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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.
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A patient is receiving lactulose three times a day. The nurse knows that the patient is not constipated and is receiving this drug for which reason?
- A. High ammonia levels due to liver failure
- B. Prevention of constipation
- C. Chronic renal failure
- D. Chronic diarrhea
Correct Answer: A
Rationale: Lactulose produces a laxative effect but also works to reduce blood ammonia levels by converting ammonia to ammonium. Ammonium is a water-soluble cation that is trapped in the intestines and cannot be reabsorbed into the systemic circulation. This effect has proved helpful in reducing elevated serum ammonia levels in patients with severe liver disease. 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.
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.
The nurse is giving oral mineral oil as an ordered laxative dose. The nurse will take measures to prevent which potential problem that may occur with mineral oil?
- A. Fecal impaction
- B. Electrolyte imbalances
- C. Lipid pneumonia
- D. Esophageal blockage
Correct Answer: C
Rationale: Lipid pneumonia may occur if the oral mineral oil is accidentally aspirated into the respiratory tract. 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.