The Health Care Provider orders gentamicin (Garamycin) for a 2-day old newborn whose weight is 1,653 grams and 38 centimeters long.

The drug reference states neonatal dosage of gentamicin for infants less than 1 week of age is 2.5 mg/kg every 12-24 hours.

The nurse would expect to administer which following safe, daily dosages for this medication? Round your answer to 2 decimal places.

Choice A rationale

While ataxia, which is impaired coordination, and seizures may occur in children with brain tumors due to pressure or irritation of specific brain regions, they are generally less consistently reported as the earliest or most frequent hallmark symptoms compared to symptoms related to increased intracranial pressure. The primary location of the tumor dictates the presence of these focal neurological signs, making them variable.

Choice B rationale

Poor fine and gross motor control can be observed if the tumor is located in the cerebellum or motor cortex, but this is a non-specific finding that could be related to many other pediatric neurological or developmental disorders. The gradual onset of motor changes often makes them less reliable as the hallmark sign compared to acute symptoms of pressure.

Choice C rationale

Fever and irritability are common but highly non-specific symptoms in pediatrics, frequently associated with routine infections. While some brain tumors may cause fever, and irritability is a sign of general discomfort or pain, these are rarely the primary indicators pointing definitively toward a brain tumor diagnosis.

Choice D rationale

Headache and vomiting, especially when occurring in the morning or upon waking, are classic symptoms indicating increased intracranial pressure (ICP), which is a common consequence of a growing mass in the fixed space of the skull. The change in position from lying down increases ICP, leading to these characteristic symptoms.

Choice A rationale

Oral administration of botulinum toxin is not effective for treating spasticity in cerebral palsy. The toxin, a neurotoxin that blocks acetylcholine release at the neuromuscular junction, would be rapidly inactivated by gastric acid and digestive enzymes in the gastrointestinal tract, preventing it from reaching the targeted spastic muscles.

Choice B rationale

Subcutaneous injection of botulinum toxin is not the correct route for treating focal spasticity. This route targets the layer beneath the skin and is often used for systemic absorption, but it does not adequately deliver the drug directly into the bulk of the affected, spastic muscles to achieve localized chemodenervation.

Choice C rationale

Botulinum toxin is administered via intramuscular injection directly into the specific muscles identified as being hypertonic or spastic. This localized injection allows the toxin to block the release of acetylcholine at the presynaptic terminals of the neuromuscular junction, thereby temporarily paralyzing or relaxing the targeted muscles for several months.

Choice D rationale

Intravenous infusion of botulinum toxin is not used for treating spasticity because this route would lead to systemic distribution. This would result in widespread muscle weakness or paralysis, which is an undesirable and potentially dangerous side effect, rather than the intended localized reduction in focal spasticity.