NUR105 M6.8: ATI Skills Modules: Bowel Elimination
While a nurse is administering a cleansing enema, the client reports abdominal cramping. Which of the following actions should the nurse take?
Answer: Lower the enema fluid container.
Lowering the enema container can slow the flow rate and help alleviate abdominal cramping.
A nurse is preparing to administer an oil retention enema to a client who has constipation. The nurse should instruct the client to retain the solution for which of the following durations?
Answer: At least 30 minutes.
The client should retain the oil retention enema for at least 30 minutes to allow the oil to soften and lubricate the stool.NUR105 M6.8: ATI Skills Modules
A nurse is preparing an adult client for an enema. The nurse should assist the client into which of the following positions?
Answer: Left lateral with the right leg flexed.
The left lateral position with the right leg flexed helps facilitate the insertion of the enema tip into the rectum.
A nurse is administering a return-flow enema to a client. After instilling 100 mL of enema fluid, which of the following actions should the nurse take?
Answer: Lower the container to allow the solution to flow back out.NUR105 M6.8: ATI Skills Modules
Lowering the container allows the enema solution to flow back out and encourages the removal of stool and gas.
A nurse is preparing to administer the first of two large-volume, cleansing enemas prescribed for a client in preparation for a diagnostic procedure. Which of the following actions should the nurse take?NUR105 M6.8: ATI Skills Modules
Answer: Warm the enema solution prior to installation.
Warming the enema solution can enhance the client’s comfort and promote relaxation of the rectal muscles.
A nurse is preparing to administer a cleansing enema to a client who has poor sphincter control. Which of the following actions should the nurse take?NUR105 M6.8: ATI Skills Modules
Answer: Place the client in the dorsal recumbent position on a bedpan.
Placing the client in the dorsal recumbent position can help prevent leakage during the enema administration.
A client who is postoperative is experiencing abdominal distention and is having difficulty expelling flatus. The nurse should expect the provider to prescribe which of the following types of enemas?
Answer: Return-flow.
A return-flow enema can help relieve abdominal distention and aid in expelling flatus by alternately introducing and removing small amounts of solution.
A nurse is administering an enema medication with sodium polystyrene sulfonate to an adult client who has hyperkalemia. To which of the following lengths should the nurse insert the rectal tube?
Answer: 7.5 cm to 10 cm (3 to 4 inches).
The rectal tube should be inserted 7.5 cm to 10 cm (3 to 4 inches) to administer the medication effectively.
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