Nursing Guide to Bowel Disorder Drugs

TEST BANK FOR PHARMACOLOGY AND THE NURSING PROCESS 8TH EDITION BY LILLEY
Chapter 51: Bowel Disorder Drugs

Lilley: Pharmacology and the Nursing Process, 8th Edition
MULTIPLE CHOICE
1. 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
ANS: C
Lipid pneumonia may occur if the oral mineral oil is accidentally aspirated into the respiratory
tract. The other options are incorrect.
DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 820

TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
2. 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.
NUtoRproduce
d. The water acts as a lubricant SINGTbowel
B.COmovements.
M
ANS: C
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 fecal impaction.

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
3. A patient will be taking bismuth subsalicylate (Pepto-Bismol) to control diarrhea. When

reviewing the patient’s other ordered medications, the nurse recognizes that which medication
or medication class will interact significantly with the Pepto-Bismol?
a. Hypoglycemic drugs
b. Antibiotics
c. Acetaminophen (Tylenol)
d. Antidepressants
ANS: A
Taking hypoglycemic drugs with an adsorbent such as bismuth subsalicylate may result in
decreased absorption of the hypoglycemic drugs. The other options are incorrect.
NURSINGTB.COM
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 816

4. 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 (Colace)
b. Lactulose (Enulose)
c. Mineral oil
d. Polyethylene glycol 3350 (GoLYTELY)
ANS: D
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.

TOP: NURSING PROCESS: Planning
5. While recovering from surgery, a 74-year-old woman started taking a stimulant laxative,
senna (Senokot), 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 N URSresults
often INGTinB. COM bowel tone and may lead to
decreased
dependency.
d. She needs to switch to glycerin suppositories to continue having daily bowel
movements.
ANS: C
Long-term use of laxatives may lead to dependency. Patients need to be taught that daily
bowel movements are not necessary for bowel health.

MSC: NCLEX: Health Promotion and Maintenance
6. A patient asks the nurse about the difference between diphenoxylate with atropine (Lomotil)
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.”
ANS: B
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.
NURSINGTB.COM

7. A patient wants to prevent problems with constipation and asks the nurse for advice about
which type of laxative is safe to use for this purpose. Which class of laxative is considered
safe to use on a long-term basis?
a. Emollient laxatives
b. Bulk-forming laxatives
c. Hyperosmotic laxatives
d. Stimulant laxatives
ANS: B
Bulk-forming laxatives are the only laxatives recommended for long-term use. Stimulant
laxatives are the most likely of all the laxative classes to cause dependence. The other options
are incorrect.

8. When administering mineral oil, the nurse recognizes that it can interfere with the absorption
of which substance?
a. Fat-soluble vitamins
b. Water-soluble vitamins
c. Minerals
d. Electrolytes
NURSINGTB.COM
ANS: A
Mineral oil can decrease the absorption of fat-soluble vitamins (A, D, E, and K). The other
options are incorrect.

9. 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 such as Pepto-Bismol
b. Anticholinergics such as belladonna alkaloids
c. Probiotics such as Lactinex
d. Lubricants such as mineral oil
ANS: B
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.

NURSINGTB.COM
10. The nurse is discussing the use of adsorbents such as bismuth subsalicylate (Pepto-Bismol)
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
ANS: A
Dark stools and blue gums are two of the possible adverse effects of bismuth subsalicylate
(see Table 51-2). The other adverse effects listed may occur with the use of other antidiarrheal
drugs.

TOP: NURSING PROCESS: Assessment
11. 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
ANS: D
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. NURSINGTB.COM
12. A patient will be taking bismuth subsalicylate (Pepto-Bismol) to control diarrhea. When
reviewing the patient’s other ordered medications, the nurse recognizes that which medication
will interact significantly with the Pepto-Bismol?
a. Acetaminophen (Tylenol), an analgesic
b. Levothyroxine (Synthroid), a thyroid replacement drug
c. Warfarin (Coumadin), an anticoagulant
d. Fluoxetine (Prozac), an antidepressant
ANS: C
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.

NURSINGTB.COM
13. A laxative has been ordered for a patient. The nurse checks the patient’s medical history and
would be concerned if which condition is present?
a. High ammonia levels due to liver failure
b. Diverticulosis
c. Abdominal pain of unknown origin
d. Chronic constipation
ANS: C
All categories of laxatives share the same general contraindications and precautions, including
avoidance in cases of drug allergy and the need for cautious use in the presence of these: acute
surgical abdomen; appendicitis symptoms such as abdominal pain, nausea, and vomiting;
fecal impaction (mineral oil enemas excepted); intestinal obstruction; and undiagnosed
abdominal pain. The other options are possible indications for laxatives.

14. 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 (Metamucil)
b. Stool softener, such as docusate salts (Colace)
c. Magnesium hydroxide (MOM)
d. Magnesium oxide tablets
ANS: C
Saline laxatives such as magnesium hydroxide (MOM) produce a watery stool, usually within
NURSINlaxatives
3 to 6 hours of ingestion. Bulk-forming GTB.Csuch
OM 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.

15. A patient is receiving lactulose (Enulose) 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
ANS: A
Lactulose (Enulose) 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.

NURSINGTB.COM
16. A patient is taking linaclotide (Linzess) 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
ANS: C
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.

17. The nurse is preparing to administer methylnaltrexone (Relistor), a peripherally acting opioid
antagonist. 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
ANS: B
Methylnaltrexone is approved only for terminally ill (hospice) patients who have
opioid-induced constipation. The
NUother
RSIN options
GTB.areCOincorrect.
M
18. A patient has been treated with alosetron (Lotronex) for severe irritable bowel syndrome
(IBS) 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.
ANS: C
Alosetron must be discontinued immediately if constipation or signs of ischemic colitis occur.
The other options are incorrect.
DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 823

NURSINGTB.COM
MULTIPLE RESPONSE
1. 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
ANS: B, C, D, F
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
laxative use.

COMPLETION
1. A 10-year-old child will be receiving docusate sodium (Colace), 120 mg/day PO, divided into
3 doses. Identify how many milligrams will the child receive per dose. _______
NURSINGTB.COM
ANS:
DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A

NURSINGTB.COM

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TEST BANK FOR PHARMACOLOGY AND THE NURSING PROCESS 8TH EDITION BY LILLEY

Chapter 51: Bowel Disorder Drugs

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 820

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 820

3. A patient will be taking bismuth subsalicylate (Pepto-Bismol) to control diarrhea. When

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 816

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 822

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 819

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 817

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 819

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 820

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 815

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 815

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 815

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 820

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 822

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 822

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 823

DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 823

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 820

DIF: COGNITIVE LEVEL: Applying (Application) REF: N/A

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