A nurse is creating a plan of care for a client who has left-sided weakness following a stroke. Which of the following interventions should the nurse include in the plan?

A. Incorrect. The lithotomy position is not appropriate for this procedure, as it can cause discomfort and embarrassment to the client. The nurse should place the client in a left lateral Sims' position with the right knee flexed for better access to the rectum and to reduce pressure on the abdominal organs.

B. Incorrect. The nurse should avoid eliciting a vagal response, as it can cause bradycardia, hypotension, and syncope in some clients. The nurse should monitor the client's vital signs and stop the procedure if signs of vagal stimulation occur.

C. Incorrect. Oral bisacodyl is a stimulant laxative that can cause abdominal cramping, diarrhea, and electrolyte imbalance. It is not indicated for fecal impaction, as it can worsen the condition by increasing the bulk and hardness of the stool. The nurse should administer an enema or a stool softener before attempting digital evacuation.

D. Correct. The nurse should insert a lubricated gloved finger and advance along the rectal wall, breaking up the stool and removing it in small pieces. The nurse should use gentle pressure and avoid injuring the rectal mucosa. The nurse should also explain the procedure to the client and obtain informed consent before performing it.

A. Instructing the client about the importance of regular medical appointments is important but not the priority because it is a secondary prevention strategy that aims to detect and treat any complications or changes in the client's condition early. The client should have regular follow-up visits with an endocrinologist, a diabetes educator, an ophthalmologist, a podiatrist, a dentist, and other health care providers as needed.

B. Encouraging the client to participate in daily exercise is important but not the priority because it is a tertiary prevention strategy that aims to reduce disability and improve quality of life for clients with chronic conditions. Exercise can help lower blood glucose levels, improve insulin sensitivity, reduce cardiovascular risk factors, enhance mood, and promote weight management for clients with type 1 diabetes mellitus. The client should consult with their health care provider before starting an exercise program and follow safety guidelines such as checking blood glucose levels before and after exercise, wearing appropriate footwear and clothing, carrying a source of fast-acting carbohydrate, and staying hydrated.

C. Explaining proper foot care techniques to the client is important but not the priority because it is a tertiary prevention strategy that aims to prevent or minimize complications such as foot ulcers, infections, and amputations for clients with type 1 diabetes mellitus. Foot care includes inspecting feet daily for any injuries or abnormalities, washing feet with mild soap and warm water, drying feet thoroughly especially between toes, applying moisturizer to prevent dryness and cracking, trimming toenails straight across and filing edges smooth, wearing clean cotton socks and well-fitting shoes, avoiding walking barefoot or exposing feet to extreme temperatures or pressure, and seeking medical attention for any foot problems.

D. Ensuring that the client understands the medication regimen is the nurse's priority because type 1 diabetes mellitus requires lifelong insulin therapy to maintain blood glucose levels within normal range and prevent complications such as ketoacidosis, hypoglycemia, and organ damage. The client needs to know how to administer insulin injections, monitor blood glucose levels, adjust insulin doses according to carbohydrate intake and physical activity, recognize and treat signs and symptoms of hypo- and hyperglycemia, and store insulin properly.