Ch. 51 EAQ's, Ch 51 Pharmacology End Chapter Review questions , Chapter 51: Bowel Disorder Drugs Review Q's, Chapter 51 Bowel Disorder Drugs Lilley, Pharmacology Chapter 51 Bowel Disorder Drugs, Pharmacology Chapter 51- Bowel Disorder Drugs
What should the nurse teach the patient who is starting prolonged antibiotic therapy?
"Due to the potential for diarrhea, take probiotics during antibiotic therapy."
The nurse is educating a patient who has diarrhea about management of this condition. Which statements by the patient indicate effective learning? Select all that apply.
"I should avoid caffeine." "I should adhere to the complete medical regimen." "I should avoid consumption of alcohol while I have diarrhea."
Which instruction would the nurse give to the patient taking methylcellulose?
"Mix in one glass of water and stir thoroughly."
The nurse is assessing a geriatric patient who takes antacids. The patient says to the nurse, "When I am constipated, I take senna, but I do not get immediate relief. Is it safe to take it?" Which response is appropriate?
"Take senna 1 hour before taking other medications."
What is essential for the nurse to teach the patient who is taking cholestyramine who is also taking multiple other medications?
"Take your other medications 2 hours before or after cholestyramine."
Which instruction is essential to teach the patient about safe usage of a stimulant laxative?
"This medication can cause electrolyte and nutrient imbalances."
What should the nurse teach the patient about lactulose?
"This medication decreases blood ammonia levels."
Which statement would the nurse make to teach the patient about docusate sodium?
"This medication will soften your stools."
The nurse is teaching the patient about bismuth subsalicylate. What instruction is appropriate? Select all that apply.
"Your gums may turn blue." "Observe your stools for a change in color." "Call the health care provider if you have ringing in the ears."
Mrs. M. is a 66-year-old retired schoolteacher. She enjoys good health and exercises three times a week with a senior citizen group in a supervised arthritis swim class at the local recreation center. She arrives at the family practice office with complaints of "constipation" and says that for the past 3 months she has had only one bowel movement every 3 days instead of one every day. In the assessment of this patient, the nurse discovers that Mrs. M. has been taking a stimulant laxative up to twice a day and is also now feeling "weak." Mrs. M. also says that she is experiencing "a lot of tummy cramping." 1.What are at least five questions the nurse should ask Mrs. M.? Provide reasons for each question. 2.What types of problems are generally related to long-term use of laxatives? Explain your answer. 3.What are some nonpharmacologic ways to help prevent constipation? 4.What over-the-counter drug is the best choice to help prevent constipation? Explain your answer.
1. Questions would include: • What are the names of the medications that you take on a regular basis (including both over-the-counter and prescription drugs)? (Reason: The medications may be causing the problem.) • What foods do you normally eat daily? Typical breakfast, lunch, dinner, and snacks? (Reason: Food intake, such as not consuming enough roughage and fiber, may be increasing the constipation.) • Other than the constipation, have you noticed anything different about your bowel elimination patterns, such as bloated feelings in your stomach? Flatus? Food intolerance? (Reason: There may be some other causes for constipation or reasons for altered bowel status that may need medical evaluation.) • How many glasses of water and other fluids do you usually drink within a 24-hour period? What is your fiber and roughage intake on a daily basis? (Reason: Liquids, fluids, and the amount of fiber intake are critical to the occurrence and subsequent nondrug treatment of constipation.) • Has anything in your life changed over the past 3 months? Are there any new medications? Has there been any change in diet? (Reason: Again, these may provide clues to the cause of the problem.) • What is your medical history? Past history of medical problems? Current health status? Any significant medical or health problems with your immediate family (family history of cancer or any type of bowel disorders)? (Reason: The cause of the constipation may be found in a thorough assessment of these areas.) 2. Dependency of the bowel on the action of the laxative may occur, and the patient might have to take the laxative to have a bowel movement. This may lead to chronic laxative dependency and related problems. Fluid and electrolyte disorders may also occur with chronic use of laxatives. 3. Increasing the intake of fluids, preferably water, as well as foods high in fiber and whole grain, green leafy vegetables, and fruits may help to minimize constipation. Exercise is also beneficial. 4. Psyllium (Metamucil) is a natural bulk-forming laxative, and methylcellulose (Citrucel) is a synthetic bulk-forming laxative. They are both viable options for helping to maintain and contribute to more normal patterns of bowel elimination. Increasing the intake of bulk and fiber is a means of increasing passage of stool and preventing constipation without the major problems of water and electrolyte loss in the olderindividual or in any aged adult. However, these drugs may result in a hardening mass if not taken with adequate fluids, such as 6 to 8 ounces of fluid. These drugs are available in wafer form and even as capsules, and they may be easier to take in these forms than in the powder form.
1. The nurse is explaining to a group of elderly patients the importance of seeking treatment for diarrhea. During the discussion with the group, a member asks, "If I have eaten something 'bad,' does it matter if I take something to stop the diarrhea?" What is the nurse's best response, considering the age of the group?
1. To answer the questions raised by the group of elderly patients, if food poisoning is suspected, antidiarrheals may not be recommended at first because the infectious process in the stool will need to be eliminated. If the patient has eaten something bad and is experiencing diarrhea, the prescriber needs to be contacted and the patient assessed. An antibiotic or other therapy may be indicated; fluid replacement may be indicated too, especially if dehydration is possible.
Which category of laxatives decreases the absorption of vitamins A, D, E, and K? 1. Saline laxatives 2. Emollient laxatives 3. Stimulant laxatives 4. Hyperosmotic laxatives
2. Emollient laxatives Emollient laxatives such as mineral oil interact with fat-soluble vitamins like vitamins A, D, E, and K and reduce their absorption. Saline and hyperosmotic laxatives interact with barbiturates and cause depression. Stimulant laxatives decrease the absorption of digoxin, nitrofurantoin, and tetracyclines.
Loperamide has which mechanism of action? 1. Improves the intestinal barrier function 2. Inhibits peristalsis in the intestinal wall 3. Inhibits the growth of intestinal microflora 4. Suppresses the growth of pathogenic bacteria
2. Inhibits peristalsis in the intestinal wall Loperamide is a synthetic antidiarrheal opiate drug. It acts by inhibiting peristalsis in the intestinal wall and intestinal secretion. This ultimately reduces the number of stools and their water content. Loperamide does not inhibit the growth of intestinal microflora. Probiotics such as Lactobacillus acidophilus act by suppressing the growth or invasion of pathogenic bacteria and by improving the intestinal barrier function.
2. A woman calls the clinic because her 4-month-old daughter has had diarrhea for about 8 hours. What is the nurse's priority action at this time?
2. The priority is prevention of dehydration. Dehydration and electrolyte loss are of major concern in such a young patient, and they can occur rapidly. Recommend that the infant be brought in based on her or his age and the length of time during which the diarrhea has continued. Aggressive treatment and possible hospitalization (if IV fluids are needed) may be necessary.
Diphenoxylate has which mechanism of action? 1. Increases intestinal motility 2. Increases intestinal excretion of water 3. Decreases peristalsis in the intestine 4. Decreases the reabsorption of water in the bowel
3. Decreases peristalsis in the intestine Diphenoxylate acts on the smooth muscle of the intestinal tract to inhibit gastrointestinal motility and excessive propulsion of the gastrointestinal tract (peristalsis). The mechanism of action is not increasing intestinal motility, increasing intestinal excretion of water, or decreasing the reabsorption of water in the bowel.
Saline laxatives have which mechanism of action? 1. Increase electrolyte concentrations in the colon. 2. Lubricate the inside of the gastrointestinal tract. 3. Increase osmotic pressure and draw water into the colon. 4. Increase the surface tension of the fluids present in the colon.
3. Increase osmotic pressure and draw water into the colon. Saline laxatives increase the osmotic pressure of the colon because they contain salts and draw water into the colon to make the stools soft. They show laxative action by increasing osmotic pressure, not by increasing the electrolyte concentration. The water is drawn into the colon, not out of the colon, to make the stool soft. The surface tension of the fluids is increased by emollient laxatives.
Constipation is a side effect of which medical disorder? 1. Hypercalcemia 2. Hyperthyroidism 3. Parkinson's disease 4. Crohn's disease
3. Parkinson's disease The autonomic nervous system function is impaired in patients with Parkinson's disease. This may cause impaired intestinal peristalsis, leading to constipation. Hypercalcemia is a metabolic disorder that does not cause constipation. Hyperthyroidism is an endocrine disorder that results from high levels of thyroxine. It does not cause constipation. Diarrhea is a classic sign of Crohn's disease.
3. An 88-year-old patient is undergoing a bowel preparation for colonoscopy. What are the nurse's priorities regarding monitoring the patient during the bowel preparation?
3. The priorities are preventing fluid and electrolyte imbalances from the bowel preparation. Bowel preparation for a colonoscopy usually begins with a clear liquid diet to NPO status, followed by a laxative, such as polyethylene glycol or magnesium citrate. The result of the preparation is a total cleansing of the bowel. The drugs used to do this cause loss of stool and resultant loss of electrolytes and fluids. Elderly patients and any patients who are not in good health, are immunocompromised, or are suffering from a chronic illness are at greater risk for dehydration and electrolyte disturbances. Therefore, monitoring their status and vital signs is essential to prevent complications resulting from fluid and electrolyte disturbances.
The nurse is assessing a patient who took senna for constipation. The nurse teaches the patient about which potential side effect? 1. Lethargy 2. Dizziness 3. Bloody stools 4. Abdominal pain
4. Abdominal pain Senna is a commonly used over-the-counter stimulant laxative. It is obtained from the dried leaves of the Cassia acutifolia plant. Senna may be used for relief of acute constipation or bowel preparation for surgery or examination. Because of its stimulating action on the gastrointestinal tract, it may cause abdominal pain. It can produce complete bowel evacuation in 6 to 12 hours. Senna is available in a variety of dosages as tablets, syrup, and granules. Lethargy, dizziness, and bloody stools are not side effects of senna.
Adsorbents have which mechanism of action? 1. Increased fluid absorption 2. Decreased gastric secretions 3. Decreased gastrointestinal motility 4. Binding to bacteria for elimination
4. Binding to bacteria for elimination Adsorbents work by coating the walls of the gastrointestinal tract. They remain in the intestine and bind the causative bacteria or toxin to the adsorbent surface so that it can be eliminated from the body through the stool. They may increase bleeding and cause constipation, dark stools, and black tongue. They do not work by increasing fluid absorption, decreasing gastric secretions, or decreasing gastrointestinal motility.
Which laxative is most suitable for long-term use? 1. Saline laxatives 2. Emollient laxatives 3. Hyperosmotic laxatives 4. Bulk-forming laxatives
4. Bulk-forming laxatives The action of bulk-forming laxatives is limited to the gastrointestinal tract. These drugs do not have any systemic effects. Thus bulk-forming laxatives are prescribed for long-term use. Saline, emollient, and hyperosmotic laxatives may cause adverse effects and thus cannot be used on a long-term basis.
Which condition is a contraindication for loperamide treatment?? 1. Nausea 2. Infection requiring antibiotic therapy 3. Diarrhea lasting 2 days 4. Escherichia coli-associated diarrhea
4. Escherichia coli-associated diarrhea Loperamide use is contraindicated in patients with severe ulcerative colitis, pseudomembranous colitis, and acute diarrhea associated with E. coli. Nausea, antibiotic use, and diarrhea lasting 2 days are not contraindications to the use of loperamide.
Which category of laxatives is contraindicated in elderly patients? 1. Emollient laxatives 2. Stimulant laxatives 3. Bulk-forming laxatives 4. Hyperosmotic laxatives
4. Hyperosmotic laxatives With hyperosmotic laxatives (e.g., polyethylene glycol, lactulose, sorbitol, and glycerin), assess baseline fluid and electrolyte levels to identify any deficits before use. Older adult patients react more adversely to this class of laxatives, so their use should be avoided. Emollient, stimulant, and bulk-forming laxatives are not contraindicated in elderly patients.
To avoid fecal impaction, psyllium should be administered with at least how many ounces of fluid?
8
1. To avoid fecal impaction, psyllium (Metamucil) should be administered with at least how many ounces of fluid? 4 6 8 10
8 Bulk-forming laxatives such as psyllium must be given with at least 8 ounces of liquid plus additional liquid each day to avoid intestinal impaction.
Which volume of fluid should be administered with psyllium to avoid fecal impaction?
8 oz
1. A 10-year-old child will be receiving docusate sodium (Colace), 120 mg/day PO, divided into 3 doses. Identify how many milligrams will the child receive per dose. _______
ANS: 40 mg DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A TOP: NURSING PROCESS: Implementation
10. The nurse is discussing the use of adsorbents such as bismuth subsalicylate (Pepto-Bismol) with a patient who has diarrhea. The nurse will warn the patient about which possible adverse effects? a. Dark stools and blue gums b. Urinary hesitancy c. Drowsiness and dizziness d. Blurred vision and headache
ANS: A Dark stools and blue gums are two of the possible adverse effects of bismuth subsalicylate (see Table 51-2). The other adverse effects listed may occur with the use of other antidiarrheal drugs. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 815 TOP: NURSING PROCESS: Assessment
15. A patient is receiving lactulose (Enulose) three times a day. The nurse knows that the patient is not constipated and is receiving this drug for which reason? a. High ammonia levels due to liver failure b. Prevention of constipation c. Chronic renal failure d. Chronic diarrhea
ANS: A Lactulose (Enulose) produces a laxative effect but also works to reduce blood ammonia levels by converting ammonia to ammonium. Ammonium is a water-soluble cation that is trapped in the intestines and cannot be reabsorbed into the systemic circulation. This effect has proved helpful in reducing elevated serum ammonia levels in patients with severe liver disease. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 822 TOP: NURSING PROCESS: Planning
8. When administering mineral oil, the nurse recognizes that it can interfere with the absorption of which substance? a. Fat-soluble vitamins b. Water-soluble vitamins c. Minerals d. Electrolytes
ANS: A Mineral oil can decrease the absorption of fat-soluble vitamins (A, D, E, and K). The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 820 TOP: NURSING PROCESS: Planning
3. A patient will be taking bismuth subsalicylate (Pepto-Bismol) to control diarrhea. When reviewing the patient's other ordered medications, the nurse recognizes that which medication or medication class will interact significantly with the Pepto-Bismol? a. Hypoglycemic drugs b. Antibiotics c. Acetaminophen (Tylenol) d. Antidepressants
ANS: A Taking hypoglycemic drugs with an adsorbent such as bismuth subsalicylate may result in decreased absorption of the hypoglycemic drugs. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 816 TOP: NURSING PROCESS: Implementation
6. A patient asks the nurse about the difference between diphenoxylate with atropine (Lomotil) and the over-the-counter drug loperamide (Imodium). Which response by the nurse is correct? a. "Lomotil acts faster than Imodium." b. "Imodium does not cause physical dependence." c. "Lomotil is available in suppository form." d. "Imodium is a natural antidiarrheal drug."
ANS: B Although the drug exhibits many characteristics of the opiate class, physical dependence on loperamide has not been reported. All antidiarrheal drugs are orally administered. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 817 TOP: NURSING PROCESS: Planning
9. The nurse is reviewing the mechanism of action of antidiarrheal drugs. Which type of antidiarrheal medication works by decreasing the intestinal muscle tone and peristalsis of the intestines? a. Adsorbents such as Pepto-Bismol b. Anticholinergics such as belladonna alkaloids c. Probiotics such as Lactinex d. Lubricants such as mineral oil
ANS: B Anticholinergic drugs work to slow peristalsis by reducing the rhythmic contractions and the smooth muscle tone of the gastrointestinal tract. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 815 TOP: NURSING PROCESS: Planning
7. A patient wants to prevent problems with constipation and asks the nurse for advice about which type of laxative is safe to use for this purpose. Which class of laxative is considered safe to use on a long-term basis? a. Emollient laxatives b. Bulk-forming laxatives c. Hyperosmotic laxatives d. Stimulant laxatives
ANS: B Bulk-forming laxatives are the only laxatives recommended for long-term use. Stimulant laxatives are the most likely of all the laxative classes to cause dependence. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 819 TOP: NURSING PROCESS: Planning
17. The nurse is preparing to administer methylnaltrexone (Relistor), a peripherally acting opioid antagonist. This drug is appropriate for which patient? a. A patient with diarrhea b. A terminally ill patient who has opioid-induced constipation c. A patient who is scheduled for a colonoscopy d. A patient who will be having colon surgery in the morning
ANS: B Methylnaltrexone is approved only for terminally ill (hospice) patients who have opioid-induced constipation. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 819 TOP: NURSING PROCESS: Planning
1. The nurse is reviewing the uses of oral laxatives. Which conditions are general contraindications to or cautions about the use of oral laxatives? (Select all that apply.) a. Irritable bowel syndrome b. Undiagnosed abdominal pain c. Nausea and vomiting d. Fecal impaction e. Ingestion of toxic substances f. Acute surgical abdomen
ANS: B, C, D, F Cautious use of laxatives is recommended in the presence of these: acute surgical abdomen; appendicitis symptoms, such as abdominal pain, nausea, and vomiting; intestinal obstruction; and undiagnosed abdominal pain. Oral laxatives must not be used with fecal impaction; mineral oil enemas are indicated for fecal impaction. The other options are indications for laxative use. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 820 TOP: NURSING PROCESS: Assessment
13. A laxative has been ordered for a patient. The nurse checks the patient's medical history and would be concerned if which condition is present? a. High ammonia levels due to liver failure b. Diverticulosis c. Abdominal pain of unknown origin d. Chronic constipation
ANS: C All categories of laxatives share the same general contraindications and precautions, including avoidance in cases of drug allergy and the need for cautious use in the presence of these: acute surgical abdomen; appendicitis symptoms such as abdominal pain, nausea, and vomiting; fecal impaction (mineral oil enemas excepted); intestinal obstruction; and undiagnosed abdominal pain. The other options are possible indications for laxatives. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 820 TOP: NURSING PROCESS: Implementation
18. A patient has been treated with alosetron (Lotronex) for severe irritable bowel syndrome (IBS) for 2 weeks. She calls the clinic and tells the nurse that she has been experiencing constipation for 3 days. The nurse will take which action? a. Advise the patient to increase intake of fluids and fiber. b. Advise the patient to hold the drug for 2 days. c. Instruct the patient to stop taking the drug and to come to the clinic right away to be evaluated. d. Instruct the patient to continue the alosetron and to take milk of magnesia for the constipation.
ANS: C Alosetron must be discontinued immediately if constipation or signs of ischemic colitis occur. The other options are incorrect. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 823 TOP: NURSING PROCESS: Implementation
2. When administering a bulk-forming laxative, the nurse instructs the patient to drink the medication mixed in a full 8-ounce glass of water. Which statement best explains the rationale for this instruction? a. The water acts to stimulate bowel movements. b. The water will help to reduce the bulk of the intestinal contents. c. These laxatives may cause esophageal obstruction if taken with insufficient water. d. The water acts as a lubricant to produce bowel movements.
ANS: C Bulk-forming drugs increase water absorption, which results in greater total volume (bulk) of the intestinal contents. Bulk-forming laxatives tend to produce normal, formed stools. Their action is limited to the gastrointestinal tract, so there are few, if any, systemic effects. However, they need to be taken with liberal amounts of water to prevent esophageal obstruction and fecal impaction. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 820 TOP: NURSING PROCESS: Implementation
16. A patient is taking linaclotide (Linzess) to treat irritable bowel syndrome (IBS). The nurse will monitor this patient for which adverse effect? a. Chest pain b. Chronic constipation c. Abdominal pain d. Elevated blood glucose levels
ANS: C Common adverse effects of linaclotide (Linzess) are diarrhea, abdominal pain, and flatulence. Elevated blood glucose levels, chest pain, and chronic constipation are not adverse effects of linaclotide. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 823 TOP: NURSING PROCESS: Assessment
1. The nurse is giving oral mineral oil as an ordered laxative dose. The nurse will take measures to prevent which potential problem that may occur with mineral oil? a. Fecal impaction b. Electrolyte imbalances c. Lipid pneumonia d. Esophageal blockage
ANS: C Lipid pneumonia may occur if the oral mineral oil is accidentally aspirated into the respiratory tract. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 820 TOP: NURSING PROCESS: Implementation
5. While recovering from surgery, a 74-year-old woman started taking a stimulant laxative, senna (Senokot), to relieve constipation caused by the pain medications. Two weeks later, at her follow-up appointment, she tells the nurse that she likes how "regular" her bowel movements are now that she is taking the laxative. Which teaching principle is appropriate for this patient? a. She needs to be sure to take this medication with plenty of fluids. b. It is important to have a daily bowel movement to promote bowel health. c. Long-term use of laxatives often results in decreased bowel tone and may lead to dependency. d. She needs to switch to glycerin suppositories to continue having daily bowel movements.
ANS: C Long-term use of laxatives may lead to dependency. Patients need to be taught that daily bowel movements are not necessary for bowel health. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 819 TOP: NURSING PROCESS: Implementation
14. A patient is severely constipated and needs immediate relief. The nurse knows that which class of laxative will provide the most rapid results? a. Bulk-forming laxative, such as psyllium (Metamucil) b. Stool softener, such as docusate salts (Colace) c. Magnesium hydroxide (MOM) d. Magnesium oxide tablets
ANS: C Saline laxatives such as magnesium hydroxide (MOM) produce a watery stool, usually within 3 to 6 hours of ingestion. Bulk-forming laxatives such as psyllium do not produce a bowel movement rapidly. Stool softeners such as docusate salts do not cause patients to defecate; they simply soften the stool to ease its passage. Magnesium oxide tablets are used as magnesium supplements, not as laxatives. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 822 TOP: NURSING PROCESS: Planning
12. A patient will be taking bismuth subsalicylate (Pepto-Bismol) to control diarrhea. When reviewing the patient's other ordered medications, the nurse recognizes that which medication will interact significantly with the Pepto-Bismol? a. Acetaminophen (Tylenol), an analgesic b. Levothyroxine (Synthroid), a thyroid replacement drug c. Warfarin (Coumadin), an anticoagulant d. Fluoxetine (Prozac), an antidepressant
ANS: C The oral anticoagulant warfarin is more likely to cause increased bleeding times or bruising when co-administered with adsorbents. This is thought to be because the adsorbents bind to vitamin K, which is needed to make certain clotting factors. Vitamin K is synthesized by the normal bacterial flora in the bowel. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 815 TOP: NURSING PROCESS: Implementation
4. A patient is about to undergo a diagnostic bowel procedure. The nurse expects which drug to be used to induce total cleansing of the bowel? a. Docusate sodium (Colace) b. Lactulose (Enulose) c. Mineral oil d. Polyethylene glycol 3350 (GoLYTELY)
ANS: D Polyethylene glycol is a very potent laxative that induces total cleansing of the bowel and is most commonly used before diagnostic or surgical bowel procedures. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 822 TOP: NURSING PROCESS: Planning
11. A patient who has been on antibiotic therapy for 2 weeks has developed persistent diarrhea. The nurse expects which medication class to be ordered to treat this diarrhea? a. Lubricants b. Adsorbents c. Anticholinergics d. Probiotics
ANS: D Probiotics work by replenishing bacteria that may have been destroyed by antibiotic therapy, thus restoring the balance of normal flora and suppressing the growth of diarrhea-causing bacteria. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 815 TOP: NURSING PROCESS: Implementation
The nurse is assessing a patient who took senna for constipation. The nurse teaches the patient about what potential side effect?
Abdominal pain
Which potential side effect would the nurse include when teaching the patient about senna?
Abdominal pain
Antilipemic drugs fall under which category of antidiarrheal drugs?
Adsorbents
Which classification describes how antilipemic drugs function as antidiarrheal drugs?
Adsorbents
Which category of antidiarrheal medications decreases peristalsis?
Anticholinergics
Which condition predisposes an individual to develop diarrhea?
Bacterial infection
Which category of antidiarrheals is contraindicated in patients with hypersensitivity and narrow-angle glaucoma?
Belladona alkaloids
Adsorbents have which mechanism of action?
Binding to bacteria for elimination
Which mechanism of action describes how adsorbents relieve diarrhea?
Binding to bacteria for elimination
2. Bismuth subsalicylate (Pepto-Bismol), as an adsorbent, has which mechanism of action? Decreased gastrointestinal motility Decreased gastric secretions Increased fluid absorption Binding to diarrhea-causing bacteria for excretion
Binding to diarrhea-causing bacteria for excretion Correct Adsorbent antidiarrheal medications bind to diarrhea-causing bacteria to form a nonabsorbable complex, which is then excreted in the stool.
Which laxative is most suitable for long-term use?
Bulk-forming laxatives
Which mechanism of action is correct for diphenoxylate?
Decreases peristalsis in the intestine
Which antidiarrheal drug causes potential side effects of dry mouth, tachycardia, abdominal pain, and blurred vision?
Diphenoxylate with atropine
Which antidiarrheal drug causes potential side effects of dry mouth, tachycardia, abdominal pain, and blurred vision?
Diphonoxylate with atropine
Which category of laxatives decreases the absorption of vitamins A, D, E, and K?
Emollient laxatives
Which condition is a contraindication for loperamide treatment?
Escherichia coli-associated diarrhea
Which category of laxatives is contraindicated in elderly patients?
Hyperosmotic laxatives
6. The nurse would question the prescription for use of bismuth subsalicylate as an antidiarrheal in a patient on aspirin daily for anticoagulation therapy due to what potential concern? Nausea Increased bleeding Constipation Urinary retention
Increased bleeding The adsorbent bismuth subsalicylate is a form of aspirin, or acetylsalicylic acid, and therefore it also has many of the same drug effects as aspirin. Bismuth subsalicylate can lead to increased bleeding times and bruising when administered with warfarin as well as aspirin and other nonsteroidal antiinflammatory drugs.
Which is the correct mechanism of action for saline laxatives?
Increases osmotic pressure and draw water into the colon
4. Milk of magnesia alleviates constipation by which action? Increasing water absorption into the colon Lubricating the passage of stool Increasing bulk within the colon Stimulating nerves that regulate defecation
Increasing water absorption into the colon Milk of magnesia is a saline laxative that increases osmotic pressure to draw water into the colon.
Which is the correct mechanism of action for loperamide?
Inhibits peristalsis in the intestinal wall
3. What is the mechanism of action of diphenoxylate (Lomotil)? It increases intestinal excretion of water. It increases intestinal motility. It decreases peristalsis in the intestinal wall. It decreases the reabsorption of water in the bowel.
It decreases peristalsis in the intestinal wall. Diphenoxylate acts on the smooth muscle of the intestinal tract to inhibit gastrointestinal motility and excessive propulsion of the gastrointestinal tract (peristalsis).
What is the mechanism of action of diphenoxylate?
It decreases peristalsis in the intestine.
Which point would the nurse teach parents about the use of bismuth subsalicylate?
It has an aspirin base
What is the mechanism of action of loperamide?
It inhibits peristalsis in the intestinal wall.
Which drug is utilized for patients with diarrhea?
Loperamide
Which medication is contraindicated in the patient with pseudomembranous colitis and diarrhea?
Loperamide
The nurse assesses a patient who is pregnant and complaining of constipation. What medications are safe for the patient to take? Select all that apply.
Mineral oil Methylcellulose
Which type of antidiarrheal would relieve pain due to rectal spasms?
Opiates
What is the route of administration of glycerin, a hyperosmotic laxative?
Rectal
Which route would be used to correctly administer glycerin?
Rectal
Which side effect of lactulose can be used as a therapeutic indication in addition to its use as a hyperosmotic laxative?
Reducing ammonia levels
5. What is an additional function of lactulose, a hyperosmotic laxative? Decreasing peripheral edema Correcting sodium imbalances Reducing ammonia levels Alleviating galactose intolerance
Reducing ammonia levels Lactulose reduces blood ammonia levels by forcing ammonia from the blood into the colon. It is useful in treating patients with hepatic encephalopathy.
What condition in the patient's history is a contraindication to the use of magnesium hydroxide?
Renal insufficiency
7. A patient is prescribed an over-the-counter laxative magnesium hydroxide (milk of magnesia). Which disorder in the patient's history would alert the nurse that there is a need to discuss this medication with the patient and the provider? Hypertension Liver dysfunction Renal insufficiency Chronic constipation
Renal insufficiency The magnesium saline laxatives are to be used with caution in patients with renal insufficiency, because they can be absorbed enough to cause hypermagnesemia. They are most commonly used to evacuate the bowel rapidly in preparation for endoscopic examination and to help remove unabsorbed poisons from the GI tract.
Which drug used to treat constipation acts by stimulation of nerves?
Senna
8. When diarrhea occurs in the pediatric patient, the nurse will advise the parents to seek emergency medical treatment for the patient if which symptoms occur? (Select all that apply.) Urination every 3 to 4 hours Malaise or lethargic Severe abdominal pain Firm or rigid abdomen Bloody diarrhea
Severe abdominal pain If diarrhea is accompanied by fever, malaise, or abdominal pain, contact the prescriber immediately because of the possibility of excessive fluid and electrolyte loss. Dehydration and electrolyte loss occur very rapidly in the pediatric patient because of the patient’s size and sensitivity to loss of fluid volume and electrolytes through the stool. Immediately report to the prescriber any abdominal distention, firm abdomen, painful abdomen, or worsening of or lack of improvement in diarrhea 24 to 48 hours after medication administration. If symptoms persist or dehydration occurs (e.g., no tears and decreased urine output in the child), contact the prescriber. If the patient is sluggish, lethargic, or confused or the diarrhea is bloody, contact the prescriber immediately or go to the closest emergency facility.</div>
Which patient should be cautioned against taking a hyperosmotic laxative?
The patient who is taking opioid medications for pain
Which patient should not take loperamide for diarrhea?
The patient with Escherichia coli-associated diarrhea
What patient should the nurse teach about the potential for constipation from the effects of his disorder?
The patient with Parkinson's disease
Which patient should not receive milk of magnesia? Select all that apply.
The patient with rectal bleeding The patient with abdominal pain The patient with nausea and vomiting
What is the mechanism of action of saline laxatives?
They increase osmotic pressure and draw water into the colon.
A patient who has constipation is prescribed a bisacodyl suppository. What does the nurse teach the patient about bisacodyl (Dulcolax) suppositories?
This medication can cause electrolyte imbalances.
What actions will the nurse take during the insertion of a rectal suppository? Select all that apply.
Wear gloves or a finger cot while inserting the suppository. Place the patient on the left side while inserting the suppository. Lubricate the suppository with water-soluble gel before insertion.
A patient is prescribed docusate to treat constipation. How will the nurse instruct the patient to take the prescribed drug?
With 6 oz of water
Which instruction would the nurse give the patient to take docusate?
With 6 oz of water
4 When the nurse teaches a patient about taking bisacodyl tablets, which instruction is correct? a"Take this medication on an empty stomach." b"Chew the tablet for quicker onset of action." c"Take this medication with juice or milk." d"Take this medication with an antacid if it upsets your stomach."
a
7 A patient has been instructed to use an over-the-counter (OTC) form of the bulk-forming laxative methylcellulose (Citrucel) to prevent constipation. The nurse will advise the patient of potential adverse effects, including (Select all that apply) afluid and electrolyte disturbances. bdecreased absorption of vitamins. cgas formation. ddarkened stools. ediscolored urine.
a,c
3 A 45-year-old woman has been diagnosed with irritable bowel syndrome (IBS) and will be taking lubiprostone (Amitiza). The nurse assesses for conditions that may be contraindications to this drug, such as aconstipation. bbowel obstruction. crenal calculi. danemia.
b
5 A patient has been receiving long-term antibiotic therapy as part of treatment for an infected leg wound. He tells the nurse that he has had "spells of diarrhea" for the last week. Which medication is most appropriate for him at this time?a bismuth subsalicylate b L. acidophilus c diphenoxylate with atropine d codeine
b
1 A patient is being prepared for a colonoscopy. The nurse expects which laxative to be used as preparation for this procedure? amethylcellulose bdocusate sodium cPEG-3350 dglycerin
c
2 The nurse is administering oral methylcellulose (Citrucel) and keeps in mind that a major potential concern with this drug is a dehydration. b tarry stools. c renal calculi. d esophageal obstruction.
d
6 A parent calls to ask about giving a medication for diarrhea to his child, 12 years of age, who is recovering from the flu. The nurse expects the prescriber to recommend which medication? abismuth subsalicylate (Pepto-Bismol) bLactobacillus GG (Culturelle) cbelladonna alkaloid/phenobarbital combination (Donnatal Elixir) dloperamide (Imodium A-D)
d
