A client who had a cerebrovascular accident (also known as a 'brain attack') becomes incontinent of feces. What is the most important nursing action to support the success of a bowel training program?1Using medication to induce elimination.b. Adhering to a definite time for attempted evacuations.3Considering previous habits associated with defecation.4Timing of elimination to take advantage of the gastrocolic reflex.

1. A client who had a cerebrovascular accident (also known as a 'brain attack') becomes incontinent of feces. What is the most important nursing action to support the success of a bowel training program?
1
Using medication to induce elimination.
b. Adhering to a definite time for attempted evacuations.
3
Considering previous habits associated with defecation.
4
Timing of elimination to take advantage of the gastrocolic reflex.

D!

The MMR vaccine provides maximal protection against these diseases when the first dose is administered between 12 and 15 months of age. At 2 months of age the first immunizations against diphtheria, tetanus, pertussis (DTaP), and polio are given. At 4 month of age the second doses of the DTaP and polio vaccines are given. At 6 months of age the third dose of the DTaP vaccine is given.
B!

This is a positive Babinski sign ; it is expected in infants but suggests upper motor neuron disease of the pyramidal tract in adults. The plantar reflex involves flexion of the toes and plantar flexion of the feet. Demonstrating normal sensory function is an abnormal reflex; it is not an indication of normal sensation. Being able to perform an active range of motion exhibits an abnormal reflex; it is not caused by intentional movement.

D!

Answer D is the lower-lateral chest, which is the area of greatest thoracic excursion. With visceral and parietal pleural inflammation (pleurisy), a low-pitched, coarse, grating sound is heard when the client breathes, particularly when approaching the height of inspiration. Bronchial breath sounds are heard over the trachea and at the nape of the neck on either side of the vertebrae. Bronchial sounds are loud, high pitched, and hollow, with a short inspiratory phase and long expiratory phase. Bronchovesicular breath sounds are heard on either side of the sternum or between the scapulae; bronchovesicular sounds have a moderate volume and medium pitch, with equal inspiratory and expiratory phases. C is the area where vesicular breath sounds are heard. Vesicular sounds are soft and low pitched, with a long inspiratory phase and a short expiratory phase; they are heard over most lung fields.
B!

Bowel training is a program for the development of a conditioned reflex that controls regular emptying of the bowel. The key to success is adherence to a strict time for evacuation based on the client's individual schedule. The indiscriminate use of laxatives can result in dependency. Although previous habits should be considered, the brain attack affects the responses of the client by altering motility, peristalsis, and sphincter control despite adherence to previous habits. The passage of food into the stomach does stimulate peristalsis, but it is only one factor that should be considered when planning a specific time for evacuation.