A nurse is preparing a cleansing enema for an adult patient who is constipated and has not responded to laxative use. Before giving the enema, the nurse should

cool the solution to 65 degrees F

boil the solution and let it cool down.

warm the solution to body temperature

warm the solution in the microwave.

Answer and Explanation

The Correct Answer is C

Choice A Using a cool solution might cause discomfort and could lead to cramping, which is not ideal for an enema administration.

Choice B Boiling the solution is unnecessary and might be unsafe, as it could cause burns or damage the components of the enema.

Choice C Warming the solution to body temperature (around 98.6°F or 37°C) is the appropriate approach, as it ensures patient comfort and reduces the risk of cramping or discomfort.

Choice D Microwaving the solution might lead to uneven heating and could potentially create hot spots, which could cause burns or discomfort for the patient.

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Correct Answer is B

Explanation

The correct answer is Choice B.

Choice A rationale: Waiting until the ostomy drainage bag is full increases the risk of leakage and can put undue pressure on the stoma, leading to potential skin irritation or damage. Regular emptying is crucial for maintaining stoma health and preventing complications.

Choice B rationale: Emptying the ostomy drainage bag when it is 1/2 full is recommended to prevent leaks and reduce pressure on the stoma. This practice helps maintain skin integrity around the stoma and ensures the drainage bag functions effectively.

Choice C rationale: Emptying the ostomy drainage bag when it is only 1/4 full may be too frequent and unnecessary, leading to increased use of supplies and potential irritation from frequent manipulation. It is more practical to aim for 1/2 full for routine care.

Choice D rationale: Waiting until the ostomy drainage bag is 3/4 full increases the risk of leakage and pressure on the stoma, similar to waiting until it is full. It is essential to empty the bag more regularly to maintain optimal stoma health and prevent issues

A. 3 to 5 days. B. 1 to 3 days. C. 2 to 3 days. D. 4 to 7 days.

Correct Answer is D

Explanation

Choice A Changing the faceplate every 3 to 5 days might be necessary for some individuals with specific needs, but it is not the typical frequency for most colostomy patients.

Choice B Changing the faceplate every 1 to 3 days is too frequent for most colostomy patients and might lead to unnecessary waste and discomfort.

Choice C Changing the faceplate every 2 to 3 days is still relatively frequent and might not be necessary for most colostomy patients.

Choice D Changing the faceplate every 4 to 7 days is the usual recommendation for colostomy patients, as it allows for sufficient wear time while minimizing the frequency of changes.

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A nurse is preparing a cleansing enema for an adult patient who is constipated and has not responded to laxative use. Before giving the enema, the nurse should

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a patient with a colostomy. The ostomy drainage bag should be emptied whenever it is

Correct Answer is B

Explanation

A patient with a colostomy asks how often the faceplate (wafer) of the ostomy appliance should be changed. The most appropriate response by the nurse is that it is usually changed every

Correct Answer is D

Explanation

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