For the 0700 to 1500 shift, the patient drinks 240 mL of coffee, 60 mL of milk, and 120 mL of apple juice at breakfast. For lunch, the patient takes 8 oz of broth and drinks 10 oz of water for the shift. What is the total intake for the 0700 to 1500 shift?
700
660
900
960
The Correct Answer is B
A. 700: This is incorrect, check the calculation in choice D rationale
B. 660: This is incorrect, check the calculation in choice D rationale
C. 900: This is incorrect, check the calculation in choice D rationale
D. To calculate the total intake, we need to convert all fluid measurements to milliliters (mL) and then add them together:
- Coffee: 240 mL
- Milk: 60 mL
- Apple juice: 120 mL
- Broth: 8 oz = 240 mL (1 oz = 30 mL)
- Water: 10 oz = 300 mL (1 oz = 30 mL)
Now, add them together:
240 mL (coffee) + 60 mL (milk) + 120 mL (apple juice) + 240 mL (broth) + 300 mL (water) = 960 mL.
Thus, the total intake is 960 mL, which corresponds to D.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. A positive Romberg sign (difficulty maintaining balance with eyes closed) can indicate a neurological issue, but it is not directly associated with a migraine.
B. A subnormal temperature (low body temperature) is not typically associated with migraines and may indicate another issue, but it is not as concerning as other findings.
C. An ill college roommate might suggest a viral illness, but it is not a direct concern for the student’s migraine. Migraines are not contagious, and other signs of illness would be more concerning.
D. Positive Brudzinski sign, which involves involuntary flexion of the hips and knees when the neck is flexed, is indicative of meningeal irritation, a sign of meningitis. This is a medical emergency and much more concerning than the symptoms of a migraine. The student should be further assessed for signs of meningitis, which requires urgent treatment.
Correct Answer is C
Explanation
A. A cervical collar is not necessary for a lumbar laminectomy. A cervical collar is used for neck surgeries or spinal cord injuries involving the cervical spine, not for lumbar procedures.
B. The head of the bed elevated 30 degrees may be appropriate for certain conditions, but after a lumbar laminectomy, it is typically recommended to keep the head of the bed flat or slightly elevated to reduce pressure on the spine.
C. Logrolling the client every 2 hr is the correct action. After a lumbar laminectomy, the nurse should use the logroll technique to turn the patient to prevent strain on the spine and promote proper healing.
D. Supine with her arms elevated on pillows is not the best position. While elevation of the arms may be helpful for comfort, the focus should be on protecting the lumbar spine and ensuring proper positioning to prevent strain.
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