A nurse is reinforcing teaching for a client who has a new ascending colostomy. Which of the following comments by the client indicates an understanding of the teaching?

This response allows the nurse to express genuine interest in the client's perspective and opens up a dialogue to understand the client's concerns or reasons for refusing to learn how to self-administer insulin. It provides an opportunity for the client to express their fears, doubts, or any barriers they may have. By actively listening to the client, the nurse can better address their concerns and provide appropriate education and support tailored to their individual needs.

The other options may come across as confrontational, judgmental, or unhelpful in establishing a therapeutic relationship with the client. It is important for the nurse to approach the situation with empathy, respect, and a non-judgmental attitude to foster effective communication and promote the client's engagement in their own care.

• Assist the client with a bath: The client is independently transferring out of bed and ambulating in the hallway. Since they are managing personal mobility well, there is no immediate need for assistance with bathing, and this does not address the client’s most pressing issues.

• Encourage oral fluid intake: The client is experiencing hard, painful bowel movements and abdominal cramping, which are signs of constipation. Increased oral fluid intake can help soften stool and promote more regular bowel movements, making this a supportive and appropriate intervention.

• Irrigate indwelling catheter with 500 mL of fluid: The client is voiding 100 mL/hr of pink urine, which is a normal finding in the early postoperative period and does not suggest catheter obstruction. Therefore, irrigation is not indicated and could introduce infection unnecessarily.

• Administer an enema: The client reports painful, incomplete bowel elimination and abdominal cramping, which may indicate constipation or fecal impaction. Administering an enema is an appropriate intervention to relieve discomfort and promote bowel evacuation.

• Encourage prolonged dangling before ambulation: The client is already ambulating independently in the hallway, indicating they are tolerating activity well. There is no evidence of orthostatic intolerance, so prolonged dangling is not necessary.