The practical nurse (PN) is administering a saline enema to a client who was admitted
because of a fever of unknown origin and is now constipated. Which techniques should
the PN use? (Select all that apply.)

Position client in left lateral recumbent position to expose buttocks.

Chill the enema solution to help reduce the client's fever.

Encourage client to retain solution for at least 5 minutes.

Insert lubricated tip of tubing 3 to 4 inches into the rectum.

Answer and Explanation

Correct Answer : A,C,D

Choice A: Positioning the client in the left lateral recumbent position allows the solution to flow by gravity into the sigmoid colon and rectum.

Choice B: Chilling the enema solution is not recommended because it can cause cramping, discomfort, and vasoconstriction, which may interfere with the client's fever assessment.

Choice C: Positioning the client in the left lateral recumbent position allows the solution to flow by gravity into the sigmoid colon and rectum.

Choice D: Inserting the lubricated tip of tubing 3 to 4 inches into the rectum prevents injury to the rectal mucosa and ensures proper placement of the tubing.

Choice E: Clamping the enema administration tubing after filling the enema bag is unnecessary and may cause air to enter the tubing, which can increase the risk of abdominal distension and gas pain.

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Correct Answer is B

Explanation

Choice A: Comprehension of simple commands is an earlier developmental stage and not directly related to the infant's ability to search for a fallen toy.

Choice B: Exploration beyond caregiver presence is a key characteristic of the sensorimotor stage in Piaget's theory. During this stage, infants develop object permanence and begin to explore their environment independently.

Choice C: Visible or audible separation anxiety is common during the early stages of infancy and is not specific to the sensorimotor stage.

Choice D: The ability to place objects in a container is more related to later developmental stages when fine motor skills are more developed.

A. Fats B. Carbohydrates C. Dairy D. Protein

Correct Answer is B

Explanation

Choice A: Fats are an important component of the diet, but they do not typically require specific counting for meal planning in the same way that carbohydrates do for clients with type 1 diabetes mellitus.

Choice B: Carbohydrates are essential for the client to count for each meal and snack. Monitoring carbohydrate intake is a key aspect of managing blood glucose levels in clients with diabetes, especially for those using short-acting insulin to cover meals.

Choice C: Dairy products, while they contain carbohydrates, are not the primary nutrient that requires counting for meal planning in diabetes management.

Choice D: Protein is an important nutrient in the diet, but it does not require the same level of counting and monitoring as carbohydrates for clients with type 1 diabetes mellitus.

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The practical nurse (PN) is administering a saline enema to a client who was admitted because of a fever of unknown origin and is now constipated. Which techniques should the PN use? (Select all that apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The practical nurse (PN) observes an infant searching for a fallen toy. According to Piaget, which additional finding should the PN correlate with this developmental stage?

Correct Answer is B

Explanation

The nurse is caring for a client diagnosed with type 1 diabetes mellitus who uses both short-acting and long-acting insulin adjusted doses throughout the day. Which nutrient is essential for the client to count for each meal and snacks?

Correct Answer is B

Explanation

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A client who is multiparous on the postpartum unit reports intense cramping while breastfeeding. What instruction should the nurse provide to this client?

The practical nurse (PN) is administering a saline enema to a client who was admitted
because of a fever of unknown origin and is now constipated. Which techniques should
the PN use? (Select all that apply.)