Nokea
A client is prescribed an antidiarrheal drug. The nurse reviews the client's medical record for possible contraindications for use. Which of the following would alert the nurse to a possible contraindication?
- A. Pseudomembranous colitis
- B. Type 1 diabetes
- C. Abdominal pain of unknown origin
- D. Liver disease
- E. Obstructive jaundice
Correct Answer: A,C,E
Rationale: Clients with pseudomembranous colitis, abdominal pain of unknown origin, and obstructive jaundice should not take antidiarrheals.
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The nurse is caring for a client who is prescribed mesalamine. The client is also taking warfarin. Which of the following interactions should the nurse monitor the client for when he is administered mesalamine with warfarin?
- A. Increased risk of immunosuppression
- B. Increased blood glucose level
- C. Increased risk of bleeding
- D. Increased risk of CNS depression
Correct Answer: C
Rationale: The client administered mesalamine and warfarin is at an increased risk of bleeding. Warfarin is an anticoagulant used as a blood thinner; mesalamine is an aminosalicylate, which is an aspirin-like compound with anti-inflammatory action. The combination of mesalamine and warfarin does not increase the risk of immunosuppression, increase the blood glucose level, or increase the risk of CNS depression. There is an increased risk of immunosuppression if an aminosalicylate interacts with methotrexate used in cancer and autoimmune conditions. There is an increased blood glucose level when oral hypoglycemic drugs interact with aminosalicylates. There is an increased risk of CNS depression when opioids are administered with aminosalicylates.
After teaching a group of nursing students about laxatives, the instructor determines that the teaching was successful when the students identify which drug as producing the laxative effect by promoting water retention in the fecal mass and softening the stool?
- A. Docusate sodium (Colace)
- B. Methylcellulose (Citrucel)
- C. Bisacodyl (Dulcolax)
- D. Lactulose (Chronulac)
Correct Answer: A
Rationale: Stool softeners, like docusate sodium (Colace) and docusate calcium (Surfak), produce their 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 is receiving a bowel evacuant in preparation for a colonoscopy. The client tells the nurse that he has been 'going to the bathroom about every 30 to 45 minutes' since he started taking the drug and his stools are 'like water.' He reports that he is thirsty and his mouth feels dry. Which nursing diagnosis would the nurse most likely identify?
- A. Risk for Infection
- B. Risk for Injury
- C. Risk for Imbalanced Fluid Volume
- D. Deficient Knowledge
Correct Answer: C
Rationale: The client's report of frequent stools, which is a result of the drug therapy, along with complaints of feeling thirsty and dry mouth suggest the nursing diagnosis of Risk for Imbalanced Fluid Volume due to the large losses of fluid from the body from the drug. There is no evidence to support a risk for infection or deficient knowledge. Risk for Injury would be appropriate if the client was experiencing drowsiness or dizziness in conjunction with the fluid losses.
The nurse is preparing to administer a laxative that adds bulk and water to the contents of the intestines, thereby stimulating intestinal peristalsis. Which of the following would the nurse be likely to administer?
- A. Docusate (Colace)
- B. Methylcellulose (Citrucel)
- C. Polycarbophil (FiberCon)
- D. Bisacodyl (Docusate)
- E. Lactulose (Chronulac)
Correct Answer: B,C
Rationale: Bulk-producing laxatives, like methylcellulose (Citrucel) and polycarbophil (FiberCon), produce their laxative effect by adding bulk and water to the contents of the intestines, thereby stimulating intestinal peristalsis. Docusate is a stool softener. Bisacodyl is a stimulant laxative. Lactulose is a hyperosmotic agent.
A nurse would most likely expect a primary health care provider to prescribe psyllium (Metamucil) to a client who is experiencing constipation related to which drug?
- A. Spironolactone (Aldactone)
- B. Clonidine (Catapres)
- C. Enalapril (Vasotec)
- D. Fexofenadine (Allegra)
- E. Amitriptyline (Elavil)
Correct Answer: A,B,D,E
Rationale: The following drugs may cause constipation in clients and require the use of a laxative to relieve constipation: anticholinergics, antihistamines (fexofenadine), phenothiazines, tricyclic antidepressants (amitriptyline), opioids, non-potassium-sparing diuretics (spironolactone), iron preparations, barium, clonidine, and calcium- or aluminum-containing antacids.