Author Question: The nurse is calculating intake and output on a patient. The patient drinks 150 mL of orange ... (Read 103 times)

cookcarl · **on:** Jul 22, 2018

The nurse is calculating intake and output on a patient.

The patient drinks 150 mL of orange juice at breakfast, voids 125 mL after breakfast, vomits 250 mL of greenish fluid, sucks on 60 mL of ice chips, and for lunch consumes 75 mL of chicken broth. Which totals for intake and output will the nurse document in the patient's medical record?
a. Intake 255; output 375
b. Intake 285; output 375
c. Intake 505; output 125
d. Intake 535; output 125

Question 2

A nurse is assessing a patient. Which assessment finding should cause a nurse to further assess for extracellular fluid volume deficit?

a. Moist mucous membranes
b. Postural hypotension
c. Supple skin turgor
d. Pitting edema

amy.lauersdorf90 · **Reply #1 on:** Jul 22, 2018

Answer to Question 1

ANS: A
Intake = 150 mL of orange juice, 60 mL of ice chips (but only counts as 30 since ice chips are half of the amount), and 75 mL of chicken broth; 150 + 30 + 75 = 255. Output = 125 mL of urine (void) and 250 mL of vomitus; 125 + 250 = 375.

Answer to Question 2

ANS: B
Physical examination findings of deficit include postural hypotension, tachycardia, thready pulse, dry mucous membranes, and poor skin turgor. Pitting edema indicates that the patient may be retaining excess extracellular fluid.