The practical nurse (PN) is administering a saline enema to a client who was admitted because of a fever of unknown origin and is now constipated. Which techniques should the PN use? (Select all that apply.)

A. Encourage client to retain solution for at least 5 minutes: Retaining the enema allows the solution to soften stool and stimulate peristalsis effectively, promoting bowel evacuation. Short retention reduces effectiveness. B. Position client in left lateral recumbent position to expose buttocks: The left lateral position (Sims’ position) aligns the rectum and sigmoid colon to facilitate easier insertion of the enema tip and optimal flow of solution. C. Insert lubricated tip of tubing 3 to 4 inches into the rectum: Proper insertion depth ensures the solution reaches the rectum without causing trauma. Lubrication minimizes discomfort and risk of injury to the rectal mucosa. D. Clamp enema administration tubing after filling enema bag: Clamping should occur before attaching the bag to prevent uncontrolled flow. Waiting until after filling is unsafe and can result in premature solution release. E. Chill the enema solution to help reduce the client's fever: Enema solutions should generally be at room or body temperature. Cold solutions may cause cramping, discomfort, or reflex contraction of the rectum, and do not reduce systemic fever.