A nurse is recording the intake and output (I&O) for a client.

The client consumed 8 oz of milk, 10 oz of water, 4 oz of gelatin, 1 egg, 1 piece of bacon, and 2 biscuits.

Which volume should the nurse record on the I&O?

Answer and Explanation

The Correct Answer is ["660"]

Step 1: Convert all liquid intake to mL: 8 oz of milk = 8 oz × 30 mL/oz = 240 mL 10 oz of water = 10 oz × 30 mL/oz = 300 mL 4 oz of gelatin = 4 oz × 30 mL/oz = 120 mL

Step 2: Sum the liquid intake: Total intake = 240 mL + 300 mL + 120 mL = 660 mL

The nurse should record 660 mL on the I&O.

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Correct Answer is C

Explanation

Choice A rationale

Using a narrower cuff can result in an inaccurate blood pressure reading by providing artificially high values due to increased pressure on a smaller surface area.

Choice B rationale

Requesting a prescription for an antihypertensive medication is premature without verifying the accuracy of the initial blood pressure measurement and considering other factors that might have influenced the reading.

Choice C rationale

Measuring the client's blood pressure in the other arm can help confirm the initial reading. Differences in readings between arms can occur, and a second measurement ensures accuracy and proper assessment.

Choice D rationale

Deflating the cuff faster when repeating the blood pressure measurement can lead to inaccurate readings. The cuff should be deflated at a standard rate to ensure reliability and accuracy in the measurement. .

A. Restrict the number of visitors for clients. B. Turn on loud music in client care areas. C. Offer the clients many choices regarding care. D. Assign different nurses to provide care for clients each day.

Correct Answer is A

Explanation

Choice A rationale

Restricting the number of visitors for clients can help reduce environmental stressors by minimizing noise and activity, creating a more calm and controlled environment conducive to healing.

Choice B rationale

Turning on loud music in client care areas is incorrect as loud noises can increase stress and anxiety in clients, hindering their recovery and comfort.

Choice C rationale

Offering the clients many choices regarding care is incorrect. Too many choices can overwhelm clients, increasing stress and making decision-making difficult, especially in an acute care setting.

Choice D rationale

Assigning different nurses to provide care for clients each day is incorrect. Consistency in caregivers helps build trust and rapport, reducing stress for the clients by providing a familiar and predictable routine. .

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A nurse is recording the intake and output (I&O) for a client. The client consumed 8 oz of milk, 10 oz of water, 4 oz of gelatin, 1 egg, 1 piece of bacon, and 2 biscuits. Which volume should the nurse record on the I&O?

Nursing Test Bank

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Correct Answer is C

Explanation

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A nurse is recording the intake and output (I&O) for a client.

The client consumed 8 oz of milk, 10 oz of water, 4 oz of gelatin, 1 egg, 1 piece of bacon, and 2 biscuits.

Which volume should the nurse record on the I&O?