The nurse is managing bowel training for a patient.

To which patient is the nurse most likely

providing care?
a. A 25-year-old patient with diarrhea
b. A 30-year-old patient with Clostridium difficile
c. A 40-year-old patient with an ileostomy
d. A 70-year-old patient with stool incontinence
ANS: D
The patient with chronic constipation or fecal incontinence secondary to cognitive impairment
may benefit from bowel training,
also called habit training. An ileostomy, diarrhea, and C. difficile all relate to uncontrollable
bowel movements, for which no
method can be used to set up a schedule of elimination.
DIF: Analyze (analysis)
OBJ: List nursing interventions included in bowel training. TOP: Implementation
MSC: Basic Care and Comfort
13. Which nursing intervention is most effective in promoting normal defecation for a patient
who has muscle weakness in the legs?
a. Administer a soapsuds enema every 2 hours.
b. Use a mobility device to place the patient on a bedside commode.
c. Give the patient a pillow to brace against the abdomen while bearing down.
d. Elevate the head of the bed 20 degrees 60 minutes after breakfast while on
bedpan.
ANS: B
The best way to promote normal defecation is to assist the patient into a posture that is as normal
as possible for defecation. Using a
mobility device promotes

If you suspect the patient of having poor sphincter control, position on bedpan in a comfortable
dorsal recumbent position. Patients
with poor sphincter control are unable to retain all of the enema solution. Administering an
enema with the patient sitting on the
toilet is unsafe because it is impossible to safely guide the tubing into the rectum, and it will be
difficult for the patient to retain the
fluid as he or she is in the position used for emptying the bowel. Rolling the patient into right-
lying Sims’ position will not help the
patient retain the enema. Use of a rectal plug to contain the solution is inappropriate and unsafe.
DIF: Apply (application)
OBJ: List nursing interventions that promote normal elimination.
TOP: Implementation MSC: Management of Care
23. A nurse is providing care to a group of patients. Which patient will the nurse see first?
a. A child about to receive a normal saline enema
b. A teenager about to receive loperamide for diarrhea
c. A dehydrated older patient about to receive a hypertonic enema
d. A middle-aged patient with myocardial infarction about to receive docusate
sodium
ANS: C
A hypertonic enema is contradicted in a dehydrated patient since it will pull fluid out of the
body; this patient should be seen first.
All the rest are expected. A child can receive normal saline enemas since they are isotonic.
Loperamide, an antidiarrheal, is given
for diarrhea. Docusate sodium is given to soften stool for patients with myocardial infarction to
prevent straining.