are often effective in infants and children. Milk of magnesia, sorbitol, and Dulcolax suppositories are not recommended.
A nurse is caring for a patient prescribed an antidiarrheal drug. For which preexisting condition of the patient should the nurse administer the drug with caution? Acute hepatitis Fecal impaction Hepatic impairment Renal impairment
Hepatic impairment Explanation: The nurse should administer antidiarrheals with caution in patients with severe hepatic impairment and inflammatory bowel disease. The nurse should administer laxatives with caution to patients with acute hepatitis and fecal impaction. Magnesium hydroxide is administered with caution to patients with any degree of renal impairment.
Mineral oil can be used as a laxative. The nurse knows that which statement regarding mineral oil is correct? Mineral oil is one of several lubricants used clinically. The onset of action of mineral oil is usually 24 to 36 hours. If aspirated, mineral oil can cause pneumonia. Mineral oil is often the preferred laxative.
If aspirated, mineral oil can cause pneumonia. Explanation: Mineral oil is the only approved lubricant for clinical use. The onset of action is 6 to 8 hours. If aspirated, mineral oil can lead to lipid pneumonia. Rarely is mineral oil the preferred laxative for constipation.
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? Increase the fluid in the intestinal contents Directly stimulate the nerve plexus in the intestinal wall Allow formation of a slippery coat on the intestinal contents Selectively antagonize opioid binding
Increase the fluid in the intestinal contents Explanation: 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.
The nurse is preparing to administer dexpanthenol to a client based on the understanding that this drug acts in which manner? Blocking dopamine receptors Increasing acetylcholine levels Exerting an osmotic pull on fluids Acting directly on the muscles of the GI tract
Increasing acetylcholine levels Explanation: Dexpanthenol works by increasing acetylcholine levels and stimulating the parasympathetic system. Metoclopramide works by blocking dopamine receptors and making the GI cells more sensitive to acetylcholine. Bulk laxatives exert an osmotic pull on fluids. Loperamide acts directly on the muscles of the GI tract to slow activity.
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? Reducing the surface tension of bowel contents Irritating the intestinal mucosa, thus increasing intestinal motility Increasing mass and water content of stool, promoting evacuation Creating a barrier between the colon wall and feces
Increasing mass and water content of stool, promoting evacuation Explanation: 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.
The nurse should explain that metoclopramide (Reglan) decreases nausea and vomiting by which of the following actions? Decreasing gastric contractions Inhibiting stimulation of the vomiting center in the brain Decreasing gastric motility Increasing gastric emptying time
Inhibiting stimulation of the vomiting center in the brain Explanation: Reglan inhibits stimulation of the vomiting center in the brain. This medication also increases the amplitude of gastric contractions and gastric motility while decreasing gastric emptying time.
A 59-year-old homeless man with a history of alcohol abuse, is admitted with dehydration and diarrhea. The admission interview indicates he collects his meals from dumpsters behind restaurants. What could be causing his diarrhea? (Select all that apply.) Intestinal infection Campylobacter bacteria Salmonella Dehydration
Intestinal infection Campylobacter bacteria Salmonella Explanation: Food contaminated with pathogenic microbes can cause diarrhea.
A client with constipation has been prescribed mineral oil. Which reason should the nurse provide for instructing the client to take the medication between meals or at bedtime? It causes sedation It enhances absorption of the drug It interferes with vitamin absorption It causes nausea and vomiting
It interferes with vitamin absorption Explanation: When mineral oil is taken orally, it interferes with absorption of the fat-soluble vitamins, namely A, D, E, and K. Therefore, it should be given in between meals or at bedtime to avoid interfering with food absorption. Mineral oil does not have a sedative effect. Administering it between meals does not enhance its absorption. Mineral oil is not absorbed; rather, it forms a coating on the feces, acts as a lubricant, softens feces, and prevents straining on bowel movements. It does not cause nausea and vomiting.
After teaching a class about irritable bowel syndrome, which statement indicates that the teaching has been successful? The disorder is relatively rare. It occurs more often in women than in men. Diarrhea is the predominant report. The cause is primarily stress related.
It occurs more often in women than in men. Explanation: Irritable bowel syndrome is a very common disorder, striking three times as many women as men and reportedly accounting for half of all referrals to GI specialists. The disorder is characterized by abdominal distress, bouts of diarrhea or constipation, bloating, nausea, flatulence, headache, fatigue, depression, and anxiety. No anatomical cause has been found for this disorder. Underlying causes might be stress related.
Which of the following is the correct rationale for why the nurse would administer a laxative at a separate time from the client's other medications? 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. 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.
Laxatives may reduce absorption of other drugs present in the GI tract. Explanation: 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.
The nurse is teaching the client about possible adverse effects associated with mineral oil. Which of the following would be most important for the nurse to include? Leakage Abdominal cramping Diarrhea Sweating
Leakage Explanation: Although abdominal cramping, diarrhea, and sweating may occur with lubricant laxatives such as mineral oil, it would be especially important to inform the client about possible leakage and staining with mineral oil, which occurs because the stool cannot be retained by the external sphincter.
What is an antidiarrheal that treats diarrhea by acting directly on the muscle wall of the bowel to slow motility? Loperamide (Imodium) Diphenoxylate (Lomotil) Sodium bicarbonate (Bellans) Omeprazole (Prilosec)
Loperamide (Imodium) Explanation: Loperamide (Imodium) is not chemically related to opioid drugs, and treats diarrhea by acting directly on the muscle wall of the bowel to slow motility.
A female client has dealt with constipation most of her adult life. She has not had relief of symptoms with most medications used in the treatment of this condition. The nurse is aware that this client will be prescribed which drug? Sorbitol Sodium polystyrene sulfonate Docusate sodium Lubiprostone
Lubiprostone Explanation: Clients with chronic idiopathic constipation are prescribed lubiprostone
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? Lubiprostone Alosetron Hyoscyamine Methylnaltrexone
Lubiprostone Explanation: 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.
Ms. Case is prescribed diphenoxylate HCl with atropine sulfate for the treatment of acute diarrhea. Ms. Case has several allergies. Which allergy places her at greatest risk for an adverse reaction to this medication due to cross-sensitivity? Atenolol Meperidine Amobarbital Mephobarbital
Meperidine Explanation: Diphenoxylate HCl with atropine sulfate is a synthetic narcotic similar in structure to meperidine, and it is classified as a schedule V drug. The antidiarrheal drug may potentiate the depressive effects of alcohol, barbiturates, and tranquilizers. Amobarbital and mephobarbital are barbiturates and can potentiate the reaction of the medication but do not cause a cross-sensitivity. Atenolol is a beta-blocker and has not been shown to produce a cross-sensitivity. Reference:
A client who is diagnosed with terminal cancer has been using opioids for pain relief and experiencing constipation despite numerous drug therapies and interventions for relief. The nurse anticipates the use of which agent for this client? Lubiprostone Psyllium Mineral oil Methylnaltrexone
Methylnaltrexone Explanation: Clients with advanced disease who are receiving palliative care and no longer are responsive to traditional laxatives may receive methylnaltrexone for treatment of opioid-induced constipation. 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. Psyllium or mineral oil probably would have been tried earlier on and most likely would be ineffective because the client's constipation is opioid induced.
The nurse is teaching a client about loperamide, which the physician has prescribed for treatment of chronic diarrhea. Which adverse effects should the nurse be sure to mention? Nausea Flatulence Disorientation Tremors
Nausea Explanation: Adverse effects of loperamide are few and generally mild, but they include nausea, abdominal pain, constipation, drowsiness, sedation, and vomiting.
The nurse should advise clients taking laxatives of which of the following adverse effects? Select all that apply: Nausea Perianal irritation Bloating Constipation Cramps
Nausea Perianal irritation Bloating Cramps Explanation: Laxatives may cause diarrhea, loss of water and electrolytes, abdominal pain or discomfort, nausea, vomiting, perianal irritation, fainting, bloating, flatulence, cramps and weakness. The nurse should advise clients taking laxatives of the possible adverse effects.
The nurse is caring for a client with Giardia lamblia and anticipates that the physician will order what drug for the treatment of this client's diarrhea? Alosetron Rifaximin Nitazoxanide Cholestyramine
Nitazoxanide Explanation: Nitazoxanide (Alinia) is an antiprotozoal agent used specifically for treating diarrhea resulting from infection with Giardia lamblia or Cryptosporidium parvum.
The nurse is preparing to administer cascara to a client. The nurse anticipates administering this drug by which route? Oral Rectal, via enema Rectal, via suppository Intramuscular
Oral Explanation: 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.
Constipation is a common problem. The nurse knows that there are many ways to decrease the risk of constipation. These include which of the following? Select all that apply. Partake in daily physical exercise. Consume food rich in fiber. Drink 64 to 80 ounces of fluids daily. Use a stimulant laxative every day. Set a routine time and place for daily bowel movement.
Partake in daily physical exercise. Consume food rich in fiber. Drink 64 to 80 ounces of fluids daily. Set a routine time and place for daily bowel movement. Explanation: 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.
A patient who has been experiencing liquid stools is prescribed polycarbophil (FiberCon). What is the reason for administering a bulk-forming laxative? Polycarbophil absorbs large amounts of water and decreases fluidity of stools. Polycarbophil will diminish the absorption of intestinal fiber and water. Polycarbophil will provide pain relief and decrease cramping and bloating. Polycarbophil will increase bile and diminish bacterial flora in the intestines.
Polycarbophil absorbs large amounts of water and decreases fluidity of stools. Explanation: Polycarbophil is an adsorbent drug that works by absorbing large amounts of water and produces stools of gelatin-like consistency. Polycarbophil will not diminish the absorption of intestinal fiber and water. Polycarbophil will cause abdominal discomfort and bloating. Polycarbophil has no effect on bacterial flora in the intestines.
A patient needing to evacuate the colon for endoscopy would likely take: Polyethylene glycol electrolyte solution (NuLYTELY) Methylcellulose (Citrucel) Psyllium (Metamucil) Mineral oil (Milkinol)
Polyethylene glycol electrolyte solution (NuLYTELY) Explanation: A patient needing to evacuate the colon for endoscopy would likely take Polyethylene glycol electrolyte solution (NuLYTELY).
A patient is scheduled for a colonoscopy in the morning. Which laxative is most likely prescribed the evening before the colonoscopy? Psyllium (Metamucil) Polyethylene glycol-electrolyte solution (NuLYTELY) Castor oil Lactulose (Cephulac)
Polyethylene glycol-electrolyte solution (NuLYTELY) Explanation: Polyethylene glycol-electrolyte solution (NuLYTELY) is a nonabsorbable oral solution that induces diarrhea within 30-60 minutes and rapidly evacuates the bowel, usually within 4 hours for a colonoscopy. Psyllium is not strong enough for a colonoscopy preparation. Castor oil is not the most commonly prescribed preparation for a colonoscopy. Lactulose is used only when the serum ammonium level is elevated.
Laxatives and cathartics are used in a wide variety of ways. The nurse knows that which of the following are appropriate uses for these drugs? Select all that apply. Preparation for colonoscopy Hepatic encephalopathy Following myocardial infarction Weight management With opioid analgesics
Preparation for colonoscopy Hepatic encephalopathy Following myocardial infarction With opioid analgesics Explanation: Laxatives are used to evacuate the large intestine before colonoscopy, to remove intestinal ammonia in patients with hepatic encephalopathy, and to decrease straining to defecate in patients after a myocardial infarction. Opioid analgesics cause constipation, which can be alleviated with laxatives. Weight management is not an appropriate use for laxatives.
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 Polyethylene glycol-electrolyte solution Lactulose Psyllium
Psyllium Explanation: 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? Psyllium can be used freely in children. 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 is useful in critically ill patients who experience constipation. Explanation: 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.
Which of the following is an important assessment for the nurse to make before administering a laxative? Once a medication is ordered by the physician, 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. It is imperative to ask clients whether they are expecting any visitors because the effects of the medication may hinder visitation. Question the client regarding the type and intensity of symptoms to provide a baseline evaluation.
Question the client regarding the type and intensity of symptoms to provide a baseline evaluation. Explanation: 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? Rectal Oral Intramuscular Intravenous
Rectal Explanation: Metoclopramide can be given orally, intramuscularly, or intravenously but not rectally.
A group of students are reviewing information about the indications for laxatives. The students demonstrate understanding of the information when they identify which of the following as an indication? Adjunct to peptic ulcer therapy to eradicate Helicobacter pylori Enhance straining efforts after surgery Remove ingested poisons from the lower GI tract Increase secretions and overall activity of the GI tract
Remove ingested poisons from the lower GI tract Explanation: Laxative, or cathartic, drugs are indicated to remove ingested poisons from the lower GI tract; as an adjunct in anthelmintic therapy when it is desirable to flush helminths from the GI tract; to prevent straining when it is clinically undesirable (such as after surgery, myocardial infarction, or obstetric delivery); for the short-term relief of constipation; and to evacuate the bowel for diagnostic procedures. Lubricants ease defecation without stimulating the movement of the GI tract. GI stimulants provide more generalized GI stimulation, resulting in an overall increase in GI activity and secretions.
A group of students are reviewing the adverse effects associated with loperamide. The students demonstrate a need for additional teaching when they identify what as an adverse effect? Sedation Dry mouth Distention Fatigue
Sedation Explanation: Sedation is an adverse effect associated with the use of opium-derivative antidiarrheal agents. The other options are possible adverse effects of loperamide. Reference:
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? Anticholinergic Serotonin antagonist Chloride channel activator Selective opioid antagonist
Serotonin antagonist Explanation: 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 nurse is teaching the client about alosetron (Lotronex), which has been prescribed to treat chronic diarrhea. The nurse is aware that alosteron has a Black Box Warning. Of which of the following adverse effects does the nurse inform the patient? Select all that apply. Severe constipation Possible bowel obstruction Hemorrhage Vomiting Urinary retention
Severe constipation Possible bowel obstruction Hemorrhage Explanation: A 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 female client is diagnosed with temporary acute diarrhea. Her other diagnoses include diabetes mellitus, dysrhythmia, and hepatic impairment. The physician orders loperamide. Based on her diagnoses, which adverse effect would the nurse observe for in this client? Signs of electrolyte imbalance Signs of hemorrhage Signs of hypercalcemia Signs of CNS toxicity
Signs of CNS toxicity Explanation: With loperamide, monitor clients with hepatic impairment for signs of CNS toxicity. Loperamide normally undergoes extensive first-pass metabolism, which may be lessened by liver disease. As a result, a larger portion of the dose reaches the systemic circulation and may cause adverse effects.
The patient has been prescribed diphenoxylate with atropine (Lomotil) for his diarrhea. The nurse recognizes that this drug is effective against diarrhea because of which of the following actions? Slows peristalsis by acting on the smooth muscles of the intestine Anti-inflammatory effects allowing absorption of fluids Antimicrobial effects Decreases GI secretion and motility
Slows peristalsis by acting on the smooth muscles of the intestine Explanation: Diphenoxylate with atropine slows peristalsis by acting on the smooth muscles in the intestines.
A hospice patient is receiving opioids for treatment of cancer pain. Which laxative will assist in the prevention of constipation? Lactulose (Cephulac) Stimulant Saline Bulk-forming
Stimulant Explanation: Stimulant laxatives are the most commonly used laxative with these patients. Lactulose is not usually recommended. Saline laxatives are not recommended due to electrolyte imbalance. Bulk-forming laxatives are not usually recommended for patients with cancer because they may not be able to drink adequate amounts of fluid required with these medications.
The nurse is caring for a client who has developed severe diarrhea a few days after beginning an antibiotic prescribed for a severe respiratory infection. The nurse is prepared to initiate what initial treatment? Imodium Stopping the causative drug Administering a medication that will slow peristalsis Administering a low-dose opioid
Stopping the causative drug Explanation: In antibiotic-associated colitis, stopping the causative drug is the initial treatment.
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? Direct stimulation of the nerve plexus in the abdominal wall Sympathetic stress reaction due to intense GI tract neurostimulation Detergent action on the surface of the intestinal bolus Formation of a slippery coat on the contents of the intestinal tract
Sympathetic stress reaction due to intense GI tract neurostimulation Explanation: 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.
Which would be most important to include when teaching a patient about using psyllium? Taking the agent with a large amount of water Taking the agent at bedtime Taking other prescribed drugs along with the psyllium Limiting the use of high fiber foods
Taking the agent with a large amount of water Explanation: A large amount of water is needed to prevent the laxative from swelling into a gelatin-like mass in the esophagus that could lead to obstruction. Psyllium can be taken any time, 1 to 3 times per day. Bulk laxatives, like psyllium, can increase the motility of the GI tract and interfere with the timing or process of absorption. Administration of other drugs with psyllium should be separated by at least 30 minutes. It would be important to encourage the patient to ingest high fiber foods to promote bowel evacuation and reduce the need for psyllium.
Mr. Hall, age 65, is admitted to the hospital for pneumonia. Since admission he has not had a bowel movement. The physician prescribes magnesium hydroxide. What would be a realistic outcome of this therapy? Within 2 to 3 hours of using the drug, the patient will experience a decrease in abdominal pain and distention. Diarrhea will be controlled through the use of the drug. The patient will not sustain injury from drug therapy. The patient will have a bowel movement after taking the drug.
The patient will have a bowel movement after taking the drug. Explanation: The desired outcome for magnesium hydroxide therapy would be for the patient to have a bowel movement after taking the drug. Within 2 to 3 hours of using simethicone, the patient will experience a decrease in abdominal pain and distention. Diarrhea will be controlled through the use of diphenoxylate HCl with atropine sulfate. The patient will not sustain injury using diphenoxylate HCl with atropine sulfate.
A young mother tells the nurse that she is giving her 2-year-old mineral oil because the child has difficulty defecating. The nurse should teach this mother about long-term administration of mineral oil decreasing the absorption of what nutrients? Vitamin B12 Vitamin C Vitamin D Iron
Vitamin D Explanation: Lubricant laxatives lubricate the fecal mass and slow colonic absorption of water from the fecal mass. These medications may interfere with the absorption of fat-soluble vitamins and if aspirated may result in a lipid aspiration pneumonia.
The nurse is preparing to administer a stimulant cathartic to the client. The nurse should inform the client of the possible adverse effect of: nausea. vomiting. diarrhea. rectal bleeding
diarrhea. Explanation: Diarrhea may result due to the action of strong, stimulant cathartics. A stimulant cathartic would not cause nausea, vomiting, or rectal bleeding.
To maximize the therapeutic effect of diphenoxylate HCl with atropine sulfate, the nurse will instruct the patient to take the medication once a day. twice a day. every 2 hours. four times a day.
four times a day. Explanation: To maximize the therapeutic effect, diphenoxylate HCl with atropine sulfate is usually administered four times daily, which serves to help maintain a therapeutic drug level.
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. laxative can alter the newborn's electrolyte levels. newborn may experience intestinal rupture. drug could cause a hypersensitivity reaction in the newborn.
newborn may experience diarrhea. Explanation: Magnesium laxatives can cause diarrhea in the newborn if the mother uses it when breastfeeding.