Nokea
A patient asks the nurse about the difference between diphenoxylate with atropine and the over-the-counter drug loperamide (Imodium). Which response by the nurse is correct?
- A. Lomotil acts faster than Imodium.
- B. Imodium does not cause physical dependence.
- C. Lomotil is available in suppository form.
- D. Imodium is a natural antidiarrheal drug.
Correct Answer: B
Rationale: Although the drug exhibits many characteristics of the opiate class, physical dependence on loperamide has not been reported. All antidiarrheal drugs are orally administered. The other options are incorrect.
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A patient is about to undergo a diagnostic bowel procedure. The nurse expects which drug to be used to induce total cleansing of the bowel?
- A. Docusate sodium
- B. Lactulose
- C. Mineral oil
- D. Polyethylene glycol 3350
Correct Answer: D
Rationale: Polyethylene glycol is a very potent laxative that induces total cleansing of the bowel and is most commonly used before diagnostic or surgical bowel procedures. The other options are incorrect.
A patient will be taking bismuth subsalicylate to control diarrhea. When reviewing the patient's other ordered medications, the nurse recognizes that which medication will interact significantly with this drug?
- A. Acetaminophen, an analgesic
- B. Levothyroxine, a thyroid replacement drug
- C. Warfarin, an anticoagulant
- D. Fluoxetine, an antidepressant
Correct Answer: C
Rationale: The oral anticoagulant warfarin is more likely to cause increased bleeding times or bruising when co-administered with adsorbents. This is thought to be because the adsorbents bind to vitamin K, which is needed to make certain clotting factors. Vitamin K is synthesized by the normal bacterial flora in the bowel. The other options are incorrect.
A patient who has been on antibiotic therapy for 2 weeks has developed persistent diarrhea. The nurse expects which medication class to be ordered to treat this diarrhea?
- A. Lubricants
- B. Adsorbents
- C. Anticholinergics
- D. Probiotics
Correct Answer: D
Rationale: Probiotics work by replenishing bacteria that may have been destroyed by antibiotic therapy, thus restoring the balance of normal flora and suppressing the growth of diarrhea-causing bacteria.
When administering a bulk-forming laxative, the nurse instructs the patient to drink the medication mixed in a full 8-ounce glass of water. Which statement best explains the rationale for this instruction?
- A. The water acts to stimulate bowel movements.
- B. The water will help to reduce the bulk of the intestinal contents.
- C. These laxatives may cause esophageal obstruction if taken with insufficient water.
- D. The water acts as a lubricant to produce bowel movements.
Correct Answer: C
Rationale: Bulk-forming drugs increase water absorption, which results in greater total volume (bulk) of the intestinal contents. Bulk-forming laxatives tend to produce normal, formed stools. Their action is limited to the gastrointestinal tract, so there are few, if any, systemic effects. However, they need to be taken with liberal amounts of water to prevent esophageal obstruction and/or fecal impaction.
A laxative has been ordered for a patient. The nurse checks the patient's medical history and would be concerned if which condition is present?
- A. High ammonia levels due to liver failure
- B. Diverticulosis
- C. Abdominal pain of unknown origin
- D. Chronic constipation
Correct Answer: C
Rationale: All categories of laxatives share the same general contraindications and precautions, including avoidance in cases of drug allergy and the need for cautious use in the presence of these: acute surgical abdomen; appendicitis symptoms such as abdominal pain, nausea, and vomiting; fecal impaction (mineral oil enemas excepted); intestinal obstruction; and undiagnosed abdominal pain. The other options are possible indications for laxatives.