A client reports that she ingested 1/2 of a liter of a prep solution for a colonoscopy. How many mL of fluid intake should the practical nurse (PN) document?
(Enter numeric value only. If rounding is required, round to the nearest whole number.)
The Correct Answer is ["500"]
1 liter is equal to 1000 milliliters. Therefore, to calculate the fluid intake in mL, we can multiply 1/2 liter by 1000 mL/liter:
1/2 liter * 1000 mL/liter = 500 mL
So, the practical nurse should document 500 mL as the client's fluid intake.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
This is the most important complication for the practical nurse (PN) to anticipate because it is a common and potentially life-threatening condition that can occur in clients with severe burns. Curling's ulcer, also known as stress ulcer, is a type of peptic ulcer that develops in the stomach or duodenum as a result of stress, shock, trauma, or burns. It is caused by decreased blood flow and increased acid secretion in the gastrointestinal tract, which damages the mucosal lining and leads to ulceration and bleeding.
The PN should anticipate Curling's ulcer in a client who experienced partial-thickness burns over 30% of the body surface area (BSA) 3 days ago, as this is a major risk factor for developing stress ulcers. The PN should monitor the client for signs and symptoms of Curling's ulcer, such as abdominal pain, nausea, vomiting, hematemesis, melena, and anemia. The PN should also administer prophylactic medications such as antacids, histamine-2 blockers, or proton pump inhibitors as prescribed by the health care provider.
Correct Answer is D
Explanation
While caring for a client with Guillain-Barre syndrome, the practical nurse (PN) should report the finding of irregular heart rate to the charge nurse. Guillain-Barre syndrome is a neurological disorder that can affect multiple body systems, including the autonomic nervous system.
Autonomic dysfunction can lead to various cardiovascular abnormalities, such as changes in heart rate and rhythm.
However, irregular heart rate can indicate potential cardiac involvement or autonomic instability, which requires prompt evaluation and intervention. Therefore, the PN should report the finding of an irregular heart rate to the charge nurse for further assessment and appropriate management.
Incorrect:
A, B- Full facial flushing and profuse diaphoresis are common symptoms that can occur in Guillain-Barre syndrome due to autonomic dysfunction. While these findings should be noted and monitored, they may not require immediate reporting unless they are severe or accompanied by other concerning symptoms.
C- Lower leg weakness is a characteristic symptom of Guillain-Barre syndrome and is expected in this condition. The PN should document and monitor the extent and progression of weakness but does not necessarily need to report it unless there are significant changes or complications.
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