PrepU Ch 39 Drug Therapy for Constipation and Elimination Problems
An instructor is preparing a teaching plan for a group of students about the usual indications for laxatives. Which would the instructor include as an indication? a. Long-term relief of constipation b. Adjunct in anthelmintic therapy c. Promotion of bearing down efforts for bowel evacuation d. Improved overall activity of the GI tract
b
An older client with constipation says, "I took a dose of psyllium yesterday, but it has not worked." Which response will the nurse make? a. "You might be eating too much food for it to work properly." b. "It might take 2 or 3 days for it to be effective." c. "There are other preparations you can try." d. "Maybe you are drinking too much water."
b
Which is an important assessment for the nurse to make before administering a laxative? a. Once a medication is ordered by the health care provider, it is unnecessary to make any additional assessments before administering the medication. b. Question the client regarding the type and intensity of symptoms to provide a baseline evaluation. c. It is imperative to ask clients whether they are expecting any visitors because the effects of the medication may hinder visitation. d. An abdominal circumference measurement is an important assessment for the nurse to make in order to evaluate medication effectiveness.
b
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? a. Hyperphosphatemia b. Hypernatremia c. Hypomagnesemia d. Hypochloremia
b
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? a. Headache b. Weakness c. Abdominal cramping d. Dizziness
c
You are caring for four clients. Which client would you know is at highest risk for constipation? a. Diabetic b. Triathlete c. Paraplegic d. Client on antihypertensive medications
c
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? a. Creating a barrier between the colon wall and feces b. Irritation of the intestinal mucosa c. Reducing the surface tension of bowel contents d. Increasing mass and water content of stool
d
The nurse is caring for a client who has had impacted stools twice in the past month. What is the most appropriate laxative for this client? a. Psyllium b. Docusate c. Magnesium hydroxide d. Mineral oil
d
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. Bismuth subsalicylate b. A stimulant laxative c. A hyperosmotic laxative d. A bulk-forming (fiber) laxative
d
The nurse is conducting a class on nonpharmacologic treatment for occasional constipation. Which treatments will the nurse recommend? (Select all that apply.) a. Eat more high-fiber foods b. Use of probiotics c. Use of prebiotics d. Decrease fluid intake e. Decrease the amount of daily exercise
a, b, c
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? a. Magnesium sulfate b. Castor oil c. Docusate d. Bisacodyl
c
A client is advised to use a bulk-forming laxative to alleviate constipation. The nurse will recommend: a. Psyllium (Metamucil). b. mineral oil. c. Docusate (Colace). d. milk of magnesia.
a
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? a. Docusate b. Psyllium c. Sorbitol d. Fiber
a
A client with constipation is prescribed psyllium. The client asks the nurse how the client should take the medication. What is the nurse's best response? a. "Take this medication with 8 ounces of water." b. "Drink 4 ounces of soda a day. " c. "Mix the medication with grapefruit juice and water." d. "You should sprinkle the medication on the food."
a
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? a. Abdominal pain and fever b. Lack of urge to defecate c. Frequent episodes of flatulence d. Lack of bowel movement for 5 days
a
The nurse is conducting a pre-colonoscopy class and knows that polyethylene glycol- electrolyte solution will be contraindicated for the client with which condition? a. Colitis b. Gastresophageal reflux disease c. Chronic constipation d. Oral stomatitis
a
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? a. lactulose b. lubiprostone c. psyllium d. Mineral oil
a
The nurse is teaching a class on laxative medications. What medication would the nurse explain is a chemical stimulant? a. Bisacodyl (Dulcolax) b. Polycarbophil (FiberCon) c. Docusate (Colace) d. Magnesium hydroxide (Milk of Magnesia)
a
The nurse receives a call from a client who is taking lactulose. The client reports having two to three soft stools every day and the client is afraid of developing diarrhea. What is the nurse's best response to this client? a. "That is exactly what the medication is supposed to do." b. "You should be having six to ten stools today, double the dose of medication." c. "Stop taking the medication immediately." d. "Only take half of your usual dose today and take your regular dose tomorrow."
a
The nurse recognizes that a client needs additional instruction if the client makes which comment about treatment for occasional constipation? a. "I will make sure that I have a bowel movement every day." b. "I will make sure to drink an adequate amount of fluid every day." c. "I will choose more foods with fiber." d. "I will obey the urge to have a bowel movement when it occurs."
a
The nurse knows that clinical conditions that can promote constipation include which of the following? Select all that apply. a. Antihistamines for allergy b. Parkinson's disease c. Anorexia d. Hypocalcemia e. Hyperthyroidism
a, b, c
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. a. drinking 6 to 10 glasses of fluid each day b. introducing organic foods into the daily diet c. consuming a high-fiber diet d. reserving at least 8 hours nightly to assure adequate sleep e. engaging in frequent physical exercise
a, c, e
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? a. lubiprostone b. docusate c. lactulose d. psyllium
b
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? a. Allow formation of a slippery coat on the intestinal contents b. Increase the fluid in the intestinal contents c. Selectively antagonize opioid binding d. Directly stimulate the nerve plexus in the intestinal wall
b
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? a. bulimia-induced purging b. laxative abuse c. effective knowledge related to laxative use d. poor intake of dietary fiber
b
A newly admitted 58-year-old client has a diagnosis of alcohol abuse and chronic liver failure. The health care provider suspects the client has hepatic encephalopathy. The client tells reports not having a bowel movement in 5 days. What laxative can this client take to lower serum ammonia levels? a. Sorbitol b. Lactulose c. Docusate sodium d. Polyethylene glycol-electrolyte solution
b
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? a. Mineral oil b. Docusate (Colace) c. Milk of magnesia d. Bisacodyl (Dulcolax)
b
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? a. Four stools per week b. Three stools per week c. Five stools per week d. Six stools per week
b
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? a. saline cathartic b. stool softener c. bulk-forming laxative d. oil retention enema
b
Older adults who are unable or unwilling to eat an adequate diet or who are debilitated may benefit from using bulk-forming laxatives. What is an important teaching regarding intake for anyone using bulk-forming laxatives? a. Ensure adequate fat intake b. Ensure adequate fluid intake c. Ensure adequate protein intake d. Ensure adequate roughage intake
b
The nurse is giving instructions to a client who will be having a colonoscopy in the morning. The client will be taking polyethylene glycol-electrolyte solution for bowel cleaning. What information will help increase the palatability of this medication? a. Warm the liquid in the microwave for 25 seconds before using it. b. Refrigerate the solution until it is cold. c. Allow the liquid to warm up before drinking it. d. Add ice cubes to each glass of liquid.
b
The nurse provides drug teaching to the client who will begin taking polycarbophil. What is the nurse's priority teaching point? a. The drug can be taken up to 6 times per day. b. Drink lots of water when taking the drug. c. Do not eat or drink anything for 2 hours after taking the medication. d. Take at night before bedtime.
b
What is the correct rationale for why the nurse would administer a laxative at a separate time from the client's other medications? a. They often taste bad and clients are less likely to take other medications. b. Laxatives may reduce absorption of other drugs present in the GI tract. c. Often laxatives make the client nauseated, which interferes with the ability to take medications. d. Because a laxative may stimulate a bowel movement, it can interfere with medication administration.
b
Which drugs used to treat constipation should be used cautiously in pediatric and debilitated clients because of the risk of aspiration leading to lipid pneumonitis? a. psyllium b. mineral oil c. lactulose d. lubiprostone
b
A 94-year-old client is to begin taking psyllium hydrophilic mucilloid daily. What instructions should the nurse include in the discharge teaching? a. Discontinue the mucilloid if no bowel movement occurs in 24 hours. b. Mix the medication with your food at your evening meal. c. Drink at least 8 ounces of fluid with the medication. d. Add all of the medications to the mucilloid.
c
A client is scheduled for a colonoscopy. The nurse knows that the preferred drug for bowel cleansing before this procedure is: a. Polyethylene glycol solution (MiraLAX) b. Psyllium (Metamucil) c. Polyethylene glycol-electrolyte solution (NuLYTELY) d. Bisacodyl (Dulcolax)
c
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? a. The amount of fiber intake b. Amount of fluid intake c. Timing of medication administration d. Previous effectiveness of laxatives
c
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? a. up to 8 days b. 5 to 7 days c. 2 to 3 days d. 12 to 24 hours
c
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? a. Preventive strategies against nausea and vomiting b. Optimal timing of food intake, fluid intake and laxative use c. Strategies for preventing dependence on laxatives d. Appropriate use of antidiarrheals in case of laxative overdose
c
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? a. Magnesium sulfate b. Bisacodyl c. Docusate d. Castor oil
c
A student asks the physiology instructor what failure to respond to the defecation reflex will cause. What would the instructor answer? a. Diarrhea b. Increased sensory stimulation of reflex c. Decreased sensory stimulation of reflex d. Involuntary evacuation
c
Which would be most important to include when teaching a patient about using psyllium? a. Taking the agent at bedtime b. Limiting the use of high fiber foods c. Taking the agent with a large amount of water d. Taking other prescribed drugs along with the psyllium
c
The nurse is aware that critically ill clients are more at risk for constipation for what reasons? (Select all that apply.) a. Increased access to a high-fiber diet b. Decrease in the amount of family interaction c. Decreased activity d. Use of opioid medications e. Change in bowel routines
c, d, e
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? a. stimulant cathartic b. saline cathartic c. bulk-forming laxative d. stool softener
d
A client needing to evacuate the colon for endoscopy would likely be prescribed which medication solution? a. mineral oil b. methylcellulose c. psyllium d. polyethylene glycol electrolyte
d
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? a. Laxatives are the preferred method for bowel management in older adults. b. Home care nurses should not become involved in their patients' bowel management. c. Psyllium can be used freely in children. d. Psyllium is useful in critically ill patients who experience constipation.
d
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? a. "Be sure to eat vegetables that provide roughage." b. "Increase your consumption of healthy fats." c. "Make sure each of your meals includes some protein." d. "Make sure you take the laxative with a glass of water."
d
The home health nurse is caring for an 82-year-old client who reports almost daily diarrhea. The nurse should assess for what common cause of diarrhea in older adults? a. Inadequate fluid intake b. Inactivity c. Antihypertensive medications d. Laxative overuse
d
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? a. "I will use milk of magnesia in conjunction with this medication until I am having daily bowel movements." b. "I will decrease the roughage in my diet while I am using this medication." c. "I will mix the dry medication with applesauce." d. "I will mix the medication with 4 to 8 ounces of liquid and follow it by an additional 4 to 8 ounces."
d
When administering a bulk laxative to a client, which action is important for the nurse to take? a. Other than standard safety measures, no additional actions are needed. b. Administer an anti-diarrheal medication simultaneously. c. Immediately place the client on a bedpan or commode. d. Administer the laxative with a full glass of water or juice.
d
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? Select all that apply: a. Bisacodyl (Dulcolax) b. Docusate sodium (Colace) c. Methylcellulose (Citrucel) d. Lactulose (Chronulac) e. Glycerin (Fleet Babylax)
d, e
