The nurse is completing the intake and output record for a preschool-age client admitted for fluid volume deficit.

The client has had the following intake and output during the shift:

Intake:

4 oz of Pedialyte

1/2 of an 8-oz cup of clear orange Jell-O

2 graham crackers

200 mL of D 5-1/2 sodium chloride IV

Output:

345 mL of urine

50 mL of loose stool

The nurse documents the client's intake as milliliters. How much liquidintake did the client have in Milliliters?
Round the answer to the nearest whole number.

Answer and Explanation

The Correct Answer is ["437"]

To convert ounces to milliliters, multiply by 29.57
4 oz of Pedialyte = 118.28 mL
1/2 of an 8-oz cup of clear orange Jell-O = 118.28 mL
2 graham crackers = no liquid intake
200 mL of D 5-1/2 sodium chloride IV = 200 mL
Total intake = 118.28 + 118.28 + 200 = 436.56 mL
Round to the nearest whole number = 437 mL
The nurse documents the client's intake as 437 mL

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Correct Answer is C

Explanation

Choice A reason:

This statement is not directly related to the client's use of bisacodyl tablets. It addresses irregular bowel movements in a general sense.

Choice B reason:

Decreasing fiber intake is not a recommended approach, especially for an older adult who may benefit from a balanced diet with adequate fiber.

Choice C reason:

This is the correct answer. Excessive use of laxatives, including bisacodyl, can lead to electrolyte imbalances. Bisacodyl is a stimulant laxative that can cause excessive fluid loss and potentially

disrupt electrolyte levels.

Choice D reason:

While chronic use of laxatives can lead to various complications, including potential harm to the rectal mucosa, this choice is not the most appropriate response to the client's current situation.

A. Chronic gastritis B. Atelectasis C. Pneumonia D. Malignant hyperthermia E. Metabolic imbalances

Correct Answer is ["B","C","E"]

Explanation

Choice A reason:

Chronic gastritis is not a common immediate postoperative complication of gastric surgery. It is more related to long-term gastric health.

Choice B reason:

Correct. Atelectasis, or partial lung collapse, is a potential complication postoperatively, especially in abdominal surgery. The nurse should assess for signs such as decreased breath sounds and reduced oxygen saturation.

Choice C reason:

Correct. Pneumonia is a potential complication due to reduced lung function and shallow breathing after surgery. The nurse should monitor for signs like fever, increased respiratory rate, and abnormal breath sounds.

Choice D reason:

Malignant hyperthermia is a rare complication related to certain types of anesthesia agents. It is not a common complication after gastric surgery

Choice E reason:

Correct. Metabolic imbalances, such as electrolyte disturbances or changes in blood glucose levels, can occur after gastric surgery. The nurse should monitor for signs like weakness, confusion, and abnormal laboratory values.

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Naxlex Comprehensive Predictor Exams

A nurse is caring for an older adult client who reports taking bisacodyl tablets daily. Which of the following responses should the nurse make?

Correct Answer is C

Explanation

A nurse is providing care for a patient who is postoperative day 2 following gastric surgery. The nurse's assessment should be planned in light of the possibility of what potential complications? Select all that apply.

Correct Answer is ["B","C","E"]

Explanation

A patient's new onset of dysphagia has required insertion of an NG tube for feeding; the nurse has modified the patient's care plan accordingly. What intervention should the nurse include in the patient's plan of care?

A patient seeking care because of recurrent heartburn and regurgitation is subsequently diagnosed with a hiatal hernia. Which of the following should the nurse include in health education?

A patient's new onset of dysphagia has required insertion of an NG tube for feeding; the nurse has modified the patient's care plan accordingly. What intervention should the nurse include in the patient's plan of care?

A patient with a diagnosis of peptic ulcer disease has just been prescribed omeprazole (Prilosec). How should the nurse best describe this medication's therapeutic action?

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The nurse's comprehensive assessment of a patient includes inspection for signs of oral cancer. What assessment finding is most characteristic of oral cancer in its early stages?