NCLEX · Basic Care and Comfort

A client is prescribed a 1,500 mL fluid restriction over 24 hours. The day shift (7a-3p) and evening shift (3p-11p) typically use more of the allotment than night shift. How should the nurse distribute the fluid?

Correct answer

Distribute proportionally with more during waking hours — commonly day shift 800 mL, evening shift 500 mL, night shift 200 mL — to accommodate meals, medications, and the client's preference while staying within the total limit

  1. A Give all 1,500 mL during the day shift
  2. B Distribute proportionally with more during waking hours — commonly day shift 800 mL, evening shift 500 mL, night shift 200 mL — to accommodate meals, medications, and the client's preference while staying within the total limit
  3. C Let the client drink freely until the limit is reached
  4. D Give equal amounts each shift regardless of activity

Why this is the answer

FLUID RESTRICTION MANAGEMENT: Distribute the daily allotment to match the client's activity and needs — more during waking/meal hours, less at night. TYPICAL DISTRIBUTION (1,500 mL example): Day (7a-3p): ~800 mL (breakfast, lunch, morning/noon meds, most active); Evening (3p-11p): ~500 mL (dinner, evening meds); Night (11p-7a): ~200 mL (minimal, just for night meds if needed); RATIONALE: Accommodates meals and medications; respects the client's normal drinking patterns; prevents the client from using the entire allotment early and being thirsty all evening/night; PRACTICAL MEASURES: Use smaller cups (perception of more fluid); ice chips (count as 1/2 their volume); frequent oral care for thirst; sugar-free hard candy or gum to stimulate saliva; involve the client in planning; track ALL intake (IV, meds, foods that are liquid at room temp like gelatin and ice cream); CONDITIONS requiring fluid restriction: heart failure, SIADH, renal failure, hyponatremia; LPN role: distribute and track fluids, educate the client, manage thirst.
Source: NCLEX-PN Physiological — Basic Care, Fluid Restriction Distribution