Chapter 58- Drugs Affecting Gastrointestinal Motility
The nurse administers metoclopramide to the patient with what condition? A) Chronic diabetic gastroparesis Impaction Encopresis Patients requiring diagnostic procedures
A increases the motility of the gastrointestinal (GI) tract by increasing the fluid in the intestinal contents, which enlarges bulk, stimulates local stretch receptors, and activates local activity. It does not block absorption of fats, stimulate the nerve plexus, or form a slippery coat. Feedback: Indications for metoclopramide include relief of acute and chronic diabetic gastroparesis, short-term treatment of gastroesophageal reflux disorder in adults who cannot tolerate standard therapy, prevention of postoperative or chemotherapy-induced nausea and vomiting, facilitation of small-bowel intubation, stimulation of gastric emptying, and promotion of intestinal transit of barium. It would not be used for treatment of impaction, encopresis, and in patients requiring diagnostic procedures.
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 Feedback: Common adverse effects of laxatives are diarrhea, abdominal cramping, and nausea. Central nervous system (CNS) adverse effects such as dizziness, headache, and weakness can occur. Rectal bleeding, confusion, and iron deficiency anemia are not associated with appropriate use of laxatives but may occur when laxatives are abused.
What drug does the nurse recognize as being classified as a chemical stimulant? A) Bisacodyl (Dulcolax) B) Polycarbophil (FiberCon) C) Magnesium hydroxide (Milk of Magnesia) D) Docusate (Colace)
Ans: A Feedback: Bisacodyl is a chemical stimulant. Polycarbophil and magnesium hydroxide are bulk laxatives. Docusate is a lubricant laxative.
The nurse administers loperamide (Imodium) to decrease the number and liquidity of stool by what mechanism? A) Decreasing intestinal motility B) Absorbing toxins C) Binding with fecal material to increase bulk D) Blocking the chemoreceptor trigger zone (CTZ)
Ans: A Feedback: Systemic antidiarrheal agents slow the motility of the gastrointestinal (GI) tract through direct action on the lining of the GI tract to inhibit local reflexes (bismuth subsalicylate), through direct action on the muscles of the GI tract to slow activity (loperamide), or through action on central nervous system (CNS) centers that cause GI spasm and slowing (opium derivatives). Options B, C, and D are not correct.
What drug does the nurse administer that inhibits intestinal peristalsis through direct effects on the longitudinal and circular muscles of the intestinal wall? A) Bismuth subsalicylate B) Loperamide (Imodium) C) Paregoric D) Magnesium citrate
Ans: B Feedback: Actions of loperamide include that it inhibits intestinal peristalsis through direct effects on the longitudinal and circular muscles of the intestinal wall, slowing motility and movement of water and electrolytes. Bismuth subsalicylate inhibits local reflexes. Paregoric works through action on CNS centers that cause GI spasm and slowing. Magnesium citrate is a laxative.
The nurse, providing patient teaching, explains that difenoxin and diphenoxylate are chemically related to what medication? A) Morphine B) Demerol C) Diphenhydramine D) Diflucan
Ans: B Feedback: Difenoxin and diphenoxylate are chemically related to meperidine and are used at doses that decrease gastrointestinal activity without having analgesic or respiratory effects.
What is the priority nursing diagnosis for an 89-year-old patient with frequent liquid stools? A) Imbalanced nutrition: less than body requirements B) Deficient fluid volume C) Deficient knowledge related to medications D) Pain related to abdominal cramping
Ans: B Feedback: Fluid volume deficits may develop rapidly in older adults with diarrhea. Older adults are more likely to develop adverse effects associated with the use of these drugs, including sedation, confusion, dizziness, electrolyte disturbances, fluid imbalance, and cardiovascular effects. Although nutrition, pain, and knowledge deficit may be concerns for this patient, they are not the priority concern.
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? Albuterol (Proventil) Digoxin (Lanoxin) Furosemide (Lasix)
Ans: B Feedback: Metoclopramide has been associated with decreased absorption of digoxin from the gastrointestinal (GI) tract. The nurse should monitor patients taking this combination carefully. The other options do not pose a concern about drugdrug interactions.
The nurse teaches the patient to best maintain optimal GI function by including what in the daily routine? A) Exercise, adequate sleep, and avoiding caffeine B) Proper diet, fluid intake, and exercise C) Proper diet, avoiding alcohol, and cautious use of laxatives D) Avoiding prescription medications, increased fluid intake, and vigorous exercise
Ans: B Feedback: The best way to maintain gastrointestinal (GI) function is through proper diet including optimizing fiber intake, adequate fluid intake, and exercise, which will stimulate GI activity. Drugs should only be used when normal function cannot be maintained. Options A, C, and D are not correct.
What is the antidiarrheal of choice the nurse will administer to children older than 2 years of age with diarrhea? A) Bismuth salts (Pepto-Bismol) B) Loperamide (Imodium) C) Paregoric (generic) D) Difenoxin (Motofen)
Ans: B Loperamide may be the antidiarrheal of choice in children older than 2 years of age if such a drug is needed. Special precautions need to be taken to monitor for electrolyte and fluid disturbances and supportive measures should be taken as needed. Serious fluid volume deficits may rapidly develop in children with diarrhea. Appropriate fluid replacement should include oral rehydration solutions. Although bismuth salts and paregoric may be given to children, they are not the drugs of choice. Difenoxin is not for use in children under 12 years of age.
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? A) Diabetes B) Hypertensive medications C) Laxative overuse D) Glaucoma
Ans: C Feedback: Diarrhea in older adults may result from laxative overuse so the nurse should assess what over-the- counter (OTC) products the patient is using. Diabetes, hypertension medications, and glaucoma are not common causes of diarrhea in patients.
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? A) Cascara (generic) B) Magnesium hydroxide (Milk of Magnesia) C) Polyethylene glycol-electrolyte solution (GoLYTELY) D) Glycerin (Sani-Supp)
Ans: D Feedback: Glycerin suppositories are the best choice for infants and young children when constipation is a problem. The other choices are not recommended for infants or children.
What antidiarrheal would the nurse administer to reduce the volume of discharge from the patient's ileostomy? A) Diphenoxylate (Lomotil) B) Octreotide (Sandostatin) C) Psyllium (Metamucil) D) Loperamide (Imodium)
Ans: D Feedback: Loperamide (Imodium), bismuth subsalicylate (Pepto-Bismol), and opium derivatives (paregoric) are indicated for the reduction of volume of discharge from ileostomies. The other options would not serve this purpose.
For what action would the nurse administer magnesium citrate? A) Block absorption of fats B) Directly stimulate the nerve plexus in the intestinal wall C) Form a slippery coat on the contents of intestine D) Increase motility, increase fluid, and enlarge bulk of fecal matter
Ans: D Feedback: Magnesium citrate is a rapid-acting, aggressive laxative that causes fecal matter to increase in bulk. It increases the motility of the gastrointestinal (GI) tract by increasing the fluid in the intestinal contents, which enlarges bulk, stimulates local stretch receptors, and activates local activity. It does not block absorption of fats, stimulate the nerve plexus, or form a slippery coat.
Lomotil = diphenoxylate with atropine
Antidiarrheals: Combination Products - diphenoxylate - chemically related to meperidine - diphenoxylate is combined with sub-therapeutic amounts of atropine - Combo may discourage recreational opiate drug use - Large dosages will result in extreme anticholinergic effects (dry mouth, abdominal pain, tachycardia, blurred vision)
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? Effectiveness of laxatives Timing of medication administration The amount of fiber in her diet Amount of fluid ingested
B Feedback: Because laxatives increase the motility of the gastrointestinal (GI) tract and some laxatives interfere with the timing or process of absorption, it is not advisable to take laxatives with other prescribed medications. The administration of laxatives and other medications should be separated by at least 30 minutes, so the nurse should question when the patient is taking the laxatives and other medication. Other options may be questions the nurse would eventually ask, but the priority is timing of medication administration.
The nurse develops a teaching plan for a 77- year-old patient who has been prescribed loperamide PRN. nurse's priority teaching point is what? May cause hallucinations or respiratory depression B) Take drug after each loose stool Drug remains in the bowel without being absorbed into the bloodstream Avoid pregnancy and breast-feeding while taking drug.
B Feedback: Loperamide is taken repeatedly after each loose stool. Teaching the patient when to take the drug is the priority teaching point. Paregoric, and not loperamide, can cause hallucinations and respiratory depression. The drug is absorbed systemically. It is unlikely a 77-year-old patient will get pregnant or breast-feed so this is not the highest priority.
A patient receiving loperamide (Imodium) should be alerted by the nurse to what possible adverse effect? A) Anxiety B) Bradycardia C) Fatigue
C Feedback: Patients should be aware that they should not drive or operate machinery while taking loperamide (Imodium) because it can cause fatigue. Anxiety, bradycardia, and urinary retention are not commonly associated with loperamide.
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?
Correct response: "Children younger than 1 year of age should not be given this medication." Explanation: Children younger than 2 years of age should not take the drugs, and those from age 2 to less than 13 years should take the liquid preparation to enhance accuracy of the dosage. Calling the prescriber is not necessary. The nurse-should not encourage over-the-counter medications for the child.
A nurse is teaching a client about diarrhea. Which statement by the client regarding diarrhea would indicate a need for additional teaching?
Correct response: "Diarrhea is a disease that has no cure." Explanation: Diarrhea is an increase in the liquidity of stool or frequency of defecation to more than 3 stools per day. It is a symptom of numerous conditions and not a disease. Diarrhea is a manifestation of basic mechanisms that increase bowel motility, and a variety of toxins and medications can cause the diarrhea. Diarrhea may be acute or chronic and mild or severe.
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?
Correct response: Abdominal cramping Explanation: Common adverse effects of laxatives are diarrhea, abdominal cramping, and nausea. CNS effects such as dizziness, headache, and weakness can occur. However, these adverse effects usually relate to the loss of fluid and electrolyte imbalance associated with laxative use and are not the most common adverse effects.
What is the correct rationale for why the nurse would administer a laxative at a separate time from the client's other medications?
Correct response: Laxatives may reduce absorption of other drugs present in the GI tract. Explanation: Laxatives may reduce absorption of other drugs present in the GI tract by combining with them chemically, or hastening their passage through the intestinal tract. Nausea, taste, and onset of action have no bearing on administration of laxatives.
A nurse is preparing a presentation for a local woman's group about irritable bowel syndrome. Which of the following would the nurse include in the presentation? Select all that apply.
Correct response: Stress may play a role in the cause of this disorder. Abdominal distress and bouts of diarrhea or constipation are common. An underlying anatomical cause has not been identified. Explanation: The underlying cause of the disorder may be related to stress. The disorder is characterized by abdominal distress, bouts of diarrhea or constipation, bloating, nausea, flatulence, fatigue, depression, and anxiety. No anatomical cause has been found for this disorder. Irritable bowel syndrome is a very common disorder. Irritable bowel syndrome typically occurs more commonly in women, affecting women 3 times as often as men.
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?
Correct response: Sympathetic stress reaction due to intense GI tract neurostimulation Explanation: The client's symptoms are most likely related to a sympathetic stress reaction due to intense neurostimulation of the GI tract or to the loss of fluid and electrolyte imbalance. Direct stimulation refers to the action of chemical stimulant laxatives. Detergent action is related to the use of docusate. Formation of a slippery coat relates to the use of mineral oil.
An older adult client has received a third dose of diphenoxylate. In addition to monitoring the number and consistency of the client's stools, the nurse should prioritize what assessment?
Correct response: assessment of fluid and electrolyte balance Explanation: After drug administration, the nurse monitors the number and consistency of stools and fluid and electrolyte balance. The client's fluid and electrolyte balance is more vulnerable during prolonged diarrhea than neurological, nutritional, or respiratory status.
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 psyllium lubiprostone lactulose
Correct response: docusate Explanation: Docusate a stool softener, may be prescribed after a myocardial infarction to prevent straining during defecation. Psyllium is a bulk-forming laxative and may require straining to eliminate. Lubiprostone and lactulose are hyperosmotic agents that are used to relieve constipation and the reduction of blood ammonia levels in hepatic encephalopathy which may require straining.
The nurse should prioritize what assessment when providing care for a client who has taken over-the-counter (OTC) bisacodyl daily for several months?
Correct response: electrolyte levels Explanation: People should not use bisacodyl frequently or for longer than 1 week because it may produce serum electrolyte and acid-base imbalances (e.g., hypocalcemia, hypokalemia, metabolic acidosis, or alkalosis). Assessment of electrolytes would thus be warranted in the care of this client. Reflexes, heart rate, and coagulation factors may be affected, but these would be consequent to alterations in electrolyte levels.
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?
Correct response: laxative abuse Explanation: Stimulant laxatives such as bisacodyl are generally useful and safe for short-term treatment of constipation, cleansing the bowel prior to endoscopic examinations, and treating fecal impaction. However, they are not safe for frequent or prolonged usage but are often used or overused in older adults.
What type of laxative would be the first choice for a client diagnosed with hemorrhoids experiencing intense pain when straining to pass stools?
Correct response: stool softener Explanation: For clients in whom straining is potentially harmful or painful, stool softeners (e.g., docusate sodium) are the agents of choice.
In the hours following the initial administration of prescribed diphenoxylate with atropine, the nurse should plan to assess the client for what adverse reaction? Select all that apply.
Correct response: urinary retention tachycardia dizziness Explanation: Adverse effects of diphenoxylate with atropine include tachycardia, dizziness, headache, flushing, nausea and vomiting, dry skin and mucous membranes, and urinary retention. This drug is not associated with pruritus or dyspnea.
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? Bisacodyl (Dulcolax) Castor oil (Neolid) Magnesium sulfate (epsom salts) Docusate (Colace)
D Feedback: Docusate is a stool softener that will make expulsion of stool easier in a traumatized body area following an episiotomy. Care must be taken to choose a mild laxative that will not enter breast milk and not affect the newborn if the mother is nursing. Docusate is the drug of choice from this list because it is mild and will produce a soft stool and decrease the need to strain. The other options would not be appropriate because they do not soften the stool and are harsher laxatives that can enter breast milk.
bisacodyl (Ducolax)
Directly stimulates the nerve plexus in intestinal wall
Magnesium citrate docusate (Colace) bisacodyl (Ducolax) metoclopramide (Reglan) loperamide (Imodium) diphenoxylate (Lomotil) (final - 8 questions)
Drugs Affecting Gastrointestinal Motility
metoclopramide (Reglan)
Gastrointestinal Stimulants - Drugs that stimulate parasympathetic activity IV (push slow) or PO
Magnesium citrate
Laxatives - Bulk stimulants - Bulk forming fiber/ increases water - Cause fecal matter to increase in bulk - turn gel like - Distend bowel to initiate reflex bowel activity - Often preferred for long term use
docusate (Colace)
Laxatives - Stool Softeners - Promote more water and fat in the stools - Lubricate the fecal material and intestinal walls - Usually act within 1-3 days
loperamide (Imodium)
• Antidiarrheals - Block stimulation of GI tract, slow motility
