Nokea
A patient has been experiencing occasional episodes of constipation and has been unable to achieve consistent relief by increasing physical activity and improving his diet. What pharmacologic intervention should the nurse recommend to the patient for ongoing use?
- A. Mineral oil enemas
- B. Bisacodyl (Dulcolax)
- C. Senna (Senokot)
- D. Psyllium hydrophilic mucilloid (Metamucil)
Correct Answer: D
Rationale: Psyllium hydrophilic mucilloid (Metamucil) is a bulk-forming laxative that is safe for ongoing use. None of the other listed laxatives should be used on an ongoing basis because of the risk of dependence.
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A patients large bowel obstruction has failed to resolve spontaneously and the patients worsening condition has warranted admission to the medical unit. Which of the following aspects of nursing care is most appropriate for this patient?
- A. Administering bowel stimulants as ordered
- B. Administering bulk-forming laxatives as ordered
- C. Performing deep palpation as ordered to promote peristalsis
- D. Preparing the patient for surgical bowel resection
Correct Answer: D
Rationale: The usual treatment for a large bowel obstruction is surgical resection to remove the obstructing lesion. Administration of laxatives or bowel stimulants are contraindicated if the bowel is obstructed. Palpation would be painful and has no therapeutic benefit.
A patient has had an ileostomy created for the treatment of irritable bowel disease and the patient is now preparing for discharge. What should the patient be taught about changing this device in the home setting?
- A. Apply antibiotic ointment as ordered after cleaning the stoma.
- B. Apply a skin barrier to the peristomal skin prior to applying the pouch.
- C. Dispose of the clamp with each bag change.
- D. Cleanse the area surrounding the stoma with alcohol or chlorhexidine.
Correct Answer: B
Rationale: Guidelines for changing an ileostomy appliance are as follows. Skin should be washed with soap and water, and dried. A skin barrier should be applied to the peristomal skin prior to applying the pouch. Clamps are supplied one per box and should be reused with each bag change. Topical antibiotics are not utilized, but an antifungal spray or powder may be used.
A nurse is caring for an older adult who has been experiencing severe Clostridium difficile-related diarrhea. When reviewing the patients most recent laboratory tests, the nurse should prioritize which of the following?
- A. White blood cell level
- B. Creatinine level
- C. Hemoglobin level
- D. Potassium level
Correct Answer: D
Rationale: In elderly patients, it is important to monitor the patients serum electrolyte levels closely. Diarrhea is less likely to cause an alteration in white blood cell, creatinine, and hemoglobin levels.
An older adult who resides in an assisted living facility has sought care from the nurse because of recurrent episodes of constipation. Which of the following actions should the nurse first perform?
- A. Encourage the patient to take stool softener daily.
- B. Assess the patients food and fluid intake.
- C. Assess the patients surgical history.
- D. Encourage the patient to take fiber supplements.
Correct Answer: B
Rationale: The nurse should follow the nursing process and perform an assessment prior to interventions. The patients food and fluid intake is more likely to affect bowel function than surgery.
A nurse is caring for a patient with constipation whose primary care provider has recommended senna (Senokot) for the management of this condition. The nurse should provide which of the following education points?
- A. Limit your fluid intake temporarily so you dont get diarrhea.
- B. Avoid taking the drug on a long-term basis.
- C. Make sure to take a multivitamin with each dose.
- D. Take this on an empty stomach to ensure maximum effect.
Correct Answer: B
Rationale: Laxatives should not be taken on an ongoing basis in order to reduce the risk of dependence. Fluid should be increased, not limited, and there is no need to take each dose with a multivitamin. Senna does not need to be taken on an empty stomach.