# A client reports daily use of senna for 6 months for chronic constipation and now must take increasing doses for the same effect. Which is the nurse's best counseling?

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> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A client reports daily use of senna for 6 months for chronic constipation and now must take increasing doses for the same effect. Which is the nurse's best counseling?

## Option

1. "Add another stimulant laxative for additive effect."
2. "Continue increasing the dose indefinitely."
3. "Switch to senna only when severe constipation occurs."
4. "Chronic stimulant laxative use causes tolerance and laxative dependence. Discuss tapering with osmotic laxatives (polyethylene glycol), fiber, and adequate fluids." **✔ Correct answer**

**Correct answer: 4**

## Explanation

Correct (2): Long-term stimulant laxative use (senna, bisacodyl) causes tolerance and laxative dependence (colon hypotonia). Switch to osmotic laxatives (PEG, lactulose), add bulk-forming (psyllium) with adequate fluids, and ensure exercise. (1,3,4) Worsen the cycle.

## In-depth explanation

Memory Tip Laxative ladder = "Bulk → Osmotic → Stimulant" (intermittent only) → Lubiprostone/linaclotide. Avoid daily stimulants long-term.

## Clinical scenario

Scenario 58-year-old female on senna daily × 6 months for chronic constipation; reports needing higher doses for the same effect.

## Key concepts

- **Stimulant laxative** — Senna, bisacodyl; activate intestinal motility but cause dependence with long-term use.
- **Osmotic laxative** — PEG, lactulose, sorbitol; pull water into the gut; safe for chronic use.
- **Bulk-forming laxative** — Psyllium, methylcellulose; require adequate fluids; first-line for chronic constipation.

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