Difficulty: Medium
Average Score: 94%
Simulated
A nurse is preparing to administer a tap water enema to a client. Which of the following actions should the nurse take?
Correct answer
C
Rationale
The correct answer is C: Place the client into a left Sims' position. This position helps to facilitate the flow of the enema solution into the colon by allowing gravity to assist in the process. Placing the client in the left Sims' position also helps to minimize discomfort and cramping during the procedure.
Option A is incorrect because sterile gloves are not necessary for administering a tap water enema. Option B is incorrect because lubricating only 1 inch of the rectal tube may not be sufficient for comfortable insertion. Option D is incorrect because raising the enema bag when the client experiences cramping may exacerbate discomfort instead of relieving it.
Option A is incorrect because sterile gloves are not necessary for administering a tap water enema. Option B is incorrect because lubricating only 1 inch of the rectal tube may not be sufficient for comfortable insertion. Option D is incorrect because raising the enema bag when the client experiences cramping may exacerbate discomfort instead of relieving it.