Author Question: A patient who has a history of chronic constipation uses a bulk laxative to prevent episodes of ... (Read 121 times)

EAugust · **on:** Jul 24, 2018

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.

Question 2

A 70-year-old patient with COPD who is new to the clinic reports taking 10 mg of prednisone daily for several years. The primary care NP should:

a. tell the patient to take the drug every other day before 9:00 AM.
b. order a serum glucose, potassium level, and bone density testing.
c. perform pulmonary function tests to see if the medication is still needed.
d. begin a gradual taper of the prednisone to wean the patient off the medication.

akudia · **Reply #1 on:** Jul 24, 2018

Answer to Question 1

A
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.

Answer to Question 2

B
Serum glucose and potassium levels are part of monitoring for side effects of steroids. Because elderly patients are more prone to certain potential catabolic adverse effects of steroid therapy, caution is required. Osteoporosis is often seen with elderly patients, so bone density testing should be performed. The medication dosing regimen should not be changed unless there is an indication of adverse effects.