A nurse is preparing a cleansing enema for an adult patient who is constipated and has not responded to laxative use. Before giving the enema, the nurse should
cool the solution to 65 degrees F
boil the solution and let it cool down.
warm the solution to body temperature
warm the solution in the microwave.
The Correct Answer is C
Choice A Using a cool solution might cause discomfort and could lead to cramping, which is not ideal for an enema administration.
Choice B Boiling the solution is unnecessary and might be unsafe, as it could cause burns or damage the components of the enema.
Choice C Warming the solution to body temperature (around 98.6°F or 37°C) is the appropriate approach, as it ensures patient comfort and reduces the risk of cramping or discomfort.
Choice D Microwaving the solution might lead to uneven heating and could potentially create hot spots, which could cause burns or discomfort for the patient.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A Stool with worms would present as visible worms or worm segments in the stool and not pus.
Choice B Occult blood refers to blood that is not visible to the naked eye and is not related to the presence of pus in the stool.
Choice C Pus in the stool is not considered a normal stool characteristic.
Choice D The presence of pus in the stool may indicate inflammation or infection in the gastrointestinal tract, potentially from conditions such as inflammatory bowel disease (IBD) or infection.
Correct Answer is D
Explanation
Choice A Alcohol swabs may be too harsh and irritating for the delicate skin around the stoma. Mild soap and water are preferred for cleaning.
Choice B Tap water alone may not be sufficient for removing debris and ensuring proper cleanliness around the stoma. Mild soap and water are preferred for cleaning.
Choice C Iodine may be too harsh and irritating for the peristomal skin. Mild soap and water are preferred for cleaning.
Choice D Mild soap and water are the best choice for cleaning around the colostomy stoma as they effectively remove debris and cleanse the area without being overly harsh on the skin.
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