A nurse is administering a tap water enema to a client who is constipated. During the administration of the enema, the client states h abdominal cramps. Which of the following actions should the nurse take to relieve the client's discomfort?

Increased urine output: This is not typically associated with heart failure. In fact, decreased urine output may occur due to reduced kidney perfusion.

B. Weight loss: While weight loss can occur in heart failure, it’s more common in adults than in children. In children, especially toddlers, weight gain or failure to thrive might be observed due to fluid retention or poor nutrition absorption.

C. Bradycardia: This is not typically a sign of heart failure. In heart failure, the heart rate is often increased (tachycardia) as the heart tries to compensate for its decreased pumping efficiency.

D. Orthopnea: This is the correct answer. Orthopnea, or difficulty breathing when lying flat, is a common symptom of heart failure. It occurs because when the body is in a horizontal position, fluid in the body is redistributed, leading to increased fluid in the lungs and difficulty breathing.

A. Stop the enema and document that the client did not tolerate the procedure: This action might be necessary in some cases, but it’s not the first action to take. The nurse should first try to alleviate the client’s discomfort.

B. Allow the client to expel some fluid before continuing: This action could potentially relieve some discomfort, but it’s not the most effective initial response. The cramping is likely due to the speed at which the fluid is entering, not the amount of fluid already administered.

C. Encourage the client to bear down: This action is not typically recommended during an enema administration as it could increase discomfort.

D. Lower the height of the solution container: This is the correct action. Lowering the height of the solution container will decrease the speed at which the fluid is entering the client’s rectum, which can help alleviate cramping and discomfort. Therefore, option D is the most appropriate action for the nurse to take.