NUR 2092 Pharmacology Ch 58 Drugs affecting GI motility

A client develops Clostridium difficile after receiving antibiotic therapy. The client asks the nurse how this occurs. Which is the nurse's best response?

"By suppressing normal flora, antibiotics allow proliferation of the organism."

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."

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."

The nurse has just finished client education with a client who is being discharged home on bulk-forming laxatives. The nurse knows the client understands discharge instructions regarding these medications when which statement is made?

"I will mix the medication with 4 to 8 ounces of liquid and follow it by an additional 4 to 8 ounces."

A postoperative surgical client, prescribed twice-daily administration of docusate sodium, is concerned about developing diarrhea. What should the nurse teach the client about docusate sodium?

"This medication will only soften your stools over the next couple of days."

The parent of an adolescent client reports that the teen has chronic diarrhea and lacks an appetite. Assessment reveals that the client is significantly underweight, has dry hair, and exhibits erosion of tooth enamel. When asked, the client reports occasional laxative use for

"constipation." What condition does the nurse consider most likely? bulimia with laxative abuse

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

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 should counsel a client to discontinue use of over-the-counter antidiarrheals and seek treatment from a health care provider if diarrhea persists for how long?

2 days

A client was prescribed a cathartic laxative prior to scheduled sigmoidoscopy. The nurse should inform the client that it will take how long to experience another bowel movement?

2 to 3 days

The nurse understands that the drug docusate sodium (Colace) would be most appropriate for what client?

A 66-year-old client who is recovering from a heart attack

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

A client is being sent home with orders for a laxative PRN. The nurse is conducting client teaching on the use of a laxative. What will the nurse inform the client is one of the most common adverse effects of a laxative?

Abdominal cramping

A client's severe diarrhea has necessitated treatment with polycarbophil. The nurse should caution the client about the possibility of what adverse effect?

Abdominal fullness and bloating

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

The nurse is preparing to administer bismuth subsalicylate to a client. What assessment is most important to make before administration?

Allergy to aspirin

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

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

Alosetron

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

Aspirin

A client is taking bisacodyl to treat constipation. The nurse suggests that the client take the drug at which time?

Before going to bed

Cholestyramine and colestipol are useful in treating diarrhea due to which cause?

Bile salt accumulation

A health care provider prescribes a chemical stimulant laxative. Which would be appropriate?

Bisacodyl

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

Bismuth subsalicylate

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 is conducting a pre-colonoscopy class and knows that polyethylene glycol- electrolyte solution will be contraindicated for the client with which condition?

Colitis

An older adult has regularly drunk mineral oil to treat occasional episodes of constipation. The nurse should encourage the client to explore other treatments because the use of oral mineral oil can result in which adverse effect?

Decreased absorption of drugs and vitamins

The nurse is aware that critically ill clients are more at risk for constipation for what reasons? (Select all that apply.)

Decreased activity Use of opioid medications Change in bowel routines

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

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

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?

Docusate

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)

What recommendations should be included in client teaching as a means of avoiding constipation?

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

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

Dry mouth Lightheadedness

What is first-line therapy for infants and children 1 to 4 years of age with diarrhea?

Electrolyte replacement

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?

Fluid and electrolyte balance

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

What instruction should be included in the plan of care as a nonpharmacologic intervention for an older adult client experiencing diarrhea? Select all that apply.

Increase fluid intake to 2-3 liters per day. Consume a diet of bland foods such as rice, soup, and crackers.

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

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?

Increasing mass and water content of stool

A nurse is completing an assessment on a client experiencing diarrhea. The client states having had diarrhea for the past few days but prior to the diarrhea experienced one week of constipation. Based on the description, what does the nurse suspect?

Irritable bowel syndrome

The nurse is preparing to administer polycarbophil to a client experiencing liquid stools. How should the nurse describe the action of this substance?

It absorbs large amounts of water and decreases fluidity of stools.

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.

Why is loperamide generally associated with fewer adverse effects than diphenoxylate?

It does not affect the central nervous system.

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 interferes with vitamin absorption

A home health nurse is caring for a client with encopresis. The client has been started on mineral oil. What would be an adverse effect of this treatment?

Leakage

Defecation is normally stimulated by what physiologic trigger?

Movements and reflexes in the gastrointestinal tract

A client diagnosed with HIV/AIDS has diarrhea that is not responding to antidiarrheal agents. Which medication will best assist in treating this client's diarrhea?

Octreotide acetate

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

Oral

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.

Oral Suppository

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

Polycarbophil

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 nurse is caring for a client who has been diagnosed with constipation. The prescriber has ordered a laxative. What other interventions will the nurse include in the teaching plan? Select all that apply.

Regular aerobic exercise Diet with fruits, vegetables, and whole grains Increase fluid intake

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

Requires a prescription It is a controlled substance

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

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 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.

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

Three stools per week

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

Rifaximin has been prescribed for a client diagnosed with traveler's diarrhea. What information should the nurse include in the teaching plan about the medication?

Used for E. coli infections

A nurse is completing an admission assessment of a client who is having diarrhea. The client states that the diarrhea started after "abdominal surgery." The client cannot recall the type of surgery. Which does the nurse suspect as the cause of the diarrhea?

You Selected: excision of the small intestine

The nurse is caring for an older client who has been prescribed bisacodyl for constipation. Which assessment finding will convince the nurse to contact the health care provider about administering the bisacodyl?

abdominal pain

A client diagnosed with irritable bowel syndrome has been prescribed alosetron. The nurse should ensure that the client has been made aware of what potentially severe adverse effect?

bowel obstruction

I 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

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

A nurse is teaching a group of older adults about nonpharmacologic strategies for preventing constipation. The nurse should recommend what practices? Select all that apply.

drinking 6 to 10 glasses of fluid each day engaging in frequent physical exercise consuming a high-fiber diet

A hospitalized client requests a magnesium citrate "bisacodyl pill" every night to "stay regular." The nurse should initially be most concerned about what potential health risk for this client?

laxative abuse

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

Which adverse effects should the nurse teach a client to possibly expect when prescribed diphenoxylate with atropine? Select all that apply.

urinary retention nausea and vomiting dizziness

A client presents with fever, vomiting, and diarrhea. What should the nurse suspects are possible causes? Select all that apply.

virus bacterial toxin