Pharmacology Chapter 58

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?"

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?

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

A postoperative surgical client, prescribed twice-daily administration of docusate sodium, is concerned about developing diarrhea. What should the nurse teach the client about docusate sodium?

"This medication will only soften your stools over the next couple of days."

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?

2

The nurse, teaching a patient to be discharged with an order to use chemical stimulant laxatives PRN, instructs the patient that one of the most common adverse effects of this type of laxative is what?

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

The nurse administers psyllium hydrophilic mucilloid (Metamucil) expecting it to have what action?

Adds bulk to the stool

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.

The nurse is caring for a patient who has had impacted stools twice in the past month. What is an appropriate laxative for this patient?

Agoral Plain

The nurse will question an order for bismuth salts (Pepto-Bismol) in a patient with what condition?

Allergy to aspirin

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:

Allergy to aspirin

What drug does the nurse recognize as being classified as a chemical stimulant?

Bisacodyl (Dulcolax)

Which of the following would the nurse expect to administer to a client with traveler's diarrhea?

Bismuth subsalicylate

When would it be appropriate for the nurse to administer a cathartic laxative to the patient? (Select all that apply.)

C) After having a baby D) After a myocardial infarction (MI) E) After anthelmintic therapy

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?

Call the prescriber about the laboratory tests.

The nurse teaches the patient who was prescribed a chemical stimulant laxative that this medication may have either a slow, steady effect or may cause severe cramping and rapid evacuation of the contents of the large intestine. What drug is the nurse teaching this patient about?

Cascara

The nurse administers metoclopramide to the patient with what condition?

Chronic diabetic gastroparesis

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

A 29-year-old woman has been prescribed alosetron (Lotronex) for irritable bowel syndrome. Before starting the drug therapy, the nurse will advise the client about which adverse effect(s)?

Constipation

The nurse administers loperamide (Imodium) to decrease the number and liquidity of stool by what mechanism?

Decreasing intestinal motility

What is the priority nursing diagnosis for an 89-year-old patient with frequent liquid stools?

Deficient fluid volume

. The nurse, providing patient teaching, explains that difenoxin and diphenoxylate are chemically related to what medication?

Demerol

The patient had surgery 2 days ago and bowel motility has not returned. What drug might the nurse administer to stimulate the gastrointestinal (GI) tract?

Dexpanthenol

A patient who is taking metoclopramide (Reglan) has come to the clinic for a follow-up visit. The nurse will be most concerned about a drug-drug interaction when learning the patient is taking what other medication?

Digoxin (Lanoxin)

What should the nurse tell the patient who will begin taking rifaximin (Xifaxan) for traveler's diarrhea?

Do not take the drug if you have bloody diarrhea.

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

Docusate (Colace)

The nurse provides drug teaching to the patient who will begin taking polycarbophil (FiberCon). What is the nurse's priority teaching point?

Drink lots of water when taking the drug.

What is first-line therapy for infants and children 1 to 4 years of age with diarrhea?

Electrolyte replacement

The nurse collects a stool culture from a patient diagnosed with traveler's diarrhea. What bacterium does the nurse expect the culture to grow?

Escherichia coli

A nurse is completing an admission assessment of a client who is having diarrhea. The client states that the diarrhea started after "abdominal surgery." The client cannot recall the type of surgery. Which does the nurse suspect as the cause of the diarrhea?

Excision of the small intestine

A patient receiving loperamide (Imodium) should be alerted by the nurse to what possible adverse effect?

Fatigue

The nurse teaches the patient that a common adverse effect of loperamide (Imodium) is what?

Fatigue

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

The nurse admits to the clinic a 7-month-old infant whose mother reports that the baby has not had a bowel movement in 6 days. What drug would be appropriate to treat this patient?

Glycerin (Sani-Supp)

. For what action would the nurse administer magnesium citrate?

Increase motility, increase fluid, and enlarge bulk of fecal matter

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 absorbs toxins and water, decreasing fluidity of stools.

A client is using psyllium hydrophilic mucilloid to promote evacuation of stool. What is the action of this medication?

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

A clinic patient with a history of heart failure requires a laxative for treatment of chronic constipation. What medication would be most appropriate for this patient?

Lactulose (Chronulac)

The home health nurse is caring for a 72-year-old man in his home. He complains about almost daily diarrhea. The nurse assesses for what common cause of diarrhea in older adults?

Laxative overuse

Which 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.

The home health nurse is caring for a patient with encopresis who was started on mineral oil therapy. The nurse teaches the patient and family that a common adverse effect is what?

Leakage

What drug does the nurse administer that inhibits intestinal peristalsis through direct effects on the longitudinal and circular muscles of the intestinal wall?

Loperamide

What antidiarrheal would the nurse administer to reduce the volume of discharge from the patient's ileostomy?

Loperamide (Imodium)

What is the antidiarrheal of choice the nurse will administer to children older than 2 years of age with diarrhea?

Loperamide (Imodium)

The hospice nurse is caring for a patient diagnosed with bone cancer who is receiving large doses of opioid medications to relieve pain. The patient has used other laxatives in the past to treat opioidinduced constipation but nothing is working now. What drug would the nurse request the family doctor to order for this patient?

Methylnaltrexone (Relistor)

The nurse is preparing to administer cascara to a client. The nurse anticipates administering this drug by which route?

Oral

The family brings a patient to the emergency department saying he has been hallucinating and falls so deeply asleep he stops breathing when not stimulated. The nurse learns the patient has been self-treating diarrhea and suspects the patient was taking what medication?

Paregoric

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)

The nurse teaches the patient to best maintain optimal GI function by including what in the daily routine?

Proper diet, fluid intake, and exercise

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 nurse is caring for a client who has been diagnosed with constipation. The prescriber has ordered a laxative. What other interventions will the nurse include in the teaching plan? Select all that apply.

Regular aerobic exercise

The nurse administers lubiprostone (Amitiza) to the patient with irritable bowel syndrome and anticipates what therapeutic action from the drug?

Secretion of chloride-rich intestinal fluid leading to increased motility

A client who is taking magnesium citrate experiences sweating, palpitations, and flushing. The nurse understands that this is most likely related to which of the following?

Sympathetic stress reaction due to intense GI tract neurostimulation

The nurse develops a teaching plan for a 77-year-old patient who has been prescribed loperamide PRN. The nurse's priority teaching point is what?

Take drug after each loose stool

A client is admitted to the hospital for pneumonia. Since admission, the client has not had a bowel movement. The physician prescribes magnesium hydroxide. What should be an outcome of this therapy?

The client will have a bowel movement after taking the drug.

A man with irritable bowel syndrome reports ongoing diarrhea and asks for a prescription for alosetron (Lotronex), which was helpful for his coworker who recently started taking the drug. What is the nurse's best response?

This drug is only approved for use in women.

A patient taking a chemical stimulant laxative and medications for heart failure and osteoarthritis calls the clinic and reports to the nurse that she is not feeling right. What is the priority question the nurse should ask this patient?

Timing of medication administration

When would it be appropriate for the nurse to administer castor oil as a laxative?

To evacuate the bowel for diagnostic procedures

What is an indication for the use of castor oil as a laxative? (Mark all that apply.)

To remove ingested poisons from the lower GI tract To evacuate the bowel for diagnostic procedures An adjunct in anthelmintic therapy

A client is taking psyllium hydrophilic mucilloid daily. What information should be included in the discharge plan?

Up to 30 g of fluid with the medication can be divided over several divided doses daily.

What is an important teaching point regarding intake for anyone using bulk-forming laxatives?

assure adequate fluid intake

A client experiencing diarrhea asks the nurse about over-the-counter (OTC) antidiarrheals. Which OTC should not be taken with aspirin?

bismuth subsalicylate

What form of laxative would likely be prescribed to manage long-term constipation?

bulk-forming laxative plus increased water intake

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?

dark stool

A community health nurse is conducting a health promotion session with a group from a local seniors' center. The nurse has addressed the issue of laxative overuse in this population. The nurse should highlight what consequence of the overuse of laxatives?

dependence

The nurse should educate the client prescribed a stimulant cathartic to be alert for which common adverse effect?

diarrhea

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 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

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?

lactase deficiency

Defecation is normally stimulated by what physiologic trigger?

movements and reflexes in the gastrointestinal tract

The nurse cautions a woman who is breastfeeding about avoiding the use of magnesium laxatives based on the understanding that the:

newborn may experience diarrhea.

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.

oral suppository

A client is scheduled for a colonoscopy in the morning. The nurse will provide information concerning which laxative?

polyethylene glycol-electrolyte solution

The nurse should know that lactulose achieves a therapeutic effect by which means?

pulling water into the intestinal lumen by osmotic pressure