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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.
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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.
The nurse is reviewing the mechanism of action of antidiarrheal drugs. Which type of antidiarrheal medication works by decreasing the intestinal muscle tone and peristalsis of the intestines?
- A. Adsorbents
- B. Anticholinergics
- C. Probiotics
- D. Lubricants
Correct Answer: B
Rationale: Anticholinergic drugs work to slow peristalsis by reducing the rhythmic contractions and the smooth muscle tone of the gastrointestinal tract. The other options are incorrect.
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.
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 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.