The healthcare provider prescribes methylprednisolone 1 mg/kg IM every 12 hours for inflammation for a child who weighs 58 pounds.

The vial is labeled, "40 mg/mL.”. How many mL should the practical nurse (PN) administer with each dose? (Enter the numerical value only. If rounding is required round to the nearest tenth.)

Choice A rationale

Collecting a urine specimen for electrolytes and protein would provide data related to renal function and fluid balance, but it does not directly address the client's current subjective symptoms of restlessness and apprehension. These symptoms are more indicative of potential hypoxemia or a psychological response to stress, which requires a more immediate and direct assessment and intervention focused on maternal-fetal well-being rather than baseline lab work. Normal urine specific gravity is 1.005-1.030, and protein should be negative.

Choice B rationale

Moving the client into a dorsal recumbent position can actually compress the inferior vena cava, leading to supine hypotensive syndrome, which further compromises placental perfusion and exacerbates fetal distress. This position is contraindicated in laboring clients, particularly when signs of potential distress are present. The ideal position for laboring clients is typically left lateral, which optimizes uterine perfusion and oxygenation.

Choice C rationale

Encouraging the client to push with the next contraction is inappropriate given the client's symptoms of restlessness and apprehension, especially at 42 weeks gestation with chorioamnionitis. These symptoms could indicate evolving fetal distress or a change in maternal status requiring further assessment, not active pushing. Pushing without complete cervical dilation can lead to cervical edema or trauma.

Choice D rationale

Providing information about the baby's status can alleviate the client's anxiety and apprehension by addressing her immediate concerns about the well-being of her fetus. Restlessness and apprehension in a laboring client, particularly with a diagnosis of chorioamnionitis, can be a symptom of hypoxemia or other complications. Open communication and reassurance are crucial in managing maternal stress and promoting a sense of control.

Choice A rationale

Impulsive and hyperactive behaviors are typically associated with conditions such as attention-deficit/hyperactivity disorder (ADHD), which involves neurodevelopmental differences affecting executive function and impulse control. While these behaviors can sometimes lead to accidents, they are not a direct sign of secondary enuresis.

Choice B rationale

Involuntary passage of feces, known as encopresis, is a distinct elimination disorder characterized by the repeated passage of stool into inappropriate places, often due to chronic constipation and overflow incontinence. It is a separate condition from enuresis, which specifically refers to involuntary urination.

Choice C rationale

Increased thirst, or polydipsia, is a common symptom of conditions like diabetes mellitus or diabetes insipidus, where the body attempts to compensate for fluid imbalances or high glucose levels. While some medical conditions causing enuresis might also involve increased thirst, it is not a direct sign of enuresis itself.

Choice D rationale

Declining invitations for sleepovers is a behavioral manifestation often observed in children with enuresis. The fear of embarrassment and shame associated with involuntary urination during sleep can lead them to avoid situations where their condition might be exposed, such as overnight stays at friends' houses.