Ricky, Age 18, Is Admitted with a Decreased Level of Consciousness

Multiple Choice

Ricky, age 18, is admitted with a decreased level of consciousness secondary to a closed head injury resulting from a fall while roller-skating. His urine output is 500cc from 6 AM to 11 AM, 1,000cc from 11 AM to 2 PM, and 350cc from 2 PM to 3 PM. Which of the following actions by the nurse is appropriate?

A) Realize that this is normal urine output and continue to monitor Ricky
B) Encourage Ricky to drink 8 to 10 glasses of fluid daily
C) Check the urine specific gravity and report any abnormality as well as the urine output
D) Decrease the IV rate from 100cc/hr to 25cc/hr, suspecting fluid excess