1. Carmen is a 40-year-old woman with a 9-month history of chronic constipation. She has tried changing her lifestyle with changes in diet, fluid intake, exercise, and fiber supplementation but has not had an improvement in her symptoms. Which of the following additional symptoms, which Carmen reports to you, support a diagnosis of constipation-predominant irritable bowel syndrome (IBS-C), and not chronic idiopathic constipation (CIC)?

2. A 51-year-old man fulfills the diagnostic criteria for chronic idiopathic constipation. He has tried fiber supplementation, sennosides, and polyethylene glycol to relieve his symptoms, with limited success. Which of the following is the most reasonable next treatment step with the highest quality of evidence to support its use by this patient?

3. A 32-year-old woman presents to the pharmacy for information regarding a nonprescription laxative. Which of the following options would be the best first step in helping this patient with her constipation?

4. John is a 42 year-old patient with CIC. His physician has recommended a nonprescription laxative. He also has chronic kidney disease (stage 4, glomerular filtration rate 25 ml/min). Which of the following recommendations is accurate to instruct this patient?

5. Nausea has been associated with which of the following medications?

6. Christina is a 39-year-old female with constipation predominant IBS (IBS-C). She also has a history of heartburn for which she is prescribed ranitidine 150 mg twice daily, although she is often late for her refills and when you discuss this with her, she says she has a difficult time remembering her evening dose of medication. Christina has recently experienced a reduction in stool frequency despite using psyllium 1 scoop daily and PEG 17 grams daily. She reports that her last bowel movement was 3 days ago. She also complains of abdominal discomfort and bloating. Which of the following choices is the best recommendation for Christina at this time?

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