A nurse is reviewing a client's intake and output and notes the following: 0.9% sodium chloride 600 mL IV infusion, cefazolin 250 mg in dextrose 5% in water 100 mL. Intermittent IV bolus, 200 mL emesis, 40 mL voided urine, and 20 mL urine from straight catheterization. The nurse should record the client's net fluid intake as how many mL? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)
The Correct Answer is ["440"]
To calculate the client's net fluid intake, we need to subtract the output (emesis and urine) from
the intake (IV infusion and IV bolus). Intake:
- 0.9% sodium chloride IV infusion: 600 mL
- Cefazolin in dextrose 5% in water IV bolus: 100 mL Output:
- Emesis: 200 mL
- Voided urine: 40 mL
- Urine from straight catheterization: 20 mL Net fluid intake = Intake - Output
Net fluid intake = (600 mL + 100 mL) - (200 mL + 40 mL + 20 mL) Net fluid intake = 700 mL - 260 mL
Net fluid intake = 440 mL
Therefore, the nurse should record the client's net fluid intake as 440 mL.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
It is essential to involve a qualified interpreter who can accurately convey information and ensure that the client fully understands the details of the procedure, potential risks, and benefits. The interpreter serves as a bridge between the nurse and the client, allowing for clear and accurate communication.
Correct Answer is C
Explanation
The nurse should assess the pulses in the extremities to ensure that circulation is not compromised by the restraints.
Once the nurse has confirmed that the peripheral pulses are intact, they should assess the client's skin integrity. Prolonged or improperly applied restraints can cause pressure injuries or skin breakdown, so it is important to check for any signs of skin damage.
After assessing peripheral pulses and skin integrity, the nurse should evaluate the client's comfort level. The nurse should address any discomfort or pain caused by the restraints and ensure that the client's physical and emotional needs are met.
While elimination needs are important, they may not pose an immediate threat to the client's safety compared to compromised circulation or skin integrity. Once the more urgent assessments have been completed, the nurse should address the client's elimination needs.
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