A patient is being seen for complaints of severe flank pain lasting for 2 days. The emergency department physician suspects that the patient has renal calculi. Which of the following tests would the nurse expect the health care provider to order?

Choice A reason: Stopping the enema entirely is premature and unnecessary for cramping, which is a common response to rapid fluid instillation. Documentation of intolerance is only appropriate if the procedure cannot be completed after attempting adjustments. This action fails to address the cramping’s cause, potentially delaying constipation relief and patient comfort.

Choice B reason: Lowering the solution container reduces the flow rate of the enema, decreasing intraluminal pressure in the colon. Cramping often results from rapid fluid instillation stretching the bowel. Slowing the flow allows the colon to accommodate the fluid, alleviating discomfort while continuing the procedure effectively.

Choice C reason: Encouraging the client to bear down is inappropriate as it may cause premature expulsion of the enema fluid, reducing its effectiveness in relieving constipation. Bearing down increases intra-abdominal pressure, potentially exacerbating cramping rather than alleviating it, and does not address the underlying cause of discomfort from fluid instillation.

Choice D reason: Allowing the client to expel fluid prematurely interrupts the enema’s purpose of softening stool and stimulating bowel movement. While it may temporarily relieve cramping, it reduces the procedure’s efficacy, potentially requiring a repeat enema, which increases patient discomfort and procedural risks like rectal irritation.

Choice A reason: A bladder scan is the first step to assess urine retention noninvasively. It measures bladder volume, determining if the client is retaining urine post-catheter removal. This guides further interventions, preventing unnecessary procedures and addressing potential complications like urinary retention or bladder distention.

Choice B reason: Increasing fluids without assessing bladder volume is premature and risky. If retention exists, more fluid could exacerbate bladder distention, causing discomfort or injury. Fluid management should follow confirmation of voiding ability, ensuring the bladder can empty effectively to avoid complications.

Choice C reason: Assisting to the bathroom assumes the client can void, which may not be true post-catheter. Without confirming bladder function via a scan, this action risks missing retention, potentially leading to bladder overdistention or urinary tract complications, delaying appropriate intervention.

Choice D reason: Inserting a straight catheter is invasive and should not be the first action. Without a bladder scan to confirm retention, catheterization risks unnecessary discomfort or infection. Noninvasive assessment precedes invasive interventions to ensure patient safety and appropriate management of post-catheter voiding issues.