ATI - Bowel Elimination Questions with Correct
Answers
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?
A) Place the client in the dorsal recumbent position on a bedpan.
B)Administer the enema while the client sits on the toilet.
C)Administer an antidiarrheal medication 3 hr prior to the enema.
D) Instill 200 mL of fluid over an hour at 15-min intervals. Correct
Answer-A) Place the client in the dorsal recumbent position on a
bedpan.
Explanation
A client who has poor sphincter control might not be able to retain the
enema solution at all. Repositioning the client over the bedpan in the
dorsal recumbent position after insertion of the rectal tube will help
contain the fluid that is likely to be expelled.
Administer the enema while the client sits on the toilet.MY
ANSWERThe angle of insertion of the rectal tube with the client in this
position could result in abrasion of the rectal wall.
Administer an antidiarrheal medication 3 hr prior to the enema.An
antidiarrheal medication will not correct poor sphincter control and
might be counterproductive to the purpose of the enema.
Instill 200 mL of fluid over an hour at 15-min intervals.This would
unnecessarily prolong the procedure and would have little or no effect
on sphincter control.
, 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?
A)Instruct the client to retain the fluid.
B)Lower the container to allow the solution to flow back out.
C)Help the client to the toilet or bedside commode.
D)Wait 5 min and instill another 100 mL of fluid. Correct Answer-
B)Lower the container to allow the solution to flow back out.
Explanation
Having the client retain the fluid is appropriate for a retention enema,
not for a return-flow enema.
Lower the container to allow the solution to flow back out.MY
ANSWERReturn-flow enemas involve moving 100 to 200 mL of fluid
into and out of the rectum. After instilling the solution, the nurse lowers
the container to allow the solution to flow back into the container and
then repeats the process several times.
Help the client to the toilet or bedside commode.Assisting the client to
the toilet or commode or providing a bedpan is appropriate for a
cleansing enema, not for a return-flow enema.
Wait 5 min and instill another 100 mL of fluid.This is inappropriate
during the administration of a return-flow enema.
While a nurse is administering a cleansing enema, the client reports
abdominal cramping. Which of the following actions should the nurse
take?
Answers
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?
A) Place the client in the dorsal recumbent position on a bedpan.
B)Administer the enema while the client sits on the toilet.
C)Administer an antidiarrheal medication 3 hr prior to the enema.
D) Instill 200 mL of fluid over an hour at 15-min intervals. Correct
Answer-A) Place the client in the dorsal recumbent position on a
bedpan.
Explanation
A client who has poor sphincter control might not be able to retain the
enema solution at all. Repositioning the client over the bedpan in the
dorsal recumbent position after insertion of the rectal tube will help
contain the fluid that is likely to be expelled.
Administer the enema while the client sits on the toilet.MY
ANSWERThe angle of insertion of the rectal tube with the client in this
position could result in abrasion of the rectal wall.
Administer an antidiarrheal medication 3 hr prior to the enema.An
antidiarrheal medication will not correct poor sphincter control and
might be counterproductive to the purpose of the enema.
Instill 200 mL of fluid over an hour at 15-min intervals.This would
unnecessarily prolong the procedure and would have little or no effect
on sphincter control.
, 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?
A)Instruct the client to retain the fluid.
B)Lower the container to allow the solution to flow back out.
C)Help the client to the toilet or bedside commode.
D)Wait 5 min and instill another 100 mL of fluid. Correct Answer-
B)Lower the container to allow the solution to flow back out.
Explanation
Having the client retain the fluid is appropriate for a retention enema,
not for a return-flow enema.
Lower the container to allow the solution to flow back out.MY
ANSWERReturn-flow enemas involve moving 100 to 200 mL of fluid
into and out of the rectum. After instilling the solution, the nurse lowers
the container to allow the solution to flow back into the container and
then repeats the process several times.
Help the client to the toilet or bedside commode.Assisting the client to
the toilet or commode or providing a bedpan is appropriate for a
cleansing enema, not for a return-flow enema.
Wait 5 min and instill another 100 mL of fluid.This is inappropriate
during the administration of a return-flow enema.
While a nurse is administering a cleansing enema, the client reports
abdominal cramping. Which of the following actions should the nurse
take?
