Chapter 42 Drugs for Bowel Disorders & GI conditions

Pancrelipase (Pancreaze) granules are ordered for a patient. Which of the following will the nurse complete before administering the drug? (select all that apply.) 1. sprinkle the granules on a nonacidic food. 2. Give the granules with or just before a meal. 3. Mix the granules with orange or grapefruit juice. 4. Ask the patient about an allergy to pork or pork products. 5. Administer the granules followed by an antacid.

Ans: 1,2,4 Rationale: Before administering pancrelipase (Pancreaze) the nurse should assess for an allergy to pork or pork products. The granules may be sprinkled on nonacidic foods and should be given 30 minutes before a meal or with meals. Options 3 and 5 are incorrect. Pancrealipase should not be given with acidic foods or beverages because the drug will be inactivated. It should not be taken with an antacid because the effect of the pancrelipase will be decreased.

A 24-year-old patient has been taking sulfasalazine (Azulfdine) for irritable bowel syndrome and complains to the nurse that he wants to stop taking the drug because of the nausea, headaches, and abdominal pain it causes. What would the nurse's best recommendation be for this patient? 1. The drug is absolutely necessary, even with the adverse effects. 2. Talk to the health care provider about dividing the doses throughout the day. 3. stop taking the drug and see if the symptoms of the irritable bowel syndrome have resolved. 4. Take an antidiarrheal drug such as loperamide (Imodium) along with the sulfasalazine.

Ans: 2 Rationale: Nausea, vomiting, diarrhea, dyspepsia, abdominal pain, and headache are common ad- verse effects of sulfasalazine (Azulfidine). Dividing the total daily dose evenly throughout the day and using the enteric-coated tablets may improve adherence. Options 1, 3, and 4 are incorrect. Patients who experience significant adverse effects of drug therapy are unlikely to comply with a drug regimen if the effects are severe. Suggesting that the patient take an antidiarrheal drug or that he stop drug therapy is not within the scope of a nurse's practice and should be items that he discusses with his health care provider.

The nurse has administered prochlorperazine (Compazine) to a patient for postoperative nausea. Before administering this medication, it is essential that the nurse check which of the following? 1. Pain level 2. Blood pressure 3. Breath sounds 4. Temperature

Ans: 2 Rationale: Prochlorperazine (Compazine) may cause decreased blood pressure or hypotension as an adverse effect. The blood pressure should be taken before administering and the drug held if the BP is be- low 90/60 mmHg or is below parameters as ordered by the provider. Options 1, 3, and 4 are incorrect. Although it is important to assess pain level, breath sounds, and temperature in the postoperative patient, prochlorperazine does not directly affect these parameters.

A client who was diagnosed with Clostridium difficile calls the clinic and says, "I'm still having diarrhea so I started taking an over-the-counter medication to stop it." How should the nurse respond? 1. "Which antidiarrheal are you taking?" 2. "How many doses have you taken?" 3. "Stop taking the medicine and come to the clinic." 4. "Is it stopping your diarrhea?"

Correct Answer: 3 Rationale 1: The identity of the antidiarrheal is not the priority. Rationale 2: The number of doses taken is not the priority. Rationale 3: Antidiarrheal use is contraindicated in cases of Clostridium difficile. Rationale 4: The effectiveness of the antidiarrheal is not the priority.

The nurse is preparing to administer chemotherapy to an oncology patient who also has an order for ondansetron (Zofran). When should the nurse administer the ondansetron? 1. Every time the patient complains of nausea 2. 30 to 60 minutes before starting the chemotherapy 3. Only if the patient complains of nausea 4. When the patient begins to experience vomiting during the chemotherapy

Ans: 2 Rationale: To be most effective, ondansetron (Zofran) or other antiemetics should be administered 30 to 60 minutes before initiating the chemotherapy drugs. Options 1, 3, and 4 are incorrect. Almost all chemotherapy drugs have emetic potential and the nurse should not wait until the patient complains of nausea or experiences vomiting before giving the drug. The patient may complain of nausea more frequently than is possible to give the drug. Other nondrug relief strategies such as diversion techniques or ginger ale should also be tried.

A patient with severe diarrhea has an order for diphenoxylate with atropine (Lomotil). When assessing for therapeutic effects, which of the following will the nurse expect to find? 1. Increased bowel sounds 2. Decreased belching and flatus 3. Decrease in loose, watery stools 4. Decreased abdominal cramping

Ans: 3 Rationale: A decrease in the number and consistency of stools is a therapeutic effect of diphenoxylate with atropine (Lomotil). Options 1, 2, and 4 are incorrect. A decrease in bowel sounds rather than an increase would be noted if the drug is having therapeutic effects. The drug has no direct effect on the causes of belching or flatus. Al- though reduction in abdominal cramping may occur due to decreased peristalsis, it is not the therapeutic indication for the drug.

The nurse is explaining the action of the gastrointestinal tract to a patient who has chronic constipation. The nurse would explain that which area is where the majority of water is absorbed from the stool mass? 1. A 2. B 3. C 4. D

Ans: 3 Rationale: The main functions of the colon are to reabsorb water from the waste material and to excrete the remaining fecal material from the body.

A patient with constipation is prescribed psyllium (Metamucil) by his health care provider. What essential teaching will the nurse provide to the patient? 1. Take the drug with meals and at bedtime. 2. Take the drug with minimal water so that it will not be diluted in the GI tract. 3. Avoid caffeine and chocolate while taking this drug. 4. Mix the product in a full glass of water and drink another glassful after taking the drug.

Ans: 4 Rationale: To avoid esophageal or gastric obstruction, psyllium (Metamucil) should be mixed with a full glass of water or juice and followed by another full glass of liquid. Options 1, 2, and 3 are incorrect. The drug should not be taken directly with meals because nutrients in the food may be bound into the psyllium and not absorbed. Psyllium should not be taken dry and should be taken with plenty of fluids. Caffeine and chocolate do not need to be avoided while on this medication.

The nurse designs a teaching plan for the client with chronic pancreatitis who receives pancrelipase (Pancreaze). What will the best plan by the nurse include as it relates to the rationale for the client to receive this drug? 1. "These enzymes replace what your ineffective pancreas cannot make." 2. "These enzymes will help promote healing of your pancreas." 3. "These enzymes promote digestion of starches and fats." 4. "These enzymes will help digest all of the food you eat."

Correct Answer: 1 Rationale 1: Chronic pancreatitis eventually leads to pancreatic insufficiency that may necessitate replacement of pancreatic enzymes. Rationale 2: Pancreatic enzymes do not help heal the pancreas. Rationale 3: Pancreatic enzymes will help digest food, but this is not the reason the client is receiving them. Rationale 4: Pancreatic enzymes will help digest food, but this is not the reason the client is receiving them.

The nurse has completed medication education for the client who takes psyllium mucilloid (Metamucil). The nurse recognizes that additional teaching is indicated when the client makes which statement? 1. "I don't need to drink extra fluids while I take this medication." 2. "My cholesterol level will be reduced somewhat with this medication." 3. "This medication is a lot more natural than other laxatives." 4. "This medication takes several days to work."

Correct Answer: 1 Rationale 1: Fluids must be increased when clients use psyllium mucilloid (Metamucil). Rationale 2: Psyllium mucilloid (Metamucil) does help to reduce cholesterol levels. Rationale 3: Psyllium mucilloid (Metamucil) is more natural than other laxatives. Rationale 4: Psyllium mucilloid (Metamucil) does take several days to work.

The primary role of the large intestine is to 1. excrete fecal matter. 2. absorb nutrients. 3. excrete enzymes. 4. control peristalsis.

Correct Answer: 1 Rationale 1: The large intestine is responsible for reabsorption of water and for fecal excretion. Rationale 2: The small intestine absorbs nutrients and drugs. Rationale 3: The stomach and small intestine excrete enzymes for digestion. Rationale 4: Peristalsis is controlled by the autonomic nervous system.

A client says she would like to control her nausea with natural products instead of drugs. What education should the nurse provide? Select all that apply. 1. "Peppermint may be effective." 2. "Some people believe ginger ale is effective against nausea." 3. "Vitamin E oil is sometimes effective for nausea." 4. "Milk is usually an effective anti-nausea treatment." 5. "There are no natural remedies for nausea."

Correct Answer: 1,2 Rationale 1: Peppermint is effective for treatment of nausea in some people. Rationale 2: Ginger ale is sometimes effective for nausea treatment. Rationale 3: There is no evidence that vitamin E oil is effective as treatment for nausea. Rationale 4: Milk is not an anti-nausea treatment. Rationale 5: Natural remedies for nausea do exist.

A nurse would question a prescription for sulfasalazine (Azulfidine) if the client is also taking which medication? Select all that apply. 1. Insulin 2. Digoxin 3. Warfarin 4. Penicillin 5. Vitamin C

Correct Answer: 1,2,3 Rationale 1: Clients with diabetes may experience hypoglycemia if sulfasalazine is taken concurrently. Rationale 2: Absorption of digoxin may be decreased. Rationale 3: Anticoagulation effects may be increased. Rationale 4: There is no drug-drug interaction with penicillin. Rationale 5: There is no drug-drug interaction with vitamin C.

A client calls the clinic and says, "I have been taking Imodium (loperamide) for diarrhea, but it isn't helping." How should the nurse respond? Select all that apply. 1. "Are you taking it after every episode of diarrhea?" 2. "Imodium is not effective against diarrhea." 3. "This medication may make you sleepy." 4. "You may have to take the maximum dose for 2 or 3 days before diarrhea slows." 5. "You should come in for assessment."

Correct Answer: 1,3,5 Rationale 1: Loperamide (Imodium) is taken as a 4 mg single dose, followed by 2 mg after each diarrhea episode up to 16 mg/day. Rationale 2: Imodium is indicated for diarrhea. Rationale 3: Imodium has the adverse effect of drowsiness. Rationale 4: Diarrhea should slow within a few hours of doses. Rationale 5: If over-the-counter medications are not effective, prescription medications may be necessary. The client should be seen in the clinic.

A client has been prescribed prochlorperazine (Compazine) for nausea. Possible adverse effects would include 1. diarrhea. 2. dry mouth. 3. hypertension. 4. bradycardia.

Correct Answer: 2 Rationale 1: Diarrhea is not an adverse effect of prochlorperazine. Rationale 2: Phenothiazines block dopamine and can cause dry mouth. Rationale 3: Hypotension, not hypertension, can occur. Rationale 4: Tachycardia, not bradycardia, can occur.

A patient with constipation has been prescribed a bulk-forming laxative. Which information will the nurse provide about taking this medication? 1. "You may take this powder dry if you take it in small amounts." 2. "Drink a full glass of water after you take this medication." 3. "Let the medication mixture set for a few minutes after mixing before drinking." 4. "Lie down for 30 minutes after you take this medication."

Correct Answer: 2 Rationale 1: Do not take this powder dry. It is a choking hazard. Rationale 2: The patient should drink a full glass of water after taking this medication. Rationale 3: The medication should be taken as soon as it is mixed. Rationale 4: There is no reason for the patient to lie down after taking this medication.

The client receives prochlorperazine (Compazine) for nausea and vomiting. The nurse notices that the client is exhibiting a stiff neck, turned to the side. What is the best action by the nurse? 1. Administer the client's as needed analgesic immediately. 2. Contact the physician immediately. 3. Hold the next dose and observe the client. 4. Ask the client if she has ever experienced this before.

Correct Answer: 2 Rationale 1: Giving an analgesic is not the priority intervention. Rationale 2: Prochlorperazine (Compazine) is a phenothiazine drug; the client is experiencing an extrapyramidal side effect known as dystonia. The nurse should immediately alert the physician and prepare to administer an antidote. Rationale 3: The client needs an antidote; holding the next dose will not relieve the symptoms. Rationale 4: Assessment is good, but the client needs an antidote.

A client has developed nausea and vomiting. What is the nurse's primary treatment? 1. Replacing fluids 2. Identifying and eliminating the cause 3. Encouraging the client to lie still 4. Providing the client with soft foods

Correct Answer: 2 Rationale 1: Replacement of fluids is essential but not the primary treatment. Rationale 2: Nausea and vomiting are often due to modifiable conditions. Eliminating the conditions is the primary treatment. Rationale 3: If the client is vomiting, lying still is difficult and may be dangerous if aspiration occurs. Rationale 4: The client should not eat while nauseated and vomiting.

Which client is most at risk to develop constipation? 1. The pediatric client who takes antibiotics for ear infections 2. The elderly client who routinely takes a stimulant laxative twice daily. 3. The young client in the hospital for an appendectomy 4. The middle-aged client who uses an enema when he travels

Correct Answer: 2 Rationale 1: The pediatric client is at low risk to develop constipation. Rationale 2: Elderly clients who abuse laxatives are at risk for constipation. Rationale 3: The young client is at low risk to develop constipation. Rationale 4: The middle-aged client is at low risk to develop constipation.

A patient who has been taking diphenoxylate with atropine (Lomotil) is very drowsy and has a respiratory rate of 10 bpm. The roommate, who brought the patient to the emergency department, states that the patient took "a whole bottle" of the drug. Which nursing action is indicated? 1. Administer a beta blocker 2. Administer naloxone 3. Administer high volume intravenous fluids 4. Administer activated charcoal

Correct Answer: 2 Rationale 1: There is no indication that a beta blocker is needed. Rationale 2: Naloxone is a narcotic antagonist to reverse the effects of opioid overdose. Rationale 3: The patient will need intravenous access, but there is no information to suggest high volume IV fluids are necessary. Rationale 4: Activated charcoal will not reverse the patient's respiratory depression.

A patient has been started on a stool softener for constipation. Which information should the nurse provide regarding onset of action? 1. "Continue to take this medication until your stool is very loose and diarrhea-like." 2. "If your discomfort gets worse, return to the clinic." 3. "This medication will work in about 8 hours." 4. "If you do not have a bowel movement by tomorrow, return to the clinic."

Correct Answer: 2 Rationale 1: There is no reason to take this medication until loose stools occur. Rationale 2: If the patient has increased discomfort, additional assessment is indicated. Rationale 3: This medication may take 2 or 3 days to work. Rationale 4: Tomorrow is too soon to evaluate that therapy is unsuccessful.

A client has been prescribed sulfasalazine (Azulfidine) for treatment of ulcerative colitis. Which nursing assessment question is essential? 1. "How long have you had ulcerative colitis?" 2. "What are you allergic to?" 3. "Are you lactose intolerant?" 4. "Do you have to stand in one place for long periods of time at your work?"

Correct Answer: 2 Rationale 1: This is not the most important assessment data. Rationale 2: The client who is allergic to sulfa drugs should not take sulfasalazine. Rationale 3: Lactose intolerance is not a significant assessment finding for this client. Rationale 4: Standing in one spot for long periods of time is not a significant issue with sulfasalazine.

While a nurse is collecting medical history, the client says, "I was diagnosed with a spastic colon." How should the nurse interpret this statement? Select all that apply. 1. The client has ulcerative colitis. 2. The client has had recurrent abdominal pain for at least 3 months. 3. The client has irritable bowel syndrome. 4. The client's disease is psychosomatic. 5. The client has Crohn's disease.

Correct Answer: 2,3 Rationale 1: Typically, the diagnosis of spastic colon is not the same as ulcerative colitis. Rationale 2: The diagnostic criterion for this disorder is recurrent abdominal pain for at least 3 days per month during the previous 3 months. Rationale 3: Irritable bowel syndrome is also known as spastic colon. Rationale 4: While there is often no organic disease found in this disorder, the pain and other findings are real. Rationale 5: Irritable bowel syndrome is not the same as Crohn's disease.

The client is scheduled for bowel surgery. What medications are appropriate for cleansing the bowel, or "bowel prep," prior to this procedure? Select all that apply. 1. Docusate sodium (Colace) 2. Bisacodyl (Dulcolax) 3. Methylcellulose (Citrucel) 4. Sodium phosphate (Fleet Phospho-Soda) 5. Mineral oil

Correct Answer: 2,4 Rationale 1: Docusate sodium (Colace) is a stool softener and is not appropriate for a "bowel prep." Rationale 2: Bisacodyl (Dulcolax) is a stimulant laxative and appropriate for a "bowel prep." Rationale 3: Methylcellulose (Citrucel) is a bulk-forming laxative and is not appropriate for a "bowel prep." Rationale 4: Sodium phosphate (Fleet Phospho-Soda) is an osmotic saline laxative and appropriate for a "bowel prep." Rationale 5: Mineral oil is not appropriate for a "bowel prep."

A client asks if he could use an over-the-counter bulk-type laxative. Which assessment finding would cause the nurse to tell the client not to use this drug? Select all that apply. 1. The client is over age 60. 2. The client takes warfarin every other day. 3. The client has type 2 diabetes. 4. The client has a history of fecal impaction. 5. The client is allergic to penicillin.

Correct Answer: 2,4 Rationale 1: There is no contraindication for use of this laxative class in clients over 60. Rationale 2: Bulk-type laxatives may decrease the absorption and effects of warfarin. Rationale 3: Bulk-type laxatives may decrease serum glucose levels in clients with type 2 diabetes. This is not an adverse outcome. Rationale 4: If there is a chance that the client has a fecal impaction, bulk-type laxatives should not be used. Rationale 5: Allergy to penicillin is not a contraindication for use of bulk-type laxatives.

The client has been vomiting for several days. The nurse would assess the client for which acid-base disturbance? 1. Metabolic acidosis 2. Respiratory alkalosis 3. Metabolic alkalosis 4. Respiratory acidosis

Correct Answer: 3 Rationale 1: Metabolic acidosis will not occur as a result of vomiting. Rationale 2: Respiratory alkalosis will not occur as a result of vomiting. Rationale 3: Metabolic alkalosis will result from excessive loss of hydrochloric acid from the stomach brought on by prolonged vomiting. Rationale 4: Respiratory acidosis will not occur as a result of vomiting.

After a client begins pancreatic enzyme replacement therapy, the nurse will assess for 1. headache. 2. dry mouth. 3. nausea and vomiting. 4. falls.

Correct Answer: 3 Rationale 1: Some anorexiants can cause headache. Rationale 2: Antidiarrheal therapy can cause dry mouth. Rationale 3: The most frequent adverse effects are GI symptoms of nausea, vomiting, and diarrhea. Rationale 4: Antiemetic therapy can cause sedation and falls.

What do Stool softeners do? 1. break up fecal material. 2. decrease peristalsis. 3. promote water absorption in the intestine. 4. increase peristalsis.

Correct Answer: 3 Rationale 1: Stimulant laxatives break up fecal material. Rationale 2: No laxatives cause decrease in peristalsis. Rationale 3: Stool softeners cause more water and fat to be absorbed. Rationale 4: Stimulant laxatives increase peristalsis.

An elderly client has constipation. He asks the nurse the reason for this. What is the best response by the nurse? 1. "You could have a serious illness and should check with your doctor." 2. "You probably drink too much alcohol and end up constipated." 3. "You probably don't eat enough fiber, so the stool stays in your intestine too long." 4. "Your large intestine is old and does not work as well as it used to."

Correct Answer: 3 Rationale 1: The client could have a serious illness, but constipation in the elderly is more likely related to dietary habits. Rationale 2: Alcohol can be a contributing factor to constipation, but the nurse should first assess alcohol intake and not just assume excessive alcohol intake. Rationale 3: If the waste material remains in the intestine too long due to lack of fiber, too much water is reabsorbed leading to small, hard stools. Rationale 4: Telling an elderly client that his intestine is old is very non-therapeutic.

The nursing instructor is teaching student nurses about lower gastrointestinal (GI) functioning and the large intestine. The nursing instructor evaluates that learning has occurred when the students make which statement? 1. "The large intestine contains host flora that manufacture vitamin E." 2. "The large intestine absorbs most of the nutrients from food." 3. "The large intestine absorbs water and eliminates stool." 4. "Food travels through the large intestine for 3 to 6 hours."

Correct Answer: 3 Rationale 1: The large intestine contains host flora that manufacture B-complex vitamins and vitamin K, not vitamin E. Rationale 2: The small intestine, not the large intestine, absorbs most of the nutrients from food. Rationale 3: Major functions of the large intestine include absorption of water and elimination of stool. Rationale 4: Food travels through the large intestine for 12 to 24 hours, not for 3 to 6 hours.

A patient who has motion sickness is going on a cruise. The nurse provides which information about the antiemetic prescribed to prevent this disorder? Select all that apply. 1. "Take a double dose of the medication for the first 2 days of the trip." 2. "Buy an over-the-counter motion sickness medication to take with this prescription." 3. "Start taking your medication before you leave for your trip." 4. "Find out how sleepy this drug will make you by taking your first dose right before bedtime." 5. "Avoid milk products while taking this medication."

Correct Answer: 3,4 Rationale 1: Taking a double dose is dangerous. Rationale 2: Taking more than one drug for the same purpose can be dangerous. Rationale 3: It may take time for the medication to take its full effect. Taking the medication before the trip is advised. Rationale 4: Taking the medication in the evening before bed will help the patient judge how sleepy it makes him. Rationale 5: There is no reason to avoid milk products.

Which statement best describes the pathogenesis of diarrhea? 1. It is infrequent passage of stool. 2. It occurs when the large intestine reabsorbs water. 3. It is caused by lack of fiber in the diet. 4. It is an increase in frequency of stool.

Correct Answer: 4 Rationale 1: Constipation is the infrequent passage of hard stools. Rationale 2: Diarrhea occurs when the large intestine fails to reabsorb water. Rationale 3: Constipation is caused by lack of exercise and fiber. Rationale 4: Diarrhea is an increase in the frequency and fluidity of bowel movements.

The client takes diphenoxylate with atropine (Lomotil) for diarrhea. The client asks the nurse why he does not experience pain relief since this drug is an opioid. What is the best response by the nurse? 1. "This drug is not an opioid; did your doctor tell you that?" 2. "You would really have to take a lot to experience pain relief." 3. "It does provide some relief from the pain associated with diarrhea." 4. "Because this opioid does not have analgesic properties."

Correct Answer: 4 Rationale 1: Diphenoxylate with atropine (Lomotil) is an opioid. Rationale 2: The amount of diphenoxylate with atropine (Lomotil) is not the issue; this opioid does not have analgesic properties. Rationale 3: Diphenoxylate with atropine (Lomotil) does not have analgesic properties and will not provide any pain relief associated with diarrhea. Rationale 4: Unlike most opioids, diphenoxylate with atropine (Lomotil) does not have analgesic properties.

The mechanism of action of the antidiarrheal atropine (Lomotil) is to 1. promote stool passage. 2. block dopamine receptors in the brain. 3. increase stool formation. 4. slow peristalsis.

Correct Answer: 4 Rationale 1: Laxatives promote stool passage and increase size of stool. Rationale 2: Antiemetics block dopamine and inhibit vomiting centers. Rationale 3: Laxatives increase stool passage. Rationale 4: Antidiarrheals such as atropine slow peristalsis and allow water reabsorption

The client takes a stool softener on a regular basis and now reports a change in bowel patterns. Which assessment finding is the priority for the nurse to discuss with the physician? 1. Stools that are smaller in size 2. An increase in bowel frequency 3. A decrease in bowel frequency 4. Cramping with each stool passed

Correct Answer: 4 Rationale 1: Stools that are smaller in size are a concern but are not the priority concern. Rationale 2: An increase in bowel frequency does not need to be reported at this time. Rationale 3: A decrease in bowel frequency does not need to be reported at this time. Rationale 4: Cramping could indicate a serious condition that should be reported to the physician.

The nurse is planning care for the client who experiences frequent constipation. What will the best plan by the nurse include? Select all that apply. 1. Increase protein in the diet. 2. Drink a glass of water every hour. 3. Increase dairy products in the diet. 4. Increase dietary fiber in the diet. 5. Increase daily physical exercise.

Correct Answer: 4,5 Rationale 1: Increasing protein in the diet will not help prevent constipation. Rationale 2: Drinking a glass of water every hour is too much fluid and can result in hyponatremia. Rationale 3: Dairy products in the diet will lead to, not prevent, constipation. Rationale 4: Increasing fiber in the diet will help prevent constipation. Rationale 5: Increasing exercise will help prevent constipation.