Pharmacology: Chapter 34: Drugs Used to Treat Constipation and Diarrhea

Which instruction will the nurse include in the discharge teaching of a patient taking psyllium? a. "Administer with a full glass of water." b. "Limit the intake of high-fiber foods." c. "Avoid mixing in juice." d. "Fat-soluble vitamin deficiency is common."

a. "Administer with a full glass of water." It is important that bulk-forming laxatives be dispersed in a full glass of water or juice before administration. High-fiber foods should not be limited. Psyllium may be mixed in juice for administration. Fat-soluble vitamin deficiency is not a common adverse effect.

Which symptom is the patient with a lactase deficiency most likely to exhibit? a. Constipation b. Excessive salivation c. Diarrhea d. Vomiting

c. Diarrhea Patients with deficiencies of digestive enzymes such as lactase or amylase have difficulty digesting certain foods. Diarrhea usually develops because of irritation from undigested food. Constipation, excessive salivation, and vomiting do not result from enzyme deficiencies.

A patient is receiving morphine for pain control. What will the nurse emphasize about preventing constipation? a. Adequate hydration consists of four full glasses of water every day. b. Laxatives should be given on a daily basis. c. Stool softeners are taken on a regular basis during opioid use. d. Enemas should be given on a weekly basis.

c. Stool softeners are taken on a regular basis during opioid use. When codeine or morphine is used regularly for pain control in cancer patients, it is imperative that the individual know that stool softeners should be initiated and continued as long as constipating medicines are being taken. Although adequate hydration is important in the prevention of constipation, individual needs vary, and hydration alone cannot prevent constipation related to opioid use. Laxatives are too harsh to be given regularly unless specifically ordered by the healthcare provider. Enemas are not a preventive measure but an intervention intended to produce a more positive outcome.

An older adult is admitted through the emergency department with complaints of nausea, abdominal tenderness, and continual stooling. On assessment, the nurse notes abdominal distention, smearing of stool on undergarments, and hypoactive bowel sounds LUQ and LLQ. The patient is unable to determine when the last bowel movement was. What is the nurse's priority assessment? a. Signs and symptoms of an infection b. An impaction c. A pattern of laxative abuse d. History of GI disease

b. An impaction A nursing priority is to determine basic needs such as last bowel movement, constipation, and pain control. The symptoms presented do not indicate an infection as a priority. Frequent stooling indicated by the history and smearing on the undergarments are signs of an impaction, or an area of hardened stool. Laxative abuse or a history of GI disease may be contributing factors that the healthcare provider will review. Although the patient may have an infection or history of GI disease, checking for an impaction is a higher priority because it is done more quickly and is more likely to yield results. These symptoms are not characteristic of laxative abuse.

Which treatment(s) would be considered safe for an infant? (Select all that apply.) a. Saline laxatives b. Bulk-forming laxatives c. Malt soup extract d. Stimulant laxatives

b. Bulk-forming laxatives c. Malt soup extract Constipation in infants can be treated with a bulk-forming laxative and malt soup extract. Saline laxatives are not appropriate for infants because of the risk of electrolyte imbalances. Stimulant laxatives are not appropriate for infants.

The nurse is assessing a patient taking lactulose to treat chronic constipation. Which adverse effect should the nurse immediately report to the healthcare provider? a. Nausea b. Abdominal spasms c. Flatulence d. Abdominal tenderness

d. Abdominal tenderness Abdominal tenderness is considered a serious adverse effect and can indicate acute abdomen. Nausea, abdominal spasms, and flatulence are common adverse effects.

Which is the laxative of choice for an older patient who is in the end stage of Alzheimer's disease and requires a daily laxative? a. Emollient b. Stimulant c. Fecal softener d. Bulk forming

d. Bulk forming Bulk-forming laxatives are considered the safest laxative for routine use because they cause water to be retained within the stool, which increases bulk, and stimulates peristalsis. Emollient laxatives reduce muscle tone and decrease peristalsis over time. Stimulant laxatives can cause cramping and should not be used on a regular basis. Fecal softeners are not laxatives.

The nurse is caring for a patient receiving palliative care with opioid-induced constipation. Laxative therapy has been unsuccessful in treating this patient. Which PRN medication should the nurse provide to best alleviate this type of constipation? a. Methylnaltrexone b. Bisacodyl c. Mineral oil d. Docusate

a. Methylnaltrexone Methylnaltrexone is used for the treatment of opioid-induced constipation in patients with advanced illness who are receiving palliative care when their response to laxative therapy has not been adequate. Bisacodyl, mineral oil, and docusate are not the treatment of choice for this situation.

Which instruction by the nurse will assist in the patient's understanding of lactulose, an osmotic laxative? a. "This medication draws water into the intestine and stimulates defecation." b. "There is increased irritability directly on the intestinal wall." c. "There is lubrication of the intestinal wall that softens the stool." d. "There is an effect on the nerves to increase the peristalsis of the intestinal smooth muscle."

a. "This medication draws water into the intestine and stimulates defecation." Osmotic laxatives (e.g., magnesium hydroxide, magnesium sulfate, magnesium citrate, sodium phosphate, lactulose, polyethylene glycol) are hypertonic compounds that draw water into the intestine from surrounding tissues.

The nurse in a long-term care facility is preparing to pass medications to the residents. To which of the following residents should the nurse administer an antidiarrheal? (Select all that apply.) a. An 80-year-old woman with diarrhea of sudden onset that has lasted 3 days b. A 76-year-old man with infectious diarrhea c. A 92-year-old man with diarrhea secondary to inflammatory bowel disease d. A 70-year-old woman with a history of chronic diarrhea from GI surgery e. An 88-year-old man that has had two episodes of stress-induced diarrhea

a. An 80-year-old woman with diarrhea of sudden onset that has lasted 3 days c. A 92-year-old man with diarrhea secondary to inflammatory bowel disease d. A 70-year-old woman with a history of chronic diarrhea from GI surgery Diarrhea of sudden onset lasting more than 2 or 3 days can cause significant fluid and water loss; therefore, an antidiarrheal is indicated. Patients with inflammatory bowel disease develop diarrhea. Rapid treatment shortens the course of the incapacitating diarrhea and allows the patient to live a more normal lifestyle. Postoperative GI surgery patients develop diarrhea. These patients may require chronic antidiarrheal therapy to allow adequate absorption of fluids and electrolytes. Antidiarrheals should not be given to patients known to have infectious diarrhea. Two bouts of diarrhea would not indicate a need for an antidiarrheal.

The nurse is assessing a patient with constipation. Which situation(s) would cause constipation? (Select all that apply.) a. Diet low in fiber and/or residue b. Excessive fluid intake c. Diet low in cheese and yogurt d. Iron supplements e. Use of morphine

a. Diet low in fiber and/or residue d. Iron supplements e. Use of morphine Constipation can be caused by diets lacking in adequate residue and/or fiber and fluids or the use of constipating medicines (morphine, codeine, and anticholinergic agents). Iron has a constipating effect. Fluid intake helps prevent constipation. Constipation can be caused by excessive intake of constipating foods such as cheese or yogurt.

Which sign(s) and symptom(s) is/are consistent with dehydration? (Select all that apply.) a. Increased hemoglobin and hematocrit b. Decreased urine specific gravity c. Mental confusion and excessive thirst d. Periorbital edema and increased blood pressure e. Nonelastic skin turgor and delayed capillary filling

a. Increased hemoglobin and hematocrit c. Mental confusion and excessive thirst e. Nonelastic skin turgor and delayed capillary filling Blood work of dehydrated patients will show falsely elevated hemoglobin and hematocrit levels as a result of decreased capillary fluid. Dehydrated patients may become confused as a result of electrolyte imbalances and often complain of thirst. Older patients may not complain of thirst as a result of perceptual changes. Dehydration is evident by nonelastic skin turgor and delayed capillary filling.

A patient who has had a myocardial infarction is advised to avoid straining with defecation. Which medication would be prescribed to this patient? a. Stool softeners b. Bulk-forming laxatives c. Stimulants d. Emollients

a. Stool softeners Stool softeners are routinely used for the prevention of constipation or to prevent straining with defecation (e.g., in patients recovering from myocardial infarction or abdominal surgery). Bulk-forming laxatives and emollients can cause straining. Stimulants can cause cramping and straining.

A friend reports using loperamide (Imodium) for continual diarrhea for a week since returning home from a vacation outside the country. Which is the nurse's best response? a. "There are some other over-the-counter products available for diarrhea, such as Kaopectate (bismuth subsalicylate)." b. "I'd stop taking the Imodium and go in to see a healthcare provider immediately. You may have an infection in your intestinal tract." c. "If you're not running a temperature, I wouldn't worry. That happens to many people when they travel." d. "As long as you can drink plenty of fluids, I'm sure the diarrhea will go away once you're back in a normal routine."

b. "I'd stop taking the Imodium and go in to see a healthcare provider immediately. You may have an infection in your intestinal tract." Diarrhea may be a defense mechanism to rid the body of infecting organisms or irritants. Diarrhea is usually self-limiting and should not be suppressed with over-the-counter products. It is safest for people who are suffering from diarrhea after traveling outside the country to visit their healthcare provider, who can determine whether an infection is present.

Which drug would be most effective for an obstetric patient who is complaining of constipation as a result of her enlarging uterus and use of prenatal vitamins? a. Saline laxative b. Lubricant laxative c. Stimulant laxative d. Mineral oil

b. Lubricant laxative Lubricant and bulk-forming laxatives may be used in the pregnant patient because little cramping accompanies their use. Saline laxatives are not safe for a pregnant woman because of the bowel distention and possible electrolyte imbalance they may cause. Stimulant laxatives are too harsh for a pregnant woman because they may cause cramping. Mineral oil is not a good laxative to use on a regular basis because it can cause malabsorption of vitamins.

The nurse is performing a premedication assessment. For which patient would laxative use be contraindicated? a. Patient with quadriplegia b. Patient with appendicitis c. Geriatric patient d. Patient with fractured femur

b. Patient with appendicitis Patients who have a history of an inflammation of the gastrointestinal (GI) tract, including gastritis, colitis, Crohn's disease, ulcerative colitis, and appendicitis, should not take laxatives and should be referred to a healthcare provider. Quadriplegic and geriatric patients as well as patients with fractures may generally take laxatives and stool softeners on a regular basis.

Which effect will the nurse expect when a patient is taking psyllium while on digoxin? a. Decreased effectiveness of the laxative b. Increased laxative effect c. Increased absorption of the digoxin d. Decreased absorption of the digoxin

d. Decreased absorption of the digoxin Do not administer products containing psyllium (e.g., Metamucil) at the same time as salicylates, nitrofurantoin, or digoxin glycosides. The psyllium may inhibit absorption. Administer these medications at least 1 hour before or 2 hours after psyllium. Digoxin does not affect laxatives.

What is the mechanism of action of a stimulant laxative? a. Draws water into the bowel to facilitate the passage of feces. b. Lubricates the intestinal wall and softens stool. c. Increases bulk and stimulates peristalsis. d. Irritates the intestine directly, promoting peristalsis and evacuation.

d. Irritates the intestine directly, promoting peristalsis and evacuation. Stimulant laxatives act directly on the intestine, causing an irritation that promotes peristalsis and evacuation. Saline laxatives draw water into the bowel to facilitate the passage of feces. Lubricant laxatives lubricate the intestinal wall and soften the stool, allowing a smooth passage of fecal contents. Bulk-producing laxatives must be administered with a full glass of water. The laxative causes water to be retained within the stool. This increases bulk, which stimulates peristalsis.

When the nurse assesses bowel habits in a patient, which is the best example of normal bowel elimination? a. Daily bowel movements b. Multiple soft stools daily c. Daily liquid stools d. Regular bowel elimination pattern of soft stool

d. Regular bowel elimination pattern of soft stool Normal bowel habits are stools that are soft and occur on a regular schedule of elimination for that particular patient. Although this may be routine for some people, it is not normal for everyone. Liquid stools are not considered normal.