A nurse is calculating a client's intake and output for an 8-hr shift. The client's intake included 1,000 ml 0.9% sodium chloride IV solution, one 6-oz cup of coffee, 6 oz of water, one 180-mL bowl of soup, 3 oz of flavored gelatin, and 3 oz of ice cream. How many mL should the nurse document as the client's total intake for the shift?

Answer and Explanation

The Correct Answer is ["1712"]

Explanation:

The total intake is:

1000 mL of IV solution + 177 mL (6 oz) of coffee + 177 mL (6 oz) of water + 180 mL of soup +

89 mL (3 oz) of flavored gelatin + 89 mL (3 oz) of ice cream

= 1712 mL

Nursing Test Bank

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Naxlex Comprehensive Predictor Exams

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Free Nursing Study Resources

Correct Answer is B

Explanation

A.Monitoring vital signs during the admission of a client with gestational hypertension requires nursing judgment and assessment skills.

B. Providing a sitz bath to a client with a fourth-degree laceration and is 2 days post- partum can be delegated to an AP. This task does not require the nurse's clinical judgment or assessment skills, and it can be safely performed by the AP following the nurse's instructions.

C.Observing an area of redness on the breast requires nursing assessment and intervention.

D.Changing the perineal pad of a client who has just been transferred from the labor ward is a task that should not be delegated to an assistive personnel (AP) since it is beyond their scope.This task requires assessment skills to evaluate the amount and type of lochia (postpartum vaginal discharge) and to monitor for signs of complications such as hemorrhage or infection. These assessments are within the scope of practice for a registered nurse.

A. Dry the infant off and cover the head. B. Stimulate the infant to cry. C. Clear the respiratory tract. D. Clamp the umbilical cord.

Correct Answer is A

No explanation

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse on the postpartum unit is planning to delegate client care to an assistive personnel (AP). Which of the following tasks should the nurse plan to delegate to the AP?

Correct Answer is B

Explanation

A nurse is assisting with the care of a newborn following a vaginal delivery. Which of the following actions should the nurse perform first?

Correct Answer is A

A nurse is preparing to administer hydroxyzine HCL 50 mg PO. Available is hydroxyzine oral suspension 25 mg/5 mL. How many mL should nurse administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

A nurse is reviewing the medical record of a client who experienced a vaginal birth 2 hr ago. The nurse should identify that which of the following findings places the client at risk for a postpartum hemorrhage?

A nurse is assisting in the care of a newborn immediately following birth. The nurse notes mucus bubbling out of the newborn's mouth and nose. Which of the following actions should the nurse take first?

A nurse is reinforcing teaching with the parents of a newborn about caring for the umbilical cord stump. Which of the following instructions should the nurse include?

A nurse is preparing to administer morphine 15 mg subcutaneously. The amount available is morphine injection 10 mg/mL. How many mL should the nurse administer? (Round to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

A nurse is caring for a newborn. How many blood vessels should the nurse expect to observe in the newborn's umbilical cord?

A nurse is caring for a client who is postpartum and asks, "When will my breast milk come in?" Which of the following responses should the nurse make?

A nurse is collecting data from a client who is postpartum. Which of the following findings should alert the nurse to the possibility of a postpartum complication?