A nurse is assisting in the plan of care for a client who has constipation after receiving opioid medication for incisional pain. Which of the following actions should the nurse take first?

The correct answer is Choice a. "You will be moderately sedated during the procedure."

Choice A rationale: Colonoscopy is a common procedure used for both diagnostic and therapeutic purposes in gastroenterology. Moderate sedation, also known as conscious sedation, is typically administered to patients undergoing colonoscopy to ensure their comfort and cooperation during the procedure. This level of sedation allows the patient to maintain their protective reflexes and respond to verbal commands, while also reducing anxiety and discomfort. The sedative agents commonly used for colonoscopy include benzodiazepines such as midazolam and analgesics such as fentanyl. The nurse should emphasize the use of moderate sedation to the patient, reassuring them that they will be in a relaxed state throughout the procedure without compromising their safety.

Choice B rationale: The statement suggesting that the patient will lie on their right side for the procedure is incorrect. During a colonoscopy, patients are typically positioned on their left side with their knees drawn up towards their chest. This left lateral decubitus position facilitates the advancement of the colonoscope through the colon and provides better visualization for the healthcare provider performing the procedure. Placing the patient on the right side would not provide optimal positioning and may hinder the progress of the colonoscopy.

Choice C rationale: The information provided in statement c. is incorrect regarding the dietary restrictions before a colonoscopy. Prior to the procedure, patients are instructed to follow a clear liquid diet for 24 to 48 hours, depending on the healthcare provider's instructions. Clear liquids include water, clear broth, tea, coffee without milk or cream, strained fruit juices (such as apple or white grape juice), and sports drinks. Solid foods, as well as liquids that are not transparent, should be avoided during this preparatory period to ensure adequate bowel cleansing and visualization during the colonoscopy.

Choice D rationale: The recommendation to warm the liquid bowel preparation before consumption, as stated in option d., is incorrect. Bowel preparations typically consist of polyethylene glycol-based solutions, which are intended to be consumed at room temperature or chilled. Warming the solution could alter its composition and taste, potentially causing discomfort or nausea in the patient. It is essential for patients to follow the specific instructions provided by their healthcare provider or the product labeling regarding the administration of bowel preparation to ensure effective bowel cleansing before the colonoscopy.

Choice E rationale: Repeated for emphasis, the advice to warm the liquid bowel preparation before consumption is incorrect and redundant. Patients should adhere strictly to the instructions provided by their healthcare provider or the product labeling regarding the administration of bowel preparation. Warming the solution is not recommended and could compromise the effectiveness of the preparation, leading to suboptimal bowel cleansing and potentially impacting the accuracy of the colonoscopy results.

The correct answer is choice B: Store opened insulin vials at room temperature for up to 4 weeks.

Choice B rationale: Opened insulin vials can be stored at room temperature (59°F to 86°F or 15°C to 30°C) for up to 4 weeks. After this period, the insulin may lose potency, and a new vial should be used.

Choice A rationale: Regular insulin is short-acting, and its peak effect occurs 2 to 3 hours after administration. Eating a snack 6 hours after insulin administration may not be necessary as the insulin would have already reached its peak effect, and blood glucose levels should be monitored accordingly.

Choice C rationale: Warming the insulin vial to dissolve crystals is not recommended. Insulin should be inspected before use, and if crystals or clumps are present, it should be discarded as this could indicate that the insulin has lost its effectiveness.

Choice D rationale: Unopened insulin vials should be stored in the refrigerator (36°F to 46°F or 2°C to 8°C) and should not be frozen. Freezing can cause insulin to lose potency or become ineffective. Once opened, insulin vials can be stored at room temperature for up to 4 weeks, as mentioned in choice B.