A female patient who is underweight tells the primary care NP ...

[Jipu 123]

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:
 
  a. prescribe docusate sodium (Colace) and decrease bisacodyl gradually.
  b. suggest she use polyethylene glycol (MiraLAX) on a daily basis instead.
  c. tell her that long-term use of suppositories is safer than long-term laxative use.
  d. counsel the patient to discontinue the laxative and increase fluid and fiber intake.

Question 2

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.

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Answer to Question 1

A
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.

Answer to Question 2

C
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.

[Jipu 123]

TYSM

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Gracias!