A nurse is preparing to acetaminophen 10/mg/kg PO to a preschool child for fever. The child 22 lb. Available is acetaminophen liquid 160 mg/5 Ml. How many mL should the nurse administer (Round the answer to nearest tenth. Use a leading zero if it applies. Do not use a trailing zero)

Choice A reason: NPH insulin has an onset of 1-2 hours, peaking at 4-12 hours. At 0900, 2 hours post-administration, the effect is minimal, with low hypoglycemia risk. Peak action, when hypoglycemia is most likely due to maximum glucose-lowering effect, occurs later, making this time less critical for monitoring.

Choice B reason: At 0730, only 30 minutes post-NPH insulin, the medication’s onset has not occurred, as it takes 1-2 hours to begin lowering glucose. Hypoglycemia is unlikely this early, as insulin levels are not yet significant. Peak effect at 4-12 hours is when monitoring is critical, making 0730 incorrect.

Choice C reason: NPH insulin peaks at 4-12 hours, with significant glucose-lowering effects by 1100 (4 hours post-0700 injection). Hypoglycemia risk is highest during this period due to insulin’s maximum activity, reducing blood glucose. Monitoring at 1100 is critical to detect and treat low glucose, preventing symptoms like tremors or seizures.

Choice D reason: At 0715, only 15 minutes post-NPH insulin, the medication has not reached its onset (1-2 hours). Hypoglycemia is unlikely, as insulin has not significantly lowered glucose. The peak effect at 4-12 hours is when hypoglycemia risk is highest, making 0715 an incorrect time for monitoring.

Choice A reason: Switching formula does not address projectile vomiting followed by hunger, suggestive of pyloric stenosis, a mechanical obstruction. Changing formula may delay diagnosis and treatment, risking dehydration or malnutrition. Immediate clinical evaluation is needed to confirm the condition and plan surgical intervention, making this response inappropriate.

Choice B reason: Frequent burping reduces air in the stomach but does not address projectile vomiting from pyloric stenosis, caused by pyloric muscle hypertrophy. This symptom requires surgical evaluation, not feeding adjustments. Burping is ineffective, as the obstruction persists, making clinical evaluation the priority to prevent complications.

Choice C reason: Projectile vomiting with hunger in a 2-month-old suggests pyloric stenosis, requiring urgent clinical evaluation for diagnosis via ultrasound and surgical planning (pyloromyotomy). Prompt assessment prevents dehydration, electrolyte imbalances, and growth issues, making this the appropriate response to ensure timely intervention for this serious condition.

Choice D reason: Oral rehydration solution treats dehydration but does not address the underlying cause of projectile vomiting, likely pyloric stenosis. This delays definitive surgical treatment, risking worsening dehydration or malnutrition. Clinical evaluation is critical to confirm the diagnosis, making rehydration a secondary, not primary, response to the symptoms.