Pre Chapter 39: Drug Therapy for Constipation and Elimination Problems

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.

An older client with constipation says, "I took a dose of psyllium yesterday, but it has not worked." Which response will the nurse make?

"It might take 2 or 3 days for it to be effective."

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

You are preparing to administer a saline cathartic when the patient mentions that they have CHF. You know that saline cathartics are contraindicated for clients with congestive heart failure due to what adverse effect?

Hypernatremia

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."

The health care provider has determined that an older adult client would benefit from using a bulk-forming laxative. What instruction should the nurse include when providing education related to proper drug use?

"Make sure you take the laxative with a glass of water."

The nurse is preparing to administer medications to a group of clients. For which client is bisacodyl contraindicated?

4-year-old

During a routine clinic visit, a client reports using an over-the-counter antidiarrheal agent for treatment of diarrhea. The nurse reviews the drug information with the client and determines the client grasps the importance of contacting the primary health care provider if the diarrhea is not resolved within which time frame?

48 hours

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 teaching a client who is to be discharged with an order to use chemical stimulant laxatives PRN. The nurse should caution the client about what potential adverse effect?

Abdominal cramping

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

A nurse has administered bismuth to a client with diarrhea. Which intervention should the nurse perform to promote an optimal response to the prescribed drug therapy?

Administer the drug after each loose bowel movement.

A client with intestinal stenosis is showing signs of colon obstruction after beginning psyllium. What intervention should the nurse prioritize?

Administer the drug with adequate fluid intake.

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.

A client reports using chamomile tea as a remedy to treat gastrointestinal upset. The nurse should assess the client for a hypersensitivity to which plants?

Although chamomile is generally safe and nontoxic, the tea is prepared from the pollen-filled flower heads and has resulted in symptoms ranging from contact dermatitis to severe anaphylactic reactions in individuals hypersensitive to ragweed, asters, and chrysanthemums.

The nurse is preparing to administer an antidiarrheal to a client. The nurse will question this order if which organism is documented on the stool sample report?

Antidiarrheals are contraindicated in clients whose diarrhea is associated with Shigella, Salmonella, and E. coli, which can harm the intestinal mucosa.

A nurse is preparing to administer diphenoxylate to a client. The nurse should teach the client they may experience which adverse effects?

Because diphenoxylate is opioid related, it may have sedative, slowed GI, and euphoric effects

The nurse is teaching a class on laxative medications. What medication would the nurse explain is a chemical stimulant?

Bisacodyl (Dulcolax)

The nurse is preparing to administer a laxative that adds bulk and water to the contents of the intestines. Which drug would the nurse be likely to administer?

Bulk-producing laxatives, like methylcellulose and polycarbophil, produce their laxative effect by adding bulk and water to the contents of the intestines, thereby stimulating intestinal peristalsis.

A client's history reveals that the client is experiencing intestinal gas. Which medication would the nurse expect the primary health care provider to prescribe?

Charcoal and simethicone are antiflatulents used to help relieve gas in the intestinal tract of a client.

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

Constipation is a frequent problem. The nurse knows that which of these statements regarding constipation is correct?

Constipation is characterized by hard, dry stools.

The nurse is aware that critically ill clients are more at risk for constipation for what reasons?

Critically ill clients are more at risk for constipation because of decreased activity, decreased access to a high-fiber diet, the use of opioid medications, and changes in usual bowel routines. Reference:

A student asks the physiology instructor what failure to respond to the defecation reflex will cause. What would the instructor answer?

Decreased sensory stimulation of reflex

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

A new mother required an episiotomy during the birth of her baby. Two days after delivery, the client is in need of a laxative. What will be the most effective drug for the nurse to administer?

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

Which of the following produce their laxative effect by dehydrating local tissues, which causes irritation and increased peristalsis, with consequent evacuation of the fecal mass?

Hyperosmotic agents, like glycerin (Fleet Babylax) and lactulose (Chronulac), produce their laxative effect by dehydrating local tissues, which causes irritation and increased peristalsis, with consequent evacuation of the fecal mass.

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

The nurse is caring for a client who is diagnosed with hepatic encephalopathy. The nurse knows that which medication will be used to treat the constipation that accompanies this condition?

Lactulose

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

Measures to prevent constipation include: drink plenty of fluids, get exercise, and eat foods high in bulk or roughage.

After teaching a group of nursing students about upper gastrointestinal system drugs, the instructor determines that the teaching was successful when the students correctly choose which drug as a gastrointestinal stimulant?

Metoclopramide

You are caring for four clients. Which client would you know is at highest risk for constipation?

Paraplegic

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 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)

A client is advised to use a bulk-forming laxative to alleviate constipation. The nurse will recommend:

Psyllium (Metamucil).

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 a history of constipation has been taking over-the-counter laxatives with good success. The client tells the nurse that he or her is relieved to have found a solution to his or her constipation. When providing health education, the nurse should prioritize what topic?

Strategies for preventing dependence on laxatives

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

Taking the agent with a large amount of water

A nurse has administered cascara sagrada to a client with constipation. Which effects should the nurse prioritize in the client after administration of the drug?

The nurse should monitor for pink-red, red-violet, red-brown, yellow-brown, or black discoloration of urine after administration of cascara sagrada to the client.

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 client taking a chemical stimulant laxative and medications for heart failure and osteoarthritis calls the clinic and reports, "I'm just not feeling right." What is the priority question the nurse should ask this client?

Timing of medication administration

The nurse is providing care to a client with hepatic encephalopathy. Which would the nurse anticipate administering to assist in lowering the client's blood ammonia level?

lactulose

A client diagnosed with hemorrhoids reports intense pain when straining to pass stools. What type of agent would the nurse expect to be the first choice for this client?

stool softener

An older client with hypertension reports frequent constipation. Which type of medication will the nurse ask the health care provider to prescribe for this client?

stool softener

The parent of a school-age client reports that the child frequently fights the urge to defecate because of a fear of using public restrooms. The nurse should inform the parent that this behavior can result in what problem?

weakened defecation reflex