A nurse is completing an 8-hr 1&0 record for a client who consumed 4 oz juice, 6 oz tea, a 100 mL cup full of ice chips, an IV bolus of 150 mL, and 8 oz broth. The nurse should record how many mL of intake on the client's record?

Answer and Explanation

The Correct Answer is ["740"]

4 oz juice → 120 mL
6 oz tea → 180 mL
100 mL ice chips → 50 mL (Ice chips are counted as half their volume when melted)
IV bolus → 150 mL
8 oz broth → 240 mL

Total intake:

120+180+50+150+240=740 mL120 + 180 + 50 + 150 + 240=740 mL

Correct answer: 740 mL

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Correct Answer is C

Explanation

A. Functional urinary incontinence: This occurs when mobility or cognitive impairments prevent the client from reaching the toilet in time. Since this client has a strong urge to void, functional incontinence is not the best fit.

B. Urinary retention: Urinary retention is the inability to empty the bladder completely, often leading to overflow incontinence. However, this client experiences urgency and leakage, not retention.

C. Urge urinary incontinence: This occurs when a strong, sudden urge to urinate leads to involuntary leakage before reaching the toilet. It is often due to overactive bladder or neurological issues.

D. Impaired skin integrity: While prolonged incontinence can lead to skin breakdown, the primary diagnosis should address the cause of incontinence rather than a secondary complication.

A. Milkshake B. Grape juice C. Lemon sherbet D. Vanilla ice cream

Correct Answer is B

Explanation

A. Milkshake: Contains milk, which is not a clear liquid.

B. Grape juice: Allowed, as it is a transparent liquid without pulp.

C. Lemon sherbet: Not a clear liquid; contains dairy and solid components.

D. Vanilla ice cream: Not clear; ice cream is a full-liquid food.

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A nurse is completing an 8-hr 1&0 record for a client who consumed 4 oz juice, 6 oz tea, a 100 mL cup full of ice chips, an IV bolus of 150 mL, and 8 oz broth. The nurse should record how many mL of intake on the client's record?

Nursing Test Bank

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