A nurse is teaching a client about preparation for a barium enema.
What client statement indicates the client requires further reinforcement of teaching?

I will eat my breakfast prior to coming in for the study.

I may need to have laxatives to expel the barium.

I will receive the barium prior to the study by rectum.

I will need to lie down during the study while retaining the barium for x-rays.

Answer and Explanation

The Correct Answer is A

The client should not eat anything before the barium enema, as this could interfere with the visualization of the colon. The client should also take a laxative and an enema the night before the test to clear the bowel of any fecal matter.

Choice B is wrong because the client may need to have laxatives to expel the barium after the test, not before. Barium can cause constipation and impaction if not eliminated promptly.

Choice C is wrong because the client will receive the barium prior to the study by rectum, which is correct. The barium is a contrast agent that helps outline the colon on X-rays.

Choice D is wrong because the client will need to lie down during the study while retaining the barium for X-rays, which is correct. The client may also be asked to change positions to allow different views of the colon.

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Correct Answer is B

Explanation

This is because itching is a subjective assessment finding, which means it is based on the personal experience, view or feeling of the

patient. The other choices are objective assessment findings, which means they are based on observable or measurable data that the nurse can collect.

For example:

Choice A is wrong because hives are a visible skin reaction that can be seen and measured by the nurse.

Choice C is wrong because vomiting is an observable action that can be verified and recorded by the nurse.

Choice D is wrong because abdominal distension is a measurable change in the size or shape of the abdomen that can be assessed by the nurse.

Normal ranges for objective assessment findings may vary depending on the source and context, but some possible examples are:

Hives: No hives or rashes on the skin are normal.
Vomiting: No vomiting or nausea are normal.
Abdominal distension: Normal abdominal girth for adults ranges from 68 to 100 cm (27 to 40 inches).

A. Speak loudly since the client is unable to observe nonverbal cues. B. Touch the client prior to speaking to gain the client’s attention. C. Orient the client to the arrangement of the room to promote independence. D. Keep the bed in the highest position to prevent the client from getting out of bed alone.

Correct Answer is C

Explanation

Orient the client to the arrangement of the room to promote independence. This strategy helps the client who is blind to navigate the environment safely and confidently. It also shows respect for the client’s autonomy and dignity.

Choice A is wrong because speaking loudly is not necessary for a client who is blind, unless they also have hearing impairment. Speaking loudly may imply that the client is less intelligent or capable, which is not true.

Choice B is wrong because touching the client prior to speaking may startle or frighten them. It is better to identify oneself verbally and ask for permission before touching the client.

Choice D is wrong because keeping the bed in the highest position may increase the risk of injury if the client tries to get out of bed alone. It also restricts the client’s mobility and independence, which may affect their self-esteem and quality of life.

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A nurse is teaching a client about preparation for a barium enema. What client statement indicates the client requires further reinforcement of teaching?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which of these assessment findings should a nurse record as subjective?

Correct Answer is B

Explanation

Which strategy should a nurse include when communicating with a client who is blind?

Correct Answer is C

Explanation

A client on digitalis has a lab report of potassium 3.0 mEq/L. The nurse would instruct the client to eat which of these foods?

A nurse is caring for a hospitalized pre-operative client experiencing insomnia in the hospital at 3:00 am (0300). Which nursing intervention is the most appropriate for this client?

A client is diagnosed with hearing loss. Which nursing intervention will best facilitate communication with the client?

Which statement by the student nurse indicates the need for further education regarding pain management in older adults? (Select all that apply).

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A nurse is teaching a client about preparation for a barium enema.
What client statement indicates the client requires further reinforcement of teaching?