The practical nurse (PN) is administering a saline enema to a client who was admitted
because of a fever of unknown origin and is now constipated. Which techniques should
the PN use? (Select all that apply.)
Position client in left lateral recumbent position to expose buttocks.
Chill the enema solution to help reduce the client's fever.
Encourage client to retain solution for at least 5 minutes.
Insert lubricated tip of tubing 3 to 4 inches into the rectum.
Correct Answer : A,C,D
Choice A: Positioning the client in the left lateral recumbent position allows the solution to flow by gravity into the sigmoid colon and rectum.
Choice B: Chilling the enema solution is not recommended because it can cause cramping, discomfort, and vasoconstriction, which may interfere with the client's fever assessment.
Choice C: Positioning the client in the left lateral recumbent position allows the solution to flow by gravity into the sigmoid colon and rectum.
Choice D: Inserting the lubricated tip of tubing 3 to 4 inches into the rectum prevents injury to the rectal mucosa and ensures proper placement of the tubing.
Choice E: Clamping the enema administration tubing after filling the enema bag is unnecessary and may cause air to enter the tubing, which can increase the risk of abdominal distension and gas pain.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A: Socioeconomics can influence a person's ability to access and afford certain foods, but the statement does not directly address the nutritional guidelines for older adults.
Choice B: Nutritional meal planning for seniors should ideally involve input from a dietitian or healthcare provider, but the statement does not directly reflect an understanding of the nutritional guidelines.
Choice C: Dietary needs for seniors over and under age 70 can differ due to factors such as changes in metabolism, physical activity levels, and overall health. The statement recognizes the importance of tailoring the meal plan to meet the specific nutritional needs of both spouses based on their respective ages.
Choice D: Age is a factor in determining dietary needs for seniors, as nutritional requirements may change as individuals age. The statement acknowledges that age plays a role in meal planning for older adults.
Correct Answer is D
Explanation
Choice A: Maintaining protein intake and increasing intake of fruits and vegetables is generally a balanced and healthy approach to nutrition.
Choice B: Decreasing protein intake and eating more whole grains and vegetables may not be necessary unless there are specific dietary restrictions or medical indications.
Choice C: Increasing protein intake with additional dairy products may not be needed and depends on individual dietary preferences and nutritional goals.
Choice D: Maintaining protein intake but substituting fish and nuts for meat and eggs can be a balanced and healthy dietary choice. Fish and nuts can provide protein and healthy fats while reducing saturated fat intake from red meat and eggs.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.
