A child weighing 20 kg with rule out sepsis is admitted to the hospital. Cefotaxime 700 mg IV q6 hrs is ordered. Safe dose is 50-200 mg/kg/day. Is this a safe dose? True means it is safe; false means it is not safe.

Choice A reason: Informing the family that supplemental feeding through an N/G tube will probably be needed is not a correct feeding instruction for a newborn with cleft lip and palate. An N/G tube is a nasogastric tube that is inserted through the nose into the stomach to provide nutrition. It is usually used for infants who have severe feeding difficulties or other medical conditions that require tube feeding. However, most infants with cleft lip and palate can be fed orally with proper techniques and equipment, and do not need an N/G tube.

Choice B reason: Demonstrating feeding the infant using the squeeze bottle and ESSR method of feeding is a correct and helpful feeding instruction for a newborn with cleft lip and palate. A squeeze bottle is a special bottle that has a soft nipple and a valve that allows the caregiver to control the flow of milk by squeezing the bottle. The ESSR method stands for Enlarge nipple opening, Stimulate the suck reflex, Swallow, and Rest. It is a technique that helps the infant to suck and swallow effectively, and to prevent choking or aspiration. The nurse should show the family how to use the squeeze bottle and the ESSR method, and let them practice under supervision.

Choice C reason: Instructing the parents to add rice cereal to the formula is not a necessary or advisable feeding instruction for a newborn with cleft lip and palate. Rice cereal is sometimes added to the formula to thicken it and reduce the risk of reflux or regurgitation. However, it is not recommended for infants younger than four months, as it may cause constipation, overfeeding, or allergic reactions. It may also interfere with the absorption of iron and other nutrients. Rice cereal is not a substitute for proper feeding techniques and equipment for infants with cleft lip and palate.

Choice D reason: Infants with cleft lip and palate usually have an easy time breastfeeding is a false and misleading feeding instruction for a newborn with cleft lip and palate. Breastfeeding is the ideal way of feeding a newborn, as it provides optimal nutrition, immunity, and bonding. However, breastfeeding can be challenging for infants with cleft lip and palate, as they may have difficulty creating a seal, latching on, or sucking effectively. Some infants may be able to breastfeed with the help of a nipple shield, a breast pump, or a supplemental nursing system. However, others may need to be fed with a bottle or a cup. The nurse should support the mother's choice of feeding method, and provide education and resources to help her succeed.

Choice A reason: She has green, loose stools with cow's milk is not a typical sign of gastroesophageal reflux in a 12-month-old. Green, loose stools may indicate an infection, an allergy, or a malabsorption problem. Cow's milk may cause an allergic reaction or intolerance in some infants, but it does not cause reflux. Reflux is when stomach contents flow back up into the esophagus, causing vomiting, regurgitation, or heartburn.

Choice B reason: She coughs and spits up while eating foods is a common symptom of gastroesophageal reflux in a 12-month-old. Coughing and spitting up may occur because the food or liquid irritates the throat or the airway, or because the infant swallows air while feeding. Reflux may be more frequent or severe when the infant eats solid foods, as they may be harder to digest or may trigger the lower esophageal sphincter to relax. Reflux may also be worse when the infant lies down, as gravity does not help to keep the food in the stomach.

Choice C reason: She has projectile vomiting after feeding is not a usual sign of gastroesophageal reflux in a 12-month-old. Projectile vomiting is when the vomit is ejected forcefully and travels a distance. It may indicate a serious condition such as pyloric stenosis, which is a narrowing of the outlet of the stomach that prevents food from passing into the small intestine. Projectile vomiting may also be caused by a bowel obstruction, a brain tumor, or a metabolic disorder.

Choice D reason: Her stools are hard and black in color is not a normal sign of gastroesophageal reflux in a 12-month-old. Hard and black stools may indicate constipation, bleeding in the upper gastrointestinal tract, or ingestion of iron supplements or certain foods. Reflux does not affect the color or consistency of the stools, unless there is an underlying condition such as an infection, an allergy, or a malabsorption problem.