A nurse is preparing to administer an enema to a client.
Which of the following actions should the nurse plan to take?
Place the client into a right lateral position.
Warm the enema solution to room temperature.
Use sterile technique.
Lubricate the tubing with an oil-based lubricant.
The Correct Answer is B
Choice A rationale
Placing the client into a right lateral position is not the standard position for administering an enema. The left lateral (Sims') position is commonly used as it facilitates the flow of the
solution into the colon.
Choice B rationale
Warming the enema solution to room temperature helps ensure the client's comfort and can prevent cramping and discomfort. Cold solutions can cause discomfort and cramping,
making the procedure less tolerable for the client.
Choice C rationale
Sterile technique is not required for administering an enema. Clean technique is generally sufficient unless otherwise indicated by the client’s condition or specific medical orders.
Choice D rationale
Lubricating the tubing is essential to ensure smooth insertion and prevent trauma to the rectal mucosa, but an oil-based lubricant is not typically used as it can interfere with the
absorption of the enema solution. Water-soluble lubricants are preferred.
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Correct Answer is B
Explanation
Choice A rationale
An ileal conduit does not provide the client with control over elimination. It is a type of urinary diversion, and the client wears an external pouch to collect urine.
Choice B rationale
In an ileal conduit, the client's ureters are attached to a section of the small intestine, which is then brought to the surface of the abdomen to form a stoma. Urine flows through this conduit into an external pouch.
Choice C rationale
An ileal conduit is not a tube that directly connects the kidney to an external pouch. It involves using a section of the small intestine to create a passageway for urine to exit the body.
Choice D rationale
Stool is not passed through an ileal conduit. The ileal conduit is specifically for urinary diversion, while stool passes through the regular gastrointestinal tract.
Correct Answer is C
Explanation
Choice A rationale
Cheese is high in calcium, which can interfere with the absorption of iron by binding to it in the digestive tract, making it less available for absorption.
Choice B rationale
Antacids containing magnesium can interfere with the absorption of iron by increasing the pH of the stomach, reducing the solubility and absorption of iron.
Choice C rationale
Orange juice is high in vitamin C, which can enhance the absorption of iron by reducing it to a form that is more easily absorbed by the body.
Choice D rationale
Milk contains calcium, which can inhibit the absorption of iron. Calcium competes with iron for absorption in the intestines, leading to reduced iron absorption.