A child experiencing an allergic reaction receives a prescription for epinephrine 0.01 mg/kg SUBQ.

The child weighs 66 pounds, and the medication is labeled "Epinephrine 1mg/mL.”. How many mL should the practical nurse (PN) administer to this child? (Enter the numerical value only. If rounding is required, round to the nearest tenth.)

Choice A rationale

Deep tendon reflexes are neurological assessments primarily used to evaluate neuromuscular excitability, particularly in conditions like preeclampsia where magnesium sulfate is administered. They are not indicated for managing fetal heart rate decelerations or chorioamnionitis, as these conditions do not directly impact spinal reflex arcs or necessitate this specific neurological monitoring. Normal reflexes range from 1+ to 2+.

Choice B rationale

Late decelerations, occurring after the peak of a contraction, indicate uteroplacental insufficiency, meaning reduced blood flow and oxygen to the fetus. A left side-lying position alleviates compression of the vena cava and aorta by the gravid uterus, thereby increasing venous return to the heart and improving uterine perfusion and oxygenation to the fetus, which is a crucial intervention.

Choice C rationale

Insertion of an indwelling urinary catheter to monitor hourly output is primarily indicated for assessing renal perfusion and fluid balance, particularly in critically ill clients or those at risk for fluid volume alterations, such as severe preeclampsia. It does not directly address or correct the underlying physiological cause of late fetal heart rate decelerations. Normal urine output is typically greater than 30 mL/hour.

Choice D rationale

Collecting a urine specimen for electrolytes and protein is a diagnostic measure for evaluating renal function, hydration status, and potential complications like preeclampsia, which presents with proteinuria. While important for overall assessment, it does not provide an immediate physiological intervention to improve uteroplacental perfusion and resolve acute fetal distress manifested by late decelerations.

Choice A rationale

Collecting a urine specimen for electrolytes and protein would not directly address the client's acute symptoms of restlessness and apprehension. While important for general assessment, these lab parameters are not the primary indicators of fetal distress or immediate maternal physiological deterioration in this context. Normal electrolyte ranges: sodium 135-145 mEq/L, potassium 3.5-5.0 mEq/L. Protein in urine is usually negative.

Choice B rationale

Moving the client into a dorsal recumbent position can actually exacerbate vena caval compression in a laboring client at 42-weeks gestation, potentially leading to supine hypotensive syndrome, which would worsen rather than alleviate restlessness and apprehension due to decreased cardiac output and uteroplacental perfusion.

Choice C rationale

Encouraging the client to push with the next contraction is inappropriate given her symptoms of restlessness and apprehension. These symptoms could indicate evolving complications, such as hypoxemia or even early stages of hypovolemic shock, requiring immediate assessment of vital signs and fetal well-being before encouraging active labor efforts.

Choice D rationale

Providing information about the baby's status can help alleviate the client's apprehension, especially if her symptoms are related to anxiety about the labor process or fetal well-being, which is common in intrapartum fever. Scientific rationale supports addressing psychological distress to improve coping mechanisms.