Nokea
A patient is severely constipated and needs immediate relief. The nurse knows that which class of laxative will provide the most rapid results?
- A. Bulk-forming laxative, such as psyllium
- B. Stool softener, such as docusate salts
- C. Magnesium hydroxide
- D. Magnesium oxide tablets
Correct Answer: C
Rationale: Saline laxatives such as magnesium hydroxide produce a watery stool, usually within 3 to 6 hours of ingestion. Bulk-forming laxatives such as psyllium do not produce a bowel movement rapidly. Stool softeners such as docusate salts do not cause patients to defecate; they simply soften the stool to ease its passage. Magnesium oxide tablets are used as magnesium supplements, not as laxatives.
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While recovering from surgery, an elderly woman started taking a stimulant laxative, senna, to relieve constipation caused by the pain medications. Two weeks later, at her follow-up appointment, she tells the nurse that she likes how 'regular her bowel movements are now that she is taking the laxative.' Which teaching principle is appropriate for this patient?
- A. She needs to be sure to take this medication with plenty of fluids.
- B. It is important to have a daily bowel movement to promote bowel health.
- C. Long-term use of laxatives often results in decreased bowel tone and may lead to dependency.
- D. She needs to switch to glycerin suppositories to continue having daily bowel movements.
Correct Answer: C
Rationale: Long-term use of laxatives may lead to dependency. Patients need to be taught that daily bowel movements are not necessary for bowel health.
A patient is taking linaclotide to treat irritable bowel syndrome (IBS). The nurse will monitor this patient for which adverse effect?
- A. Chest pain
- B. Chronic constipation
- C. Abdominal pain
- D. Elevated blood glucose levels
Correct Answer: C
Rationale: Common adverse effects of linaclotide (Linzess) are diarrhea, abdominal pain, and flatulence. Elevated blood glucose levels, chest pain, and chronic constipation are not adverse effects of linaclotide.
The nurse is reviewing the uses of oral laxatives. Which conditions are general contraindications to or cautions about the use of oral laxatives? (Select all that apply.)
- A. Irritable bowel syndrome
- B. Undiagnosed abdominal pain
- C. Nausea and vomiting
- D. Fecal impaction
- E. Ingestion of toxic substances
- F. Acute surgical abdomen
Correct Answer: B,C,D,F
Rationale: Cautious use of laxatives is recommended in the presence of these: acute surgical abdomen; appendicitis symptoms, such as abdominal pain, nausea, and vomiting; intestinal obstruction; and undiagnosed abdominal pain. Oral laxatives must not be used with fecal impaction; mineral oil enemas are indicated for fecal impaction. The other options are indications for other laxative use.
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.
A patient has been treated with alosetron for severe irritable bowel syndrome for 2 weeks. She calls the clinic and tells the nurse that she has been experiencing constipation for 3 days. The nurse will take which action?
- A. Advise the patient to increase intake of fluids and fiber.
- B. Advise the patient to hold the drug for 2 days.
- C. Instruct the patient to stop taking the drug and to come to the clinic right away to be evaluated.
- D. Instruct the patient to continue the alosetron and to take milk of magnesia for the constipation.
Correct Answer: C
Rationale: Alosetron must be discontinued immediately if constipation or signs of ischemic colitis occur. The other options are incorrect.