A patient is using laxatives 3 times daily to lose weight. After stopping laxative use, the patient
has difficulty with constipation and
wonders if laxatives should be taken again. Which information will the nurse share with the
patient?
a. Long-term laxative use causes the bowel to become less responsive to stimuli, and
constipation may occur.
b. Laxatives can cause trauma to the intestinal lining and scarring may result,
leading to decreased peristalsis.
c. Long-term use of emollient laxatives is effective for treatment of chronic
constipation and may be useful in certain situations.
d. Laxatives cause the body to become malnourished, so when the patient begins
eating again, the body absorbs all of the food, and no waste products are
produced.
ANS: A
Teach patients about the potential harmful effects of overuse of laxatives, such as impaired
bowel motility and decreased response
to sensory stimulus. Make sure the patient understands that laxatives are not to be used long term
for maintenance of bowel
function. Increasing fluid and fiber intake can help with this problem. Laxatives do not cause
scarring. Even if malnourished, the
body will produce waste if any substance is consumed.
DIF: Understand (comprehension)
OBJ: Discuss psychological and physiological factors that influence the elimination process.
TOP: Teaching/Learning MSC: Health Promotion and Maintenance
7. A patient recovering from a hip fracture is having difficulty defecating into a bedpan while
lying in bed. Which action by the nurse
will assist the patient in having a successful bowel movement?
a. Preparing to administer a barium enema
b. Withholding narcotic pain medication
c. Administering laxatives to the patient
d. Raising the head of the bed
ANS: D
Lying in bed is an unnatural position; raising the head of the bed assists the patient into a more
normal position that allows proper
contraction of muscles for elimination. Laxatives would not give the patient control over bowel
movements. A barium enema is a
diagnostic test, not an intervention to promote defecation. Pain-relief measures should be given;
however, preventative action
should be taken to prevent constipation.
DIF: Apply (application)
OBJ: Discuss psychological and physiological factors that influence the elimination process.
TOP: Implementation MSC: Basic Care and Comfort
8. Which patient is most at risk for increased peristalsis?
a. A 5-year-old child who ignores the urge to defecate owing to embarrassment
b. A 21-year-old female with three final examinations on the same day
c. A 40-year-old female with major depressive disorder
d. An 80-year-old male in an assisted-living environment
ANS: B
Stress can stimulate digestion and increase peristalsis, resulting in diarrhea; three finals on the
same day is stressful. Ignoring the
urge to defecate, depression, and age-related changes of the older adult (80-year-old man) are
causes of constipation, which is from
slowed peristalsis.
DIF: Apply (application)
OBJ: Describe common physiological alterations in elimination.
TOP: Assessment MSC: Psychosocial Integrity
9. A patient expresses concerns over having black stool. The fecal occult test is negative. Which
response by the nurse is most
appropriate?
a. “This is probably a false negative; we should rerun the test.”
b. “You should schedule a colonoscopy as soon as possible.”
c. “Are you under a lot of stress?”
d. “Do you take iron supplements?”
ANS: D
Certain medications and supplements, such as iron, can alter the color of stool (black or tarry).
Since the fecal occult test is
negative, bleeding is not occurring. The fecal occult test takes three separate samples over a
period of time and is a fairly reliable
test. A colonoscopy is health prevention screening that should be done every 5 to 10 years; it is
not the nurse’s initial priority.
Stress alters GI motility and stool consistency, not color.