A nurse is reviewing medications for a client who has just been diagnosed with a small bowel obstruction. The nurse should withhold senna prescribed orally based on understanding of which of the following?

A. Take with at least two full glasses of water : This is the correct answer. Bulk-forming laxatives require adequate fluid intake to swell in the intestine, forming a gel-like substance that aids in stool formation and bowel movement. Without sufficient water, they can cause or worsen constipation.
B. Increase food intake: This is not specific to the administration of bulk-forming laxatives and may not directly address the proper use of the medication.
C. Decrease water intake: This is incorrect and potentially harmful, as inadequate water intake can lead to impaction or obstruction when taking bulk-forming laxatives.
D. Exercise more than three times a week: While regular exercise is beneficial for bowel health, this instruction does not directly relate to the specific needs of taking bulk-forming laxatives.

A. Laxatives are contraindicated in clients who have a small bowel obstruction: This is the correct answer. Laxatives like senna are contraindicated in the presence of a bowel obstruction as they can increase peristalsis and pressure in the bowel, leading to complications such as perforation.
B. An osmotic laxative, such as magnesium citrate, should be substituted in this client: This is incorrect. Osmotic laxatives are also contraindicated in bowel obstruction because they can draw water into the bowel and worsen the obstruction or cause severe complications.
C. The prescribed medication should be administered via NG route rather than the oral route for this client: This is incorrect. Administering any form of laxative via the NG route does not address the contraindication in bowel obstruction and is not a safe practice in this context.
D. Bulk-forming laxatives such as psyllium should be substituted for this client: This is incorrect. Bulk-forming laxatives are also contraindicated in bowel obstruction due to the risk of worsening the obstruction and causing complications.