Prep U's - Chapter 39 - Drug Therapy for Constipation and Elimination Problems

The nurse is preparing to administer medications to a group of clients. For which client is bisacodyl contraindicated? A. 75-year-old B. 35-year-old C. 4-year-old D. 17-year-old

Answer: C Rationale: Bisacodyl is contraindicated in clients younger than 6 years of age.

The nurse is conducting a class on prevention of constipation and informs the participants that constipation is associated with fluid intake that is less than how much per day? A. 5,000 mL B. 10,000 mL C. 3,500 mL D. 2,000 mL

Answer: D Rationale: Constipation is associated with fluid intake less than 2000 mL/d.

An adult client asks the nurse how many stools per week is considered "normal." The nurse should indicate that there is no fixed number, but that functional constipation is diagnosed at what frequency? A. Five stools per week. B. Four stools per week. C. Three stools per week. D. Six stools per week.

Answer: C Rationale: Due to variations in diet and other factors, there is no "normal" number of stools, but the traditional medical definition of constipation includes three or fewer bowel movements per week.

An older client with hypertension reports frequent constipation. Which type of medication will the nurse ask the health care provider to prescribe for this client? A. saline cathartic B. oil retention enema C. stool softener D. bulk-forming laxative

Answer: C Rationale: A stool softener is the agent of choice for a client who should avoid straining when having a bowel movement, such as a client with hypertension. Saline cathartics are for occasional use and are prescribed to cleanse the bowel prior to or following a diagnostic procedure. Oil retention enemas are used to help with a fecal impaction. Bulk-forming laxatives are recommended for long-term use in clients who are debilitated or unable to eat an adequate diet.

After teaching a group of nursing students about laxatives, the instructor determines that the teaching was successful when the students correctly choose which drug as producing the laxative effect by promoting water retention and softening the stool? A. Docusate B. Methylcellulose C. Lactulose D. Bisacodyl

Answer: A Rationale: A stool softener, like docusate, produces its laxative effect by promoting water retention in the fecal mass and softening the stool. Methylcellulose is a bulk-producing laxative. Bisacodyl is a stimulant laxative. Lactulose is a hyperosmolar laxative.

The nurse has just finished client education with a client who is being discharged home on bulk-forming laxatives. The nurse knows the client understands discharge instructions regarding these medications when which statement is made? A. "I will mix the medication with 4 to 8 ounces of liquid and follow it by an additional 4 to 8 ounces." B. "I will use milk of magnesia in conjunction with this medication until I am having daily bowel movements." C. "I will mix the dry medication with applesauce." D. "I will decrease the roughage in my diet while I am using this medication."

Answer: A Rationale: Bulk-forming laxatives need to be taken with at least 8 oz of water or other liquid. The other options are incorrect statements and would indicate further need for teaching.

The nurse provides drug teaching to the client who will begin taking polycarbophil. What is the nurse's priority teaching point? A. Drink lots of water when taking the drug. B. Do not eat or drink anything for 2 hours after taking the medication. C. Take at night before bedtime. D. The drug can be taken up to 6 times per day.

Answer: A Rationale: Clients must take plenty of water with polycarbophil. If only a little water is consumed, the medication may absorb enough fluid in the esophagus to swell the food into a gelatin-like mass that can cause obstruction and other severe problems. The drug should be taken no more than four times a day and should not be taken at night.

The nurse is caring for a client who is diagnosed with hepatic encephalopathy. The nurse knows that which medication will be used to treat the constipation that accompanies this condition? A. Lactulose B. Mineral oil C. Psyllium D. Bisacodyl

Answer: A Rationale: Clients with hepatic encephalopathy are prescribed lactulose which helps to decrease the amount of ammonia in the intestine.

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? A. docusate B. psyllium C. lactulose D. lubiprostone

Answer: A Rationale: 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.

After teaching a group of nursing students about upper gastrointestinal system drugs, the instructor determines that the teaching was successful when the students correctly choose which drug as a gastrointestinal stimulant? A. Metoclopramide B. Ranitidine C. Omeprazole D. Misoprostol

Answer: A Rationale: Metoclopramide is classified as a gastrointestinal stimulant. Ranitidine is a histamine H2 receptor antagonist. Omeprazole is a proton pump inhibitor. Misoprostol is a miscellaneous acid reducer.

You are preparing to administer a saline cathartic when the patient mentions that they have CHF. You know that saline cathartics are contraindicated for clients with congestive heart failure due to what adverse effect? A. Hypernatremia B. Hyperphosphatemia C. Hypomagnesemia D. Hypochloremia

Answer: A Rationale: Patients with congestive heart failure are at risk of fluid retention and edema with sodium-containing laxatives.

A group of students are reviewing the actions of laxatives on the GI tract. The students demonstrate understanding when they state what about bulk stimulants? A. Allow formation of a slippery coat on the intestinal contents. B. Selectively antagonize opioid binding. C. Increase the fluid in the intestinal contents. D. Directly stimulate the nerve plexus in the intestinal wall.

Answer: C Rationale: Bulk laxatives increase the fluid in the intestinal contents, which enlarges bulk and stimulates local stretch receptor and activates local activity. Chemical stimulant laxatives directly stimulate the nerve plexus in the intestinal wall. Mineral oil, a lubricant, forms a slippery coat on the contents of the intestinal tract. Methylnaltrexone acts as a selective antagonist to opioid binding at the mu receptor.

Psyllium (Metamucil) is a bulk-forming laxative available over-the-counter and frequently used. The nurse knows that which of these statements regarding use of psyllium is correct? A. Psyllium is useful in critically ill patients who experience constipation. B. Home care nurses should not become involved in their patients' bowel management. C. Laxatives are the preferred method for bowel management in older adults. D. Psyllium can be used freely in children.

Answer: A Rationale: Psyllium should be administered to children only under health care provider supervision. In older adults, dietary fiber, adequate fluid consumption, and exercise are the preferred method for bowel management. Critically ill patients often experience constipation from decreased physical activity and, at times, administration of opioid analgesics. Home care nurses should determine patients' risk for constipation and assist in bowel management.

A client is scheduled for a colonoscopy in the morning. What laxative would the nurse expect to be prescribed the evening before the procedure? A. Polyethylene glycol-electrolyte solution B. Psyllium C. Castor oil D. Lactulose

Answer: A Rationale: Saline or stimulant cathartics are acceptable as used for occasional bowel preparations for endoscopic or radiologic examinations.

The nurse is caring for a client with a K+ level of 6.1 mEq/dL. The nurse is prepared to administer what medication to assist in lowering this lab value? A. Sodium polystyrene sulfonate B. Lactulose C. Bisacodyl D. Polyethylene glycol solution

Answer: A Rationale: Sodium polystyrene sulfonate is prescribed for the treatment of increased potassium levels.

The nurse should advise clients taking laxatives of which adverse effects? Select all that apply. A. Nausea B. Cramps C. Diarrhea D. Perianal irritation E. Bloating

Answer: A, B, C, D, E Rationale: Laxatives may cause diarrhea, loss of water and electrolytes, abdominal pain or discomfort, nausea, vomiting, perianal irritation, fainting, bloating, flatulence, cramps and weakness. The nurse should advise clients taking laxatives of these possible adverse effects.

The nurse is aware that critically ill clients are more at risk for constipation for what reasons? (Select all that apply.) A. Use of opioid medications. B. Decreased activity. C. Decrease in the amount of family interaction. D. Change in bowel routines. E. Increased access to a high-fiber diet.

Answer: A, B, D Rationale: Critically ill clients are more at risk for constipation because of decreased activity, decreased access to a high-fiber diet, the use of opioid medications, and changes in usual bowel routines.

A client reports using chamomile tea as a remedy to treat gastrointestinal upset. The nurse should assess the client for a hypersensitivity to which plants? Select all that apply. A. Asters B. Fox glove C. Lavender D. Ragweed E. Chrysanthemums

Answer: A, D, E Rationale: Although chamomile is generally safe and nontoxic, the tea is prepared from the pollen-filled flower heads and has resulted in symptoms ranging from contact dermatitis to severe anaphylactic reactions in individuals hypersensitive to ragweed, asters, and chrysanthemums. Fox glove is the original source of digitalis. Lavender is an herb which is used for a variety of ailments.

The nurse is preparing to administer an antidiarrheal to a client. The nurse will question this order if which organism is documented on the stool sample report? Select all that apply. A. Salmonella B. Staphylococcus C. Streptococcus D. Shigella E. Escherichia coli

Answer: A, D, E Rationale: Antidiarrheals are contraindicated in clients whose diarrhea is associated with Shigella, Salmonella, and E. coli, which can harm the intestinal mucosa. Using antidiarrheals with diarrhea associated with Staphylococcus or Streptococcus is not as concerning.

A nurse is caring for a client who has been diagnosed with constipation. The health care provider has ordered a laxative. What other interventions will the nurse include in the teaching plan? Select all that apply. A. Diet with fruits, vegetables, and whole grains. B. Decrease stress. C. Smoking cessation. D. Increase fluid intake. E. Regular aerobic exercise.

Answer: A, D, E Rationale: Lifestyle management of a client diagnosed with constipation is to maintain normal bowel function. Interventions include a diet with more fruits, vegetables, and whole grains; increased exercise; and increased fluid intake. Decreasing stress and smoking cessation re not priorities in maintaining normal bowel function; however, they may help improve the client's overall health and should be encouraged when addressing the client's general health status.

What recommendations should be included in client teaching as a means of avoiding constipation? (Select all that apply.) A. Eat foods high in bulk or roughage. B. Take an opioid pain medication daily. C. Avoid defecating when the urge occurs. D. Drink plenty of fluids. E. Be active and exercise daily.

Answer: A, D, E Rationale: Measures to prevent constipation include: drink plenty of fluids, get exercise, and eat foods high in bulk or roughage. Opioid medications can cause constipation and are therefore not a means of prevention. Avoiding the need to defecate when the urge occurs can lead to constipation.

A client's history reveals that the client is experiencing intestinal gas. Which medication would the nurse expect the primary health care provider to prescribe? Select all that apply. A. Simethicone B. Ondansetron C. Ranitidine D. Omeprazole E. Charcoal

Answer: A, E Rationale: Charcoal and simethicone are antiflatulents used to help relieve gas in the intestinal tract of a client. Omeprazole and ranitidine are used to treat hyperacidity disorders. Ondansetron is used to treat nausea and vomiting.

A client reports to the nurse about needing to strain to defecate. The client adds that defecating is very painful. What laxative will the nurse suggest to the prescriber based on the painful defecation? A. Sorbitol B. Docusate C. Psyllium D. Fiber

Answer: B Rationale: A laxative such as a stool softener like docusate sodium is recommended for clients who are straining or for whom defecation is painful. Sorbitol may be given with activated charcoal to remove toxic substances. Bulk-forming laxatives such as psyllium are used in clients who are debilitated, older, or unable or unwilling to eat an adequate diet. Fluids and fiber are indicated for all clients to encourage a healthy bowel regimen.

A health care provider prescribes a chemical stimulant laxative. Which would be appropriate? A. Lactulose B. Bisacodyl C. Docusate D. Polycarbophil

Answer: B Rationale: Bisacodyl is a chemical stimulant laxative. Polycarbophil is a bulk laxative. Docusate is a lubricant laxative. Lactulose is a bulk laxative.

The nurse is caring for an older client who has been prescribed bisacodyl for constipation. Which assessment finding will convince the nurse to contact the health care provider about administering the bisacodyl? A. dry oral mucus membranes. B. abdominal pain. C. slow heartbeat. D. productive cough.

Answer: B Rationale: Bisacodyl is a stimulant cathartic that acts by irritating the gastrointestinal mucosa and pulling water into the bowel lumen. The additional water in the bowel causes feces to move through the intestines rapidly to cause a watery stool. Contraindications to bisacodyl include abdominal pain or cramps. The health care provider will need to rule out obstruction before the bisacodyl can be given safely. The medication is not contraindicated for a slow heartbeat, productive cough, or dry oral mucus membranes.

The nurse would caution a client with which condition against frequent use of milk of magnesia for treatment of constipation? A. The client with constipation caused by the use of opioid analgesics. B. The client with decreased renal function. C. The client with chronic constipation. D. The client with decreased liver function.

Answer: B Rationale: Clients with decreased renal function may develop hypermagnesemia if mail of magnesia is used frequently.

The nurse is teaching a client being discharged with a prescription for senna. The nurse should caution the client about what potential adverse effect? A. confusion B. abdominal cramping C. rectal bleeding D. gastroesophageal reflux

Answer: B Rationale: Common adverse effects of chemical stimulant laxatives like senna are diarrhea, abdominal cramping, and nausea. Central nervous system (CNS) adverse effects such as dizziness, headache, and weakness can occur. Rectal bleeding and confusion are not associated with appropriate use of laxatives but may occur when laxatives are abused. Reflux is not expected.

The parent of a school-age client reports that the child frequently fights the urge to defecate because of a fear of using public restrooms. The nurse should inform the parent that this behavior can result in what problem? A. chronic diarrhea. B. weakened defecation reflex. C. strengthened gastrocolic reflex. D. bowel incontinence.

Answer: B Rationale: In people who often inhibit the defecation reflex or fail to respond to the urge to defecate, constipation develops as the reflex weakens. None of the other options result from this lack of response.

What is the correct rationale for why the nurse would administer a laxative at a separate time from the client's other medications? A. They often taste bad, and clients are less likely to take other medications. B. Laxatives may reduce absorption of other drugs present in the GI tract. C. Often laxatives make the client nauseated, which interferes with the ability to take medications. D. Because a laxative may stimulate a bowel movement, it can interfere with medication administration.

Answer: B Rationale: 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 client diagnosed with ulcerative colitis has been prescribed sulfasalazine. The nurse should prioritize which finding on the ongoing assessment? A. Frequent loose or watery stools. B. Severe blood- and mucus-filled diarrhea. C. Mild symptoms of contact dermatitis. D. Abdominal pain and distention.

Answer: B Rationale: The nurse should monitor for severe blood- and mucus-filled diarrhea in the client with ulcerative colitis. Pain and fatigue also accompany this disorder. Abdominal pain and distention are clinical manifestations of Crohn's disease. When clients hypersensitive to ragweed, asters, and chrysanthemums are administered the chamomile herb, mild symptoms of contact dermatitis are observed. Frequent loose or watery stools are not associated with ulcerative colitis.

A nurse is teaching a group of older adults about nonpharmacologic strategies for preventing constipation. The nurse should recommend what practices? Select all that apply. A. reserving at least 8 hours nightly to assure adequate sleep. B. engaging in frequent physical exercise. C. drinking 6 to 10 glasses of fluid each day. D. consuming a high-fiber diet. E. introducing organic foods into the daily diet.

Answer: B, C, D Rationale: Nonpharmacologic measures for preventing constipation include increased fiber intake, exercise, and adequate fluids. Organic foods do not have any particular benefit in the prevention of constipation. Adequate sleep has multiple benefits, but reduced constipation is not among these.

After administering diphenoxylate to a client, the nurse would assess the client closely for increased CNS depression if the client was also prescribed which medication? Select all that apply. A. Sucralfate B. Zolpidem C. Temazepam D. Glyburide E. Fexofenadine

Answer: B, C, E Rationale: The nurse should monitor a client closely for increased CNS depression when diphenoxylate is given to a client taking antihistamines (fexofenadine), opioids, sedatives (zolpidem), and hypnotics (temazepam). Individuals taking glyburide should use caution using aminosalicylates due to the decreased blood glucose level which can occur. Sucralfate can decrease the absorption of a proton pump inhibitor when they are used together.

The nurse is providing care to a client with hepatic encephalopathy. Which would the nurse anticipate administering to assist in lowering the client's blood ammonia level? A. Mineral oil B. psyllium C. lactulose D. lubiprostone

Answer: C Rationale: A client with hepatic encephalopathy may have high levels of ammonia in their blood; lactulose can be used to lower the level of ammonia in the client's blood. Lubiprostone is a hyperosmotic agent that is used to relieve constipation. Psyllium is a bulk-forming laxative. Mineral oil is an emollient that lubricates the intestinal walls and softens the stool, thereby enhancing passage of fecal material.

Which would be most important to include when teaching a patient about using psyllium? A. Taking other prescribed drugs along with the psyllium. B. Taking the agent at bedtime. C. Taking the agent with a large amount of water. D. Limiting the use of high fiber foods.

Answer: C Rationale: A large amount of water is needed to prevent the laxative from swelling into a gelatin-like mass in the esophagus that could lead to obstruction. Psyllium can be taken any time, 1 to 3 times per day. Bulk laxatives, like psyllium, can increase the motility of the GI tract and interfere with the timing or process of absorption. Administration of other drugs with psyllium should be separated by at least 30 minutes. It would be important to encourage the patient to ingest high fiber foods to promote bowel evacuation and reduce the need for psyllium.

A student asks the physiology instructor what failure to respond to the defecation reflex will cause. What would the instructor answer? A. Diarrhea B. Involuntary evacuation. C. Decreased sensory stimulation of reflex. D. Increased sensory stimulation of reflex.

Answer: C Rationale: Failure to respond to the defecation reflex causes the reflex to weaken. Therefore the other options are incorrect.

After teaching a group of nursing students about upper gastrointestinal system drugs, the instructor determines that the teaching was successful when the students correctly choose which drug as a gastrointestinal stimulant? A. Omeprazole B. Misoprostol C. Metoclopramide D. Ranitidine

Answer: C Rationale: Metoclopramide is classified as a gastrointestinal stimulant. Ranitidine is a histamine H2 receptor antagonist. Omeprazole is a proton pump inhibitor. Misoprostol is a miscellaneous acid reducer.

The nurse is conducting a pre-colonoscopy class and knows that polyethylene glycol- electrolyte solution will be contraindicated for the client with which condition? A. Chronic constipation B. Gastroesophageal reflux disease. C. Colitis D. Oral stomatitis

Answer: C Rationale: Polyethylene glycol-electrolyte solution is contraindicated in clients who have colitis.

A client is advised to use a bulk-forming laxative to alleviate constipation. The nurse will recommend: A. milk of magnesia. B. Docusate (Colace). C. Psyllium (Metamucil). D. mineral oil.

Answer: C Rationale: Psyllium is a bulk-forming laxative. Docusate is a stool softener. Mineral oil is a lubricant. Both are laxatives, having milder action than cathartics, which include the stimulant milk of magnesia.

A client is advised to use a bulk-forming laxative to alleviate constipation. The nurse will recommend: A. milk of magnesia. B. mineral oil. C. Psyllium (Metamucil). D. Docusate (Colace).

Answer: C Rationale: Psyllium is a bulk-forming laxative. Docusate is a stool softener. Mineral oil is a lubricant. Both are laxatives, having milder action than cathartics, which include the stimulant milk of magnesia.

The nurse is preparing to administer psyllium (Metamucil) to a client. The nurse instructs the client to mix the medication in how much liquid? A. 90 mL B. 120 mL C. 240 mL D. 30 mL

Answer: C Rationale: Psyllium should be taken with a full glass of liquid; therefore, it should be mixed in 240 mL (8 ounces) of liquid.

A client has ingested a toxic substance. Which medication is the preferred medication for the removal of a toxic agent? A. Bisacodyl B. Lactulose C. Sorbitol D. Psyllium

Answer: C Rationale: Sorbitol may be given with activated charcoal to remove toxic substances. Lactulose is used to prevent absorption of intestinal ammonia in clients with hepatic encephalopathy. Bisacodyl is for occasional use to cleanse the bowel for endoscopic or radiologic examinations. Bulk-forming laxatives such as psyllium are used in clients who are debilitated, older, or unable or unwilling to eat an adequate diet.

You are caring for four clients. Which client would you know is at highest risk for constipation? A. Client on antihypertensive medications. B. Diabetic C. Paraplegic D. Triathlete

Answer: C Rationale: Spinal cord injury (SCI) impairs the ability of an individual to sense that a bowel movement is imminent, and the ability to control the timing and place of bowel evacuation. Common problems that the individual with SCI must cope with include incontinence and fecal impaction, which, if left untreated, may result in perforation of the bowel.

The health care provider has determined that an older adult client would benefit from using a bulk-forming laxative. What instruction should the nurse include when providing education related to proper drug use? A. "Be sure to eat vegetables that provide roughage." B. "Increase your consumption of healthy fats." C. "Make sure you take the laxative with a glass of water." D. "Make sure each of your meals includes some protein."

Answer: C Rationale: With psyllium-containing preparations, there have been reports of obstruction in the GI tract when the compound was taken with insufficient fluid. Therefore, it is important to take the drug with at least 8 ounces (240 mL) of water or another liquid. The other advice offers appropriate guidance related to nutrition, but it does not address proper drug use.

The nurse is caring for a new mother who had to have an episiotomy during the birth of her baby. Two days after delivery the client is in need of a laxative. What will the nurse administer? A. Bisacodyl B. Castor oil C. Magnesium citrate D. Docusate

Answer: D Rationale: A mild laxative may be used after delivery with care that it not enter breast milk and affect the newborn if the mother is nursing. Docusate would be 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 for this client.

After teaching a group of nursing students about laxatives, the instructor determines that the teaching was successful when the students correctly choose which drug as producing the laxative effect by promoting water retention and softening the stool? A. Lactulose B. Bisacodyl C. Methylcellulose D. Docusate

Answer: D Rationale: A stool softener, like docusate, produces its laxative effect by promoting water retention in the fecal mass and softening the stool. Methylcellulose is a bulk-producing laxative. Bisacodyl is a stimulant laxative. Lactulose is a hyperosmolar laxative.

A client taking bisacodyl and medications for heart failure and osteoarthritis calls the nurse and states, "I'm just not feeling right." What is the priority for the nurse to ask this client about? A. the amount of fiber intake. B. previous effectiveness of laxatives. C. amount of fluid intake. D. timing of medication administration.

Answer: D Rationale: 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 client 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 recognizes that a client needs additional instruction if the client makes which comment about treatment for occasional constipation? A. "I will choose more foods with fiber." B. "I will obey the urge to have a bowel movement when it occurs." C. "I will make sure to drink an adequate amount of fluid every day." D. "I will make sure that I have a bowel movement every day."

Answer: D Rationale: Clients who believe that a daily bowel movement is necessary need further instruction.

Which is an important assessment for the nurse to make before administering a laxative? A. Once a medication is ordered by the health care provider, it is unnecessary to make any additional assessments before administering the medication. B. It is imperative to ask clients whether they are expecting any visitors because the effects of the medication may hinder visitation. C. An abdominal circumference measurement is an important assessment for the nurse to make in order to evaluate medication effectiveness. D. Question the client regarding the type and intensity of symptoms to provide a baseline evaluation.

Answer: D Rationale: It is important to assess the client before giving any medication. Important assessments include a review of the client's chart for the course of treatment and discovering the reason for administration of the prescribed drug. Question the client regarding the type and intensity of symptoms (e.g., pain, discomfort, diarrhea, or constipation) to provide a baseline for evaluation of the effectiveness of drug therapy. Listen first to bowel sounds and then palpate the abdomen, monitoring the client for signs of guarding or discomfort. An abdominal circumference measurement and the presence of visitors are not critical assessments prior to administration of the medication.

A patient with a long history of alcohol abuse has been admitted to an acute medical unit with signs and symptoms of hepatic encephalopathy. His current medication orders include QID doses of oral lactulose. What desired outcomes should the nurse associate with this drug order? A. Patient will express an understanding of his current bowel regimen. B. Patient will have formed bowel movements that do not contain frank or occult blood. C. Patient will express relief from constipation. D. Patient will have three to four loose bowel movements each day.

Answer: D Rationale: Lactulose is used to reduce serum ammonia levels by pulling water into the colon. In this case, frequent, loose bowel movements are an expected outcome. A patient with hepatic coma or hepatic encephalopathy would not normally be expected to express an understanding of his or her drug regimen. The goal of treatment is not the relief of constipation. Bowel movements would not be formed.

While discussing the use of laxatives a student asks the nursing instructor what indicates normal bowel elimination. What would be the best response by the instructor? A. "A semi-formed stool." B. "One bowel movement daily in the morning." C. "One bowel movement daily after dinner." D. "A soft, formed stool."

Answer: D Rationale: Normal bowel elimination should produce a soft, formed stool without pain.

A client is scheduled for a colonoscopy. The nurse knows that the preferred drug for bowel cleansing before this procedure is: A. Bisacodyl (Dulcolax) B. Polyethylene glycol solution (MiraLAX) C. Psyllium (Metamucil) D. Polyethylene glycol-electrolyte solution (NuLYTELY)

Answer: D Rationale: Polyethylene glycol-electrolyte solution taken orally will rapidly provoke extensive diarrhea with complete emptying of the lower intestine. Polyethylene glycol solution, bisacodyl, and psyllium work much more slowly and are useful in managing constipation.

The nurse working at a long-term care facility frequently screens residents for risk factors for constipation. What common risk factor does the nurse look for? A. active infection B. diabetes mellitus C. hypertension managed by a beta-adrenergic blocker. D. impaired mobility

Answer: D Rationale: Several risk factors are associated with the development of constipation, including diet and lifestyle, particularly decreased levels of physical activity. Diabetes, infection, and the use of beta-blockers are not risk factors for this problem.

The nurse is giving instructions to a client who will be having a colonoscopy in the morning. The client will be taking polyethylene glycol-electrolyte solution for bowel cleaning. What information will help increase the palatability of this medication? A. Warm the liquid in the microwave for 25 seconds before using it. B. Allow the liquid to warm up before drinking it. C. Add ice cubes to each glass of liquid. D. Refrigerate the solution until it is cold.

Answer: D Rationale: The client should refrigerate the solution to increase the palatability and also to ensure its potency.

A nurse is caring for a patient with intestinal stenosis who has been prescribed psyllium. During the course of the treatment, the patient shows the signs of colon obstruction. What intervention should the nurse perform to avoid the occurrence of colon obstruction? A. Provide foods high in bulk or roughage. B. Give mineral oil to the patient after meals. C. Administer the drug after chilling it. D. Administer the drug with adequate fluid intake.

Answer: D Rationale: The nurse should administer the drug with adequate fluid intake to avoid obstruction of the esophagus, stomach, small intestine, and colon in a patient with intestinal stenosis. Mineral oil is given to the patient as a laxative on an empty stomach in the evening. The nurse should provide foods high in bulk or roughage to avoid constipation in a patient receiving laxatives. The nurse administers a laxative with an unpleasant or salty taste after chilling it to disguise its taste.

A health care provider has prescribed bisacodyl to a client with constipation. The client reports epigastric pain and a burning sensation after taking the drug. Which instruction should the nurse provide to the client? A. Immediately stop taking the drug. B. Take antacids between meals. C. Take the drug in powdered form. D. Avoid milk before taking the drug.

Answer: D Rationale: The nurse should instruct the client to avoid milk, antacids, H2 antagonists, and proton pump inhibitors one to two hours before taking the bisacodyl tablets because the enteric coating may dissolve early before reaching the intestinal tract, resulting in gastric lining irritation or dyspepsia and decreasing the laxative effect of the drug. The nurse need not instruct the client to immediately stop taking the drug, take the drug in powdered form, or take antacids between meals as these interventions will not help in preventing gastric lining irritation.