PrepU - Chapter 58

A caregiver of a 1-year-old asks the nurse if the caregiver can give the diphenoxylate that was prescribed for an older sibling to the child. Which is the nurse's best response?

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

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

A client is prescribed an antidiarrheal that acts directly on the muscle wall of the bowel to slow motility. The nurse would identify which drug as being prescribed?

Loperamide

The nurse is preparing to administer cascara to a client. The nurse anticipates administering this drug by which route?

Oral

The client has been prescribed diphenoxylate with atropine (Lomotil) for diarrhea. The nurse recognizes that this drug is effective against diarrhea because of which action?

Slows peristalsis by acting on the smooth muscles of the intestine

A client has ingested a toxic substance. Which medication is the preferred medication for the removal of a toxic agent?

Sorbital

A client who is taking magnesium citrate experiences sweating, palpitations, and flushing. The nurse understands that this is most likely related to which of the following?

Sympathetic stress reaction due to intense GI tract neurostimulation

A client is taking psyllium hydrophilic mucilloid daily. What information should be included in the discharge plan?

Up to 30 g of fluid with the medication can be divided over several divided doses daily.

A middle-aged client, frustrated by increasingly frequent episodes of constipation, is highly reluctant to take medications. What nonpharmacologic measure should the nurse recommend?

Use of a fiber supplement

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?

"A soft, formed stool."

A nurse is teaching a group of older adults about strategies for preventing constipation that do not involve the use of medications. The nurse should recommend what intervention? Select all that apply.

- Consuming a high-fiber diet - Drinking 6 to 10 glasses of fluid each day - Engaging in frequent physical exercise

Which of the following are effects that a client might experience while taking diphenoxylate (Lomotil)? Select all that apply:

- Euphoric effects - Sedative effects - Slowed GI effects

What medical diagnoses would the nurse suspect if the client is experiencing diarrhea with mucus, proteins, and blood in the stool? Select all that apply.

- Gastroenteritis - Diverticulitis - Ulcerative colitis - Crohn's disease

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

Which method is used to discourage the client from taking an excessive dosage of diphenoxylate HCl?

A small amount of atropine sulfate is combined with diphenoxylate HCl.

Before administering alosetron, the nurse should ensure that the client has been made aware of what potentially severe adverse effect?

Bowel obstruction

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

Diphenoxylate with atropine sulfate resolves diarrhea by what mechanism of action?

Decreasing intestinal motility

A community health nurse is conducting a health promotion session with a group from a local seniors' center. The nurse has addressed the issue of laxative overuse in this population. The nurse should highlight what consequence of the overuse of laxatives?

Dependence

Which would be most important to include when teaching a patient about using psyllium?

Taking the agent with a large amount of water

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

Aspirin

Defecation is normally stimulated by what physiologic trigger?

Movements and reflexes in the gastrointestinal tract

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

Nausea

What assessment is most important to make before administering bismuth subsalicylate?

Assess for allergy to aspirin

A nurse is teaching a client about diarrhea. Which statement by the client regarding diarrhea would indicate a need for additional teaching?

"Diarrhea is a disease that has no cure."

A nurse is teaching a client about antidiarrheal medications. Which statements are included in the teaching? Select all that apply.

- "If diarrhea continues for more than 3 days, additional actions are necessary." - "An episode of diarrhea is a defense mechanism of the body." - "Diarrhea may be acute or chronic." - "Young children and the elderly are at risk for serious fluid and electrolyte disturbances."

What classification of medication can cause diarrhea? Select all that apply.

- Antineoplastic agents - Antibacterials - Selective serotonin reuptake inhibitors (SSRIs) - Magnesium-based antacids

What is a true statement regarding diphenoxylate with atropine? Select all that apply.

- It is a controlled substance - Requires a prescription

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

- Suppository - Oral

The nurse administers metoclopramide orally at 9:00 AM to a patient with GERD. The nurse would expect this drug to exert its maximum effectiveness at which time?

10:00 AM to 10:30 AM

A client has contacted the clinic, stating to the nurse, "I've been taking loperamide for the past day-and-a-half, and my diarrhea shows no signs of slowing down." The nurse should respond to the client in the knowledge that loperamide should be discontinued if the diarrhea does not improve within what time frame?

12 hours

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

2

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

A bulk-forming (fiber) laxative

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?

Abdominal pain and fever

Which would the nurse identify as being affected by dexpanthenol?

Acetylcholine

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.

When administering a bulk laxative to a client, which action is important for the nurse to take?

Administer the laxative with a full glass of water or juice.

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

Allergy to aspirin

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 fluid and electrolyte balance

The parent of a 15-year-old girl reports that the teen has chronic diarrhea, lacks an appetite, is significantly underweight with dry hair and skin while an oral assessment reveals erosion of tooth enamel. When asked, the client reports occasional laxative use for "constipation." What medical condition do these findings best support?

Bulimia with laxative abuse

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.

A nurse is caring for a client who 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.

The nurse should educate the client prescribed a stimulant cathartic to be alert for which common adverse effect?

Diarrhea

The nurse is preparing to administer a stimulant cathartic to the client. The nurse should inform the client of the possible adverse effect of:

Diarrhea.

The nurse explains that there is no "normal" number of daily stools because of differences in what contributing factor?

Diet

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

Dizziness

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?

Docusate

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)

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

Ducosate

When describing the drugs used to treat traveler's diarrhea, which would the nurse identify as the most common cause?

E. coli

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

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

A prescriber adds psyllium to the medication administration record for a client experiencing diarrhea. Which is the best rationale for the addition of psyllium?

It absorbs toxins and water, decreasing fluidity of stools.

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

Lactase deficiency

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

What is the correct rationale for why the nurse would administer a laxative at a separate time from the client's other medications?

Laxatives may reduce absorption of other drugs present in the GI tract.

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?

Lubiprostone

The nurse is caring for a client with Giardia lamblia and anticipates that the provider will order what drug for the treatment of this client's diarrhea?

Nitazoxanide

A client is scheduled for a colonoscopy in the morning. The nurse will provide information concerning which laxative?

Polyethylene glycol-electrolyte solution

A client is scheduled for a colonoscopy in the morning. What laxative would the nurse expect to be prescribed the evening before the procedure?

Polyethylene glycol-electrolyte solution

A hospital client has been scheduled for a barium enema the following morning. The nurse should anticipate what prescription for the client's bowel preparation?

Polyethylene glycol-electrolyte solution

A client is scheduled for a colonoscopy. The nurse knows that the preferred drug for bowel cleansing before this procedure is:

Polyethylene glycol-electrolyte solution (NuLYTELY)

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 is useful in critically ill patients who experience constipation.

The nurse should know that lactulose achieves a therapeutic effect by which means?

Pulling water into the intestinal lumen by osmotic pressure

Which is an important assessment for the nurse to make before administering a laxative?

Question the client regarding the type and intensity of symptoms to provide a baseline evaluation.

A client with diarrhea was instructed by the pharmacist to take bismuth subsalicylate. The client took the medication as instructed for 36 hours and has now called the clinic reporting dark stools that are "nearly black." What is the nurse's best action?

Reassure the client that this is an expected effect of the drug that does not indicate pathology.

A client is admitted to the hospital for pneumonia. Since admission, the client has not had a bowel movement. The physician prescribes magnesium hydroxide. What should be an outcome of this therapy?

The client will have a bowel movement after taking the drug.