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An oil retention enema is prescribed for a hospitalized client. The practical nurse (PN) should administer the enema solution at which temperature?

The solution temperature should be determined by the client’s comfort level

The temperature of the enema is unrelated to the enema’s eﬀectiveness

The solution should approximate the client’s body temperature (98°F or 36°C).

The temperature should be higher (110°F or 43°C) than the client’s body temperature

Answer and Explanation

The Correct Answer is C

An oil retention enema is used to soften the stool and lubricate the rectum, making it easier to pass the stool. It is usually oil-based and contains 90-120 ml of solution³.
The temperature of the enema solution aﬀects the eﬀectiveness and comfort of the procedure. If the solution is too hot or cold, it can cause pain, cramps, or damage to the rectal tissue³. If the solution is too warm, it can also stimulate peristalsis and cause the client to expel the enema before it has time to work⁴.
The ideal temperature for an enema solution is close to the client’s body temperature, which is around 98°F or 36°C. This temperature ensures that the solution is comfortable and does not cause adverse reactions³⁴.

Option A is incorrect because the client’s comfort level may not reﬂect the optimal temperature for the

enema.

Option B is incorrect because the temperature of the enema does aﬀect its eﬀectiveness and safety. Option D is incorrect because the temperature is too high and can cause harm to the client.

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Correct Answer is B

Explanation

Choice A reason: Collaborating with physical therapist to develop programs for injured employees to return to work is not a secondary prevention strategy, but rather a tertiary prevention strategy, which involves restoring and rehabilitating the health and function of individuals who have experienced illness or injury.

Choice B reason: Helping plant workers identify signs of carpal tunnel syndrome is a secondary prevention strategy, which involves detecting and treating health problems early before they become more serious or complicateD.

Choice C reason: Organizing an influenza immunization campaign is not a secondary prevention strategy, but rather a primary prevention strategy, which involves preventing or reducing the occurrence or severity of health problems before they happen.

Choice D reason: Teaching plant workers about proper lifting techniques is not a secondary prevention strategy, but rather a primary prevention strategy, which involves preventing or reducing the occurrence or severity of health problems before they happen.

A. "It is a tool that is used to determine your maximum level of self-sufficiency.” B. "It is a test that determines which activities you feel most comfortable performinG.” C. "It is a tool used by insurance companies to determine qualifications for medical reimbursement." D. "It is a tool that is used to assess what services you will need a home health aide to perform for you."

Correct Answer is A

Explanation

Choice A reason: "It is a tool that is used to determine your maximum level of self-sufficiency.” This nursing response is appropriate because it accurately describes the purpose of the FIM, which is a standardized instrument that measures the client's level of independence in performing 18 activities of daily living and mobility tasks.

Choice B reason: "It is a test that determines which activities you feel most comfortable performinG.” This nursing response is not appropriate because it does not describe the purpose of the FIM, which is not a test that measures the client's comfort level, but rather their functional ability.

Choice C reason: "It is a tool used by insurance companies to determine qualifications for medical reimbursement." This nursing response is not appropriate because it does not describe the purpose of the FIM, which is not a tool that determines the client's eligibility for insurance coverage, but rather their functional status and progress.

Choice D reason: "It is a tool that is used to assess what services you will need a home health aide to perform for you." This nursing response is not appropriate because it does not describe the purpose of the FIM, which is not a tool that evaluates the client's need for home care services, but rather their functional capacity and improvement.

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An oil retention enema is prescribed for a hospitalized client. The practical nurse (PN) should administer the enema solution at which temperature?

Nursing Test Bank

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