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: This is not a correct statement, as bradycardia, bounding pulses, and cyanosis are not typical signs and symptoms of moderate congestive heart failure. Bradycardia may indicate a heart block or a vagal response, bounding pulses may indicate a patent ductus arteriosus or aortic regurgitation, and cyanosis may indicate a severe right-to-left shunt or a pulmonary embolism¹.

Choice B reason: This is not a correct statement, as overdiuresis, increased appetite, and increased thirst are not typical signs and symptoms of moderate congestive heart failure. Overdiuresis may indicate a renal dysfunction or a diuretic overdose, increased appetite may indicate a normal growth spurt or a metabolic disorder, and increased thirst may indicate dehydration or diabetes¹.

Choice C reason: This is not a correct statement, as wheezing, pallor, and capillary refill time < 2 seconds are not typical signs and symptoms of moderate congestive heart failure. Wheezing may indicate a bronchospasm or an asthma attack, pallor may indicate anemia or shock, and capillary refill time < 2 seconds may indicate a normal or increased peripheral perfusion¹.

Choice D reason: This is the correct statement, as tachypnea, cough, and tachycardia are typical signs and symptoms of moderate congestive heart failure. Tachypnea may indicate a respiratory distress or a pulmonary edema, cough may indicate a fluid accumulation or an infection in the lungs, and tachycardia may indicate a compensatory mechanism or a cardiac arrhythmia¹².

Choice A reason: This is the correct statement, as the knee-chest position can help reduce the cyanosis and hypoxia in infants with tetralogy of Fallot. This position increases the systemic vascular resistance and decreases the right-to-left shunting of blood, improving the pulmonary blood flow and oxygenation¹².

Choice B reason: This is not a correct statement, as the Trendelenburg position can worsen the cyanosis and hypoxia in infants with tetralogy of Fallot. This position decreases the systemic vascular resistance and increases the right-to-left shunting of blood, reducing the pulmonary blood flow and oxygenation¹².

Choice C reason: This is not a correct statement, as feeding the infant every 2 hours around the clock can cause overfeeding and fatigue in infants with tetralogy of Fallot. These infants may have poor appetite and weight gain due to their cardiac condition, and they may need frequent rest periods during feeding. Feeding the infant on demand or every 3 to 4 hours may be more appropriate¹³.

Choice D reason: This is not a correct statement, as adding rice cereal to the formula can increase the risk of aspiration and choking in infants with tetralogy of Fallot. These infants may have difficulty swallowing and coordinating their breathing, and they may need a thin and easily digestible formula. Adding rice cereal to the formula may also increase the caloric density and volume, which can cause overfeeding and fatigue¹³.