Pharm Chapter 58 - Drugs Affecting Gastrointestinal Motility

While discussing the use of laxatives a student asks the nursing instructor what indicates normal bowel elimination. 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." Normal bowel elimination should produce a soft, formed stool without pain.

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? * "Children younger than 1 year of age should not be given this medication." * "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." * "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.

The nurse should prioritize what assessment when providing care for a client who has taken over-the-counter (OTC) bisacodyl daily for several months? *bleeding *apical heart rate *deep tendon reflexes *electrolyte levels

*electrolyte levels People should not use bisacodyl frequently or for longer than 1 week because it may produce serum electrolyte and acid-base imbalances (e.g., hypocalcemia, hypokalemia, metabolic acidosis, or alkalosis). Assessment of electrolytes would thus be warranted in the care of this client. Reflexes, heart rate, and coagulation factors may be affected, but these would be consequent to alterations in electrolyte levels.

The nurse collects a stool culture from a patient diagnosed with travelers diarrhea. What bacterium does the nurse expect the culture to grow? A) Escherichia coli B) Staphylococcus aureus C) Streptococcus type B D) Pseudomonas

Ans: A Feedback: Escherichia coli is the most common cause of travelers diarrhea. Staphylococcus, Streptococcus, and Pseudomonas would be highly unlikely to grow in the stool of a patient with travelers diarrhea.

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 24 hours 36 hours 72 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 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 Laxatives and cathartics are contraindicated in clients with abdominal pain. The presence of fever would also be a possible indication of infection.

The nurse teaches the patient that a common adverse effect of loperamide (Imodium) is what? A) Fatigue B) Flatulence C) Disorientation D) Tremors

Ans: A Feedback: Adverse effects associated with antidiarrheal drugs, such as constipation, distention, abdominal discomfort, nausea, vomiting, dry mouth, and even toxic megacolon, are related to their effects on the gastrointestinal (GI) tract. Other adverse effects that have been reported include fatigue (option A), weakness, dizziness, and rash. options B, C, and D are not correct.

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

Ans: A Feedback: Alosetron (Lotronex) is approved for use in women with irritable bowel syndrome with diarrhea being the predominant complaint and should be discontinued immediately if the patient develops constipation or symptoms of ischemic colitis. Patients must read and sign a patientphysician agreement before it can be prescribed. Options B, C, and D are not correct.

What drug does the nurse recognize as being classified as a chemical stimulant? A) Bisacodyl (Dulcolax) B) Polycarbophil (FiberCon) C) Magnesium hydroxide (Milk of Magnesia) D) Docusate (Colace)

Ans: A Feedback: Bisacodyl is a chemical stimulant. Polycarbophil and magnesium hydroxide are bulk laxatives. Docusate is a lubricant laxative.

The nurse, teaching a patient to be discharged with an order to use chemical stimulant laxatives PRN, instructs the patient that one of the most common adverse effects of this type of laxative is what? A) Abdominal cramping B) Rectal bleeding C) Confusion D) Iron deficiency anemia

Ans: A Feedback: Common adverse effects of laxatives are diarrhea, abdominal cramping, and nausea. Central nervous system (CNS) adverse effects such as dizziness, headache, and weakness can occur. Rectal bleeding, confusion, and iron deficiency anemia are not associated with appropriate use of laxatives but may occur when laxatives are abused.

The patient had surgery 2 days ago and bowel motility has not returned. What drug might the nurse administer to stimulate the gastrointestinal (GI) tract? A) Dexpanthenol B) Docusate C) Psyllium (Metamucil) D) Senna

Ans: A Feedback: Dexpanthenol is indicated for the prevention of intestinal atony or loss of intestinal muscle tone in postoperative adults. Docusate, psyllium, and senna are laxatives that would not be indicated for the postoperative patient with no bowel activity.

The nurse administers metoclopramide to the patient with what condition? A) Chronic diabetic gastroparesis B) Impaction C) Encopresis D) Patients requiring diagnostic procedures

Ans: A Feedback: Indications for metoclopramide include relief of acute and chronic diabetic gastroparesis, short-term treatment of gastroesophageal reflux disorder in adults who cannot tolerate standard therapy, prevention of postoperative or chemotherapy-induced nausea and vomiting, facilitation of small-bowel intubation, stimulation of gastric emptying, and promotion of intestinal transit of barium. It would not be used for treatment of impaction, encopresis, and in patients requiring diagnostic procedures.

The nurse administers lubiprostone (Amitiza) to the patient with irritable bowel syndrome and anticipates what therapeutic action from the drug? A) Secretion of chloride-rich intestinal fluid leading to increased motility B) Adding bulk to the fecal matter to ease the process of stooling C) Irritation of the inner lining of the bowel to increase bowel motility D) Stimulate the bowel by increasing innervation

Ans: A Feedback: Lubiprostone is a locally acting chloride channel activator that increases the secretion of a chloride-rich intestinal fluid without changing sodium or potassium levels. Increasing the intestinal fluid leads to increased motility. It does not add bulk, irritate the inner lining, or innervate the bowel.

The hospice nurse is caring for a patient diagnosed with bone cancer who is receiving large doses of opioid medications to relieve pain. The patient has used other laxatives in the past to treat opioid-induced constipation but nothing is working now. What drug would the nurse request the family doctor to order for this patient? A) Methylnaltrexone (Relistor) B) Castor oil C) Paregoric D) Mineral oil

Ans: A Feedback: Methylnaltrexone (Relistor) was approved in 2008 for the treatment of opioid-induced constipation in patients with advanced disease who are receiving palliative care and are no longer responsive to traditional laxatives. Castor oil, mineral oil, and paregoric would likely be ineffective in this patient.

The family brings a patient to the emergency department saying he has been hallucinating and falls so deeply asleep he stops breathing when not stimulated. The nurse learns the patient has been self-treating diarrhea and suspects the patient was taking what medication? A) Paregoric B) Bismuth subsalicylate C) Loperamide D) Colace

Ans: A Feedback: Opium derivatives, like paregoric, are associated with light-headedness, sedation, euphoria, hallucinations, and respiratory depression related to their effect on opioid receptors. Nonopioids such as bismuth subsalicylate and loperamide would not cause respiratory depression. Colace is a stool softener, not an antidiarrheal.

The nurse administers loperamide (Imodium) to decrease the number and liquidity of stool by what mechanism? A) Decreasing intestinal motility B) Absorbing toxins C) Binding with fecal material to increase bulk D) Blocking the chemoreceptor trigger zone (CTZ)

Ans: A Feedback: Systemic antidiarrheal agents slow the motility of the gastrointestinal (GI) tract through direct action on the lining of the GI tract to inhibit local reflexes (bismuth subsalicylate), through direct action on the muscles of the GI tract to slow activity (loperamide), or through action on central nervous system (CNS) centers that cause GI spasm and slowing (opium derivatives). Options B, C, and D are not correct.

What drug does the nurse administer that inhibits intestinal peristalsis through direct effects on the longitudinal and circular muscles of the intestinal wall? A) Bismuth subsalicylate B) Loperamide C) Paregoric D) Magnesium citrate

Ans: B Feedback: Actions of loperamide include that it inhibits intestinal peristalsis through direct effects on the longitudinal and circular muscles of the intestinal wall, slowing motility and movement of water and electrolytes. Bismuth subsalicylate inhibits local reflexes. Paregoric works through action on CNS centers that cause GI spasm and slowing. Magnesium citrate is a laxative.

A patient taking a chemical stimulant laxative and medications for heart failure and osteoarthritis calls the clinic and reports to the nurse that she is not feeling right. What is the priority question the nurse should ask this patient? A) Effectiveness of laxatives B) Timing of medication administration C) The amount of fiber in her diet D) Amount of fluid ingested

Ans: B Feedback: Because laxatives increase the motility of the gastrointestinal (GI) tract and some laxatives interfere with the timing or process of absorption, it is not advisable to take laxatives with other prescribed medications. The administration of laxatives and other medications should be separated by at least 30 minutes, so the nurse should question when the patient is taking the laxatives and other medication. Other options may be questions the nurse would eventually ask, but the priority is timing of medication administration.

The nurse, providing patient teaching, explains that difenoxin and diphenoxylate are chemically related to what medication? A) Morphine B) Demerol C) Diphenhydramine D) Diflucan

Ans: B Feedback: Difenoxin and diphenoxylate (anti diarrheal) are chemically related to meperidine (Demerol - opioid analgesic) and are used at doses that decrease gastrointestinal activity without having analgesic or respiratory effects.

What is the priority nursing diagnosis for an 89-year-old patient with frequent liquid stools? A) Imbalanced nutrition: less than body requirements B) Deficient fluid volume C) Deficient knowledge related to medications D) Pain related to abdominal cramping

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

A clinic patient with a history of heart failure requires a laxative for treatment of chronic constipation. What medication would be most appropriate for this patient? A) Senna (Senokot) B) Lactulose (Chronulac) C) Magnesium sulfate (Milk of Magnesia) D) Castor oil (Neoloid)

Ans: B Feedback: Lactulose is often the drug of choice when a patient with cardiovascular problems requires a laxative. It is salt free, an important consideration in patients with heart failure; it acts by exerting a gentle osmotic pull of fluid into the intestinal lumen. Senna, magnesium sulfate, and castor oil are more aggressive laxatives and might not be the best choice for a patient with cardiovascular problems.

The nurse develops a teaching plan for a 77-year-old patient who has been prescribed loperamide PRN. The nurses priority teaching point is what? A) May cause hallucinations or respiratory depression B) Take drug after each loose stool C) Drug remains in the bowel without being absorbed into the bloodstream D) Avoid pregnancy and breast-feeding while taking drug.

Ans: B Feedback: Loperamide is taken repeatedly after each loose stool. Teaching the patient when to take the drug is the priority teaching point. Paregoric, and not loperamide, can cause hallucinations and respiratory depression. The drug is absorbed systemically. It is unlikely a 77-year-old patient will get pregnant or breast-feed so this is not the highest priority.

What is the antidiarrheal of choice the nurse will administer to children older than 2 years of age with diarrhea? A) Bismuth salts (Pepto-Bismol) B) Loperamide (Imodium) C) Paregoric (generic) D) Difenoxin (Motofen)

Ans: B Feedback: Loperamide may be the antidiarrheal of choice in children older than 2 years of age if such a drug is needed. Special precautions need to be taken to monitor for electrolyte and fluid disturbances and supportive measures should be taken as needed. Serious fluid volume deficits may rapidly develop in children with diarrhea. Appropriate fluid replacement should include oral rehydration solutions. Although bismuth salts and paregoric may be given to children, they are not the drugs of choice. Difenoxin is not for use in children under 12 years of age.

A patient who is taking metoclopramide (Reglan) has come to the clinic for a follow-up visit. The nurse will be most concerned about a drug-drug interaction when learning the patient is taking what other medication? A) Albuterol (Proventil) B) Digoxin (Lanoxin) C) Furosemide (Lasix) D) Acetylsalicylic acid (ASA)

Ans: B Feedback: Metoclopramide has been associated with decreased absorption of digoxin from the gastrointestinal (GI) tract. The nurse should monitor patients taking this combination carefully. The other options do not pose a concern about drugdrug interactions.

The nurse provides drug teaching to the patient who will begin taking polycarbophil (FiberCon). What is the nurses priority teaching point? A) Do not eat or drink anything for 2 hours after taking the medication. B) Drink lots of water when taking the drug. C) Take at night before bedtime. D) The drug can be taken up to six times per day.

Ans: B Feedback: Patients must take plenty of water with polycarbophil. If only a little water is consumed, the medication may absorb enough fluid in the esophagus to swell the food into a gelatin-like mass that can cause obstruction and other severe problems. The drug should be taken no more than four times a day and should not be taken at night.

The nurse will question an order for bismuth salts (Pepto-Bismol) in a patient with what condition? A) Rheumatoid arthritis B) Allergy to aspirin C) Hypertension D) Viral gastroenteritis

Ans: B Feedback: Pepto-Bismol has aspirin in it and should not be given to a patient with an allergy to aspirin. There is no contraindication for a patient with rheumatoid arthritis, hypertension, or viral gastroenteritis.

The nurse teaches the patient to best maintain optimal GI function by including what in the daily routine? A) Exercise, adequate sleep, and avoiding caffeine B) Proper diet, fluid intake, and exercise C) Proper diet, avoiding alcohol, and cautious use of laxatives D) Avoiding prescription medications, increased fluid intake, and vigorous exercise

Ans: B Feedback: The best way to maintain gastrointestinal (GI) function is through proper diet including optimizing fiber intake, adequate fluid intake, and exercise, which will stimulate GI activity. Drugs should only be used when normal function cannot be maintained. Options A, C, and D are not correct.

The nurse is caring for a patient who has had impacted stools twice in the past month. What is an appropriate laxative for this patient? A) Milk of Magnesia B) Agoral Plain C) Colace D) Dulcolax

Ans: B Feedback: Mineral oil (Agoral Plain) is not absorbed and forms a slippery coat on the contents of the intestinal tract. When the intestinal bolus is coated with mineral oil, less water is drawn out of the bolus and the bolus is less likely to become hard or impacted. Other options shown do not have this same effect of reducing the risk of another impaction as well as helping to eliminate stool.

The home health nurse is caring for a 72-year-old man in his home. He complains about almost daily diarrhea. The nurse assesses for what common cause of diarrhea in older adults? A) Diabetes B) Hypertensive medications C) Laxative overuse D) Glaucoma

Ans: C Feedback: Diarrhea in older adults may result from laxative overuse so the nurse should assess what over-the-counter (OTC) products the patient is using. Diabetes, hypertension medications, and glaucoma are not common causes of diarrhea in patients.

When would it be appropriate for the nurse to administer castor oil as a laxative? A) To ease the passage of stool in the patient who recently had a baby B) To remove ingested poisons from the lower gastrointestinal (GI) tract C) To evacuate the bowel for diagnostic procedures D) To treat chronic constipation

Ans: C Feedback: Indications include evacuating the bowel for diagnostic procedures and for short-term treatment of constipation. Castor oil is not indicated to remove ingested poisons nor to ease the passage of stool after having a baby. This drug should only be used on a short-term basis and is not for the treatment of chronic constipation because repeated use will cause GI tract exhaustion.

The home health nurse is caring for a patient with encopresis who was started on mineral oil therapy. The nurse teaches the patient and family that a common adverse effect is what? A) Nausea B) Vomiting C) Leakage D) Vitamin C deficiency

Ans: C Feedback: Leakage and staining may be a problem when mineral oil is used and the stool cannot be retained by the external sphincter. Mineral oil does not cause nausea, vomiting, or vitamin C deficiency.

A patient receiving loperamide (Imodium) should be alerted by the nurse to what possible adverse effect? A) Anxiety B) Bradycardia C) Fatigue D) Urinary retention

Ans: C Feedback: Patients should be aware that they should not drive or operate machinery while taking loperamide (Imodium) because it can cause fatigue. Anxiety, bradycardia, and urinary retention are not commonly associated with loperamide.

What should the nurse tell the patient who will begin taking rifaximin (Xifaxan) for travelers diarrhea? A) Do not start taking the drug until the diarrhea has persisted for at least 24 hours. B) Taking the antibiotic will allow you to enjoy the local water and food without concern. C) Do not take the drug if you have bloody diarrhea. D) Start the drug 3 days before leaving for your trip and continue until you return.

Ans: C Feedback: Rifaximin should not be taken if a patient has bloody diarrhea or diarrhea that persists for more than 48 hours. It is started after the signs and symptoms of the disease develop and is taken for 3 days. The traveler should still avoid exposure to foreign bacteria by not drinking tap water and by avoiding fruits and vegetables washed in tap water. Options A, B, and D are not correct.

When would it be appropriate for the nurse to administer a cathartic laxative to the patient? (Select all that apply.) A) Partial small-bowel obstruction B) Appendicitis C) After having a baby D) After a myocardial infarction (MI) E) After anthelmintic therapy

Ans: C, D, E Feedback: Laxative, or cathartic, drugs are indicated for the short-term relief of constipation; to prevent straining when it is clinically undesirable (such as after surgery, myocardial infarction, or obstetric delivery); to evacuate the bowel for diagnostic procedures; to remove ingested poisons from the lower gastrointestinal (GI) tract; and as an adjunct in anthelmintic therapy when it is desirable to flush helminths from the GI tract. They are not indicated when a patient has an appendicitis or a partial small-bowel obstruction.

A new mother required an episiotomy during the birth of her baby. Two days after delivery, the patient is in need of a laxative. What will be the most effective drug for the nurse to administer? A) Bisacodyl (Dulcolax) B) Castor oil (Neolid) C) Magnesium sulfate (epsom salts) D) Docusate (Colace)

Ans: D Feedback: Docusate is a stool softener that will make expulsion of stool easier in a traumatized body area following an episiotomy. Care must be taken to choose a mild laxative that will not enter breast milk and not affect the newborn if the mother is nursing. Docusate is 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 because they do not soften the stool and are harsher laxatives that can enter breast milk.

What antidiarrheal would the nurse administer to reduce the volume of discharge from the patients ileostomy? A) Diphenoxylate (Lomotil) B) Octreotide (Sandostatin) C) Psyllium (Metamucil) D) Loperamide (Imodium)

Ans: D Feedback: Loperamide (Imodium), bismuth subsalicylate (Pepto-Bismol), and opium derivatives (paregoric) are indicated for the reduction of volume of discharge from ileostomies. The other options would not serve this purpose.

For what action would the nurse administer magnesium citrate? A) Block absorption of fats B) Directly stimulate the nerve plexus in the intestinal wall C) Form a slippery coat on the contents of intestine D) Increase motility, increase fluid, and enlarge bulk of fecal matter

Ans: D Feedback: Magnesium citrate is a rapid-acting, aggressive laxative that causes fecal matter to increase in bulk. It increases the motility of the gastrointestinal (GI) tract by increasing the fluid in the intestinal contents, which enlarges bulk, stimulates local stretch receptors, and activates local activity. It does not block absorption of fats, stimulate the nerve plexus, or form a slippery coat.

The nurse administers psyllium hydrophilic mucilloid (Metamucil) expecting it to have what action? A) Slows peristalsis B) Promotes reabsorption of water into bowel C) Has antibacterial properties D) Adds bulk to the stool

Ans: D Feedback: Metamucil is a natural substance that forms a gelatin-like bulk of the intestinal contents. This agent stimulates local activity. It is considered milder and less irritating than many other bulk stimulants. Patients must use caution and take it with plenty of water because Metamucil absorbs large amounts of water and produces stools of gelatin-like consistency. It does not slow peristalsis, promote water reabsorption, or have antibacterial properties.

The nurse teaches the patient who was prescribed a chemical stimulant laxative that 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 is the nurse teaching this patient about? A) Bismuth salts B) Bisacodyl C) Castor oil D) Cascara

Ans: D Feedback: Specifically related to chemical stimulants, cascara, although a reliable agent, may have a either slow, steady action or may cause severe cramping and rapid evacuation of the contents of the large intestine. Bisacodyl and castor oil do not have potential adverse effect. Bismuth salts are an antidiarrheal.

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

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.) 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.

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

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

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. *Administer the medication as prescribed. *Hold the medication. *Discuss the issues with another nurse on the unit.

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.

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)? *Constipation *Breathlessness and hypotension *Hyperthyroidism *Impaired cardiac function

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 admits to the clinic a 7-month-old infant whose mother reports that the baby has not had a bowel movement in 6 days. What drug would be appropriate to treat this patient? A) Cascara (generic) B) Magnesium hydroxide (Milk of Magnesia) C) Polyethylene glycol-electrolyte solution (GoLYTELY) D) Glycerin (Sani-Supp)

D Feedback: Glycerin suppositories are the best choice for infants and young children when constipation is a problem. The other choices are not recommended for infants or children.

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 Change in bowel routines Use of opioid medications

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 Diphenoxylate with atropine sulfate resolves diarrhea by decreasing intestinal motility.

What type of laxative would be the first choice for a client diagnosed with hemorrhoids experiencing intense pain when straining to pass stools? *stool softener *saline cathartic *stimulant cathartic *bulk-forming laxative

stool softener For clients in whom straining is potentially harmful or painful, stool softeners (e.g., docusate sodium) are the agents of choice.

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

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 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 Dexpanthenol (GI Stimulant) 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.

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 irritates the intestinal mucosa, thus increasing intestinal motility. It increases mass and water content of stool, promoting evacuation. It creates a barrier between the colon wall and feces.

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.

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 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.

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 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 bo

Defecation is normally stimulated by what physiologic trigger? Movements and reflexes in the gastrointestinal tract Stimulation from the medulla oblongata Synthesis and release of digestive enzymes Changes in the osmolarity of bowel contents

Movements and reflexes in the gastrointestinal tract Defecation is normally stimulated by movements and reflexes in the gastrointestinal tract. It does not result from changes in osmolarity, central nervous system (CNS) stimulation of the medulla, or the release of digestive enzymes.

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 *Castor oil *Lactulose

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

Which is an important assessment for the nurse to make before administering a laxative? **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. **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. 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 Metoclopramide can be given orally, intramuscularly, or intravenously but not rectally.

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 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 patient is receiving lactulose (Enulose) three times a day. The nurse knows that the patient is not constipated and is receiving this drug for which reason? a. High ammonia levels due to liver failure b. Prevention of constipation c. Chronic renal failure d. Chronic diarrhea

a. High ammonia levels due to liver failure Lactulose (Enulose) produces a laxative effect but also works to reduce blood ammonia levels by converting ammonia to ammonium. Ammonium is a water-soluble cation that is trapped in the intestines and cannot be reabsorbed into the systemic circulation. This effect has proved helpful in reducing elevated serum ammonia levels in patients with severe liver disease. The other options are incorrect.

A patient will be taking bismuth subsalicylate (Pepto-Bismol) to control diarrhea. When reviewing the patient's other ordered medications, the nurse recognizes that which medication or medication class will interact significantly with the Pepto-Bismol? a. Hypoglycemic drugs b. Antibiotics c. Acetaminophen (Tylenol) d. Antidepressants

a. Hypoglycemic drugs Taking hypoglycemic drugs with an adsorbent such as bismuth subsalicylate may result in decreased absorption of the hypoglycemic drugs. The other options are incorrect.

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? * assessment of cognition and neurological status *assessment of oxygen saturation and respiratory rate *assessment of nutritional status *assessment of fluid and electrolyte balance

assessment of 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 is more vulnerable during prolonged diarrhea than neurological, nutritional, or respiratory status.

The nurse is preparing to administer methylnaltrexone (Relistor), a peripherally acting opioid antagonist. This drug is appropriate for which patient? a. A patient with diarrhea b. A terminally ill patient who has opioid-induced constipation c. A patient who is scheduled for a colonoscopy d. A patient who will be having colon surgery in the morning

b. A terminally ill patient who has opioid-induced constipation Methylnaltrexone is approved only for terminally ill (hospice) patients who have opioid-induced constipation. The other options are incorrect.

A patient wants to prevent problems with constipation and asks the nurse for advice about which type of laxative is safe to use for this purpose. Which class of laxative is considered safe to use on a long-term basis? a. Emollient laxatives b. Bulk-forming laxatives c. Hyperosmotic laxatives d. Stimulant laxatives

b. Bulk-forming laxatives Bulk-forming laxatives are the only laxatives recommended for long-term use. Stimulant laxatives are the most likely of all the laxative classes to cause dependence. The other options are incorrect.

Before administering alosetron, the nurse should ensure that the client has been made aware of what potentially severe adverse effect? *bowel obstruction *blood dyscrasias *anal fissures *diverticulosis

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.

A patient is taking linaclotide (Linzess) to treat irritable bowel syndrome (IBS). The nurse will monitor this patient for which adverse effect? a. Chest pain b. Chronic constipation c. Abdominal pain d. Elevated blood glucose levels

c. Abdominal pain Common adverse effects of linaclotide (Linzess) are diarrhea, abdominal pain, and flatulence. Elevated blood glucose levels, chest pain, and chronic constipation are not adverse effects of linaclotide.

A patient is severely constipated and needs immediate relief. The nurse knows that which class of laxative will provide the most rapid results? a. Bulk-forming laxative, such as psyllium (Metamucil) b. Stool softener, such as docusate salts (Colace) c. Magnesium hydroxide (MOM) d. Magnesium oxide tablets

c. Magnesium hydroxide (MOM) Saline laxatives such as magnesium hydroxide (MOM) produce a watery stool, usually within 3 to 6 hours of ingestion. Bulk-forming laxatives such as psyllium do not produce a bowel movement rapidly. Stool softeners such as docusate salts do not cause patients to defecate; they simply soften the stool to ease its passage. Magnesium oxide tablets are used as magnesium supplements, not as laxatives.

A patient will be taking bismuth subsalicylate (Pepto-Bismol) to control diarrhea. When reviewing the patient's other ordered medications, the nurse recognizes that which medication will interact significantly with the Pepto-Bismol? a. Acetaminophen (Tylenol), an analgesic b. Levothyroxine (Synthroid), a thyroid replacement drug c. Warfarin (Coumadin), an anticoagulant d. Fluoxetine (Prozac), an antidepressant

c. Warfarin (Coumadin), an anticoagulant The oral anticoagulant warfarin is more likely to cause increased bleeding times or bruising when co-administered with adsorbents. This is thought to be because the adsorbents bind to vitamin K, which is needed to make certain clotting factors. Vitamin K is synthesized by the normal bacterial flora in the bowel. The other options are incorrect.

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

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? dark stool photosensitivity 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 client who has suffered a myocardial infarction is prescribed a laxative to help prevent straining during defecation. Which medication would the nurse expect to administer? docusate psyllium lubiprostone lactulose

docusate Docusate a stool softener, may be prescribed after a myocardial infarction to prevent straining during defecation. Psyllium is a bulk-forming laxative and may require straining to eliminate. Lubiprostone and lactulose are hyperosmotic agents that are used to relieve constipation and the reduction of blood ammonia levels in hepatic encephalopathy which may require straining.

The nurse should prioritize what assessment when providing care for a client who has taken over-the-counter (OTC) bisacodyl daily for several months? *bleeding *apical heart rate *deep tendon reflexes *electrolyte levels

electrolyte levels People should not use bisacodyl frequently or for longer than 1 week because it may produce serum electrolyte and acid-base imbalances (e.g., hypocalcemia, hypokalemia, metabolic acidosis, or alkalosis). Assessment of electrolytes would thus be warranted in the care of this client. Reflexes, heart rate, and coagulation factors may be affected, but these would be consequent to alterations in electrolyte levels.

A patient calls the clinic and tells the nurse of a need to sleep. In talking with the patient, the nurse notes that the patient has had diarrhea and has taken loperamide (Imodium). The nurse knows that a common side effect of loperamide (Imodium) is: fatigue. flatulence. disorientation. tremors.

fatigue. Other adverse effects that have been reported include fatigue, weakness, dizziness, and skin rash.

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 *hyperthyroidism *intestinal neoplasm *colitis

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.

A hospitalized client's request for a magnesium citrate "bisacodyl pill" every night to "keep regular" should alert the nurse to what potential health risk for the client? * laxative abuse * bulimia-induced purging *poor intake of dietary fiber * effective knowledge related to laxative use

laxative abuse Stimulant laxatives such as bisacodyl are generally useful and safe for short-term treatment of constipation, cleansing the bowel prior to endoscopic examinations, and treating fecal impaction. However, they are not safe for frequent or prolonged usage but are often used or overused in older adults.

The nurse should know that lactulose achieves a therapeutic effect by which means? *decreasing the viscosity of intestinal contents in the duodenum *pulling water into the intestinal lumen by osmotic pressure *irritating the intestinal mucous membrane *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.