Unit2: Ch 58- Drugs Affecting Gastrointestinal Motility (Karch 7th Ed)

Question 1

The nurse teaches the patient to best maintain optimal GI function by including what in the daily
routine?
A) Exercise, adequate sleep, and avoiding caffeine
B) Proper diet, fluid intake, and exercise
C) Proper diet, avoiding alcohol, and cautious use of laxatives
D) Avoiding prescription medications, increased fluid intake, and vigorous exercise

Answer 1

Ans: B
Feedback:
The best way to maintain gastrointestinal (GI) function is through proper diet including optimizing
fiber intake, adequate fluid intake, and exercise, which will stimulate GI activity. Drugs should only be
used when normal function cannot be maintained. Options A, C, and D are not correct.

Question 2

The nurse admits to the clinic a 7-month-old infant whose mother reports that the baby has not had a
bowel movement in 6 days. What drug would be appropriate to treat this patient?
A) Cascara (generic)
B) Magnesium hydroxide (Milk of Magnesia)
C) Polyethylene glycol-electrolyte solution (GoLYTELY)
D) Glycerin (Sani-Supp)

Answer 2

Ans: D
Feedback:
Glycerin suppositories are the best choice for infants and young children when constipation is a
problem. The other choices are not recommended for infants or children.

Question 3

3. The nurse provides drug teaching to the patient who will begin taking polycarbophil (FiberCon). What
   is the nurse’s priority teaching point?
   A) Do not eat or drink anything for 2 hours after taking the medication.
   B) Drink lots of water when taking the drug.
   C) Take at night before bedtime.
   D) The drug can be taken up to six times per day.

Answer 3

Ans: B
Feedback:
Patients must take plenty of water with polycarbophil. If only a little water is consumed, the medication
may absorb enough fluid in the esophagus to swell the food into a gelatin-like mass that can cause
obstruction and other severe problems. The drug should be taken no more than four times a day and
should not be taken at night.

Question 4

A new mother required an episiotomy during the birth of her baby. Two days after delivery, the patient
is in need of a laxative. What will be the most effective drug for the nurse to administer?
A) Bisacodyl (Dulcolax)
B) Castor oil (Neolid)
C) Magnesium sulfate (epsom salts)
D) Docusate (Colace)

Answer 4

Ans: D
Feedback:
Docusate is a stool softener that will make expulsion of stool easier in a traumatized body area
following an episiotomy. Care must be taken to choose a mild laxative that will not enter breast milk
and not affect the newborn if the mother is nursing. Docusate is the drug of choice from this list
because it is mild and will produce a soft stool and decrease the need to strain. The other options would
not be appropriate because they do not soften the stool and are harsher laxatives that can enter breast
milk.

Question 5

The nurse, teaching a patient to be discharged with an order to use chemical stimulant laxatives PRN,
instructs the patient that one of the most common adverse effects of this type of laxative is what?
A) Abdominal cramping
B) Rectal bleeding
C) Confusion
D) Iron deficiency anemia

Answer 5

Ans: A
Feedback:
Common adverse effects of laxatives are diarrhea, abdominal cramping, and nausea. Central nervous
system (CNS) adverse effects such as dizziness, headache, and weakness can occur. Rectal bleeding,
confusion, and iron deficiency anemia are not associated with appropriate use of laxatives but may
occur when laxatives are abused.

Question 6

A patient taking a chemical stimulant laxative and medications for heart failure and osteoarthritis calls
the clinic and reports to the nurse that she is not feeling right. What is the priority question the nurse
should ask this patient?
A) Effectiveness of laxatives
B) Timing of medication administration
C) The amount of fiber in her diet
D) Amount of fluid ingested

Answer 6

Ans: B
Feedback:
Because laxatives increase the motility of the gastrointestinal (GI) tract and some laxatives interfere
with the timing or process of absorption, it is not advisable to take laxatives with other prescribed
medications. The administration of laxatives and other medications should be separated by at least 30
minutes, so the nurse should question when the patient is taking the laxatives and other medication.
Other options may be questions the nurse would eventually ask, but the priority is timing of medication
administration.

Question 7

A patient who is taking metoclopramide (Reglan) has come to the clinic for a follow-up visit. The nurse
will be most concerned about a drug-drug interaction when learning the patient is taking what other
medication?
A) Albuterol (Proventil)
B) Digoxin (Lanoxin)
C) Furosemide (Lasix)
D) Acetylsalicylic acid (ASA)

Answer 7

Ans: B
Feedback:
Metoclopramide has been associated with decreased absorption of digoxin from the gastrointestinal
(GI) tract. The nurse should monitor patients taking this combination carefully. The other options do
not pose a concern about drug drug interactions.

Question 8

What should the nurse tell the patient who will begin taking rifaximin (Xifaxan) for traveler’s diarrhea?
A) Do not start taking the drug until the diarrhea has persisted for at least 24 hours.
B) Taking the antibiotic will allow you to enjoy the local water and food without concern.
C) Do not take the drug if you have bloody diarrhea.
D) Start the drug 3 days before leaving for your trip and continue until you return.

Answer 8

Ans: C
Feedback:
Rifaximin should not be taken if a patient has bloody diarrhea or diarrhea that persists for more than 48
hours. It is started after the signs and symptoms of the disease develop and is taken for 3 days. The
traveler should still avoid exposure to foreign bacteria by not drinking tap water and by avoiding fruits
and vegetables washed in tap water. Options A, B, and D are not correct.

Question 9

A clinic patient with a history of heart failure requires a laxative for treatment of chronic constipation.
What medication would be most appropriate for this patient?
A) Senna (Senokot)
B) Lactulose (Chronulac)
C) Magnesium sulfate (Milk of Magnesia)
D) Castor oil (Neoloid)

Answer 9

Ans: B
Feedback: Lactulose is often the drug of choice when a patient with cardiovascular problems requires a laxative. It
is salt free, an important consideration in patients with heart failure; it acts by exerting a gentle osmotic
pull of fluid into the intestinal lumen. Senna, magnesium sulfate, and castor oil are more aggressive
laxatives and might not be the best choice for a patient with cardiovascular problems.

Question 10

A man with irritable bowel syndrome reports ongoing diarrhea and asks for a prescription for alosetron
(Lotronex), which was helpful for his coworker who recently started taking the drug. What is the
nurse’s best response?
A) This drug is only approved for use in women.
B) This drug is used as a laxative.
C) This drug is contraindicated with irritable bowel syndrome.
D) This drug is no longer on the market for prescription use.

Answer 10

Ans: A
Feedback:
Alosetron (Lotronex) is approved for use in women with irritable bowel syndrome with diarrhea being
the predominant complaint and should be discontinued immediately if the patient develops constipation
or symptoms of ischemic colitis. Patients must read and sign a patient physician agreement before it can
be prescribed. Options B, C, and D are not correct.

Question 11

The nurse administers psyllium hydrophilic mucilloid (Metamucil) expecting it to have what action?
A) Slows peristalsis
B) Promotes reabsorption of water into bowel
C) Has antibacterial properties
D) Adds bulk to the stool

Answer 11

Ans: D
Feedback:
Metamucil is a natural substance that forms a gelatin-like bulk of the intestinal contents. This agent
stimulates local activity. It is considered milder and less irritating than many other bulk stimulants.
Patients must use caution and take it with plenty of water because Metamucil absorbs large amounts of
water and produces stools of gelatin-like consistency. It does not slow peristalsis, promote water
reabsorption, or have antibacterial properties.

Question 12

The nurse administers loperamide (Imodium) to decrease the number and liquidity of stool by what
mechanism?
A) Decreasing intestinal motility
B) Absorbing toxins
C) Binding with fecal material to increase bulk
D) Blocking the chemoreceptor trigger zone (CTZ)

Answer 12

Ans: A
Feedback:
Systemic antidiarrheal agents slow the motility of the gastrointestinal (GI) tract through direct action on
the lining of the GI tract to inhibit local reflexes (bismuth subsalicylate), through direct action on the
muscles of the GI tract to slow activity (loperamide), or through action on central nervous system
(CNS) centers that cause GI spasm and slowing (opium derivatives). Options B, C, and D are not
correct.

Question 13

The nurse teaches the patient that a common adverse effect of loperamide (Imodium) is what?
A) Fatigue
B) Flatulence
C) Disorientation
D) Tremors

Answer 13

Ans: A
Feedback:
Adverse effects associated with antidiarrheal drugs, such as constipation, distention, abdominal
discomfort, nausea, vomiting, dry mouth, and even toxic megacolon, are related to their effects on the
gastrointestinal (GI) tract. Other adverse effects that have been reported include fatigue (option A),
weakness, dizziness, and rash. options B, C, and D are not correct.

Question 14

The nurse will question an order for bismuth salts (Pepto-Bismol) in a patient with what condition?
A) Rheumatoid arthritis
B) Allergy to aspirin
C) Hypertension
D) Viral gastroenteritis

Answer 14

Ans: B
Feedback:
Pepto-Bismol has aspirin in it and should not be given to a patient with an allergy to aspirin. There is no
contraindication for a patient with rheumatoid arthritis, hypertension, or viral gastroenteritis.

Question 15

The home health nurse is caring for a 72-year-old man in his home. He complains about almost daily
diarrhea. The nurse assesses for what common cause of diarrhea in older adults?
A) Diabetes
B) Hypertensive medications
C) Laxative overuse
D) Glaucoma

Answer 15

Ans: C
Feedback:
Diarrhea in older adults may result from laxative overuse so the nurse should assess what over-thecounter
(OTC) products the patient is using. Diabetes, hypertension medications, and glaucoma are not
common causes of diarrhea in patients.

Question 16

What is the antidiarrheal of choice the nurse will administer to children older than 2 years of age with
diarrhea?
A) Bismuth salts (Pepto-Bismol)
B) Loperamide (Imodium)
C) Paregoric (generic)
D) Difenoxin (Motofen)

Answer 16

Ans: B
Feedback:
Loperamide may be the antidiarrheal of choice in children older than 2 years of age if such a drug is
needed. Special precautions need to be taken to monitor for electrolyte and fluid disturbances and
supportive measures should be taken as needed. Serious fluid volume deficits may rapidly develop in
children with diarrhea. Appropriate fluid replacement should include oral rehydration solutions.
Although bismuth salts and paregoric may be given to children, they are not the drugs of choice.
Difenoxin is not for use in children under 12 years of age.

Question 17

What antidiarrheal would the nurse administer to reduce the volume of discharge from the patient’s
ileostomy?
A) Diphenoxylate (Lomotil)
B) Octreotide (Sandostatin)
C) Psyllium (Metamucil)
D) Loperamide (Imodium)

Answer 17

Ans: D
Feedback:
Loperamide (Imodium), bismuth subsalicylate (Pepto-Bismol), and opium derivatives (paregoric) are
indicated for the reduction of volume of discharge from ileostomies. The other options would not serve
this purpose.

Question 18

The nurse teaches the patient who was prescribed a chemical stimulant laxative that this medication
may have either a slow, steady effect or may cause severe cramping and rapid evacuation of the
contents of the large intestine. What drug is the nurse teaching this patient about?
A) Bismuth salts
B) Bisacodyl
C) Castor oil
D) Cascara

Answer 18

Ans: D
Feedback:
Specifically related to chemical stimulants, cascara, although a reliable agent, may have a either slow,
steady action or may cause severe cramping and rapid evacuation of the contents of the large intestine. Bisacodyl and castor oil do not have potential adverse effect. Bismuth salts are an antidiarrheal.

Question 19

What is the priority nursing diagnosis for an 89-year-old patient with frequent liquid stools?
A) Imbalanced nutrition: less than body requirements
B) Deficient fluid volume
C) Deficient knowledge related to medications
D) Pain related to abdominal cramping

Answer 19

Ans: B
Feedback:
Fluid volume deficits may develop rapidly in older adults with diarrhea. Older adults are more likely to
develop adverse effects associated with the use of these drugs, including sedation, confusion, dizziness,
electrolyte disturbances, fluid imbalance, and cardiovascular effects. Although nutrition, pain, and
knowledge deficit may be concerns for this patient, they are not the priority concern.

Question 20

What drug does the nurse recognize as being classified as a chemical stimulant?
A) Bisacodyl (Dulcolax)
B) Polycarbophil (FiberCon)
C) Magnesium hydroxide (Milk of Magnesia)
D) Docusate (Colace)

Answer 20

Ans: A
Feedback:
Bisacodyl is a chemical stimulant. Polycarbophil and magnesium hydroxide are bulk laxatives.
Docusate is a lubricant laxative.

Question 21

The nurse is caring for a patient who has had impacted stools twice in the past month. What is an
appropriate laxative for this patient?
A) Milk of Magnesia
B) Agoral Plain
C) Colace
D) Dulcolax

Answer 21

Ans: B
Feedback:
Mineral oil (Agoral Plain) is not absorbed and forms a slippery coat on the contents of the intestinal
tract. When the intestinal bolus is coated with mineral oil, less water is drawn out of the bolus and the
bolus is less likely to become hard or impacted. Other options shown do not have this same effect of
reducing the risk of another impaction as well as helping to eliminate stool.

Question 22

The home health nurse is caring for a patient with encopresis who was started on mineral oil therapy.
The nurse teaches the patient and family that a common adverse effect is what?
A) Nausea
B) Vomiting
C) Leakage
D) Vitamin C deficiency

Answer 22

Ans: C
Feedback:
Leakage and staining may be a problem when mineral oil is used and the stool cannot be retained by
the external sphincter. Mineral oil does not cause nausea, vomiting, or vitamin C deficiency.

Question 23

When would it be appropriate for the nurse to administer a cathartic laxative to the patient? (Select all
that apply.)
A) Partial small-bowel obstruction
B) Appendicitis
C) After having a baby
D) After a myocardial infarction (MI)
E) After anthelmintic therapy

Answer 23

Ans: C, D, E
Feedback:
Laxative, or cathartic, drugs are indicated for the short-term relief of constipation; to prevent straining
when it is clinically undesirable (such as after surgery, myocardial infarction, or obstetric delivery); to
evacuate the bowel for diagnostic procedures; to remove ingested poisons from the lower
gastrointestinal (GI) tract; and as an adjunct in anthelmintic therapy when it is desirable to flush
helminths from the GI tract. They are not indicated when a patient has an appendicitis or a partial
small-bowel obstruction.

Question 24

When would it be appropriate for the nurse to administer castor oil as a laxative?
A) To ease the passage of stool in the patient who recently had a baby
B) To remove ingested poisons from the lower gastrointestinal (GI) tract
C) To evacuate the bowel for diagnostic procedures
D) To treat chronic constipation

Answer 24

Ans: C
Feedback:
Indications include evacuating the bowel for diagnostic procedures and for short-term treatment of
constipation. Castor oil is not indicated to remove ingested poisons nor to ease the passage of stool after
having a baby. This drug should only be used on a short-term basis and is not for the treatment of
chronic constipation because repeated use will cause GI tract exhaustion.

Question 25

For what action would the nurse administer magnesium citrate?
A) Block absorption of fats
B) Directly stimulate the nerve plexus in the intestinal wall
C) Form a slippery coat on the contents of intestine
D) Increase motility, increase fluid, and enlarge bulk of fecal matter

Answer 25

Ans: D
Feedback:
Magnesium citrate is a rapid-acting, aggressive laxative that causes fecal matter to increase in bulk. It increases the motility of the gastrointestinal (GI) tract by increasing the fluid in the intestinal contents,
which enlarges bulk, stimulates local stretch receptors, and activates local activity. It does not block
absorption of fats, stimulate the nerve plexus, or form a slippery coat.

Question 26

The nurse administers metoclopramide to the patient with what condition?
A) Chronic diabetic gastroparesis
B) Impaction
C) Encopresis
D) Patients requiring diagnostic procedures

Answer 26

Ans: A
Feedback:
Indications for metoclopramide include relief of acute and chronic diabetic gastroparesis, short-term
treatment of gastroesophageal reflux disorder in adults who cannot tolerate standard therapy,
prevention of postoperative or chemotherapy-induced nausea and vomiting, facilitation of small-bowel
intubation, stimulation of gastric emptying, and promotion of intestinal transit of barium. It would not
be used for treatment of impaction, encopresis, and in patients requiring diagnostic procedures.

Question 27

What drug does the nurse administer that inhibits intestinal peristalsis through direct effects on the
longitudinal and circular muscles of the intestinal wall?
A) Bismuth subsalicylate
B) Loperamide
C) Paregoric
D) Magnesium citrate

Answer 27

Ans: B
Feedback:
Actions of loperamide include that it inhibits intestinal peristalsis through direct effects on the
longitudinal and circular muscles of the intestinal wall, slowing motility and movement of water and
electrolytes. Bismuth subsalicylate inhibits local reflexes. Paregoric works through action on CNS
centers that cause GI spasm and slowing. Magnesium citrate is a laxative.

Question 28

The family brings a patient to the emergency department saying he has been hallucinating and falls so
deeply asleep he stops breathing when not stimulated. The nurse learns the patient has been self- treating diarrhea and suspects the patient was taking what medication?
A) Paregoric
B) Bismuth subsalicylate
C) Loperamide
D) Colace

Answer 28

Ans: A
Feedback:
Opium derivatives, like paregoric, are associated with light-headedness, sedation, euphoria,
hallucinations, and respiratory depression related to their effect on opioid receptors. Nonopioids such as
bismuth subsalicylate and loperamide would not cause respiratory depression. Colace is a stool
softener, not an antidiarrheal.

Question 29

The nurse develops a teaching plan for a 77-year-old patient who has been prescribed loperamide PRN.
The nurse’s priority teaching point is what?
A) May cause hallucinations or respiratory depression
B) Take drug after each loose stool
C) Drug remains in the bowel without being absorbed into the bloodstream
D) Avoid pregnancy and breast-feeding while taking drug.

Answer 29

Ans: B
Feedback:
Loperamide is taken repeatedly after each loose stool. Teaching the patient when to take the drug is the
priority teaching point. Paregoric, and not loperamide, can cause hallucinations and respiratory
depression. The drug is absorbed systemically. It is unlikely a 77-year-old patient will get pregnant or
breast-feed so this is not the highest priority.

Question 30

A patient receiving loperamide (Imodium) should be alerted by the nurse to what possible adverse
effect?
A) Anxiety
B) Bradycardia
C) Fatigue
D) Urinary retention

Answer 30

Ans: C
Feedback:
Patients should be aware that they should not drive or operate machinery while taking loperamide
(Imodium) because it can cause fatigue. Anxiety, bradycardia, and urinary retention are not commonly
associated with loperamide.

Question 31

The patient had surgery 2 days ago and bowel motility has not returned. What drug might the nurse
administer to stimulate the gastrointestinal (GI) tract?
A) Dexpanthenol
B) Docusate
C) Psyllium (Metamucil)
D) Senna

Answer 31

Ans: A
Feedback:
Dexpanthenol is indicated for the prevention of intestinal atony or loss of intestinal muscle tone in
postoperative adults. Docusate, psyllium, and senna are laxatives that would not be indicated for the
postoperative patient with no bowel activity.

Question 32

The hospice nurse is caring for a patient diagnosed with bone cancer who is receiving large doses of
opioid medications to relieve pain. The patient has used other laxatives in the past to treat opioidinduced
constipation but nothing is working now. What drug would the nurse request the family doctor
to order for this patient?
A) Methylnaltrexone (Relistor)
B) Castor oil
C) Paregoric
D) Mineral oil

Answer 32

Ans: A
Feedback:
Methylnaltrexone (Relistor) was approved in 2008 for the treatment of opioid-induced constipation in
patients with advanced disease who are receiving palliative care and are no longer responsive to
traditional laxatives. Castor oil, mineral oil, and paregoric would likely be ineffective in this patient.

Question 33

The nurse, providing patient teaching, explains that difenoxin and diphenoxylate are chemically related
to what medication?
A) Morphine
B) Demerol
C) Diphenhydramine
D) Diflucan

Answer 33

Ans: B
Feedback:
Difenoxin and diphenoxylate are chemically related to meperidine and are used at doses that decrease
gastrointestinal activity without having analgesic or respiratory effects.

Question 34

The nurse collects a stool culture from a patient diagnosed with traveler’s diarrhea. What bacterium
does the nurse expect the culture to grow?
A) Escherichia coli
B) Staphylococcus aureus
C) Streptococcus type B
D) Pseudomonas

Answer 34

Ans: A
Feedback:
Escherichia coli is the most common cause of traveler’s diarrhea. Staphylococcus, Streptococcus, and
Pseudomonas would be highly unlikely to grow in the stool of a patient with traveler’s diarrhea.

Question 35

The nurse administers lubiprostone (Amitiza) to the patient with irritable bowel syndrome and
anticipates what therapeutic action from the drug?
A) Secretion of chloride-rich intestinal fluid leading to increased motility
B) Adding bulk to the fecal matter to ease the process of stooling
C) Irritation of the inner lining of the bowel to increase bowel motility
D) Stimulate the bowel by increasing innervation

Answer 35

Ans: A
Feedback:
Lubiprostone is a locally acting chloride channel activator that increases the secretion of a chloride-rich
intestinal fluid without changing sodium or potassium levels. Increasing the intestinal fluid leads to
increased motility. It does not add bulk, irritate the inner lining, or innervate the bowel.