nclex question. solving intake

[reinAya]

i know how to solve. its just about finding out a patients intake.

i got this from an online review (im not sure if its allowed to mention it). to be safe, i wont.

and i will rephrase the question.

patient a undergoes peritoneal dialysis. physician ordered 2000ml / 2l to be instilled for 40 mins. the rn measures the outflow and records 1,800 ml. during the shift, the patient drinks 700 ml of fluids and voids 400 ml. record patient's a intake.

i answered 500 ml. 2000 ml (inflow) - 1800 ml (outflow) = 200 ml

plus 700 ml (fluids) - 400 ml (voids/urine) = 300

200 ml (inflow,outflow difference) + 300 ml (diff of fluids and urine) = 500 ml..

but the right answer is 900 ml. they ddnt show the calculation.

the explanation goes this way.. "inflow and intake are recorded separately. the difference between inflow and outflow is considered intake.

that's it. sorry guys.. im just confused.

should i or should i not.. minus 700 ml (intake) from 400 ml (urine)???

based from their answer,. it seems like.. they added 700 ml (intake) plus 200 ml ( diff. of inflow, outflow) = 900 ml

i thought, to solve intake, u have to find out difference between intake and output.. the difference is the total intake.. im totally confused now.. iv been reviewing.. maybe im just in panic.. but please refresh me.

note: i do not intend to violate the copyright. its just that, im doing self review, and online. i do not have any teacher to ask. thanks for your help everyone!

[lavender59]

According to Kaplan RN 2010 Strategies Nclex Review Book (this is how they calculated)

200mL- retained dialysate

700mL- fluid drunk

______

900mL - total fluid intake

[goldruss17]

I had the same question. Thanks for the clarification.

[soontobesunny]

seems as though Kaplan hasn't changed much in the last few years....I had same question and missed it. There answer rationale is difficult to decipher

[QuenymamiRN]

You don't count the urine output when considering input, that's why it's 900ml

[Taylo040]

Thanks for clarifying

[nurseprnRN, BSN, RN]

I actually found your post hard to decipher, mostly because of punctuation issues and lack of capital letters in spots. But the basic premise is ridiculously simple. Really. To do these problems accurately, you will always:

1) Add up everything that went in -- oral, IV, irrigation, dialysate, tube feeds, anything that went IN

2) Add up everything that came out -- urine, tube drainage, dialysate returned, anything that came OUT

Calculate the difference. If more went IN than came OUT, then the patient is +the difference, in positive fluid balance. So if you got 3200cc in and 3000cc out, your patient is +200cc, with 200cc more than he started with.

If more came OUT than went IN, the patient is in negative fluid balance. So if you had 2100cc in and 2350cc out, your patient is -250cc,with 250cc less than he started with. (this is generally what you want to see)

[dayane.janeide]

Tks a lot. Big help, Lavender.

[rob4546, ADN, BSN, MSN]

Okay, maybe I can help. I have seen this question and asked an instructor about it not too long ago. Here goes.....

The question is talking about the intake, and the intake only. Yes the intake and output are recorded separately and have different meanings and this question only wants the intake. The intake of fluids is easy, it is the 700 mL. Now you have to deal with the dialysate. There was 2000 mL put in and only 1800 mL out which leaves you with 200 mL and added to the intake would make 900 mL and the answer they are looking for.

This is where I asked why you only use the difference between in and out of dialysate and not the oral and urine out. "The dialysate is never meant to be a fluid intake so it would not be counted as such. The fact that you were not able to drain the 200 mL is the reason you would only count the 200 mL. You can't suction that fluid out so the body will (or have already) absorbed it and that would be counted as an intake." I put it in quotations but this is just summary of her answer.

If you look at it this way, then it works out. I believe that this is a little misleading, unless this is a normal calculation or process for dialysis that I did not learn in class. I think it would have been better to ask for the current patient fluid balance which would be more straight forward.

Oh, well..... I wouldn't worry about this. The chances of you seeing a question like this on the NCLEX is very slim. Just remember to read the question and only answer what they are asking.... Not anything more than that. Intake is intake. Outputs are outputs.. ETC.

[5678kma]

That was a very poorly written question on Kaplan's part. I haven't come across a worse one yet in my review. Thank you for asking this.