Chapter 79: Laxatives

Chapter 79: Laxatives

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. A nurse is taking a history on a clinic patient who reports being constipated. Upon further questioning, the nurse learns that the patient’s last stool was 4 days ago, that it was of normal, soft consistency, and that the patient defecated without straining. The patient’s abdomen is not distended, and bowel sounds are present. The patient reports usually having a stool every 1 to 2 days. What will the nurse do?

a.	Ask about recent food and fluid intake.
b.	Discuss the use of polyethylene glycol [MiraLax].
c.	Recommend a bulk laxative.
d.	Suggest using a bisacodyl [Dulcolax] suppository.

 

 

ANS:  A

Constipation cannot necessarily be defined by the frequency of bowel movements, because this varies from one individual to another. Constipation is defined in terms of a variety of symptoms, including hard stools, infrequent stools, excessive straining, prolonged effort, and unsuccessful or incomplete defecation. A common cause of constipation is diet, especially fluid and fiber intake; therefore, when changes in stool patterns occur, patients should be questioned about food and fluid intake. Because this patient has only more infrequent stools and is not truly constipated, laxatives are not indicated.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 963

TOP:   Nursing Process: Diagnosis

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

2. A patient is admitted with lower abdominal pain and nausea. The nurse performing the initial assessment notes that the patient’s abdomen is distended and firm, and hypoactive bowel sounds are present. The patient has not had a stool for 3 days. The nurse will contact the provider, who will:

a.	order a bulk-forming laxative.
b.	order extra fluids and fiber.
c.	perform diagnostic tests.
d.	prescribe a cathartic laxative.

 

 

ANS:  C

Laxatives are contraindicated for patients with abdominal pain, nausea, cramps, or other symptoms of abdominal disease or an acute surgical abdomen. Laxatives should not be used in patients with obstruction or impaction. This patient shows signs of abdominal obstruction, and laxatives could cause a bowel perforation secondary to increased peristalsis. A bulk-forming laxative is contraindicated. Patients with acute abdomens should be kept NPO pending diagnosis. A cathartic laxative is contraindicated.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   pp. 963-964

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

3. A patient with renal disease is scheduled for a colonoscopy. Before the procedure, the nurse will anticipate administering:

a.	glycerin suppository.
b.	magnesium hydroxide (MOM).
c.	polyethylene glycol and electrolytes.
d.	sodium phosphate.

 

 

ANS:  C

Polyethylene glycol (PEG) plus electrolytes (ELS) is one of two bowel cleansers used before colonoscopy to clear the bowel. PEG-ELS products are preferred, because unlike sodium phosphate, they are isotonic and do not increase the likelihood of dehydration and electrolyte imbalance. Glycerin suppositories and magnesium hydroxide are not used for bowel cleansing.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   pp. 968-969

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

4. The parent of a child with cerebral palsy reports that the child has pebble-like stools most of the time and seems uncomfortable if several days have passed between stools. The nurse will suggest that the parent discuss which medication with the child’s provider?

a.	Bisacodyl [Dulcolax] suppositories
b.	Magnesium citrate
c.	Methylcellulose [Citrucel]
d.	Polyethylene glycol [MiraLax]

 

 

ANS:  D

Polyethylene glycol is an osmotic laxative widely used for chronic constipation, which this child has, because it provides relief from abdominal discomfort, improves stool consistency, and increases frequency. Bisacodyl is not recommended for long-term use. Magnesium citrate causes increased water loss, and methylcellulose can also cause impaction.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 967

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies