Question 1

A patient who has a history of chronic constipation uses a bulk laxative to prevent episodes of acute constipation.The patient reports having an increased frequency of episodes.The primary care NP should recommend:

A) adding docusate sodium (Colace).
B) polyethylene glycol (MiraLAX) and bisacodyl (Dulcolax).
C) lactulose (Chronulac) and polyethylene glycol (MiraLAX).
D) adding nonpharmacologic measures such as biofeedback.

Accepted Answer

Patients treated for long-term constipation should begin with a bulk laxative.If that is not effective,the addition of a second laxative may be necessary.Using two laxatives from the same category is not recommended.A stool softener,such as docusate sodium,is appropriate.Bisacodyl is not a second-line treatment.Lactulose and polyethylene glycol are from the same category.

Question 2

A patient who takes digoxin reports taking psyllium (Metamucil)three or four times each month for constipation.The primary care NP should counsel this patient to:&#10;A) decrease fluid intake to avoid cardiac overload.&#10;B) change the laxative to docusate sodium (Colace).&#10;C) take the digoxin 2 hours before taking the psyllium.&#10;D) ask the cardiologist about taking an increased dose of digoxin.

Accepted Answer

Laxatives can affect the absorption of drugs in the intestine by decreasing transit time.Digoxin is a drug that is affected by decreased transit time.Patients should be counseled to take the drugs 2 hours apart.

Question 3

A female patient who is underweight tells the primary care NP that she has been using bisacodyl (Dulcolax)daily for several years.The NP should:&#10;A) prescribe docusate sodium (Colace) and decrease bisacodyl gradually.&#10;B) suggest she use polyethylene glycol (MiraLAX) on a daily basis instead.&#10;C) tell her that long-term use of suppositories is safer than long-term laxative use.&#10;D) counsel the patient to discontinue the laxative and increase fluid and fiber intake.

Accepted Answer

Patients who abuse laxatives are at risk for cathartic colon and for electrolyte imbalances.These patients should be weaned from their stimulant laxative and placed on safer long-term laxatives,such as a bulk laxative or stool softener.Polyethylene glycol is a stimulant.Long-term use of suppositories causes rectal irritation.Discontinuing the laxative without a long-term laxative will lead to rebound constipation.

Question 4

A 5-year-old child has chronic constipation.The primary care NP plans to prescribe a laxative for long-term management.In addition to pharmacologic therapy,the NP should also recommend _____ g of fiber per day.

A) 10
B) 15
C) 20
D) 25

Accepted Answer

Each day a child should receive 1 g of fiber per year of age plus 5 g after 2 years of age.

Question 5

A patient who has cerebral palsy is wheelchair dependent and receives enteral nutrition via a gastrostomy tube.The patient has infrequent,hard bowel movements despite using a high-fiber formula and receiving 1500 mL of fluid per day.The NP should order:

A) bisacodyl (Dulcolax).
B) docusate sodium (Colace).
C) polyethylene glycol (MiraLAX).
D) sodium phosphate (Fleets) enema.

Accepted Answer

Fluids,fiber,and exercise,which help most people,are not applicable to people who are wheelchair bound.Other individuals with congestive heart failure are unable to tolerate these mechanisms.Osmotic laxatives,such as polyethylene glycol are used to manage long-term constipation.It is essential for clinicians to know their patients and assess what is reasonable for them to do.

Question 6

A patient reports having occasional acute constipation with large,hard stools and pain and asks the primary care NP about medication to treat this condition.The NP learns that the patient drinks 1500 mL of water daily; eats fruits,vegetables,and bran; and exercises regularly.The NP should recommend:

A) a daily bulk laxative.
B) long-term docusate sodium.
C) a saline laxative as needed.
D) glycerin suppositories as needed.

Accepted Answer

Mild short-term constipation may be treated with a saline laxative or a bulk laxative as needed.Daily laxatives are not recommended.Glycerin suppositories can cause irritation of the rectum with long-term use.

Question 7

A primary care NP sees a patient who reports having decreased frequency of stools over the past few months.In the clinic today,the patient has severe abdominal cramping and an abdominal radiograph shows an increased stool load in the sigmoid colon and rectum.The NP should:

A) give magnesium hydroxide (Milk of Magnesia).
B) start daily methylcellulose (Citrucel) and increased fluids.
C) order a sodium phosphate enema and psyllium (Metamucil).
D) recommend polyethylene glycol (MiraLAX) and 2000 mL of fluid daily.

Accepted Answer

If a patient is severely constipated,an enema is indicated.When there is underlying chronic constipation,long-term management may be necessary.Bulk laxatives,such as psyllium,are first-line treatments for long-term constipation.

Question 8

A primary care nurse practitioner (NP)sees a patient who is concerned about constipation.The NP learns that the patient has three to four bowel movements per week with occasional hard stools but no straining with defecation.The NP should recommend:

A) increased intake of fluids and fiber.
B) docusate sodium (Colace) as needed.
C) psyllium (Metamucil) on a daily basis.
D) polyethylene glycol (MiraLAX) as needed.

Accepted Answer

The objective definition of constipation is two or fewer bowel movements per week or excessive straining.This patient does not meet these criteria,so the NP should recommend increasing fluids and fiber to help soften stools.Laxatives should not be used unless constipation is present or is chronic to avoid laxative dependence.

Deck 28: Laxatives