A nurse is preparing to administer a tap water enema to a client. Which of the following actions should the nurse take?

Don sterile gloves prior to the procedure.

Lubricate 1 inch of the tip of the rectal tube prior to insertion.

Place the client into a left Sims' position.

Raise the enema bag if the client experiences cramping.

Answer and Explanation

The Correct Answer is C

A. Sterile gloves are not necessary for a tap water enema; clean, non-sterile gloves are sufficient.

B.   Lubricating the tip of the rectal tube is appropriate to ease insertion and enhance client comfort.
C.   Placing the client into a left Sims' position facilitates optimal administration of a tap water enema.
D.   Lowering, not raising, the enema bag will allow for a slower flow and may reduce cramping.

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Correct Answer is D

Explanation

A. While some clients may be receptive to a scientific perspective, cultural beliefs and practices can significantly influence health-related decisions and behaviors.
B. Assigning clients to specific cultural categories can lead to stereotyping and may not account for the individual variations within a cultural group.
C. Disease and illness can indeed be influenced by cultural factors, including beliefs about health and healing practices.

D. The meaning of behavior can vary widely across cultures, and understanding the cultural context is crucial for providing culturally competent care.

A. Wrapping the finger in a warm cloth B. Rubbing the fingertip with an alcohol pad C. Puncturing the side of the fingertip D. Elevating the finger above heart level

Correct Answer is D

Explanation

A. Wrapping the finger in a warm cloth helps improve blood flow and can facilitate the blood sample collection.
B. Rubbing the fingertip with an alcohol pad cleans the site before the puncture.

C. Puncturing the side of the fingertip is less painful and avoids the pain receptors.

D. The nurse should intervene if the client elevates the finger above the level of the heart. Holding the finger below the level of the heart in a dependent position will help increase blood flow to the area and ensure an adequate specimen for collection.

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A nurse is preparing to administer a tap water enema to a client. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

To plan culturally competent care, a nurse should consider that:

Correct Answer is D

Explanation

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Correct Answer is D

Explanation

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