A nurse in a provider's clinic is caring for a client who has diarrhea

The nurse is providing teaching for the client who has diarrhea. Select the 4 instructions that the nurse should include in the teaching.

A. "Use the complete name of the medication magnesium sulfate.": Safe medication documentation requires writing the full medication name to avoid dangerous abbreviations that can lead to misinterpretation. Abbreviations such as “MgSO₄” are associated with medication errors because they may be confused with other drugs or dosing instructions. Using the full name, magnesium sulfate, follows national medication safety recommendations.

B. "Delete the space between the numerical dose and the unit of measure.": Medication safety guidelines recommend leaving a clear space between the number and the unit of measurement (for example, 5 mg rather than 5mg). Removing the space can make the dose difficult to read and increases the risk that the number and unit may be misinterpreted during transcription.

C. "Write the letter U when noting the dosage of insulin.": The abbreviation “U” for units is considered a dangerous abbreviation because it can easily be mistaken for a zero, the number four, or the abbreviation “cc.” To prevent dosing errors, the word “units” should always be written out fully when documenting insulin or other medications measured in units.

D. "Use the abbreviation SC when indicating an injection.": The abbreviation “SC” for subcutaneous is discouraged because it can be misread as “SL” (sublingual) or “SQ.” Medication safety standards recommend writing the full word “subcutaneous” to ensure clarity and prevent administration errors related to route confusion.

Rationale for correct choices

• Urinary output: The client produced only 15 mL of urine between 1100 and 1200 and none afterward, which indicates significantly decreased urine output. Postoperative urine output should generally remain at least about 30 mL/hr in adults to reflect adequate renal perfusion and circulating volume. Oliguria may signal hypovolemia, early shock, or decreased kidney perfusion after surgery. This finding requires prompt provider notification for further evaluation

• Reported pain level: The client reports worsening pain from 6/10 to 8/10 even after receiving IV morphine. Increasing pain despite analgesic administration can indicate complications such as internal bleeding, inadequate pain control, or surgical complications. Severe uncontrolled pain also increases sympathetic stimulation, which may contribute to tachycardia and physiologic stress.

• Vital signs: The client’s heart rate increased from 76/min to 116/min while blood pressure slightly decreased. Tachycardia in the postoperative period may indicate pain, hypovolemia, bleeding, or other complications. When combined with decreased urine output and worsening pain, the vital sign changes raise concern for possible postoperative complications such as fluid deficit or hemorrhage. These changes require prompt provider review.

Rationale for incorrect choices

• Neurological assessment: The neurological findings indicate that the client is drowsy but easily arousable and oriented to person, place, and time. The client can move all extremities and shows no evidence of neurological decline. Mild drowsiness is expected after anesthesia and opioid administration. These findings do not suggest an immediate complication requiring provider notification.

• Incisional drainage: The abdominal dressing had drainage that was marked at admission, and no additional drainage was noted afterward. Monitoring surgical drainage is important, but stable drainage without progression suggests the incision site remains unchanged. There is no indication of excessive bleeding, rapid saturation of the dressing, or new drainage. Therefore, this finding does not require immediate reporting.

• Gastrointestinal assessment: Hypoactive bowel sounds are a common and expected finding in the immediate postoperative period due to anesthesia and reduced gastrointestinal motility. The client initially experienced nausea but reported relief after receiving metoclopramide. These findings are consistent with normal postoperative recovery.