A nurse is caring for a client who has bowel incontinence and is placed on a bowel training program. Which of the following actions should the nurse take?

Teach the client to strain when having a bowel movement.

Encourage the client to drink a hot beverage just before she needs to defecate.

Allow the client to sit on the toilet for 1 hr to defecate.

Limit exercise for the client while she is on the bowel training program.

Answer and Explanation

The Correct Answer is B

A. Teach the client to strain when having a bowel movement. Straining can cause harm and is not recommended.
B. Encourage the client to drink a hot beverage just before she needs to defecate. A hot beverage can stimulate bowel movements and help establish a routine.
C. Allow the client to sit on the toilet for 1 hr to defecate. Prolonged sitting can cause discomfort and is not practical.
D. Limit exercise for the client while she is on the bowel training program. Exercise is beneficial for overall health and can promote regular bowel movements.

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Free Nursing Study Resources

Correct Answer is A

Explanation

A. Instruct the client to use the hallway grab bars when walking. This is correct. Using hallway grab bars provides support and stability, helping to prevent falls in clients with osteoporosis.
B. Assist the client to the bathroom every 4 hr. Assisting the client to the bathroom regularly is important, but every 4 hours might not be frequent enough and doesn't directly address fall prevention throughout all activities.
C. Administer an antianxiety medication at bedtime. Antianxiety medications can cause sedation and increase the risk of falls, especially in older adults.
D. Monitor the client's activity every 2 hr. Monitoring the client’s activity is important, but this does not provide specific fall prevention strategies or interventions.

A. Cleanse the urethral meatus. B. Apply sterile gloves. C. Attach the pre-filled syringe to the inflation bulb. D. Saturate the cotton balls with antiseptic.

Correct Answer is B

Explanation

A. Cleanse the urethral meatus. This step occurs after preparing the sterile field and donning sterile gloves.
B. Apply sterile gloves. This is correct. The first step in the standardized procedure is to apply sterile gloves to maintain aseptic technique throughout the catheter insertion process.
C. Attach the pre-filled syringe to the inflation bulb. This step is part of the preparation but comes after the sterile gloves are applied.
D. Saturate the cotton balls with antiseptic. This step occurs after donning sterile gloves.

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A nurse is caring for a client who has bowel incontinence and is placed on a bowel training program. Which of the following actions should the nurse take?

Nursing Test Bank

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