Challenge Your Exam Readiness With Our Free AOCNP Practice Questions

Opioid-induced constipation (OIC) is predictable and should be prevented. First-line prophylaxis is a stimulant laxative (senna or bisacodyl), with or without a stool softener; titrate to 1–2 soft BMs/day. If inadequate, add an osmotic agent (polyethylene glycol, lactulose, magnesium hydroxide as renal function allows). Bulk-forming fiber (Option A) can worsen bloating and is ineffective in slowed-transit OIC. Antidiarrheals (Option C) are contraindicated. For persistent OIC despite optimized oral regimens, peripherally acting µ-opioid receptor antagonists (PAMORAs) like naloxegol, naldemedine, or methylnaltrexone can rapidly restore bowel function without reversing central analgesia; assess for GI obstruction risk before use. Abruptly stopping opioids (Option D) is unsafe and undermines pain control. APRNs should provide written bowel plans at opioid initiation, assess for red flags (obstruction, severe abdominal pain), encourage mobility and hydration as tolerated, and review interacting medications (anticholinergics). Document regimen effectiveness and adjust proactively during titration of analgesics.