Davis + unit 4 Urinary

The nurse needs a clean-catch midstream urine specimen from a female patient. After explaining the process, the patient asks, "Why do I need to start, stop, and then restart urinating?" Which reason answers the patient's question? 1.The procedure prevents antibiotic treatment due to a contaminated specimen. 2.The ability to stop and start a urine stream evaluates bladder control. 3.Stopping the stream allows urine collection without contamination of the specimen cup. 4.The patient is able to manage the process and not soil the specimen cup label.

1.The procedure prevents antibiotic treatment due to a contaminated specimen. Cleansing the area and then voiding a small amount of urine cleans the area and the urethral opening to prevent specimen contamination. Unnecessary use of antibiotics should be avoided. [Page reference: 666]

The nurse working in a long-term care facility is preparing to place an indwelling urinary catheter ordered for a patient. For which reason would the nurse decide to use a 20 French catheter that is 40 centimeters in length? 1.The patient is a newly admitted male who is recovering from an acute illness. 2.The patient is a female who is incontinent without an indwelling catheter. 3.The patient is a male who had an indwelling catheter for a prolonged period. 4.The patient is a female of small stature who has never had a catheter

3.The patient is a male who had an indwelling catheter for a prolonged period. The male patient who had an indwelling catheter for a prolonged period will need a 20 French that is 40 centimeters in length to accommodate the longer urethra. [Page reference: 675] Test Taking Tip: Do not be surprised if you see an NCLEX question about equipment. It is important to know the type of equipment used for specific situations, how to use it correctly, and how to evaluate if it is safe.

The nurse is preparing to place an indwelling urinary catheter in a male patient. As the nurse begins the procedure, it is noted that the urinary meatus is not visible at the tip of the penis. At which conclusion will the nurse arrive? 1.The patient is uncircumcised, and retracting the foreskin will expose the urinary meatus. 2.The patient has epispadias, and the urinary meatus is located along one side of the penis. 3.The patient may have hypospadias, and the urinary meatus is located on the underside of the penis. 4.The patient is likely to have a surgically made suprapubic opening into the bladder.

3.The patient may have hypospadias, and the urinary meatus is located on the underside of the penis. Some patients have a urinary meatus that is located on the underside of the penis; a condition called hypospadias. [Page reference: 676]

The nurse works in a long-term care facility that promotes bladder training for patients identified as good candidates. Which situation does the nurse recognize as a patient who is successfully bladder trained? 1.The patient who is dry when assisted to void every 2 hours 2.The patient who calls for assistance and remains dry if assisted quickly 3.The patient who remains continent for prolonged periods and at night 4.The patient who remains continent if assisted to void every hour

3.The patient who remains continent for prolonged periods and at night Successful bladder training is when the patient is able to remain dry for prolonged periods and at night. [Page reference: 671]

The nurse is assigning patient care to an unlicensed assistive personnel (UAP). Several of the patients need assistance with toileting. For which patient is it most important for the nurse to provide specific instructions to the UAP? 1.A male patient who can stand independently at the bedside 2.A female patient who is unable to stand without assistance 3.A male patient with urinary frequency who is on bedrest 4.The female patient who had a total hip replacement

4. The female patient who had a total hip replacement The most important instruction to the UAP is that this patient will need to use a fracture pan for toileting. The patient's hip joint cannot be bent or adducted until ordered by the health-care provider. [Page reference: 665] Test Taking Tip: When answering a question in which all patients need some instruction for care, look for the patient who is at greatest risk. Safety is always the first consideration when providing instructions for patient care.

The nurse is reviewing laboratory results during a sports physical for a high school athlete. The patient's creatinine level is elevated, but other laboratory values are normal. Which reason for the elevation does the nurse recognize? 1.Intense, daily workouts during sport practices 2.Uric acid retention is causing the elevation 3.Undiagnosed kidney disorder or disease 4.Counterbalancing a low production of urea

1.Intense, daily workouts during sport practices Creatinine is a waste product formed from muscle metabolism. Athletes, especially during intense workouts, will exhibit an elevated creatinine level. [Page reference: 663]

The nurse is caring for a patient who had the formation of a continent urostomy after bladder trauma. The patient tells the nurse that this surgery was selected so the patient would feel normal. For which condition will the nurse need to prepare the patient? 1.Urinary incontinence is expected to occur through the urethra. 2.Skin around the reservoir opening is prone to breakdown. 3.Digestion will be affected due to the amount of small intestine used. 4.Spasms of the newly formed reservoir will indicate that urine needs to be drained.

1.Urinary incontinence is expected to occur through the urethra. The newly formed reservoir drains through the urethra, and incontinence does occur. The patient needs to drain the reservoir throughout the day via self-catheterization through the urethra. [Page reference: 678]

The nurse is keeping a strict intake and output (I&O) on a patient. The patient drank 900 mL of water, had 1000 mL of intravenous (IV) fluids, and had 240 mL of ice chips during an 8-hour period. In the same period, the patient voided 750 mL of urine and vomited 300 mL of liquid. The nurse determines that how much fluid difference exists in mLs between the intake and output?

-970 The nurse should total the patient's intake, which is a total of 2020 mL. Remember that liquid from ice chips is half the amount of the ice (120 mL in this problem). Then the nurse totals the patient's output and subtracts it from the intake. The calculation indicates that the patient had 970 mL more intake than output. [Page reference: 666]

The nurse is providing care for a patient who is ordered to receive an indwelling urinary catheter. Which reason does the nurse recognize as a need for intermittent catheterization instead? 1.A patient has not been able to empty the bladder since the use of general anesthesia. 2.A patient is acutely ill with a renal infection and is placed on strict intake and output. 3.A patient is severely debilitated and at the end of life from a terminal disease. 4.A patient is being prepared for a scheduled abdominal surgery.

1.A patient has not been able to empty the bladder since the use of general anesthesia. Sometimes surgery or certain types of anesthesia can cause urinary retention. In this situation, the nurse would recognize the need for intermittent catheterization because the cause is likely to be short-lived. An indwelling catheter will not resolve urinary retention. [Page reference: 669] Test Taking Tip: This question is a good example of the importance of careful reading. The question is one that requires analysis, but the question does not contain any verbal clues or a clarifying word. NCLEX will may emphasize clarifying words, but be alert that some questions just require careful reading and interpretation.

The nurse in a pediatric clinic is seeing a young school-age patient. The parent reports symptoms that include poor appetite, vomiting, diarrhea, and sleeplessness. The parent also reported that the patient had an episode of urinary incontinence at school. Which condition does the nurse suspect? 1.A urinary tract infection (UTI) causing symptoms that are unique to children 2.Gastrointestinal infection that is causing physical and emotional stress 3.Respiratory infection resulting in symptoms triggered by hypoxia 4.An emotional crisis causing physical illness and regressive behavior

1.A urinary tract infection (UTI) causing symptoms that are unique to children Children do not exhibit the same symptoms with a UTI as do adults. The symptoms reported by the parent are typical of a child with a UTI, which should be the condition the nurse suspects. [Page reference: 679]

The nurse receives an order from the health-care provider to discontinue the indwelling urinary catheter for a patient. Which steps will the nurse perform to remove the catheter? Select all that apply. 1.Attach a 10-mL syringe to the port used for balloon inflation. 2.Ask the patient to bear down and check for passage of urine. 3.Instruct the patient to use the bathroom when the urge to void occurs. 4.Empty and measure the urine in the collection bag.he legs. 5.Place a waterproof pad beneath the patient's perineum and between the legs.

1.Attach a 10-mL syringe to the port used for balloon inflation. 4.Empty and measure the urine in the collection bag.he legs. 5.Place a waterproof pad beneath the patient's perineum and between the legs. The fluid in the balloon is removed from the same port that was used to inflate the balloon. A 10-mL syringe will hold the maximum amount of fluid used for inflation. The nurse will empty and measure the urine in the collection bag and document the amount. The urine in the tubing should be emptied into the bag for output accuracy. A waterproof pad or towel is placed to collect any urine that is released with the removal of the catheter. [Page reference: 693, 694]

The nurse works in a long-term care facility. Many patients, assigned to the nurse need assistance with toileting. When should the nurse offer assistance in order to promote normal toileting? 1.Before and after meals 2.Before bathing 3.Before getting dressed 4.Before visiting hours

1.Before and after meals Voiding before and after meals and before bedtime will promote normal toileting. Voiding before a meal will prevent interruption in eating. After a meal, the patient may need to void due to liquid intake. Most people will void before bedtime to prevent needing to get up during the night. [Page reference: 669]

The nurse is providing care for a patient with continuous bladder irrigation after prostate surgery. Which evaluations will the nurse make during the irrigation process? Select all that apply. 1.Check the bladder drainage for the presence of clots. 2.Look at the color of the drainage from the bladder. 3.Check for bladder distention if the patient reports fullness. 4.Decide when to change the catheter for the presence of clots. 5.Determine the patient's response to the irrigation process.

1.Check the bladder drainage for the presence of clots. 2. Look at the color of the drainage from the bladder. 5. Determine the patient's response to the irrigation process. The purpose of continuous bladder irrigation is to keep blood diluted and to prevent the formation of clots. The nurse will attempt to keep the drainage from the bladder between clear and light pink. Effectively flushing blood from the bladder will prevent the formation of clots. The nurse needs to evaluate how the patient is tolerating the irrigation process. [Page reference: 691]

The nurse manager is sharing the Centers for Medicare and Medicaid standards with the nursing staff. For which reasons does the nurse manager reinforce the need for meticulous technique when inserting and caring for patients with urinary catheters? Select all that apply. 1.Payment will be denied for catheter-related hospital-acquired infections. 2.Facilities cannot recoup certain expenses for a patient who gets a urinary tract infection (UTI) after a catheter is inserted in the hospital. 3.Careful aseptic technique is the first line of prevention for hospital-acquired, catheter-related infections. 4.Hospitals with high levels of catheter-related, hospital-acquired UTIs will lose Medicare and Medicaid status. 5.Nurses can be held responsible and fined for causing a UTI in a hospital setting.

1.Payment will be denied for catheter-related hospital-acquired infections. 2.Facilities cannot recoup certain expenses for a patient who gets a urinary tract infection (UTI) after a catheter is inserted in the hospital. 3.Careful aseptic technique is the first line of prevention for hospital-acquired, catheter-related infections. 1. The Centers for Medicare and Medicaid will no longer make payment if a patient has a catheter-related, hospital-acquired UTI. Option 2:Expenses that are denied will include antibiotics, extra hospital days, or any other expenses related to treatment of a UTI acquired in the hospital setting after catheter insertion. Option 3:Aseptic technique used during the insertion and care of a patient with a catheter is the best way to prevent UTIs. [Page reference: 676]

_____________________ is defined as a urinary output greater than 3000 mL/day. 1.Polyuria 2.Dysuria 3.Hematuria 4.Oliguria

1.Polyuria Polyuria is the term used for excessive urinary output. Polyuria can be caused by a disease process such as diabetes mellitus or by medications such as diuretics. [Page reference: 663, 664]

The nurse is monitoring a patient who had surgery for an enlarged prostate. Treatment involves the maintenance of a continuous bladder irrigation system. Which finding would support an increase in the rate of irrigation fluid? 1.Red-colored drainage and clots in the tubing 2.A decrease in the amount of draining fluid 3.Bladder drainage that is pink in color 4.A report about painful bladder spasms

1.Red-colored drainage and clots in the tubing The irrigation is intended to prevent blood clots from forming in the bladder and blocking the drainage of urine and irrigation fluid. This finding will support an increase in the rate of irrigation. [Page reference: 674]

The nurse assigns patient care to an unlicensed assistive personnel (UAP). Several patients will require catheter care. Which action by the UAP during catheter care would cause the nurse to intervene immediately? 1.The UAP is cleaning the tubing upward toward the insertion site. 2.The UAP is cleaning the urinary catheter with perineal wash. 3.The UAP performs perineum care before performing catheter care. 4.The UAP holds the urinary catheter with a gloved hand to prevent traction during cleaning.

1.The UAP is cleaning the tubing upward toward the insertion site. Cleaning catheter tubing toward the insertion site will promote bacteria migration into the bladder and cause an infection. The UAP should be stopped immediately. [Page reference: 677]

The nurse is preparing to change a suprapubic catheter. Which principles will the nurse use during this process? Select all that apply. 1.The area around the suprapubic tract is cleaned with sterile swabs. 2.The new catheter is inserted 4 to 6 inches into the suprapubic tract. 3.Hold the new catheter at a 90-degree angle for insertion into the suprapubic tract. 4.Note the amount drained from the balloon so that the same amount can be replaced. 5.The new catheter is tugged gently after the balloon is filled.

1.The area around the suprapubic tract is cleaned with sterile swabs. 5. The new catheter is tugged gently after the balloon is filled. After the catheter is removed, the area around the suprapubic tract is cleaned with sterile swabs from the catheter kit. A slight tug on the new suprapubic catheter will seat the catheter in the bladder opening. [Page reference: 678]

The nurse is assigned care for multiple patients. Which patient does the nurse anticipate will need assistance with self-catheterization? 1.The patient who recently had a vaginal hysterectomy 2.The patient with an enlarged prostate gland 3.The patient diagnosed with a genetic kidney disorder 4.The patient who experiences nocturia twice nightly

1.The patient who recently had a vaginal hysterectomy After a vaginal hysterectomy, the patient is likely to experience urinary retention due to swelling in the vaginal region. This patient may need to perform self-catheterization for a period after discharge until edema is resolved. [Page reference: 669]

The nurse works in a long-term care facility and is caring for a patient with urinary incontinence. The nurse and patient decide together that the patient may benefit from a bladder training program. Which action by the nurse is unnecessary? 1.Make arrangements that someone assist the patient to the bathroom at set times. 2.Offer fluids to the patient throughout the day to assure good urinary tract health. 3.Notify the health-care provider of the patient's wishes and obtain an order for the program. 4.Teach the patient to avoid caffeinated beverages and to drink more fluids during the day.

2.Offer fluids to the patient throughout the day to assure good urinary tract health.

The nurse is interviewing a female patient who states, "I have bladder pain sometimes and I just drink more water and it gets better." Which information is most important for the nurse to provide to the patient? 1."If it does not get better, you may need an antibiotic." 2."You may be getting bladder infections that can spread to your kidneys." 3."Don't use a diaphragm or methods that use spermicide for birth control." 4."You should always be sure to void after sexual intercourse."

2."You may be getting bladder infections that can spread to your kidneys." The information that informs the patient about life-changing risk is the most important. Kidney infections can cause scarring and the loss of kidney function. [Page reference: 679] Test Taking Tip: When you are asked to find the answer that is most important, ask yourself the consequences relative to each option. Look for the option that causes the patient the greatest risk or has the potential for being the most damaging.

The nurse is caring for patients with indwelling urinary catheters. Which principles will the nurse observe with regard to the urinary drainage bags? Select all that apply. 1.Hang the bag on a moveable part of the bed, such as the side rails. 2.Avoid situations that allow urine to flow back into the bladder. 3.Record the amount of urine by checking the graduated marks on the side of the drainage bag. 4.Keep the drainage system closed until the collection bag is full to decrease the risk of contamination. 5.When emptying the collection bag, do not contaminate the spout.

2.Avoid situations that allow urine to flow back into the bladder.. 5.When emptying the collection bag, do not contaminate the spout. Urine that has been in the tubing or urinary drainage bag is susceptible to bacteria growth. Allowing that urine to flow back into the bladder can cause a urinary tract infection (UTI).. The spout should not touch any surface when the urinary collection bag is emptied. The spout should be wiped with an alcohol wipe before it is closed. [Page reference: 676]

The health-care provider orders a urinalysis for a patient with an indwelling urinary catheter. Which steps will the nurse perform to obtain the specimen? Select all that apply. 1.Draw a urine sample from the urine already present in the tubing. 2.Clean the port located in the tubing with an alcohol swab. 3.Using a blunt needle, withdraw 5 to 8 mL of urine from the port. 4.Unclamp the catheter tubing to allow the urine to flow freely into the collection bag. 5.Clamp the tubing below the level of the port to collect fresh urine.

2.Clean the port located in the tubing with an alcohol swab. 3.Using a blunt needle, withdraw 5 to 8 mL of urine from the port. 4.Unclamp the catheter tubing to allow the urine to flow freely into the collection bag. 5.Clamp the tubing below the level of the port to collect fresh urine. The port is cleaned with alcohol to prevent the introduction of pathogens into the tubing. The specimen is also protected from contamination. Option 3:A blunt needle is used to prevent damage to the membrane of the port. Only 5 to 8 mL of urine is needed for urinalysis. The technique is aseptic. Option 4:It is important that the nurse unclamp the tubing after the specimen is collected. The urine needs to flow freely to the collection bag. Option 5:In order to collect a fresh urine sample, the tubing is clamped below the port for 15 to 30 minutes. The urine that is in the tubing should be emptied in the collection bag before clamping the tubing. [Page reference: 689]

The nurse works in a long-term care facility and is caring for a patient with urinary incontinence. The nurse and patient decide together that the patient may benefit from a bladder training program. Which action by the nurse is unnecessary? 1.Make arrangements that someone assist the patient to the bathroom at set times. 2.Offer fluids to the patient throughout the day to assure good urinary tract health. 3.Notify the health-care provider of the patient's wishes and obtain an order for the program. 4.Teach the patient to avoid caffeinated beverages and to drink more fluids during the day.

2.Offer fluids to the patient throughout the day to assure good urinary tract health. Bladder training is a nursing intervention and does not require a health-care provider's order. [Page reference: 671]

The nurse is collecting a urine sample from a patient. Which description indicates an abnormal urine characteristic? 1.The urine is pale golden yellow in color. 2.The urine has a moderate amount of sediment. 3.The urine has an odor that is slightly aromatic. 4.The urine is clear in appearance.

2.The urine has a moderate amount of sediment. When urine has a moderate amount of sediment, it is indicative of uric acid, mucus, bacteria, and phosphates. Normal urine has no sediments. [Page reference: 663]

The nurse works in a long-term care facility and is caring for a patient who is continuously incontinent. The patient is a debilitated older adult male with a diagnosis of diabetes mellitus. The nurse notes the presence of reddened skin on the perineum and buttocks. Which recommendation will the nurse make to the health-care provider? 1.The patient be given an indwelling catheter 2.Prescribed ointment for the patient's skin 3.A condom catheter be applied to the patient 4.The patient be placed on preventive care for skin damage

3.A condom catheter be applied to the patient The use of a condom catheter is the best recommendation the nurse can make to the health-care provider. An order may or may not be required; however, given the patient's diagnosis and risk for poor circulation or infection, at least consultation is appropriate. [Page reference: 674] Test Taking Tip: The question requires critical thinking and the application of clinical problem solving. Which option will make the biggest difference in the patient's condition? Hopefully, you focused on prevention of further damage and complications.

The nurse is providing care for a patient with anuria related to severe vomiting and diarrhea. Which health-care provider treatment order would be unexpected by the nurse? 1.Rehydration 2.Medication 3.Dialysis 4.Rest

3.Dialysis This patient is not a candidate for dialysis because kidney function is likely to resume after the dehydration is addressed. [Page reference: 664]

The nurse is reviewing the urine pH of a patient diagnosed with a urinary tract infection (UTI). Which change will the nurse suggest to the patient to help resolve the UTI? 1.Add more citrus fruits, dairy products, and vegetables to the diet. 2.Wear underwear with cotton panels that touch the perineal area. 3.Increase the protein intake and add cranberries to the daily diet. 4.Be careful about taking bubble baths or using products that cause urethral irritation.

3.Increase the protein intake and add cranberries to the daily diet. When a patient has a UTI, the urine is likely to be alkaline instead of acidic. Increasing protein and adding cranberries will make the urine more acidic and help resolve the existing condition. [Page reference: 679] Test Taking Tip: The question is an example of the need for careful reading. The question asks about resolution of an existing condition and not about prevention of future incidences. The construction does not give you any hints; there are two options about diet and two about behavior. However, there can only be one correct answer, and both of the behavior options are correct statements; both are eliminated.

The nurse is providing care for a patient who had bladder cancer. Surgery was performed to create an ileal conduit. Which care issue does the nurse recognize with this type of diversion surgery? 1.The surgery site is likely to become infected. 2.The created stoma is prone to bleeding. 3.The challenge is for effective skin care. 4.The incidence for incontinence remains.

3.The challenge is for effective skin care. The biggest challenge after formation of an ileal conduit is for effective skin care and maintenance. The area is constantly exposed to urine and is prone to breakdown from maceration. [Page reference: 678]

The nurse has a patient who is on a 24-hour urinary collection. The unlicensed assistive personnel (UAP) reports to the nurse that the final needed urine specimen was accidentally flushed. Which action will the nurse take? 1.Call the health-care provider to ask if a new specimen collection needs to be started. 2.Ask the UAP to add the next collected specimen to the collection jug. 3.Document the specific reasons that caused the collection to be started again. 4.Dispose of the collection jug and start the collection process over.

4.Dispose of the collection jug and start the collection process over. The collected urine and the collection jug will be discarded and the collection process will start over. [Page reference: 666]

The nurse is delegating the process of monitoring a patient's output to an unlicensed assistive personnel (UAP). Which factor related to urinary output will the nurse instruct the UAP to report immediately? 1.If the patient voids every 2 to 4 hours 2.If the a single urinary output is more than 150 mL at a time 3.If the patient voids 200 mL more than the intake 4.If the urinary output is <30 mL an hour for 2 consecutive hours.

4.If the urinary output is <30 mL an hour for 2 consecutive hours. Normal urinary output is at least 30 mL or more per hour. The UAP should be instructed to immediately report to the nurse if the hourly output falls below that level for 2 consecutive hours. [Page reference: 668, 669] Test Taking Tip: This question requires that you apply information from various concepts of nursing. NCLEX expects you to be aware of the parameters for normal body functioning. Apply that knowledge to every scenario, as well as what the nurse will do if that action answers the question. In this question, you must also be aware of appropriate instructions to the UAP.

The nurse has been working with a patient for several weeks on a bladder training program. The patient is incontinent less than 1 hour after scheduled toileting. Which action by the nurse is appropriate? 1.Change the patient's scheduled voiding times to every half-hour. 2.Initiate short periods of fluid limitations in order to promote some success. 3.Make sure that assistive personnel have been following the training schedule. 4.Make sure the patient gets perineal care at least every 2 hours.

4.Make sure the patient gets perineal care at least every 2 hours. Some patients are just not able to achieve success with bladder training. The patient needs to be protected from skin breakdown related to incontinence. The patient should be changed and cleaned at least every 2 hours. [Page reference: 671] Test Taking Tip: It is important for you to understand what interventions can be initiated by the nurse. Reassessment, initiation, and evaluation are always the steps that occur in nursing in an attempt to provide patients with appropriate and effective nursing care.

The nurse works in a health-care provider's office where reagent testing on a urine sample is performed on every new patient. The nurse is aware that which result is unavailable with this testing? 1.The presence of dehydration based on specific gravity 2.The presence of glucose and ketones 3.The presence and level of protein 4.The presence of a sexually transmitted infection

4.The presence of a sexually transmitted infection Reagent testing is not specific to the presence of a sexually transmitted infection. [Page reference: 666]

The nurse is completing an education program focused on urinary catheter placement for female patients. Which statement on the program review is incorrect? 1.Older females may have a urethral meatus inside the vagina. 2.The expected location of the female urinary meatus is between the clitoris and vaginal opening. 3.Patients with long-term placement of a urinary catheter have an obvious urethral meatus. 4.Young, healthy females have an obvious urethral meatus.

4.Young, healthy females have an obvious urethral meatus. Young, healthy females have an unobvious urethral meatus that looks like a dimple or a tiny slit or crease. [Page reference: 675, 676] Test Taking Tip: Remember that knowledge of anatomy and physiology is important for safe and effective nursing interventions. Being able to visualize body systems and landmarks will be useful in answering some questions.

The nurse is caring for a patient with continuous bladder irrigation after prostate surgery. At the end of the shift, the nurse notes that 875 mL of irrigation fluid has been used. The catheter collection bag has been emptied of a total of 1350 mL of fluid. Which will the nurse document as the patient's urinary output for the shift? 1.475 mL 2.1825 mL 1.875 mL 4.1350 mL

475mL 475 mL is the amount of urine produced during the shift. The total amount emptied from the collection bag minus the amount of irrigation fluid leaves the amount of urine passed during the shift. [Page reference: 674]

The nurse works in an acute care facility and is assigned to care for multiple patients. Which patient will the nurse place on strict intake and output (I&0) monitoring? 1.The patient with 1000-mL intake and a 550-mL output in an 8-hour shift 2.The patient with an intake of 1800 mL and an output of 1050 mL in 24 hours 3.The patient with a daily intake of 3000 mL and an output of 2750 mL 4.The patient who is restricted to a 24-hour fluid intake of 1000 mL with an output of 550 mL

The patient with an intake of 1800 mL and an output of 1050 mL in 24 hours yThe difference in the patient's I&O is 750 mL In order to be balanced, the difference of output should fall between 300 and 500 mL less than intake. The nurse will place this patient on I&O for strict monitoring. [Page reference: 666] Test Taking Tip: This question requires multiple steps to find the right answer. You need to identify what normal intake and output means. Each option requires a mathematical evaluation. In addition, you must be aware that the timelines vary. NCLEX will use complex questions to determine critical thinking and appropriate problem solving.