Evolve HESI Practice Exam

What instruction should the nurse provide to the UAP who places a client in a left lateral position prior to administering a soap suds enema?

1. Leave the client in the left lateral position.

2. Reposition in a Sim's position with the client's weight on the anterior ilium.

3. Ask the client if they are comfortable.

4. Cover the client with a blanket to keep warm.

The correct answer is: Reposition in a Sim's position with the client's weight on the anterior ilium.

The correct instruction involves repositioning the client in a Sim's position, where the client lies on their left side with the right leg flexed up towards the abdomen. This position utilizes gravity to facilitate the flow of the enema solution and helps ensure that the solution reaches the sigmoid colon effectively. It also allows for easier access to the rectum for administration and enhances comfort during the procedure. Additionally, the Sim's position can reduce the risk of rectal injury that may occur if the client is not appropriately positioned. While leaving the client in a left lateral position is a common practice, it is not as beneficial for enema administration as the Sim's position, which is specifically designed for this type of procedure. Comfort and warmth are important factors in patient care, but the priority during the administration of a soap suds enema is to ensure the positioning maximizes the effectiveness of the enema.