A nurse appropriately measures intake and output by:
A. Recording 50% of ice chip consumption
B. Checking urinary output every 24 hours
C. Emptying the chest tube drainage every 2 hours
D. Subtracting liquid medications from the total intake
A
A. Measure liquids with meals, gelatin, custards, ice cream, Popsicles, sherbets, ice chips (recorded as 50% of measured volume [e.g., 100 ml of ice chips equals 50 ml of water]).
B. Instruct client and family to call nurse to empty contents of urinal, urine hat, or commode each time it is used.
C. Chest tube drainage is emptied ONLY when container is nearly full. A closed system is necessary to maintain lung reexpansion.
D. Liquid medicines such as antacids are counted as fluid intake, as are fluids with medications.
You might also like to view...
When teaching a pregnant client about the physiologic changes occurring during pregnancy, the nurse reviews the effect of pregnancy on glucose metabolism. Which of the following would the nurse include as the underlying reason for the effect?
A) Pancreatic function is affected by pregnancy. B) Glucose is utilized more rapidly during a pregnancy. C) The pregnant woman increases her dietary intake. D) Glucose is diverted through the placenta to assist the fetus.
The nurse is caring for the patient with a history of addiction. The nurse notes that although the patient is in severe pain, the patient's requests for pain medication have been ignored
Which ethical principle is the nurse exercising when advocating for appropriate pain relief? 1. Justice 2. Autonomy 3. Beneficence 4. Nonmaleficence
The nurse is assessing a patient for a possible conductive hearing loss. What should the nurse perform first?
1. external ear exam 2. Weber test 3. Rinne test 4. tympanogram
A pregnant patient arrives for her second prenatal appointment
Her previous pregnancy ended at 19 weeks and she has 3-year-old twins born at 30 weeks' gestation. How should the nurse document her "G" and "L" for her records? A) G2 L2 B) G2 L0 C) G3 L2 D) G3 L0