1
NUR 235 EXAM 2 QUESTIONS AND ANSWERS
2025
CLEAN A 1/1/25 EXAM
,NUR 235 EXAM NUR 235 EXAM
NUR 235 EXAM 2 QUESTIONS AND
ANSWERS 2025
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?
a) the duration of the procedure
b) 10 to 15 min
c) until the client feels the urge to defecate
d) at least 30 min - d) at least 30 min
a nurse is prepapring an adult client for an enema. the nurse should assist the client
into which of the following position?
a) prone
b) dorsal recumbent
c) right lateral with both knees at chest
d) left lateral with the right leg flexed - d) left lateral with the right leg flexed
(makes it easier for enema solution to flow by gravity into the sigmoid and
descending colon, flexed leg promotes exposure of anus for rectal tube insertion)
a client who is postoperative is experiencing abdominal distention and is having
difficult expelling flatus. the nurse should expect the provider to prescribe which of
the following types of enemas?
,NUR 235 EXAM NUR 235 EXAM
a) cleaning
b) return flow
c) medicated
d) oil-retention - b) return flow
expel flatus, stimulate peristalsis, and relieve abdominal distention
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 - a) place the client in
the dorsal recumbent position on a bedpan
a nurse is administering an enema medicated with sodium polystyrene sulfonate to
an adult client who has hyperkalemia. to which of the following lengths should the
nurse insert the rectal tube?
a) 2.5 cm to 3.75 cm (1 to 1.5 in)
, NUR 235 EXAM NUR 235 EXAM
b) 5 cm to 7.5 cm (2-3 in)
c) 7.5 cm to 10 com (3-4 in)
d) 10 cm to 12.5 cm (4-5 in) - c) 7.5 cm to 10 com (3-4 in)
when a nurse is administering a cleansing enema, the client reports abdominal
cramping. which of the following actions should the nurse take?
a) measure the clients vital signs
b) notify the primary care provider
c) lower the enema fluid container
d) stop the enema instillation - c) lower the enema fluid container
a nurse is administering a return-flow to a client. after instilling 100mL of enema
fluid, which of the following actions should the nurse take?
a) instruct the cleint 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 - b) lower the container to allow
the solution to flow back out
(return flow enemas involve moving 100-200 mL in and out of rectum. after
instilling the solution, the nurse lowers the container to allow the solution to flow
back in and out)
NUR 235 EXAM 2 QUESTIONS AND ANSWERS
2025
CLEAN A 1/1/25 EXAM
,NUR 235 EXAM NUR 235 EXAM
NUR 235 EXAM 2 QUESTIONS AND
ANSWERS 2025
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?
a) the duration of the procedure
b) 10 to 15 min
c) until the client feels the urge to defecate
d) at least 30 min - d) at least 30 min
a nurse is prepapring an adult client for an enema. the nurse should assist the client
into which of the following position?
a) prone
b) dorsal recumbent
c) right lateral with both knees at chest
d) left lateral with the right leg flexed - d) left lateral with the right leg flexed
(makes it easier for enema solution to flow by gravity into the sigmoid and
descending colon, flexed leg promotes exposure of anus for rectal tube insertion)
a client who is postoperative is experiencing abdominal distention and is having
difficult expelling flatus. the nurse should expect the provider to prescribe which of
the following types of enemas?
,NUR 235 EXAM NUR 235 EXAM
a) cleaning
b) return flow
c) medicated
d) oil-retention - b) return flow
expel flatus, stimulate peristalsis, and relieve abdominal distention
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 - a) place the client in
the dorsal recumbent position on a bedpan
a nurse is administering an enema medicated with sodium polystyrene sulfonate to
an adult client who has hyperkalemia. to which of the following lengths should the
nurse insert the rectal tube?
a) 2.5 cm to 3.75 cm (1 to 1.5 in)
, NUR 235 EXAM NUR 235 EXAM
b) 5 cm to 7.5 cm (2-3 in)
c) 7.5 cm to 10 com (3-4 in)
d) 10 cm to 12.5 cm (4-5 in) - c) 7.5 cm to 10 com (3-4 in)
when a nurse is administering a cleansing enema, the client reports abdominal
cramping. which of the following actions should the nurse take?
a) measure the clients vital signs
b) notify the primary care provider
c) lower the enema fluid container
d) stop the enema instillation - c) lower the enema fluid container
a nurse is administering a return-flow to a client. after instilling 100mL of enema
fluid, which of the following actions should the nurse take?
a) instruct the cleint 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 - b) lower the container to allow
the solution to flow back out
(return flow enemas involve moving 100-200 mL in and out of rectum. after
instilling the solution, the nurse lowers the container to allow the solution to flow
back in and out)
