PHARM CH 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? a)"By suppressing normal flora, antibiotics allow proliferation of the organism." b)"The diarrhea is a result of overgrowth of viruses attacking the cells in the bowels." c)"This is common of all antibiotic therapy and hospitalized clients." d)"The antibiotic decreases the white blood count, which allows for bacteria to invade the body."

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

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? a)"Children younger than 1 year of age should not be given this medication." b)"The medication needs to be adjusted for the 1-year-old's weight." c)"There are over-the-counter medications that are better for the 1-year-old." d)"I will call the prescriber to find out if this is safe."

a)"Children younger than 1 year of age should not be given this medication."

A client was prescribed a cathartic laxative prior to scheduled sigmoidoscopy. The nurse should inform the client that it will take how long before he/she will experience a bowel movement? a)2 to 3 days b)5 to 7 days c)12 to 24 hours d)up to 8 days

a)2 to 3 days

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? a)48 hours b)24 hours c)36 hours d)72 hours

a)48 hours

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)Abdominal cramping b)Dizziness c)Headache d)Weakness

a)Abdominal cramping

Diphenoxylate with atropine sulfate resolves diarrhea by what mechanism of action? a)Decreasing intestinal motility b)Absorbing toxins c)Inhibiting cellular division in causative bacteria d)Binding with fecal material to increase bulk

a)Decreasing intestinal motility

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? a)Dizziness b)Polyuria c)Paleness of the face d)Bradycardia

a)Dizziness

What is first-line therapy for infants and children 1 to 4 years of age with diarrhea? a)Electrolyte replacement b)Paregoric c)Difenoxin (Motofen) d)Bismuth salts (Pepto-Bismol)

a)Electrolyte replacement

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)Increase the fluid in the intestinal contents b)Directly stimulate the nerve plexus in the intestinal wall c)Selectively antagonize opioid binding d)Allow formation of a slippery coat on the intestinal contents

a)Increase the fluid in the intestinal contents

A prescriber adds psyllium to the medication administration record for a client experiencing diarrhea. Which is the best rationale for the addition of psyllium? a)It absorbs toxins and water, decreasing fluidity of stools. b)It binds and expels toxins into the stool. c)It causes bloating and swells the colon. d)It reduces exchange of proteins and mucus in the stools.

a)It absorbs toxins and water, decreasing 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? a)It absorbs toxins and water, decreasing fluidity of stools. b)It causes bloating and swells the colon. c)It binds and expels toxins into the stool. d)It reduces exchange of proteins and mucus in the stools.

a)It absorbs toxins and water, decreasing fluidity of stools.

The nurse is teaching a client about loperamide, which the health care provider has prescribed for treatment of chronic diarrhea. Which adverse effects should the nurse be sure to mention? a)Nausea b)Disorientation c)Flatulence d)Tremors

a)Nausea

The nurse is preparing to administer cascara to a client. The nurse anticipates administering this drug by which route? a)Oral b)Intramuscular c)Rectal, via suppository d)Rectal, via enema

a)Oral

A client is scheduled for a colonoscopy. The nurse knows that the preferred drug for bowel cleansing before this procedure is: a)Polyethylene glycol-electrolyte solution (NuLYTELY) b)Psyllium (Metamucil) c)Bisacodyl (Dulcolax) d)Polyethylene glycol solution (MiraLAX)

a)Polyethylene glycol-electrolyte solution (NuLYTELY)

A 59-year-old homeless client is admitted with dehydration and diarrhea. The admission interview indicates that the client regularly collects food from dumpsters behind restaurants. What pathogen could be causing the cause of the diarrhea? Select all that apply. a)Shigella b)Listeria monocytogenes c)Clostridium difficile d)Salmonella e)Staphylococcus aureus

a)Shigella b)Listeria monocytogenes d)Salmonella e)Staphylococcus aureus

Which would be most important to include when teaching a patient about using psyllium? a)Taking the agent with a large amount of water b)Taking other prescribed drugs along with the psyllium c)Limiting the use of high fiber foods d)Taking the agent at bedtime

a)Taking the agent with a large amount of water

Specific drug therapy for diarrhea depends on the cause and may include which treatment? Select all that apply. a)bile-binding medications b)anticholinergics c)enzymatic replacement therapy d)5-HT3 receptor antagonists e)antibacterial agents

a)bile-binding medications c)enzymatic replacement therapy d)5-HT3 receptor antagonists e)antibacterial agents

Before administering alosetron, the nurse should ensure that the client has been made aware of what potentially severe adverse effect? a)bowel obstruction b)diverticulosis c)blood dyscrasias d)anal fissures

a)bowel obstruction

After teaching a group of nursing students about laxatives, the instructor determines that the teaching was successful when the students identify which example of an irritant laxative? Select all that apply. a)cascara sagrada b)glycerine c)bisacodyl d)polyethylene glycol e)polycarbophil

a)cascara sagrada c)bisacodyl

Defecation is normally stimulated by what physiologic trigger? a)movements and reflexes in the gastrointestinal tract b)stimulation from the medulla oblongata c)changes in the osmolarity of bowel contents d)synthesis and release of digestive enzymes

a)movements and reflexes in the gastrointestinal tract

A client needing to evacuate the colon for endoscopy would likely be prescribed which medication? a)polyethylene glycol electrolyte solution b)methylcellulose c)psyllium d)mineral oil

a)polyethylene glycol electrolyte solution

A hospice client is receiving opioids for treatment of cancer pain. Which laxative will best assist in the prevention of constipation? a)stimulant b)bulk-forming c)saline d)lactulose

a)stimulant

What type of laxative would be the first choice for a client diagnosed with hemorrhoids experiencing intense pain when straining to pass stools? a)stool softener b)bulk-forming laxative c)saline cathartic d)stimulant cathartic

a)stool softener

A nurse is teaching a client who is prescribed diphenoxylate with atropine. Which statement by the client indicates the teaching was effective? a)"I will add this medication to my daily medication schedule." b)"As my stools decrease, I will discontinue this medication." c)"My urine should be dark and cloudy." d)"I will start working out at the gym before my bowel habits become more normal."

b)"As my stools decrease, I will discontinue this medication."

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? a)1:00 PM to 2:00 PM b)10:00 AM to 10:30 AM c)12 noon to 12:30 PM d)11:00 AM to 11:30 AM

b)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? a)3 b)2 c)4 d)1

b)2

What recommendations should be included in client teaching as a means of avoiding constipation? (Select all that apply.) a)Avoid defecating when the urge occurs. b)Eat foods high in bulk or roughage. c)Take an opioid pain medication daily. d)Drink plenty of fluids. e)Be active and exercise daily.

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

What medical diagnoses would the nurse suspect if the client is experiencing diarrhea with mucus, proteins, and blood in the stool? Select all that apply. a)Irritable bowel disease b)Gastroenteritis c)Ulcerative colitis d)Crohn's disease e)Diverticulitis

b)Gastroenteritis c)Ulcerative colitis d)Crohn's disease e)Diverticulitis

A nurse is completing an assessment on a client experiencing diarrhea. The client states having 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? a)Laxative abuse b)Irritable bowel syndrome c)Ulcerative colitis d)Peripheral vascular disease

b)Irritable bowel syndrome

What is the correct rationale for why the nurse would administer a laxative at a separate time from the client's other medications? a)Often laxatives make the client nauseated, which interferes with the ability to take medications. b)Laxatives may reduce absorption of other drugs present in the GI tract. c)They often taste bad and clients are less likely to take other medications. d)Because a laxative may stimulate a bowel movement, it can interfere with medication administration.

b)Laxatives may reduce absorption of other drugs present in the GI tract.

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)Question the client regarding the type and intensity of symptoms to provide a baseline evaluation.

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)Use of opioid medications c)Decreased activity d)Change in bowel routines e)Decrease in the amount of family interaction

b)Use of opioid medications c)Decreased activity d)Change in bowel routines

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? a)assessment of oxygen saturation and respiratory rate b)assessment of fluid and electrolyte balance c)assessment of cognition and neurological status d)assessment of nutritional status

b)assessment of 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? a)hyperthyroidism b)functional diarrhea disorder c)intestinal neoplasm d)colitis

b)functional diarrhea disorder

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. a)subcutaneous injection b)oral c)suppository d)intramuscular injection e)intravenous

b)oral c)suppository

The nurse is preparing to administer a stimulant cathartic to the client. The nurse should inform the client of the possible adverse effect of: a)nausea. b)rectal bleeding. c)diarrhea. d)vomiting.

c)diarrhea.

The nurse should prioritize what assessment when providing care for a client who has taken over-the-counter (OTC) bisacodyl daily for several months? a)apical heart rate b)deep tendon reflexes c)electrolyte levels d)bleeding

c)electrolyte levels

The nurse is educating new parents on prevention and treatment of constipation with children. What is the most effective and safest way to treat constipation in a 2-year-old prior to bowel training? a)bisacodyl suppositories b)sorbitol c)glycerin suppositories d)milk of magnesia

c)glycerin suppositories

Which is a likely cause of diarrhea experienced by an older adult? a)fluid volume deficit b)antihypertensive agents c)laxative abuse d)anemia

c)laxative abuse

A middle-aged client, frustrated by increasingly frequent episodes of constipation, is highly reluctant to take medications. What nonpharmacologic measure should the nurse recommend? a)daily consumption of 6 to 8 L of fluids b)use of a ginger or ginseng supplement c)use of a fiber supplement d)adoption of a low-fat diet

c)use of a fiber supplement

A client has contacted the clinic, stating to the nurse, "I've been taking loperamide for the past day-and-a-half, and my diarrhea shows no signs of slowing down." The nurse should respond to the client in the knowledge that loperamide should be discontinued if the diarrhea does not improve within what time frame? a)3 to 4 days b)2 days c)12 hours d)1 week

c)12 hours

The nurse understands that the drug docusate sodium (Colace) would be most appropriate for what client? a)A 46-year-old client who has not had a bowel movement in 4 days b)A 74-year-old client who takes bisacodyl daily at home c)A 66-year-old client who is recovering from a heart attack d)A 52-year-old client who is preparing for a colonoscopy

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

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)Lack of bowel movement for 5 days b)Frequent episodes of flatulence c)Abdominal pain and fever e)Lack of urge to defecate

c)Abdominal pain and fever

A client experiencing diarrhea asks the nurse about over-the-counter (OTC) antidiarrheals. Which OTC should not be taken with aspirin? a)Polycarbophil b)Loperamide c)Bismuth subsalicylate d)Octreotide

c)Bismuth subsalicylate

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? a)Magnesium citrate b)Castor oil c)Docusate d)Bisacodyl

c)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? a)Mineral oil b)Bisacodyl (Dulcolax) c)Docusate (Colace) d)Milk of magnesia

c)Docusate (Colace)

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)Sorbitol b)Psyllium c)Ducosate d)Fiber

c)Ducosate

A client is using psyllium hydrophilic mucilloid to promote evacuation of stool. What is the action of this medication? a)It irritates the intestinal mucosa, thus increasing intestinal motility. b)It creates a barrier between the colon wall and feces. c)It increases mass and water content of stool, promoting evacuation. d)It reduces the surface tension of bowel contents.

c)It increases mass and water content of stool, promoting evacuation.

What is the reason for administering a bulk-forming laxative like polycarbophil to a client experiencing liquid stools? a)Polycarbophil will diminish the absorption of intestinal fiber and water. b)Polycarbophil will increase bile and diminish bacterial flora in the intestines. c)Polycarbophil absorbs large amounts of water and decreases fluidity of stools. d)Polycarbophil will provide pain relief and decrease cramping and bloating.

c)Polycarbophil absorbs large amounts of water and decreases fluidity of stools.

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? a)hypertension b)hyperglycemia c)dark stool d)photosensitivity

c)dark stool

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? a)"There are over-the-counter medications that are better for the 1-year-old." b)"I will call the prescriber to find out if this is safe." c)"The medication needs to be adjusted for the 1-year-old's weight." d)"Children younger than 1 year of age should not be given this medication."

d)"Children younger than 1 year of age should not be given this medication."

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: a)Hypothyroidism b)Hypertension c)Urinary retention d)Allergy to aspirin

d)Allergy to aspirin

A nurse is caring for a client that 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? a)Discuss the issues with another nurse on the unit. b)Hold the medication. c)Administer the medication as prescribed. d)Call the prescriber about the laboratory tests.

d)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? a)Gastroesophageal reflux disease b)Oral stomatitis c)Chronic constipation d)Colitis

d)Colitis

When describing the drugs used to treat traveler's diarrhea, which would the nurse identify as the most common cause? a)Staphylococcus aureus b)Pseudomonas c)C. difficile d)E. coli

d)E. coli

The nurse should explain that metoclopramide (Reglan) decreases nausea and vomiting by which of the following actions? a)Increasing gastric emptying time b)Decreasing gastric contractions c)Decreasing gastric motility d)Inhibiting stimulation of the vomiting center in the brain

d)Inhibiting stimulation of the vomiting center in the brain

Which is a common cause of diarrhea in older adults? a)The normal aging process b)Glaucoma c)Poor muscle tone d)Laxative overuse

d)Laxative overuse

The client has been prescribed diphenoxylate with atropine (Lomotil) for diarrhea. The nurse recognizes that this drug is effective against diarrhea because of which action? a)Antimicrobial effects b)Decreases GI secretions c)Anti-inflammatory effects allowing absorption of fluids d)Slows peristalsis by acting on the smooth muscles of the intestine

d)Slows peristalsis by acting on the smooth muscles of the intestine

A patient calls the clinic and tells the nurse of a need to sleep. In talking with the patient, the nurse notes that the patient has had diarrhea and has taken loperamide (Imodium). The nurse knows that a common side effect of loperamide (Imodium) is: a)tremors. b)flatulence. c)disorientation. d)fatigue.

d)fatigue.

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? a)inflammatory bowel disorder b)Clostridium difficile c)irritable bowel syndrome d)lactase deficiency

d)lactase deficiency