The nurse is calculating the output of a client at the end of the shift. The nurse notes the following: the client voided 400 mL at 1100 and 350 at 1415. The chest tube was previously marked at 155 mL and is now 175 mL. The nasogastric tube has 575 mL in the drainage container and the Jackson Pratt drain had 25 mL emptied from it. How many ml's should the nurse record as output for the shift
The Correct Answer is ["1370"]
To calculate total output, we sum all recorded outputs:
- Urine output:
- 400 mL + 350 mL = 750 mL
- Chest tube drainage:
- 175 mL (current) - 155 mL (previous) = 20 mL
- Nasogastric tube drainage: 575 mL
- Jackson-Pratt drain output: 25 mL
Total Output = 750 + 20 + 575 + 25 = 1,370 mL
Correct Answer: 1,370 mL
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Constipation: Hypocalcemia causes diarrhea, while hypercalcemia causes constipation.
B. Negative Trousseau’s sign: A positive Trousseau’s sign (carpal spasm during BP cuff inflation) is expected with hypocalcemia.
C. BP of 180/88: Severe hypocalcemia may cause hypotension, not hypertension.
D. Numbness and tingling of the extremities: Hypocalcemia can occur after a total thyroidectomy due to accidental removal or damage to the parathyroid glands. Neuromuscular excitability, including paresthesia (numbness and tingling), tetany, and muscle spasms, are classic signs.
Correct Answer is A
Explanation
A. Obtain vital signs: Dizziness and lightheadedness during dialysis suggest hypotension, a common complication. The nurse should first assess vital signs to determine the severity before taking further action.
B. Bolus the client with 1000 mL of normal saline: If the client is hypotensive, a smaller fluid bolus (e.g., 250–500 mL) would be more appropriate.
C. Turn off the dialysis machine immediately: Stopping dialysis abruptly may cause fluid overload and other complications. The rate may need adjustment but not immediate cessation.
D. Notify the health care provider as soon as possible: While important, assessing the client’s current status is the priority before contacting the provider.
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