154 Prep U Practice Quiz 4 Part 2
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 soft, formed stool."
A client is prescribed polyethylene glycol-electrolyte solution in preparation for a colonoscopy. The nurse would instruct the client to do which of the following?
"Drink 8 ounces every 10 minutes."
Which patient statement indicates to the nurse that the patient is experiencing an adverse effect of hyoscyamine?
"I feel like my heart is going to jump out of my chest." Adverse effects of hyoscyamine: tachycardia, palpitations, urinary retention, blurred vision, constipation
The nurse should counsel a client to discontinue use of over-the-counter antidiarrheals and seek treatment from a health care provider if diarrhea persists for how long?
2 days
When administering a bulk laxative to a client, which action is important for the nurse to take?
Administer the laxative with a full glass of water or juice.
When reviewing the medical record of a client who is to receive a chemical stimulant laxative, the nurse would monitor the client closely if he had which condition?
Coronary artery disease
The nurse should advise clients taking laxatives of which of the following adverse effects?
Cramps Perianal irritation Nausea Bloating
A 94-year-old client is to begin taking psyllium hydrophilic mucilloid daily. What instructions should the nurse include in the discharge teaching?
Drink at least 8 ounces of fluid with the medication.
Older adults who are unable or unwilling to eat an adequate diet or who are debilitated may benefit from using bulk-forming laxatives. What is an important teaching regarding intake for anyone using bulk-forming laxatives?
Ensure adequate fluid intake
Which of the following are effects that a client might experience while taking diphenoxylate (Lomotil)?
Euphoric effects Sedative effects Slowed GI effects Because diphenoxylate (Lomotil) is opioid-related, it may have sedative, slowed GI, and euphoric effects but no analgesic or anti-inflammatory activity.
A client is prescribed oxybutynin as a transdermal patch. The nurse would instruct the client to change the patch at which frequency?
Every 4 days
A 57-year-old female client has a history of two myocardial infarctions in the past 3 years. She presents to the health care provider's office with symptoms of an overactive bladder. She requests an anticholinergic medication that she saw advertised on television. What does the nurse expect the provider to do for this client?
Explain to the client that the medication is contraindicated because of her medical history Anticholinergic drugs are contraindicated for clients with BPH, myasthenia gravis, hyperthyroidism, narrow-angle glaucoma, tachydysrhythmias, myocardial infarction, heart failure, or conditions associated with esophageal reflux.
A patient using an oxybutynin patch must change the patch daily.
False An oxybutynin patch is changed approximately every 4 days.
A 59-year-old homeless man with a history of alcohol abuse, is admitted with dehydration and diarrhea. The admission interview indicates he collects his meals from dumpsters behind restaurants. What could be causing his diarrhea?
Intestinal infection Campylobacter bacteria Salmonella
A client is using psyllium hydrophilic mucilloid to promote evacuation of stool. What is the action of this medication?
It increases mass and water content of stool, promoting evacuation.
A client with constipation has been prescribed mineral oil. Which reason should the nurse provide for instructing the client to take the medication between meals or at bedtime?
It interferes with vitamin absorption
After teaching a class about irritable bowel syndrome, which statement indicates that the teaching has been successful?
It occurs more often in women than in men.
A client has been prescribed an anticholinergic medication. What instructions should the nurse provide related to safety when outside in hot weather?
Keep well hydrated
What is the correct rationale for why the nurse would administer a laxative at a separate time from the client's other medications?
Laxatives may reduce absorption of other drugs present in the GI tract.
The nurse is teaching a client about loperamide, which the health care provider has prescribed for treatment of chronic diarrhea. Which adverse effects should the nurse be sure to mention?
Nausea
A client is scheduled for a colonoscopy. The nurse knows that the preferred drug for bowel cleansing before this procedure is:
Polyethylene glycol-electrolyte solution (NuLYTELY)
Which nursing diagnosis is highest priority for a patient with history of urinary urgency who is taking oxybutynin (Ditropan)?
Risk for impaired urinary elimination
A female client is diagnosed with temporary acute diarrhea. Her other diagnoses include diabetes mellitus, dysrhythmia, and hepatic impairment. The physician orders loperamide. Based on her diagnoses, which adverse effect would the nurse observe for in this client?
Signs of CNS toxicity
The nurse should educate the client prescribed a stimulant cathartic to be alert for which common adverse effect?
diarrhea
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
Because of the systemic effects of anticholinergic drugs, patients using these drugs are more susceptible to:
heat stroke related to decreased perspiration.
A nurse is caring for a client prescribed an antidiarrheal drug. Based on the nurse's understanding of the drug, the nurse would administer the drug cautiously to the client with which condition?
hepatic impairment
A client with hypertension is to receive an anticholinergic agent. The nurse would be especially alert for:
increased blood pressure.
The nurse cautions a woman who is breastfeeding about avoiding the use of magnesium laxatives based on the understanding that the:
newborn may experience diarrhea.
A hospice client is receiving opioids for treatment of cancer pain. Which laxative will best assist in the prevention of constipation?
stimulant
The nurse is about to administer a laxative to a client for the first time. What should be included in client education?
"It is not uncommon to experience some abdominal discomfort and flatulence."
The nurse administers metoclopramide orally at 9:00 AM to a patient with GERD. The nurse would expect this drug to exert its maximum effectiveness at which time?
10:00 AM to 10:30 AM
A patient is receiving oxybutinin transdermally. The nurse would anticipate that the effects of this drug would last for how long?
4 days
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?
Abdominal cramping
Which manifestations would indicate urinary tract infection?
Chills and fever Flank pain Urinary frequency Urinary frequency, urgency, burning on urination, chills, fever, and flank pain are all symptoms of urinary tract infection (UTI).
A patient who experiences frequent constipation asks the nurse for advice regarding which agent would be best for long-term daily use? The nurse will respond that the best for daily use is which of the following?
Docusate (Colace)
The nurse knows that there are many ways to decrease the risk of constipation. These include which of the following?
Drink 64 to 80 ounces of fluids daily. Partake in daily physical exercise. Consume food rich in fiber. Set a routine time and place for daily bowel movement.
An infant is brought to the pediatric clinic. The mother tells the nurse the child is constipated and she doesn't know what to do. What would the nurse tell the mother is the safest and most effective way to treat constipation in children prior to bowel training?
Glycerin suppositories
Which is a common cause of diarrhea in older adults?
Laxative overuse
What would be most important to monitor in a client receiving an agent for BPH?
Prostate-specific antigen level
A group of students are reviewing information about the indications for laxatives. The students demonstrate understanding of the information when they identify which of the following as an indication?
Remove ingested poisons from the lower GI tract
Unwanted anticholinergic effects include:
constipation and dry mouth
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?
laxative abuse
Which is a likely cause of diarrhea experienced by an older adult?
laxative abuse
An older client is taking an anticholinergic agent. After teaching the client about the drug, which client statement indicates the need for additional teaching?
"I need to exercise frequently outside in the warm weather." The client should avoid temperature extremes and exertion in warm temperatures because of possible heat intolerance
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 instructructions regarding these medications when which statement is made?
"I will mix the medication with 4 to 8 ounces of liquid and follow it by an additional 4 to 8 ounces."
Which statement by a client leads the nurse to believe that the client understands how to safely and effectively use bulk-forming laxatives?
"I will mix the medication with around a cup of fluid and then drink the mixture."
A 73-year-old woman is experiencing recurrent constipation. The woman reports to the nurse that she experiences constipation despite the fact that she takes docusate on a daily basis and performs cleansing enemas several times weekly. How should the nurse best respond to this client's statements?
"Taking too many laxatives can make your bowels dependent on them, making you more susceptible to constipation."
The nurse is teaching the client how to treat diarrhea and discussing general guidelines. The nurse reminds the client to stop taking the antidiarrheal medication and to call the clinic if fever and abdominal pain become severe, after how many days?
2
Recovering from laxative abuse takes time and patience. After using laxatives to stimulate defecation, approximately how long will it take for the fecal column to re-establish with normal food intake?
2 to 3 days After the colon empties with defecation, it takes 2 to 3 days with normal food intake for the fecal column to re-establish.
A nurse instructs a client taking an antidiarrheal agent to stop the drug and call the health care provider if the client does not experience relief within which time frame?
48 hours
The nurse understands that the drug docusate sodium (Colace) would be most appropriate for what client?
A 66-year-old client who is recovering from a heart attack
The nurse is seeing a 69-year-old client who is highly physically active and consumes a balanced diet that includes adequate fluid intake. Despite this, the client states experiencing occasional constipation in recent months. What remedy should be the nurse's first suggestion?
A bulk-forming (fiber) laxative
The nurse is assessing a client who reports constipation. The use of a medication to treat this problem is contraindicated if the client reports what symptom?
Abdominal pain and fever
A nurse should screen a client for signs of which of the following medical conditions as the use of laxatives in these clients is contraindicated?
Acute appendicitis Intestinal obstruction Fecal impaction
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?
Administer the drug with adequate fluid intake.
Some anticholinergic drugs have the same clinical indications in the pediatric population as in the adult population. Which statement accurately describes a difference between the populations related to the use of anticholinergics?
Adverse effects tend to be more severe in children.
A group of students are reviewing the contraindications for the use of urinary tract antispasmodics. The students demonstrate the need for additional review when they identify what as a contraindication?
Anticoagulant therapy
A patient has been prescribed oxybutynin for the treatment of an overactive bladder. What instruction should a nurse provide if the patient wishes to use the transdermal form of the drug?
Apply the drug to the dry area of the hip, abdomen, or buttocks. The nurse should also instruct the patient to remove the old patch and rotate sites of new application every seven days.
Which would the nurse include in a teaching plan for a client who is prescribed an anticholinergic agent?
Avoiding activities that require alertness
A client is taking bisacodyl to treat constipation. The nurse suggests that the client take the drug at which time?
Before going to bed
A health care provider prescribes a chemical stimulant laxative. Which would be appropriate?
Bisacodyl
A nurse is caring for a client with cancer regularly administered opioids. The client tells you she needs a laxative. What would be the best laxative?
Bisacodyl
A male client is being prescribed a urinary tract antispasmodic medication. Considering the effects of this classification on medications, which baseline assessment should be performed and recorded?
Blood pressure Intraocular pressure Urinary flow Pulse
Which adverse effects might be experienced by a patient taking an antispasmodic?
Blurred vision Dizziness Vomiting Blurred vision, vomiting, dizziness, and tachycardia are some common adverse effects of antispasmodics due to the cholinergic blocking action.
A male client asks the nurse why he needs the preoperative anticholinergic medication ordered by the anesthesiologist. The nurse explains that anticholinergic drugs are given preoperatively to prevent which anesthesia associated complication?
Bradycardia Anticholinergic drugs are given preoperatively to prevent anesthesia-associated complications such as bradycardia, excessive respiratory secretions, and hypotension.
Michael is 3 days' postoperative from open heart surgery. He has not had a bowel movement since the day prior to surgery. The health care provider has ordered magnesium hydroxide. The nurse administering this medication knows that the drug acts by which mechanism?
Causing the retention of water in the intestinal lumen
The client asks the nurse why he cannot remain on a laxative indefinitely. Which of the following is the correct response?
Chronic use of laxatives can lead to constipation.
The nurse is conducting a pre-colonoscopy class and knows that polyethylene glycol- electrolyte solution will be contraindicated for the client with which condition?
Colitis
A patient is receiving oxybutyin for treatment of overactive bladder. The patient also takes haloperidol (Haldol) drug as an antipsychotic agent. What effect of interaction of these two drugs should the nurse observe in the patient?
Decreased effect of the antipsychotic drug
A client who experiences frequent constipation is using psyllium (Metamucil). The nurse knows what contraindications to using psyllium?
Difficulty swallowing Gastrointestinal obstruction Fecal impaction Undiagnosed abdominal pain
The nurse is preparing a teaching plan for a patient who is using mineral oil. Which would the nurse include as a possible adverse effect?
Dizziness Abdominal cramping Leakage of stool Weakeness
A patient with benign prostatic hypertrophy is receiving treatment with finasteride (Proscar). What is an appropriate patient instruction?
Do not let your wife handle the pills.
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?
Docusate
What recommendations should be included in client teaching as a means of avoiding constipation?
Drink plenty of fluids. Be active and exercise daily. Eat foods high in bulk or roughage.
When describing the drugs used to treat traveler's diarrhea, which would the nurse identify as the most common cause?
E. coli
Which would the nurse identify as an drug that blocks testosterone production to relieve the symptoms of benign prostatic hypertrophy?
Finasteride
Which would lead a nurse to suspect that a client most likely has pyelonephritis?
Flank pain Flank pain, chills, fever, and tenderness are indicative of pyelonephritis. Urinary frequency, dysuria, and urgency are associated with cystitis.
A client is seeking treatment for bladder spasms causing dysuria and urgency. Which clinical condition identified in the client's medical history will serve to contraindicate treatment with a urinary tract antispasmodic medication?
Glaucoma
The nurse knows that which of the following are appropriate uses for laxative drugs?
Hepatic encephalopathy Preparation for colonoscopy With opioid analgesics Following myocardial infarction Laxatives are used to evacuate the large intestine before colonoscopy, to remove intestinal ammonia in patients with hepatic encephalopathy, and to decrease straining to defecate in patients after a myocardial infarction. Opioid analgesics cause constipation, which can be alleviated with laxatives. Weight management is not an appropriate use for laxatives.
When describing the various anticholinergic agents to a group of students, the instructor would identify which agent as being available in sublingual form?
Hyoscyamine
The nurse understands that older clients taking anticholinergic drugs are more likely to have all of the following symptoms EXCEPT:
Hypertension
Mineral oil can be used as a laxative. The nurse knows that which statement regarding mineral oil is correct?
If aspirated, mineral oil can cause pneumonia. Mineral oil is the only approved lubricant for clinical use. The onset of action is 6 to 8 hours. If aspirated, mineral oil can lead to lipid pneumonia. Rarely is mineral oil the preferred laxative for constipation.
Oxybutynin (Ditropan) is a cholinergic drug used to treat bladder instability which is characterized by which symptoms?
Incontinence Frequency Urgency Leakage Dysuria
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?
Increase the fluid in the intestinal contents
In pharmacology class the students are learning about the mechanism of action of different laxatives. What would the students learn about the mechanism of action of psyllium hydrophilic mucilloid?
Increasing mass and water content of stool
Prior to administering oxybutynin (Ditropan) to a client, the nurse should get a full medical history because the use of oxybutynin (Ditropan) is contraindicated in clients with what issues?
Intestinal blockage Urinary tract blockage Myasthenia gravis The use of oxybutynin (Ditropan) is contraindicated in clients with the following: known hypersensitivity, glaucoma, myasthenia gravis, abdominal bleeding, and intestinal, gastric, or urinary tract blockages.
The nurse is teaching the client about possible adverse effects associated with mineral oil. Which of the following would be most important for the nurse to include?
Leakage Although abdominal cramping, diarrhea, and sweating may occur with lubricant laxatives such as mineral oil, it would be especially important to inform the client about possible leakage and staining with mineral oil, which occurs because the stool cannot be retained by the external sphincter.
The home health nurse is visiting with a client who has been prescribed diphenoxylate with atropine (Lomotil) for chronic diarrhea. Which of the following adverse effects should the nurse be aware of when assessing the client's present condition?
Lightheadedness Dry mouth Adverse effects include dry skin and mucous membranes, nausea, constipation and lightheadedness.
A nurse is caring for an elderly patient with a UTI. Which assessment should the nurse perform while caring for this patient?
Monitor the patient's vital signs every four hours. When caring for a patient with UTI undergoing urinary tract anti-infective drug therapy, the nurse should monitor vital signs of the patient every four hours after administration of the drug or as ordered by the primary health care provider. Any significant rise in body temperature is reported to the primary health care provider because the methods of reducing the fever or culture and sensitivity tests may need to be repeated.
The nurse is caring for an older adult. What is the primary nursing intervention to increase fluid intake in older adults?
Offer a variety of fluids to the client every hour.
A health care provider prescribes a urinary antispasmodic as a transdermal patch. The nurse identifies this as drug as:
Oxybutynin
What would a nurse expect to be prescribed for a patient experiencing bladder spasms?
Oxybutynin
The nurse is caring for a client who is allergic to aspirin. Which over-the-counter medication should the nurse caution the client to avoid?
Pepto-Bismol
A client is scheduled for a colonoscopy in the morning. What laxative would the nurse expect to be prescribed the evening before the procedure?
Polyethylene glycol-electrolyte solution
A male client is prescribed an anticholinergic drug by his health care provider. He likes to hike with his grandchildren. The home care nurse instructs the client that anticholinergic medications have which effect?
Prevents sweating and heat loss and increasing the risk of heat stroke
A male client 69 years of age comes to the clinic reporting various urinary symptoms, including reduced flow and blood in the urine. The nurse knows that the health care provider must rule out what condition in this client before treatment is started for benign prostatic hypertrophy?
Prostate cancer Prostate cancer should always be ruled out before treatment is started for BPH, because early stage prostate cancer has few signs or symptoms.
The nurse is caring for a client who will need to use a medication to assist in the prevention of constipation for an extended period of time. The nurse is aware that which drug is the most desirable for long-term use?
Psyllium
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?
Psyllium is useful in critically ill patients who experience constipation. Critically ill patients often experience constipation from decreased physical activity and, at times, administration of opioid analgesics.
Which is an important assessment for the nurse to make before administering a laxative?
Question the client regarding the type and intensity of symptoms to provide a baseline evaluation.
The nurse is caring for a client who has developed severe diarrhea a few days after beginning an antibiotic prescribed for a severe respiratory infection. The nurse is prepared to initiate what initial treatment?
Stopping the causative drug
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?
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
Which is an appropriate intervention for a side effect of a urinary antispasmodic medication?
Suck on ice or hard candy to treat dry mouth.
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?
Sympathetic stress reaction due to intense GI tract neurostimulation 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.
When considering the possible gastrointestinal side effects, what instruction should the nurse provide a client being prescribed a urinary tract antispasmodic?
Take medication with food
Which would be most important to include when teaching a patient about using psyllium?
Taking the agent with a large amount of water
A 78-year-old client is about to begin home care and has been prescribed an anticholinergic. What should the home care nurse explain to the client and her family about this medication?
The client may benefit from additional fiber and fluids in her diet. The client may need assistance with ambulation. The client may be at increased risk of heat stroke.
A client is admitted to the hospital for pneumonia. Since admission, the client has not had a bowel movement. The physician prescribes magnesium hydroxide. What should be an outcome of this therapy?
The client will have a bowel movement after taking the drug.
A client is taking psyllium hydrophilic mucilloid daily. What information should be included in the discharge plan?
Up to 30 g of fluid with the medication can be divided over several divided doses daily. The daily dose of up to 30 g can be divided over several doses. The client should not mix the medication with food or other medications. The mucilloid should not be discontinued if the client does not have a bowel movement.
A client calls the clinic and tells the nurse about some urinary difficulties she is experiencing. What signs/symptoms would indicate to the nurse that this client may be experiencing overactive bladder syndrome?
Urge incontinence Urinary urgency Frequency of urination Symptoms of an overactive bladder include urinary urgency, frequent urination throughout the day and night, and urge incontinence.
Which laboratory test should the nurse monitor to evaluate treatment effectiveness, when a client has been prescribed a medication to manage bladder spasms associated with a urinary tract infection?
Urine culture and sensitivity
The nurse is aware that critically ill clients are more at risk for constipation for what reasons?
Use of opioid medications Decreased activity Change in bowel routines
The nurse is conducting a class on nonpharmacologic treatment for occasional constipation. Which treatments will the nurse recommend?
Use of probiotics Use of prebiotics Eat more high-fiber foods
A young mother tells the nurse that she is giving her 2-year-old mineral oil because the child has difficulty defecating. The nurse should teach this mother about long-term administration of mineral oil decreasing the absorption of what nutrients?
Vitamin D
What form of laxative would likely be prescribed to manage long-term constipation?
bulk-forming laxative plus increased water intake
An anticholinergic drug is given to a 73-year-old man to treat his Parkinson disease. The man also has benign prostatic hyperplasia (BPH). The most important instruction the nurse can give to the patient with regard to his medication and medical diagnosis is to
call his doctor if he cannot urinate. If an anticholinergic drug is taken, this can lead to urinary retention and bladder sphincter spasm. The patient should be encouraged to void or empty his bladder before taking the drug.
The nurse is preparing to administer a stimulant cathartic to the client. The nurse should inform the client of the possible adverse effect of:
diarrhea
The nurse is educating new parents on prevention and treatment of constipation with children. What is the most effective and safest way to treat constipation in a 2-year-old prior to bowel training?
glycerin suppositories
A client is scheduled for a colonoscopy in the morning. The nurse will provide information concerning which laxative?
polyethylene glycol-electrolyte solution
