Which actions could the nurse safely delegate to the unlicensed ...

[rlane42]

Which actions could the nurse safely delegate to the unlicensed assistive personnel (UAP)? Select all that apply.
 
  1. Assist the client to use the bedpan for bowel elimination.
  2. Change the ostomy appliance for the new ostomy.
  3. Administer a cleansing enema.
  4. Remove a fecal impaction.
  5. Determine effectiveness of cleansing enema.

Question 2

The nurse is caring for a client who complains of frequent constipation. Which factor in the client's history is least likely to be the cause of the constipation?
 
  1. Inadequate fluid intake
  2. Repeated inhibition of the urge to defecate
  3. Inadequate fiber intake
  4. The presence of Escherichia coli

[Joy Chen]

Answer to Question 1

Correct Answer: 1,3

The UAP can be entrusted with assisting the client to use a bedpan, and can administer most types of enemas. However, only the nurse can change a new ostomy appliance, because of the need to assess the drainage and the site. Because of the risk of vagal nerve stimulation, the nurse should remove fecal impactions. Assessing the effectiveness of any treatment should be performed by the nurse.

Answer to Question 2

Correct Answer: 4

The bowel normally contains Escherichia coli, and its presence would not contribute to constipation. Inadequate fluid intake or fiber intake could result in constipation, and correcting these generally is the first recommendation for treatment. Clients who frequently resist the urge to defecate can develop constipation because of the expansion of the rectum to accommodate accumulated feces, eventually losing sensitivity to the need to defecate.

[rlane42]

Excellent

[mjenn52]

TYSM