The mother of a 2-month-old infant is afraid of giving her child immunizations and asks why they are necessary. The nurse's best response would be:

Choice A reason: Placing the infant in Trendelenburg position (head lower than feet) after eating is not a good suggestion to minimize reflux. This position may increase the abdominal pressure and the risk of aspiration. The infant should be placed in an upright or semi-upright position (30 to 45 degrees) for at least 30 minutes after feeding to reduce reflux and prevent regurgitation¹.

Choice B reason: Thickening the formula with rice cereal is a common and effective suggestion to minimize reflux. The rice cereal increases the viscosity and weight of the formula, making it less likely to flow back into the esophagus. The amount of rice cereal added should be about 1 teaspoon per ounce of formula, unless otherwise instructed by the health care provider².

Choice C reason: Giving continuous nasogastric tube feedings is not a necessary or desirable suggestion to minimize reflux. Nasogastric tube feedings are used for infants who have severe reflux and cannot tolerate oral feedings, or who have other medical conditions that require tube feeding. Nasogastric tube feedings may have complications such as infection, irritation, displacement, or obstruction of the tube. They may also interfere with the infant's oral development and bonding with the caregiver³.

Choice D reason: Giving larger, less frequent feedings is not a helpful suggestion to minimize reflux. Larger feedings may overfill the stomach and increase the pressure on the lower esophageal sphincter, which is the muscle that prevents reflux. Less frequent feedings may also make the infant more hungry and irritable, and cause more crying and swallowing of air. The infant should be given smaller, more frequent feedings to reduce reflux and promote digestion.

Choice A reason: This is not the correct order, as IV fluids at 2x maintenance are not enough to restore the blood volume and perfusion in hypovolemic shock. The child needs a rapid IV fluid bolus of 20 ml/kg to replace the fluid losses and improve the hemodynamic status¹.

Choice B reason: This is not the correct order, as medication to support cardiac function should be given after the IV fluid bolus, not before. The fluid bolus is the first priority to increase the preload and cardiac output in hypovolemic shock. Medications such as inotropes or vasopressors may be needed if the fluid bolus is not effective or causes adverse effects¹².

Choice C reason: This is the correct order, as oxygen, IV fluid bolus of 20 ml/kg, and medications to support cardiac function are the appropriate interventions for hypovolemic shock. Oxygen is given to improve the oxygen delivery and tissue perfusion. IV fluid bolus of 20 ml/kg is given to restore the blood volume and improve the hemodynamic status. Medications such as inotropes or vasopressors are given to support the cardiac function and maintain the blood pressure¹².

Choice D reason: This is not the correct order, as IV fluid bolus of 10 ml/kg is not enough to restore the blood volume and perfusion in hypovolemic shock. The child needs a rapid IV fluid bolus of 20 ml/kg to replace the fluid losses and improve the hemodynamic status¹.