Pharm PrepU Chapter 39
In what client circumstance would the use of a bulk-forming laxative be contraindicated?
acute abdominal pain
While discussing the use of laxatives a student asks the nursing instructor what indicates normal bowel elimination. What would be the best response by the instructor?
"A soft, formed stool."
The nurse recognizes that a client needs additional instruction if the client makes which comment about treatment for occasional constipation?
"I will make sure that I have a bowel movement every day."
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 instructructions 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 73-year-old woman is experiencing recurrent constipation. The woman reports to the nurse that she experiences constipation despite the fact that she takes docusate on a daily basis and performs cleansing enemas several times weekly. How should the nurse best respond to this client's statements?
"Taking too many laxatives can make your bowels dependent on them, making you more susceptible to constipation."
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?
"That is exactly what the medication is supposed to do."
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?
2 to 3 days
The nurse is preparing to administer psyllium (Metamucil) to a client. The nurse instructs the client to mix the medication in how much liquid?
240 mL
The nurse is preparing to administer medications to a group of clients. For which client is bisacodyl contraindicated?
4-year-old
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 clent is being sent home with orders for a laxative PRN. What should the nurse inform the client is one of the most common adverse effects of a laxative?
Abdominal cramping
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
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 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.
When administering a bulk laxative to a client, which action is important for the nurse to take?
Administer the laxative with a full glass of water or juice.
A female client calls the clinic and reports not feeling good to the nurse. The client tells the nurse that the client was recently prescribed a laxative. The nurse knows that the client takes other medications for congestive heart failure and osteoarthritis. What should the nurse question the client about?
Administration of the laxative in relation to taking the other medications
When would it be desirable for the nurse to give the client a laxative? Select all that apply.
After having a baby After an MI After anthelmintic therapy
What recommendations should be included in client teaching as a means of avoiding constipation? (Select all that apply.)
Be active and exercise daily. Drink plenty of fluids. Eat foods high in bulk or roughage.
A client taking oxycodone (Oxy-Contin) for severe pain has developed fecal impaction. The nurse knows that fecal impaction can be alleviated with:
Bisacodyl (Dulcolax) suppository.
The nurse should advise clients taking laxatives of which of the following adverse effects? Select all that apply:
Bloating Cramps Perianal irritation Nausea
It is determined that a client in a hepatic coma needs a laxative. Lactulose is prescribed. What should the nurse monitor to assess the efficacy of the lactulose therapy?
Blood ammonia levels
The nurse is aware that critically ill clients are more at risk for constipation for what reasons? (Select all that apply.)
Change in bowel routines Decreased activity Use of opioid medications
Which clients are at risk for constipation? Select all that apply.
Client with a repair of a femur fracture A pregnant women in her third trimester Elderly clients with Alzheimer's disease A client with chronic pain
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.
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 relfex
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 new mother 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 (Colace)
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)
A 94-year-old client is to begin taking psyllium hydrophilic mucilloid daily. What instructions should the nurse include in the discharge teaching?
Drink at least 8 ounces of fluid with the medication.
A client has been instructed to take polycarbophil (FiberCon). What should be an instruction on the use of this drug as a laxative?
Drink lots of water when taking the drug.
An infant is brought to the pediatric clinic. The mother tells the nurse the child is constipated and she doesn't know what to do. What would the nurse tell the mother is the safest and most effective way to treat constipation in children prior to bowel training?
Glycerin suppositories
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
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 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?
Lactulose
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
A home health nurse is caring for a 72-year-old male in his home. The client reports diarrhea on an almost-daily basis. What would the nurse explain to this client is a common cause of diarrhea in older adults?
Laxative overuse
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.
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)
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.
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.
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?
Refrigerate the solution until it is cold.
A client with a history of constipation has been taking over-the-counter laxatives with good success. The client tells the nurse that he is relieved to have found a solution to his 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
The nurse explains that there is no "normal" number of daily stools because of differences in what contributing factor?
diet
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
The nurse should prioritize what assessment when providing care for a client who has taken over-the-counter (OTC) bisacodyl daily for several months?
electrolyte levels
What is a noted risk factor for the development of constipation?
hypothyroidism
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 hospitalized client's request for a magnesium citrate "bisacodyl pill" every night to "keep regular" should alert the nurse to what potential health risk for the client?
laxative abuse
A 75-year-old client is prescribed magnesium hydroxide for constipation. The nurse's assessment reveals that the clent is being treated for rheumatoid arthritis and hypertension. The client is in assisted living and is on a low-sodium diet. Before the magnesium hydroxide therapy begins, it will be most important for the nurse to assess the client's:
medication history.
A client needing to evacuate the colon for endoscopy would likely be prescribed which medication?
polyethylene glycol electrolyte solution
In the defecation process, what is caused by gastrocolic and duodenocolic reflexes?
propulsion of feces into the rectum
What type of laxative would be the first choice for a client diagnosed with hemorrhoids experiencing intense pain when straining to pass stools?
stool softener
What physiological result occurs when an individual regularly fails to take needed bathroom breaks?
weakened defecation 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?
Ducosate
A nurse is teaching a group of older adults about strategies for preventing constipation that do not involve the use of medications. The nurse should recommend what intervention? Select all that apply.
consuming a high-fiber diet engaging in frequent physical exercise drinking 6 to 10 glasses of fluid each day