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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.
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The nurse is preparing to administer methylnaltrexone. This drug is appropriate for which patient?
- A. A patient with diarrhea
- B. A terminally ill patient who has opioid-induced constipation
- C. A patient who is scheduled for a colonoscopy
- D. A patient who will be having colon surgery in the morning
Correct Answer: B
Rationale: Methylnaltrexone is approved only for terminally ill (hospice) patients who have opioid-induced constipation. The other options are incorrect.
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.
The nurse is discussing the use of adsorbents such as bismuth subsalicylate with a patient who has diarrhea. The nurse will warn the patient about which possible adverse effects?
- A. Dark stools and blue gums
- B. Urinary hesitancy
- C. Drowsiness and dizziness
- D. Blurred vision and headache
Correct Answer: A
Rationale: Dark stools and blue gums are two of the possible adverse effects of bismuth subsalicylate. The other adverse effects listed may occur with the use of other antidiarrheal drugs.
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.
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.