The nurse is evaluating the fluid balance of a client who was admitted yesterday with dehydration and who has been receiving IV fluids since admission. An increase in which parameter indicates to the nurse that the client is rehydrating?

Choice a reason: A 3 mL syringe is the most accurate device for measuring a 2 mL dose of a viscous liquid solution due to its design and gradation precision. Syringes provide clearly marked measurement lines, allowing for highly accurate dosing, especially for amounts as small as 2 mL. For viscous liquids, the controlled plunger mechanism of a syringe ensures smooth and consistent measurement and delivery. This is critical in nursing practice, as even slight deviations in medication dosing can lead to therapeutic failures or adverse effects. Additionally, syringes are designed to handle a variety of liquid viscosities, reducing the likelihood of measurement errors caused by sticking or uneven flow. By eliminating the need for visual estimation common with other tools, the syringe minimizes user error and enhances patient safety. The 3 mL capacity ensures the nurse can measure the exact dose without overloading or underutilizing the equipment, maintaining both precision and ease of use.

Choice b reason: A one-ounce medicine cup is less accurate for measuring a 2 mL dose due to its relatively larger size and less precise measurement gradations. Medicine cups are typically designed for measuring larger volumes, such as 5 mL, 15 mL, or more, and are not ideal for small doses. The wide surface area and less detailed markings make it difficult to accurately align the liquid level to the desired measurement, especially for small amounts like 2 mL. This can result in over- or under-dosing, which is particularly problematic when administering potent medications. Additionally, the open design of medicine cups may make pouring viscous liquids challenging, as the liquid may stick to the sides of the cup, leading to further inaccuracies. While convenient for larger doses or liquid mixtures, the medicine cup does not offer the precision required for small, specific dosages in clinical practice.

Choice c reason: A tuberculin syringe, which has a capacity of 1 mL, is specifically designed for administering very small doses, such as subcutaneous or intradermal injections. Using it for a 2 mL dose is impractical and could lead to dosing errors. The nurse would need to fill the syringe twice to administer the full 2 mL, increasing the risk of cumulative measurement inaccuracies. This approach is also time-consuming and may lead to wastage of the medication, as viscous liquids can leave residue inside the syringe, further complicating the dose calculation. Additionally, the markings on a tuberculin syringe are optimized for fractions of a milliliter, not for whole milliliter increments, making it unsuitable for measuring a 2 mL dose. Using this tool for a dose beyond its designed capacity contradicts best practices in nursing, which emphasize using equipment tailored to the specific requirements of the medication and patient.

Choice d reason: Using a 3 mL syringe with a sterile needle is unnecessary and not recommended for administering an oral medication. While the 3 mL syringe itself is suitable for measuring a 2 mL dose, the inclusion of a sterile needle is irrelevant and introduces an additional risk of improper administration. Oral medications are not meant to be injected, and the presence of a needle could lead to accidental use or injury. Furthermore, sterile needles are specifically intended for invasive procedures, such as intramuscular or intravenous injections, and their inclusion in an oral medication protocol is not only superfluous but also contraindicated. The presence of the needle complicates the preparation process without providing any benefit, detracting from the simplicity and efficiency of administering the medication orally. In nursing practice, ensuring that the equipment matches the route of administration is crucial to patient safety and protocol adherence.

Choice A reason: Printing electronic medical record (EMR) from backup server is not the best action to take first. It may not be possible or feasible to access the backup server if the system is down. It may also delay the communication and delivery of the prescriptions to the lab.

Choice B reason: Notifying information services department of the situation is the best action to take first. It alerts the experts who can troubleshoot and fix the problem as soon as possible. It also allows the nurse to obtain guidance on how to proceed with the documentation and prescriptions.

Choice C reason: Identifying information as late entry in the record is a relevant action to take, but not the first one. It ensures the accuracy and completeness of the EMR, but it does not address the immediate issue of the system failure. The nurse may not be able to enter the information until the system is restored.

Choice D reason: Waiting for notification that the system has been rebooted is not a proactive action to take first. It may waste valuable time and compromise the client's care. The nurse should not assume that the system will be rebooted automatically or quickly.