A nurse is documenting a client’s fluid intake over the past 8 hours.
Which of the following items should be recorded as 120 mL of fluid in the client’s intake and output record?

Choice A rationale

Discussing the risk factors for colon cancer may not be helpful or comforting to a client who is expressing anger about their diagnosis. It might lead to feelings of guilt or regret if the client feels they could have done something to prevent the disease.

Choice B rationale

Focusing on future management of the illness may be overwhelming for a client who is currently expressing anger about their diagnosis. It might be more beneficial to address the client’s current emotional state before discussing future plans.

Choice C rationale

Providing written information about the phases of loss and grief may be helpful, but it may not address the client’s immediate emotional needs. The client may not be ready to read and process this information while they are expressing anger.

Choice D rationale

Reassuring the client that anger is an expected response to grief can validate the client’s feelings and help them feel understood. It’s important to acknowledge and validate the client’s emotions during this difficult time.

Choice A rationale

Regular inspection of the cord for frays or tears is crucial to ensure the safe operation of the home oxygen concentrator. A damaged cord can pose a risk of electric shock or fire.

Choice B rationale

Keeping the unit at least 1.2 m (4 ft) away from a gas stove is important because oxygen supports combustion. An oxygen-rich environment can cause materials to ignite more easily and make fires burn at a faster rate.

Choice C rationale

Considering the purchase of a generator for power backup is a good idea. In case of a power outage, a backup power source would ensure the continuous operation of the oxygen concentrator, which is critical for patients who are dependent on supplemental oxygen.

Choice D rationale

Monitoring for signs of hypoxia is essential. Despite receiving oxygen therapy, a patient may still experience hypoxia if the oxygen flow rate is insufficient, or if there are issues with the equipment. Signs of hypoxia include shortness of breath, rapid breathing, restlessness, confusion, and cyanosis (bluish color of the skin, lips, or nails)12.

Choice E rationale

Choosing synthetic clothing and bedding is not recommended. Synthetic materials can build up static electricity, which can spark and cause a fire in an oxygen-enriched environment.