Chapter 58 - Drugs Affecting Gastrointestinal Mobility
The nurse teaches the patient that a common adverse effect of loperamide is what? A) Fatigue B) Flatulence C) Disorientation D) Tremors
Ans: A Adverse effects associated with antidiarrheal drugs such as constipation, distension, abdominal discomfort, nausea, vomiting, dry mouth, and even toxic megacolon, are related to their effects on the GI tract. Other adverse effect that have been reported include fatigue.
What drug does the nurse recognize as being classified as a chemical stimulant? A) Bisacodyl B) Polycarbophil C) Magnesium hydroxide D) Docusate
Ans: A Bisacodyl is a chemical stimulant. Polycarbophil and mag hydroxide are bulk laxatives. Docusate is a lubricant laxative.
The patient had surgery 2 days ago and bowel motility has not returned. What drug might the nurse administer to stimulate the GI tract? A) Dexpanthenol B) Docusate C) Psyllium D) Senna
Ans: A Dexpanthenol is indicated for the prevention of intestinal atony or loss of intestinal muscle tone in postoperative adults.
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) Strepococcus Type B D) Psuedomonas
Ans: A E Coli is the most common cause of travelers diarrhea.
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 Indictiations for metoclopramide include relief of acute and chronic diabetic gastroparesis, short term treatment of GERD in adults who can not tolerate standard therapy, prevention of postoperative or chemo induced nausea and vomiting, facilitation of small bowel intubation, stimulation of gastric emptying, and promotion of intestinal trasnit of barium. It would not be used for treatment of impaction, encopresis, and in patients requiring diagnostic procedures.
The nurse administers lubiprostone 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 motility D) Stimulate the bowel by increasing innervation
Ans: A 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 meds to relieve pain. The pt 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 B) Castor oil C) Paregoric D) Mineral oil
Ans: A Methylnaltrexone was approved for 2008 for 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 with this patient.
The family brings a patient to the ED 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 Opium derivates, like paregoric, are associated with lightheadedness, sedation, euphoria hallucinations, and respiratory depression related to their effect on opioid receptors. Nonopioids such as bismuth sub and loperamide would not cause respiratory depression. Colace is a stool softener, not an antidiarrheal.
The nurse administers loperamide to decrease the number and liquidity of stool by what mechanism? A) Decreasing intestinal motility B) Absorbing toxins C) Biding with fecal material to increase bulk D) Blocking the chemoreceptor trigger zone
Ans: A Systemic antidiarrheal agents slow the mobility of the GI tract through direct action on the lining of the GI tract to inhibit local reflexes, through direct action on the muscles of the GI tract to slow activity, or through action on central nervous system centers that cause GI spams and slowing.
What drug does the nurse adinister 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 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.
The nurse, proving patient teaching, explains that difenoxin and diphenoxylate are chemically related to what medications? A) Morphine B) Demerol C) Diphenhydramine D) Diflucan
Ans: B Difenoxin and diphenoxylate are chemically related to meperidine and are used at doses that decrease GI activity without having analgesic or respiratory effects.
What is the priority nursing diagnosis for an 89 yo 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 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 deficient may be concerned for this patient, they are not the priority.
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 B) Lactulose C) Magnesium sulfate D) Castor Oil
Ans: B Lactulose is often the drug of choice when a patient with cardiovascular problems require 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.
The nurse develops a teaching plan for a 77 yo patient who has been prescribed loperamide PRN> The nurses priority teaching is what? A) May cause hallucinations or respiratory depression B) Take the drug after each loose stool C) Drug remains in the bowel without being absorbed into the blood stream D) Avoid pregnancy and breast-feeding while taking the drug
Ans: B Loperamide is taken repeatedly after each loose stool. Teaching when to take the drug is a priority teaching point. Paregoric causes hallucinations and resp depression, it is absorbed systemically, and it is unlikely a 77 yo patient will get pregnant.
What is the antidiarrheal of choice the nurse will administer to children older than 2 years of age with diarrhea? A) Bismuth salts B) Loperamide C) Paregoric D) Difenoxin
Ans: B Loperamide may be the antidiarrheal of choice in children older than 2 years of age if such drug is needed.
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) Colase D) Dulcolax
Ans: B Mineral oil ( Agoral Plain) is not absorbed and forms a slippery coat on the contents of the intestinal tract. The other options shown do not have this same effect of reducing the risk of another impaction as well as helping to eliminate stool.
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 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. This drug should be taken no more than 4 times a day and should not be taken at night.
The home health nurse is caring for a 72 yo man in his home. He complains about almost daily diarrhea. The nurse assess for what common cause of diarrhea in older adults? A) Diabetes B) Hypertensive medications C) Laxative overuse D) Glaucoma
Ans: C Diarrhea in older adults may result from laxative overuse so the nurse should assess what otc drugs the patient is using.
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 GI tract C) to evacuate the bowel for diagnostic procedures D) To trat chronic constipation
Ans: C 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 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 case GI tract exhaustion.
When would it be appropriate for the nurse to administer a cathartic laxative to the patient? SATA A) Partial-bowel obstruction B) Appendicitis C) After having a baby D) After a mi E) After anthelmintic therapy
Ans: C, D, E Laxative, or cathartic, drugs are indicated for the short-term relief of constipation, to prevent straining when it is clinically undesirable, such as surgery, MI, or obstetric delivery. Also to evacuate the bowel for diagnostic procedures, to remove ingested poisons from the lower gi tract, and as an adjunct in anthelminitc therapy when it is desirable to flush helminths from the GI tract.
The nurse administers psyllium hydrophilic mucilliod expecting it to have what action? A) Slow peristalsis B) Promotes reabsorption of water into the bowel C) Has antibacterial properties D) Adds bulk to the stool
Ans: D Psyllium hydrophilic mucilliod 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.
What antidiarreal would the nurse administer to reduce the volume of discharge from the patients ileostomy? A) Diphenoxylate B) Octreotide C) Psyllium D) Loperamide
Ans: D Loperamide, bismuth subsalicylate, and opium derivatives are indicated for the reduction of volume of discharge from ileostomies.
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 mobility, increase fluid, and enlarge bulk of fecal matter
Ans: D Magnesium citrate is a rapid-acting, aggressive laxative that causes fecal matter to increase in bulk. It increases the motility of the 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 teaches the patient who is 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 Specifically related to chemical stimulants, cascara, although a reliable agent, may have either slow, steady action or may cause severe cramping and rapid evacuation of the contents of the large intestine.
A man with irritable bowl syndrome reports ongoing diarrhea and asks for a prescription for Alosetron, which was helpful for his coworker who recently started taking the drug. What is the nurses best response? A) The drug is only approved for use in women B) This drug is a laxative C) This durg is contraindicated with irritable bowl syndrome D) This drug is no longer on the market for prescription use
Answer: A Alosetron 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.
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 affects of this type of laxative is what? A) Abdominal cramping B) Rectal bleeding C) Confusion D) Iron deficiency anemia
Answer: A Common adverse effects of laxatives are diarrhea, abdominal cramping, and nausea. The other answers are ot associated with appropriate use of laxatives but may occur if laxatives are abused.
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
Answer: B Because laxatives increase the mobility of the GI tract and some laxatives interfere with the timing process of absorption, it is not advisable with other prescribed medications. The administration of laxatives and other medications and should be separated by at least 30 mins, so the nurse should question when the patient is taking the laxatives and other meds.
The nurse will question an order for bismuth salts in a patient with what condition? A) Rheumatoid arthritis B) Allergy to aspirin C) Hypertension D) Viral gastroenteritis
Answer: B Bismuth salts 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 RA, hypertensionm or viral gas.
A patient who is taking metoclopramide 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 B) Digoxin C) Furosemide D) Acetylsalicylic acid
Answer: B Metoclopramide has been associated with decreased absorption of digoxin from the GI tract. The nurse should monitor patients taking this combination carefully.
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
Answer: B The best way to maintain GI function is through proper diet including optimizing fiber intake, and exercise, which will stimulate GI activity.
A patient receiving loperamide should be alerted by the nurse to what possible adverse effect? A) Anxiety B) Bradycardia C) Fatigue D) Urinary retention
Answer: C Loperamide may cause fatigue.
What should the nurse tell the patient who will begin taking rifaximin for travelers disease? A) Do not start 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 is you have bloody diarrhea D) Start the drug 3 days before leaving for your trip and continue when you return
Answer: C Rifaximin should not be taken if a patient has bloody 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 veggies washed up in tap water.
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 (Dulcalax) B) Castor Oil ( Neolid) C) Magnesium sulfate (epsom salts) D) Docusate (Colace)
Answer: D Docusate is a stool softener that will make expulsion of stool easier in a traumatized area following a episiotomy. Care must be taken to choose a mild laxative that will not enter the breast milk and not affect the newborn if the mother is nursing. Docusate is the choice as 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 the breast milk.
The nurse admits to the clinic a 7 month old infant whose mother reports that the baby has not had a bowl movement in 6 days. What drug would be appropriate to treat this patient? A) Cascara B) Magneisum hydroxide (milk of magnesia) C) Polyethylene glycol-electrolyte solution ( GoLYTELY) D) Glycerin (Sani-Supp)
Answer: D Glycerin suppositories are the best choice for infants and young children when constipation is a problem.
The home health nurse is caring for a patient with encopresis wo 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
Laakage and staining may be a problem when mineral oil is used and the stool cannot be retained by the external sphincter. Mineral oil doesnt cause nausea, vomiting, or vitamin c def.
