The nurse receives report at 0700 on a client who has 600 mL of IV fluid left in the bag. The IV is running at 100 mL per hour. At what time should the nurse expect to change the bag (military time)?

1500

1300

1400

1600

Answer and Explanation

The Correct Answer is B

A. 1500: This is incorrect
B. The calculation is as follows:
Remaining fluid: 600 mL
IV rate: 100 mL/hour
Time to empty the bag: 600 mL ÷ 100 mL/hour = 6 hours
Adding 6 hours to the report time:
0700 + 0600 = 1300
The correct answer is 1300.
C. 1400: This is incorrect
D. 1500: This is incorrect

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Correct Answer is D

Explanation

A. The prone position is not suitable post-craniotomy as it can increase intracranial pressure and may compromise respiratory function.
B. The dorsal recumbent position is not ideal for patients post-craniotomy, as it can hinder optimal intracranial pressure management.
C. The lateral recumbent position is generally avoided immediately after craniotomy to prevent pressure on the surgical site and ensure proper cerebral perfusion.
D. The Semi-Fowler's position helps reduce intracranial pressure, promotes venous drainage, and is generally recommended for post-operative care following a craniotomy.

A. Assessing pupils for reactivity, equality, symmetry, and accommodation B. Obtaining vital signs every four hours while hospitalized C. Performing serial Glasgow Coma Scales throughout hospitalization D. Performing a Mini Mental Status Exam at admission and discharge

Correct Answer is C

Explanation

A. Assessing pupils is important, but it provides only partial information about the overall neurologic status and does not give a comprehensive picture of improvement or deterioration.
B. Vital signs can indicate some changes in condition but are not specific to neurologic status and do not provide detailed insight into cognitive or motor function.
C. Performing serial Glasgow Coma Scales allows for a standardized and objective assessment of a patient's level of consciousness, motor responses, and verbal responses over time, making it the most effective method to evaluate neurologic status.
D. The Mini Mental Status Exam provides useful information about cognitive function but may not capture acute changes in neurologic status as effectively as the Glasgow Coma Scale.

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The nurse receives report at 0700 on a client who has 600 mL of IV fluid left in the bag. The IV is running at 100 mL per hour. At what time should the nurse expect to change the bag (military time)?

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