Asked by QUYNH NGUYEN on Apr 27, 2024

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A nurse is checking orders. Which order should the nurse question?

A) A normal saline enema to be repeated every 4 hours until stool is produced
B) A hypertonic solution enema for a patient with fluid volume excess
C) A Kayexalate enema for a patient with severe hypokalemia
D) An oil retention enema for a patient with constipation

Hyperkalemia

A condition characterized by an excessively high level of potassium in the bloodstream, potentially impacting heart function.

Hypokalemia

A condition where there is an abnormally low level of potassium in the bloodstream.

Hypertonic Solution

A solution that has a higher concentration of solutes than the inside of the cells, leading to the movement of water out of the cell.

  • Identify appropriate nursing interventions for patients with bowel elimination problems.
  • Understand the principles and procedures for administering enemas and managing fecal impactions.
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Verified Answer

AG
Alexis GalenoMay 03, 2024
Final Answer :
C
Explanation :
Kayexalate binds to and helps excrete potassium, so it would be contraindicated in patients who are hypokalemic (have low potassium). Normal saline enemas can be repeated without risk of fluid or electrolyte imbalance. Hypertonic solutions are intended for patients who cannot handle large fluid volume and are contraindicated for dehydrated patients. Oil retention enemas lubricate the feces in the rectum and colon and are used for constipation.