Keeping an accurate I&O record is part of the nurse assistant’s duties. If the client is incontinent, how should the nurse assistant document the output?
  1. Inform the nurse that the client has voided or defecated.
  2. Do not document at all, since it cannot be measured.
  3. Record on the output side of the I&O sheet each time the bed is wet.
  4. Review the client’s intake and record the same amount in the output side of the I&O sheet.
Explanation
Answer: C - If the client is incontinent (cannot control bowels and/or urine), record this on the output side of the I&O sheet each time the bed is wet. Even though the urine cannot be measured, it will be obvious that the client’s kidneys are functioning.
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