A nurse is caring for a client who reports constipation. The provider has prescribed an enema. Identify the sequence of steps the nurse should take to administer the enema. (Move the steps into the box on the right, placing them in the selected order of performance. Use all the steps)
Confirm the client's identity by checking her wristband
Provide for the client's privacy by dosing the curtains
Asset the cent into the Sims position
Insert the tip of the enema tubing into the client's rectum
The Correct Answer is B,A,C,D
The correct sequence of steps the nurse should take to administer the enema is:
1. Provide for the client's privacy by closing the curtains.
2. Confirm the client's identity by checking her wristband.
3. Assist the client into the Sims position.
4. Insert the tip of the enema tubing into the client's rectum.
Proper infection control measures, preparing the enema solution, monitoring the flow rate, and documenting the procedure are among other important considerations that should be taken into account.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
When reinforcing teaching with a client who has a new prescription for aluminum hydroxide to treat heartburn, the nurse should include constipation as an adverse effect of the medication. Aluminum hydroxide is an antacid commonly used to neutralize stomach acid and provide relief from heartburn and indigestion. However, one of its potential side effects is constipation. Aluminum hydroxide can slow down intestinal motility, leading to infrequent or difficult bowel movements.
Hypertension: Aluminum hydroxide is not known to cause hypertension (high blood pressure). However, clients with pre-existing hypertension should be cautious when using antacids containing sodium bicarbonate, as the sodium content may impact blood pressure levels.
Flatulence: Flatulence (excessive gas) is not a common adverse effect of aluminum hydroxide. It primarily works by neutralizing stomach acid and does not typically cause increased gas production.
Headache: Headache is not commonly reported as an adverse effect of aluminum hydroxide. It is more likely to be associated with other factors such as the underlying condition causing heartburn or individual factors.
Correct Answer is ["B","D"]
Explanation
When reinforcing teaching with a client who has a duodenal ulcer and a new prescription for cimetidine, the nurse should include the following instructions:
"Avoid taking the medication at bedtime.": Cimetidine is most effective when taken during waking hours to help control gastric acid secretion. Taking it at bedtime may not provide optimal therapeutic benefits.
"You will need to continue taking this medication for up to 6 weeks.": Cimetidine is often prescribed for the treatment of duodenal ulcers and may require several weeks of continuous use to promote healing. It is important for the client to understand the duration of treatment and the need for adherence to the prescribed regimen.
The following statements are incorrect or not applicable:
"Drinking grapefruit juice while taking cimetidine can lead to toxicity.": Cimetidine does not have a known interaction with grapefruit juice. However, it is always important to consult the healthcare provider or pharmacist about potential drug interactions, including those related to specific foods or beverages.
"Take an antacid 30 minutes prior to taking cimetidine to minimize stomach upset.": Cimetidine is an H2 receptor antagonist that works by reducing stomach acid production. It is not necessary to take an antacid prior to taking cimetidine to minimize stomach upset. However, if the client experiences stomach upset or discomfort, they should consult their healthcare provider for further guidance on managing these symptoms.
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