A child is ordered Digoxin 25 mcg IV twice a day.

The child weighs 13.2 lbs.

The pediatric dose is 25-50 mcg/kg/day.

Available is 0.1 mg/mL ampule.

What would be drawn up for a single dose?

Choice A rationale

While clients with Cushing's syndrome may experience fatigue due to elevated cortisol levels affecting sleep patterns and muscle catabolism, clustering activities only in the morning may not adequately address the fluctuating energy levels or provide sufficient rest periods throughout the day. A more balanced approach involving rest periods and activity modification throughout the day is generally more beneficial.

Choice B rationale

Clients with Cushing's syndrome often experience fluid retention and edema due to the mineralocorticoid effects of excess cortisol. Therefore, increasing fluid intake would exacerbate fluid overload rather than alleviate symptoms. Fluid restriction and diuretic therapy may be necessary to manage fluid balance and prevent complications like hypertension and heart failure.

Choice C rationale

Cushing's syndrome is characterized by endogenous overproduction of cortisol, meaning the body already produces too much. Requesting a medical prescription for cortisol would further elevate cortisol levels, worsening the client's symptoms and potentially leading to adrenal crisis if exogenous cortisol is administered in addition to already elevated endogenous levels. Management focuses on reducing cortisol.

Choice D rationale

Assessing daily weights is crucial for clients with Cushing's syndrome due to the propensity for fluid retention and weight gain caused by increased mineralocorticoid activity of cortisol. Daily weights provide an objective measure of fluid balance and can indicate exacerbation or improvement of edema, helping guide interventions and monitor treatment effectiveness. Normal weight fluctuation should be within 1-2 kg in 24 hours.

Choice A rationale

Local funeral home morgues would be quickly overwhelmed and inadequate for mass casualties resulting from a nuclear detonation. The sheer volume of bodies would exceed their capacity, and they may lack the specialized facilities required for handling contaminated remains, posing significant public health and safety risks. Normal morgue capacity is designed for typical mortality rates.

Choice B rationale

Refrigerated trucks provide a temporary, scalable solution for storing a large number of bodies, helping to prevent decomposition and the spread of pathogens in a mass casualty event. This method allows for organized collection and identification processes to be established while awaiting more permanent arrangements, crucial in disaster response. Proper refrigeration maintains body integrity.

Choice C rationale

Hospital morgues, like local funeral home morgues, have limited capacity and are primarily designed for routine patient deaths. In a large-scale disaster, they would be rapidly overfilled, compromising their ability to manage current hospital fatalities and posing logistical challenges for body management and identification. Normal hospital morgues are equipped for standard operations.

Choice D rationale

Mass graves are a last resort in extreme mass casualty events when conventional methods of body disposal are overwhelmed or impractical due to scale, contamination, or resource limitations. While a somber decision, they can be a necessary measure to manage large numbers of deceased individuals safely and efficiently, preventing widespread public health crises. Proper procedures minimize environmental impact.