Which type of enema is typically used to relieve constipation by instilling and retaining fluid for a short period before expelling?
Lactulose Enema
Fleet Enema
Tap water enema
Mineral Enema
The Correct Answer is B
Rationale:
A. Lactulose is usually administered orally to soften stools, not as a short-retention enema.
B. A Fleet enema is a hypertonic solution that draws fluid into the colon, is retained briefly, and promotes rapid evacuation of stool to relieve constipation.
C. Tap water enemas are hypotonic and typically require immediate expulsion, not short retention.
D. Mineral oil enemas are retention enemas, meant to soften stool over a longer period, not for rapid evacuation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is []
Explanation
Rationale:
- Potential Condition: The client presents with jaundice, ascites, abdominal distention, confusion, and abnormal liver function tests (elevated AST, ALT, and bilirubin, with low albumin), consistent with cirrhosis and fluid volume excess.
- Actions to Take:
- Administer diuretics (such as spironolactone or furosemide) to reduce fluid retention and help manage ascites.
- Monitor fluid intake and output to evaluate fluid balance and effectiveness of diuretic therapy.
- Parameters to Monitor:
- Blood pressure is important because hypotension is present and can worsen with fluid shifts and diuretic therapy.
- Abdominal girth is monitored to track the progression or reduction of ascites.
Correct Answer is B
Explanation
Rationale:
A. Restlessness can occur with electrolyte imbalances or hypoxia, but it is not a hallmark of low albumin or protein malnutrition.
B. Low serum albumin and total protein decrease plasma oncotic pressure, allowing fluid to shift from the vascular space into interstitial tissues, leading to peripheral and sometimes generalized edema (anasarca).
C. Pallor is more indicative of anemia, which may coexist but is not a direct effect of hypoalbuminemia.
D. Confusion can result from electrolyte disturbances, hypoxia, or hepatic encephalopathy, but it is not a direct manifestation of low albumin.
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