The nurse is preparing to administer an enema to a patient.Which type of enema is most likely to lead to circulatory overload?

A) Hypertonic solution
B) Soapsuds
C) Tap water
D) Harris flush

A tap-water (hypotonic)enema should not be repeated after first instillation because water toxicity or circulatory overload can develop.Hypertonic solution is useful for patients who cannot tolerate large volumes of fluid.Only 120 to 180 mL (4 to 6 ounces)is usually effective (e.g. ,commercially prepared Fleet enema).A soapsuds enema (SSE)consists of pure castile soap added to tap water or normal saline,depending on the patient's condition and the frequency of administration.Use only castile pure soap.The recommended ratio of pure soap to solution is 5 mL (1 teaspoon)to 1000 mL (1 quart)warm water or saline.Add soap to the enema bag after water is in place to reduce excessive suds.The Harris flush enema is a return-flow enema that helps to expel intestinal gas.Fluid alternately flows into and out of the large intestine.This stimulates peristalsis in the large intestine and assists in expelling gas.