CHAPTER 40 Drug Therapy for Diarrhea
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." "This is common of all antibiotic therapy and hospitalized clients." "The antibiotic decreases the white blood count, which allows for bacteria to invade the body." "The diarrhea is a result of overgrowth of viruses attacking the cells in the bowels."
"By suppressing normal flora, antibiotics allow proliferation of the organism." Explanation: Antibiotic-associated colitis is a serious condition that results from oral or parenteral antibiotic therapy from any client. By suppressing normal flora in the colon, antibiotics allow proliferation of other bacteria, especially gram-positive anaerobic Clostridium difficile organisms. These organisms cause fever, abdominal pain, and severe diarrhea with stools containing mucus, pus, and sometimes blood. Symptoms may develop within a few days or several weeks after the causative antibiotic is discontinued. C-diff is not common in all antibiotic therapy and hospitalized clients. The antibiotic does not decrease the WBC but decreases the bacteria, allowing the WBC to attack the bacteria. The diarrhea is not a result of overgrowth of viruses.
A client develops Clostridium difficile after receiving antibiotic therapy. The client asks the nurse how this occurs. Which is the nurse's best response? "The diarrhea is a result of overgrowth of viruses attacking the cells in the bowels." "The antibiotic decreases the white blood count, which allows for bacteria to invade the body." "This is common of all antibiotic therapy and hospitalized clients." "By suppressing normal flora, antibiotics allow proliferation of the organism."
"By suppressing normal flora, antibiotics allow proliferation of the organism." Explanation: Antibiotic-associated colitis is a serious condition that results from oral or parenteral antibiotic therapy from any client. By suppressing normal flora in the colon, antibiotics allow proliferation of other bacteria, especially gram-positive anaerobic Clostridium difficile organisms. These organisms cause fever, abdominal pain, and severe diarrhea with stools containing mucus, pus, and sometimes blood. Symptoms may develop within a few days or several weeks after the causative antibiotic is discontinued. C-diff is not common of all antibiotic therapy and hospitalized patients. The antibiotic does not decrease the WBC but decreases the bacteria allowing the WBC to attack the bacteria. The diarrhea is not a result of overgrowth of viruses.
During an assessment of a client experiencing diarrhea, which question is appropriate for the nurse in determining the possible cause of the diarrhea? "Can you tell me what you ate the last 24 hours?" "Have you recently consumed uncooked ground beef?" "Have you been vaccinated for hepatitis A?" "Do you wash your hands after you use the restroom?"
"Can you tell me what you ate the last 24 hours?" Explanation: During an assessment, the nurse should ask about food consumed in the last 24 hours. Intestinal infections with viruses, bacteria or protozoa are from uncooked ground beef, poultry, eggs, and dairy products. Asking about consumption of uncooked ground beef does not focus on the other sources of intestinal infections. Asking about washing hands after using the restroom is not appropriate since it is directed towards possible E. coli contamination. Vaccination for the hepatitis A is not pertinent for the assessment at this time. Two of the most common viral organisms responsible for diarrhea are rotavirus or Norwalk-like virus
During an assessment of a client experiencing diarrhea, which question is appropriate for the nurse in determining the possible cause of the diarrhea? "Can you tell me what you ate the last 24 hours?" "Do you wash your hands after you use the restroom?" "Have you been vaccinated for hepatitis A?" "Have you recently consumed uncooked ground beef?"
"Can you tell me what you ate the last 24 hours?" Explanation: During an assessment, the nurse should ask about food consumed in the last 24 hours. Intestinal infections with viruses, bacteria or protozoa are from uncooked ground beef, poultry, eggs, and dairy products. Asking about consumption of uncooked ground beef does not focus on the other sources of intestinal infections. Asking about washing hands after using the restroom is not appropriate since it is directed towards possible E. coli contamination. Vaccination for the hepatitis A is not pertinent for the assessment at this time. Two of the most common viral organisms responsible for diarrhea are rotavirus or Norwalk-like virus.
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? "The medication needs to be adjusted for the 1-year-old's weight." "There are over-the-counter medications that are better for the 1-year-old." "I will call the prescriber to find out if this is safe." "Children younger than 2 years of age should not be given this medication."
"Children younger than 2 years of age should not be given this medication." Explanation: Children younger than 2 years of age should not take the drugs, and those from age 2 to less than 13 years should take the liquid preparation to enhance accuracy of the dosage. Calling the prescriber is not necessary. The nurse-should not encourage over-the-counter medications for the child.
A nurse is teaching a client about diarrhea. Which statement by the client regarding diarrhea would indicate a need for additional teaching? "Diarrhea may be acute or chronic." "Diarrhea is a disease that has no cure." "Some medications may cause diarrhea." "More than 3 liquid stools a day is defined as diarrhea."
"Diarrhea is a disease that has no cure." Explanation: Diarrhea is an increase in the liquidity of stool or frequency of defecation to more than 3 stools per day. It is a symptom of numerous conditions and not a disease. Diarrhea is a manifestation of basic mechanisms that increase bowel motility, and a variety of toxins and medications can cause the diarrhea. Diarrhea may be acute or chronic and mild or severe
The nurse is about to administer diphenoxylate (Lomotil) to a client for the first time. Which of the following side effects should be included in the teaching about this medication? "You can expect to feel an increase in energy on this medication." "Perianal irritation is a side effect of this medication." "This medication has few side effects so you may not notice any." "This medication may make you feel lightheaded or drowsy."
"This medication may make you feel lightheaded or drowsy." Explanation: Diphenoxylate (Lomotil) is chemically related to opioid drugs; therefore, it may have sedative and euphoric effects as well as a list of other side effects. It does not increase energy or cause perianal irritation, although perianal irritation is often a result of diarrhea.
The nurse is about to administer diphenoxylate (Lomotil) to a client for the first time. Which of the following side effects should be included in the teaching about this medication? • "This medication may make you feel lightheaded or drowsy." • "This medication has few side effects so you may not notice any." • "Perianal irritation is a side effect of this medication." • "You can expect to feel an increase in energy on this medication."
"This medication may make you feel lightheaded or drowsy." Explanation: Diphenoxylate (Lomotil) is chemically related to opioid drugs; therefore, it may have sedative and euphoric effects as well as a list of other side effects. It does not increase energy or cause perianal irritation, although perianal irritation is often a result of diarrhea.
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 12 hours 7 days 1 day
2 days Explanation: 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 more than 2 days. Diarrhea lasting more than 2 days can indicate infection or a condition that will require more intense treatment with prescription medication. Dehydration can occur if untreated. Diarrhea of 12 hours to 1 day can be viral. Diarrhea for 7 days can be life threatening
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? • 72 hours • 24 hours • 36 hours • 48 hours
48 hours Explanation: If the client experiences no response within 48 hours, the client should notify her health care provider to determine a possible underlying medical cause for the diarrhea.
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? 72 hours 48 hours 36 hours 24 hours
48 hours Explanation: If the client experiences no response within 48 hours, the client should notify her health care provider to determine a possible underlying medical cause for the diarrhea
A patient has been instructed to use polycarbophil (FiberCon) for diarrhea. The nurse teaches that the drug works in which of the following ways? Absorbs water and produces gelatin-like stools Destroys the causative organism Slows GI motility to allow water reabsorption Encourages proper absorption of water into the system
Absorbs water and produces gelatin-like stools Explanation: Polycarbophil is an OTC absorbent drug most often used as bulk-forming laxative. It can absorb large amounts of water and produce stools of gelatin-like consistency
The nurse is caring for a client who has anorexia nervosa and is being treated for chronic diarrhea. The nurse is aware that the client's diarrhea is due to what reason? Intestinal infection Binging Abuse of laxatives Anxiety
Abuse of laxatives Explanation: Clients with anorexia nervosa and bulimia suffer diarrhea due to chronic laxative abuse as a way to lose weight or prevent gaining any additional weight related to binging.
Diarrhea can be caused by innumerable factors, including drugs. Which of the following medications can cause diarrhea? Tacrolimus SSRIs Misoprostol All of these
All of these Explanation: Many oral drugs irritate the GI tract and may cause diarrhea, including acarbose, antacids that contain magnesium, antibacterials, antineoplastic agents, colchicine, laxatives, metformin, metoclopramide, misoprostol, selective serotonin reuptake inhibitors, tacrine, and tacrolimus
The nurse is caring for a client with HIV who has developed diarrhea. The nurse is aware that diarrhea occurs in HIV clients for what most common reasons? (Select all that apply.) IBS Antiretroviral drug therapy Diverticulitis Intestinal neoplasms Intestinal infections
Antiretroviral drug therapy Intestinal infections Explanation: Clients with HIV often develop diarrhea related to drug therapy and also as a part of an opportunistic intestinal infection.
The nurse cautions a client with what allergy to avoid the use of bismuth salts in the treatment of diarrhea? Nuts Penicillin Aspirin Eggs
Aspirin Explanation: Clients who are allergic to aspirin should not use bismuth salts
A client experiencing diarrhea asks the nurse about over-the-counter (OTC) antidiarrheals. Which OTC should not be taken with aspirin? Bismuth subsalicylate Polycarbophil Octreotide Loperamide
Bismuth subsalicylate Explanation: Bismuth subsalicylate is a commonly used OTC used for diarrhea. It has a salicylate, which is in the family of aspirin. A nurse should teach the client that use of the medication with aspirin can cause an overdose. Octreotide acetate is a synthetic form of somatostatin and is used for diarrhea as it decreases GI secretion and motility. Polycarbophil is a bulk-forming laxative. Loperamide is a synthetic derivative of meperidine that decreases GI motility by its effect on intestinal muscles.
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? Hold the medication. Administer the medication as prescribed. Discuss the issues with another nurse on the unit. Call the prescriber about the laboratory tests.
Call the prescriber about the laboratory tests. Explanation: The nurse knows that the use of diphenoxylate with atropine requires caution with clients that have renal or hepatic compromise. The nurse should call the provider and make sure the provider is aware of the laboratory values before administering the medication. Discussion with other nurses is not warranted. The medication does not need to be held at this time as diphenoxylate with atropine is not contraindicated with renal or hepatic compromise but can be administered with caution
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." "I will call the prescriber to find out if this is safe." "The medication needs to be adjusted for the 1-year-old's weight." "There are over-the-counter medications that are better for the 1-year-old."
Children younger than 1 year of age should not be given this medication." Explanation: Children younger than 2 years of age should not take this drug, and those from age 2 to less than 13 years should take the liquid preparation to enhance accuracy of the dosage. Calling the prescriber is not necessary. The nurse should not encourage over-the-counter medications for the child
The nurse is assessing a 68-year-old man with chronic diarrhea. The past medical history does not reveal any current conditions that might be contributing. The patient mentions that he used to have a problem with constipation. The nurse is aware that which of the following might be the cause of his diarrhea? Eating a low-fiber diet Eating a high-fiber diet Chronic use of laxatives Chronic use of antacids
Chronic use of laxatives Explanation: The excessive use or abuse of laxatives may lead to diarrhea
The nurse is assessing a 68-year-old man with chronic diarrhea. The past medical history does not reveal any current conditions that might be contributing. The patient mentions that he used to have a problem with constipation. The nurse is aware that which of the following might be the cause of his diarrhea? Eating a low-fiber diet Chronic use of laxatives Eating a high-fiber diet Chronic use of antacids
Chronic use of laxatives Explanation: The excessive use or abuse of laxatives may lead to diarrhea.
The nurse is caring for a patient who has finished a course of clindamycin for an infection. Today the patient reports fever, abdominal pain, and loose, watery stools with mucus. The nurse recognizes this patient needs to be screened for which organism? • Escherichia coli • Campylobacter • Clostridium difficile • Human immunodeficiency virus
Clostridium difficile Explanation: Antibiotic-associated colitis is a serious condition that results from antibiotic therapy. By suppressing normal flora in the colon, antibiotics allow proliferation of other bacteria, especially C. difficile.
The nurse is caring for a 68-year-old patient with diarrhea. The patient has been prescribed an antidiarrheal. The nurse is aware this patient is at risk for developing which of the following? Anemia Pedal edema Constipation Volume overload
Constipation Explanation: Older people may safely take most antidiarrheal drugs, but cautious use is indicated to avoid inducing constipation
Diphenoxylate with atropine sulfate resolves diarrhea by what mechanism of action? Binding with fecal material to increase bulk Inhibiting cellular division in causative bacteria Decreasing intestinal motility Absorbing toxins
Decreasing intestinal motility Explanation: Diphenoxylate with atropine sulfate resolves diarrhea by decreasing intestinal motility.
What is the priority nursing diagnosis for an 89-year-old client with frequent liquid stools? Deficient knowledge related to medications Pain related to abdominal cramping Deficient fluid volume Imbalanced nutrition: less than body requirements
Deficient fluid volume Explanation: 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 deficit may be concerns for this client, they are not the priority concern.
A male client develops diarrhea secondary to antibiotic therapy. He is to receive two tablets of diphenoxylate HCl with atropine sulfate (Lomotil) orally as needed for each loose stool. The nurse should inform him that he may experience: • dizziness. • increase in appetite. • muscle aches. • bradycardia.
Dizziness. Explanation: The most common adverse effects of diphenoxylate HCl with atropine sulfate are drowsiness and dizziness related to the drug's chemical similarity to meperidine, an opioid. Tachycardia is an adverse effect, not bradycardia. Muscle aches and an increase in appetite are not adverse effects of the drug.
When describing the drugs used to treat traveler's diarrhea, which would the nurse identify as the most common cause? C. difficile Staphylococcus aureus Pseudomonas E. coli
E. coli Explanation: The most common cause of traveler's diarrhea is E. coli
What is first-line therapy for infants and children 1 to 4 years of age with diarrhea? Bismuth salts (Pepto-Bismol) Difenoxin (Motofen) Electrolyte replacement Paregoric
Electrolyte replacement Explanation: Special precautions need to be taken to monitor for electrolyte and fluid disturbances and supportive measures taken as needed. Serious fluid volume deficits may rapidly develop in children with diarrhea. Appropriate fluid replacement should include oral rehydration solutions
What is first-line therapy for infants and children 1 to 4 years of age with diarrhea? Paregoric Bismuth salts (Pepto-Bismol) Difenoxin (Motofen) Electrolyte replacement
Electrolyte replacement Explanation: Special precautions need to be taken to monitor for electrolyte and fluid disturbances and supportive measures taken as needed. Serious fluid volume deficits may rapidly develop in children with diarrhea. Appropriate fluid replacement should include oral rehydration solutions.
At your general medicine practice, your newest patient is a 2-year-old girl from Nigeria whose mother reports the child has excellent health, except for the diarrhea she has demonstrated. Diarrhea started within days of their arrival in the United States 3 weeks ago. History reveals nothing remarkable, but her mother comments on her love of (and continual consumption of) ice cream, something new to her since coming to this country. What would you expect her treatment to involve? Increase fluid intake, especially milk Eliminate ice cream from her diet, as any new food causes diarrhea Eliminate milk products from her diet Increase cheese consumption, as cheese can have a constipating effect on many people
Eliminate milk products from her diet Explanation: Eliminating milk and milk products from her diet will eliminate the cause of her diarrhea
Specific drug therapy for diarrhea depends on the cause and may include which of the following? Select all that apply. • None of these • Anticholinergics • Bile-binding medications • Enzymatic replacement therapy
Enzymatic replacement therapy Bile-binding medications Explanation: Specific drug therapy for diarrhea depends on the cause of the symptom and may include the use of enzymatic replacement therapy or the use of bile salt-binding drugs.
The nurse collects a stool culture from a client diagnosed with traveler's diarrhea. What bacterium does the nurse expect the culture to grow? Staphylococcus aureus Streptococcus type B Pseudomonas Escherichia coli
Escherichia coli Explanation: Escherichia coli is the most common cause of traveler's diarrhea. Staphylococcus, Streptococcus, and Pseudomonas would be highly unlikely to grow in the stool of a client with traveler's diarrhea.
The nurse collects a stool culture from a client diagnosed with traveler's diarrhea. What bacterium does the nurse expect the culture to grow? • Escherichia coli • Staphylococcus aureus • Streptococcus type B • Pseudomonas
Escherichia coli Explanation: Escherichia coli is the most common cause of traveler's diarrhea. Staphylococcus, Streptococcus, and Pseudomonas would be highly unlikely to grow in the stool of a client with traveler's diarrhea.
Determining the cause of diarrhea in a patient is important. It enables choosing the correct treatment. The nurse recognizes that a stool specimen is sometimes necessary to determine correct therapy. The nurse recognizes that a green, liquid stool may be from which of the following? Inflammatory bowel disease Cholecystitis Shigella Escherichia coli
Escherichia coli Explanation: Infections caused by Salmonella or E. coli usually produce green and liquid or semiliquid stools. Shigella usually produces blood-tinged mucus. Inflammatory bowel disorders often produce nonbloody mucus.
The nurse is teaching the client about alosetron (Lotronex), which has been prescribed to treat chronic diarrhea. The nurse is aware that alosetron has a Black Box Warning. Of which of the following adverse effects does the nurse inform the patient? Select all that apply. Hemorrhage Possible bowel obstruction Urinary retention Severe constipation Vomiting
Hemorrhage Possible bowel obstruction Severe constipation Explanation: A Black Box Warning is designed to alert nurses to the serious GI adverse effects of alosetron, such as severe constipation, with possible bowel obstruction, perforation, and hemorrhage
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 binds and expels toxins into the stool. It absorbs toxins and water, decreasing fluidity of stools. It reduces exchange of proteins and mucus in the stools. It causes bloating and swells the colon.
It absorbs toxins and water, decreasing fluidity of stools. Explanation: Polycarbophil and psyllium are most often used as bulk-forming laxatives as they absorb toxin and water, decreasing the fluidity of the stools. They do not cause bloating and swell the colon or reduce the exchange of proteins and mucus in the stools.
Which is a common cause of diarrhea in older adults? The normal aging process Laxative overuse Glaucoma Poor muscle tone
Laxative overuse Explanation: Diarrhea in older adults may occur from laxative overuse
The nurse is teaching a client about diphenoxylate with atropine sulfate which has been prescribed for treatment of acute diarrhea. For which adverse effect should the nurse teach the client to anticipate? Bradycardia Diaphoresis Nausea Increased appetite
Nausea Explanation: Adverse effects of diphenoxylate with atropine sulfate include nausea, vomiting, dizziness, headache, drowsiness, and tachycardia. The incidence and severity of most adverse effects are low when the medication is used appropriately.
The nurse is teaching a client about diphenoxylate with atropine sulfate which has been prescribed for treatment of acute diarrhea. For which adverse effect should the nurse teach the client to anticipate? • Diaphoresis • Increased appetite • Nausea • Bradycardia
Nausea Explanation: Adverse effects of diphenoxylate with atropine sulfate include nausea, vomiting, dizziness, headache, drowsiness, and tachycardia. The incidence and severity of most adverse effects are low when the medication is used appropriately.
The nurse is teaching a client about diphenoxylate with atropine sulfate which has been prescribed for treatment of acute diarrhea. For which adverse effect should the nurse teach the client to anticipate? Bradycardia Increased appetite Diaphoresis Nausea
Nausea Explanation: Adverse effects of diphenoxylate with atropine sulfate include nausea, vomiting, dizziness, headache, drowsiness, and tachycardia. The incidence and severity of most adverse effects are low when the medication is used appropriately
Patients with diarrhea from an infection related to Giardia lamblia require an antiprotozoal agent. The nurse will expect the patient will be prescribed which of the following? Nitazoxanide (Alinia) Octreotide acetate (Sandostatin) Rifaximin (Xifaxan) Colestipol (Colestid) Nitazoxanide (Alinia)
Nitazoxanide (Alinia) Explanation: Nitazoxanide (Alinia) is an antiprotozoal agent used to treat diarrhea caused by an infection with G. lamblia. Rifaximin is a structural analog of the antimycobacterial drug. Octreotide acetate (Sandostatin) is a synthetic form of somatostatin. Colestipol is a bile-binding drug
A client experiencing diarrhea asks the nurse about over-the-counter (OTC) antidiarrheals. Which OTC should not be taken with aspirin? octreotide bismuth subsalicylate loperamide polycarbophil
bismuth subsalicylate Explanation: Bismuth subsalicylate is a commonly used OTC medication for diarrhea. It has a salicylate, which is in the family of aspirin. A nurse should teach the client that use of the medication with aspirin can cause an overdose. Octreotide acetate is a synthetic form of somatostatin and is used for diarrhea as it decreases GI secretion and motility. Polycarbophil is a bulk-forming laxative. Loperamide is a synthetic derivative of meperidine that decreases GI motility by its effect on intestinal muscles
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? dehydration and hyperkalemia bulimia with laxative abuse anorexia nervosa sodium retention
bulimia with laxative abuse Explanation: Enamel erosion is a hallmark of bulimia. The report of "occasional" laxative use plus the report of chronic diarrhea raises the strong potential for laxative abuse. None of the other options would account for the tooth enamel erosion
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? anorexia nervosa sodium retention bulimia with laxative abuse dehydration and hyperkalemia
bulimia with laxative abuse Explanation: Enamel erosion is a hallmark of bulimia. The report of "occasional" laxative use plus the report of chronic diarrhea raises the strong potential for laxative abuse. None of the other options would account for the tooth enamel erosion.
The health care provider (HCP) has determined that a client diagnosed with bacterial gastroenteritis following an overseas trip is a candidate for antibacterial drug therapy. The nurse knows that the HCP will select the appropriate drug based on which factor? number of days with diarrhea symptomatology the country from which the client returned causative agent
causative agent Explanation: In bacterial gastroenteritis or diarrhea, the choice of antibacterial drug depends on the causative organism and susceptibility tests. The other information will not influence selection.
A male client develops diarrhea secondary to antibiotic therapy. He is to receive two tablets of diphenoxylate HCl with atropine sulfate (Lomotil) orally as needed for each loose stool. The nurse should inform him that he may experience: muscle aches. increase in appetite. dizziness. bradycardia.
dizziness. Explanation: The most common adverse effects of diphenoxylate HCl with atropine sulfate are drowsiness and dizziness related to the drug's chemical similarity to meperidine, an opioid. Tachycardia is an adverse effect, not bradycardia. Muscle aches and an increase in appetite are not adverse effects of the drug.
A male client develops diarrhea secondary to antibiotic therapy. He is to receive two tablets of diphenoxylate HCl with atropine sulfate (Lomotil) orally as needed for each loose stool. The nurse should inform him that he may experience: increase in appetite. dizziness. muscle aches. bradycardia.
dizziness. Explanation: The most common adverse effects of diphenoxylate HCl with atropine sulfate are drowsiness and dizziness related to the drug's chemical similarity to meperidine, an opioid. Tachycardia is an adverse effect, not bradycardia. Muscle aches and an increase in appetite are not adverse effects of the drug
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? hyperthyroidism colitis functional diarrhea disorder intestinal neoplasm
functional diarrhea disorder Explanation: The client is describing functional diarrhea disorder where the diarrhea occurs as a result of stress or anxiety. The client does not have hyperthyroid, intestinal neoplasm, or colitis. While all of these conditions can lead to diarrhea, the client's description does not support any of these diagnoses
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? colitis hyperthyroidism functional diarrhea disorder intestinal neoplasm
functional diarrhea disorder Explanation: The client is describing functional diarrhea disorder where the diarrhea occurs as a result of stress or anxiety. The client does not have hyperthyroid, intestinal neoplasm, or colitis. While all of these conditions can lead to diarrhea, the client's description does not support any of these diagnoses.
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? Clostridium difficile inflammatory bowel disorder irritable bowel syndrome lactase deficiency
lactase deficiency Explanation: Deficiency of lactase, which breaks down lactose to simple sugars (i.e., glucose and galactose) that can be absorbed by the gastrointestinal (GI) mucosa, inhibits digestion of milk and milk products. Lactase deficiency commonly occurs among people of African and Asian descent.
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? • magnesium sulfate • senna • polyethylene glycol-electrolyte solution • polycarbophil
polyethylene glycol-electrolyte solution Explanation: Polyethylene glycol-electrolyte solution is often prescribed for bowel preparation before diagnostic tests. Magnesium sulfate is more commonly used for emergency situations. Senna and polycarbophil are most often used for short-term relief of constipation.
When would it be appropriate for the nurse to administer castor oil as a laxative? to remove ingested poisons from the lower gastrointestinal (GI) tract to evacuate the bowel for diagnostic procedures to treat chronic constipation to ease the passage of stool in the client who recently had a baby
· to evacuate the bowel for diagnostic procedures Explanation: 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 having a baby. This drug should only be used on a short-term basis and is not for the treatment of chronic constipation; repeated use will cause GI tract exhaustion
A client develops Clostridium difficile after receiving antibiotic therapy. The client asks the nurse how this occurs. Which is the nurse's best response? • "The antibiotic decreases the white blood count, which allows for bacteria to invade the body." • "The diarrhea is a result of overgrowth of viruses attacking the cells in the bowels." • "This is common of all antibiotic therapy and hospitalized clients." • "By suppressing normal flora, antibiotics allow proliferation of the organism."
• "By suppressing normal flora, antibiotics allow proliferation of the organism." Explanation: Antibiotic-associated colitis is a serious condition that results from oral or parenteral antibiotic therapy from any client. By suppressing normal flora in the colon, antibiotics allow proliferation of other bacteria, especially gram-positive anaerobic Clostridium difficile organisms. These organisms cause fever, abdominal pain, and severe diarrhea with stools containing mucus, pus, and sometimes blood. Symptoms may develop within a few days or several weeks after the causative antibiotic is discontinued. C-diff is not common in all antibiotic therapy and hospitalized clients. The antibiotic does not decrease the WBC but decreases the bacteria, allowing the WBC to attack the bacteria. The diarrhea is not a result of overgrowth of viruses.
During an assessment of a client experiencing diarrhea, which question is appropriate for the nurse in determining the possible cause of the diarrhea? • "Have you been vaccinated for hepatitis A?" • "Do you wash your hands after you use the restroom?" • "Can you tell me what you ate the last 24 hours?" • "Have you recently consumed uncooked ground beef?"
• "Can you tell me what you ate the last 24 hours?" Explanation: During an assessment, the nurse should ask about food consumed in the last 24 hours. Intestinal infections with viruses, bacteria or protozoa are from uncooked ground beef, poultry, eggs, and dairy products. Asking about consumption of uncooked ground beef does not focus on the other sources of intestinal infections. Asking about washing hands after using the restroom is not appropriate since it is directed towards possible E. coli contamination. Vaccination for the hepatitis A is not pertinent for the assessment at this time. Two of the most common viral organisms responsible for diarrhea are rotavirus or Norwalk-like virus.
The nurse is caring for a client who has anorexia nervosa and is being treated for chronic diarrhea. The nurse is aware that the client's diarrhea is due to what reason? • Intestinal infection • Abuse of laxatives • Binging • Anxiety
• Abuse of laxatives Explanation: Clients with anorexia nervosa and bulimia suffer diarrhea due to chronic laxative abuse as a way to lose weight or prevent gaining any additional weight related to binging.
The nurse cautions a client with what allergy to avoid the use of bismuth salts in the treatment of diarrhea? • Eggs • Nuts • Aspirin • Penicillin
• Aspirin Explanation: Clients who are allergic to aspirin should not use bismuth salts.
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? • Administer the medication as prescribed. • Discuss the issues with another nurse on the unit. • Hold the medication. • Call the prescriber about the laboratory tests.
• Call the prescriber about the laboratory tests. Explanation: The nurse knows that the use of diphenoxylate with atropine requires caution with clients that have renal or hepatic compromise. The nurse should call the provider and make sure the provider is aware of the laboratory values before administering the medication. Discussion with other nurses is not warranted. The medication does not need to be held at this time as diphenoxylate with atropine is not contraindicated with renal or hepatic compromise but can be administered with caution.
Which of the following nursing diagnoses is a priority for a client who is 89 years old and has frequent liquid stools? • Pain related to abdominal cramping • Deficient Fluid Volume related to excessive losses in liquid stools • Deficient Knowledge related to medications • Imbalanced Nutrition: Less than Body Requirements
• Deficient Fluid Volume related to excessive losses in liquid stools Explanation: Fluid volume deficits may develop rapidly in older adults with diarrhea.
What is first-line therapy for infants and children 1 to 4 years of age with diarrhea? • Electrolyte replacement • Paregoric • Bismuth salts (Pepto-Bismol) • Difenoxin (Motofen)
• Electrolyte replacement Explanation: Special precautions need to be taken to monitor for electrolyte and fluid disturbances and supportive measures taken as needed. Serious fluid volume deficits may rapidly develop in children with diarrhea. Appropriate fluid replacement should include oral rehydration solutions.
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 • Intestinal neoplasm • Colitis • Hyperthyroidism
• Functional diarrhea disorder Explanation: The client is describing functional diarrhea disorder where the diarrhea occurs as a result of stress or anxiety. The client does not have hyperthyroid, intestinal neoplasm, or colitis. While all of these conditions can lead to diarrhea, the client's description does not support any of these diagnoses.
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? • Intestinal neoplasm • Colitis • Hyperthyroidism • Functional diarrhea disorder
• Functional diarrhea disorder Explanation: The client is describing functional diarrhea disorder where the diarrhea occurs as a result of stress or anxiety. The client does not have hyperthyroid, intestinal neoplasm, or colitis. While all of these conditions can lead to diarrhea, the client's description does not support any of these diagnoses.
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 reduces exchange of proteins and mucus in the stools. • It absorbs toxins and water, decreasing fluidity of stools. • It binds and expels toxins into the stool. • It causes bloating and swells the colon.
• It absorbs toxins and water, decreasing fluidity of stools. Explanation: Polycarbophil and psyllium are most often used as bulk-forming laxatives as they absorb toxin and water, decreasing the fluidity of the stools. They do not cause bloating and swell the colon or reduce the exchange of proteins and mucus in the stools.
Which is a common cause of diarrhea in older adults? • Laxative overuse • Glaucoma • The normal aging process • Poor muscle tone
• Laxative overuse Explanation: Diarrhea in older adults may occur from laxative overuse.
The nurse is teaching the client about alosetron (Lotronex), which has been prescribed to treat chronic diarrhea. The nurse is aware that alosetron has a Black Box Warning. Of which of the following adverse effects does the nurse inform the patient? Select all that apply. • Vomiting • Urinary retention • Severe constipation • Hemorrhage • Possible bowel obstruction
• Severe constipation • Possible bowel obstruction • Hemorrhage Explanation: A Black Box Warning is designed to alert nurses to the serious GI adverse effects of alosetron, such as severe constipation, with possible bowel obstruction, perforation, and hemorrhage.
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 • sodium retention • anorexia nervosa • dehydration and hyperkalemia
• bulimia with laxative abuse Explanation: Enamel erosion is a hallmark of bulimia. The report of "occasional" laxative use plus the report of chronic diarrhea raises the strong potential for laxative abuse. None of the other options would account for the tooth enamel erosion.
The health care provider has prescribed polycarbophil to a client for the treatment of diarrhea. The nurse should teach the client to expect what effect? • a cessation of diarrhea and no bowel movements for 2 to 3 days • large stools of a gelatin-like consistency • small but firm, formed stools • a transition to rectal oozing over the next 12 to 24 hours
• large stools of a gelatin-like consistency Explanation: Polycarbophil absorbs large amounts of water and produces stools of gelatin-like consistency. None of the other options are accurate when discussing polycarbophil.
