A nurse is caring for an elderly client experiencing gastrointestinal discomfort.
Retain the fluid for a few minutes before expelling
Be aware of potential electrolyte imbalances
Avoid using enemas frequently
Understand the benefits of different solutions
Follow provider instructions on enema type and solution
Increase intake of fluids to aid bowel movement
Correct Answer : A,C,E
Rationale:
- Retaining the fluid allows the enema to soften stool and stimulate peristalsis effectively.
- Avoiding frequent use prevents dependence and irritation of the bowel.
- Following provider instructions ensures safe and appropriate selection of enema type and solution for the client’s condition.
- Electrolyte imbalances, benefits of solutions, and fluid intake are important considerations but are broader teaching points, not immediate enema administration instructions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C","E"]
Explanation
Rationale:
- Retaining the fluid allows the enema to soften stool and stimulate peristalsis effectively.
- Avoiding frequent use prevents dependence and irritation of the bowel.
- Following provider instructions ensures safe and appropriate selection of enema type and solution for the client’s condition.
- Electrolyte imbalances, benefits of solutions, and fluid intake are important considerations but are broader teaching points, not immediate enema administration instructions.
Correct Answer is ["B","E","F"]
Explanation
Rationale:
A. Family history increases risk for heart disease and arthritis but is not a direct risk factor for peptic ulcer disease.
B. Smoking increases gastric acid secretion, reduces mucosal healing, and significantly raises PUD risk.
C. Alcohol use is denied by the client and therefore is not a contributing factor in this case.
D. Adalimumab use (an immunosuppressant for rheumatoid arthritis/psoriasis) does not directly increase PUD risk.
E. NSAIDs inhibit prostaglandin synthesis, reducing the gastric mucosal barrier and predisposing to ulcer formation.
F. H. pylori infection is a primary cause of peptic ulcers due to its damaging effect on gastric mucosa.
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