The nurse observes a mother administering ferrous sulfate (iron drops) to her 11-month-old child, followed by 2 ounces (60 mL) of orange juice.

What should be the nurse’s subsequent action?

Answer is... Choice D. Red blood cell count of 2.3 x 10²/L.

Choice A rationale:

In considering the 9-week-old infant scheduled for a cleft lip repair, it's crucial to evaluate various physiological parameters to ensure optimal surgical outcomes. The urine specific gravity of 1.011 falls within the normal range for infants, typically ranging from 1.001 to 1.020. This parameter primarily reflects the concentration of solutes in the urine and is influenced by hydration status. While deviations from the normal range may indicate certain renal conditions or hydration imbalances, a value of 1.011 alone does not signify a critical concern warranting immediate attention before surgery.

Choice B rationale:

A white blood cell count of 10,000/mm³ suggests a normal leukocyte count within the expected range for infants. The normal range for white blood cell count in infants is approximately 6,000 to 17,000/mm³. This parameter serves as an indicator of the body's immune response and can elevate in response to infection or inflammation. However, in the absence of clinical signs or symptoms suggestive of infection, such as fever or localized inflammation at the surgical site, a white blood cell count of 10,000/mm³ is not indicative of an urgent issue necessitating immediate communication with the surgeon.

Choice C rationale:

Weight gain of 2 pounds (0.91 kg) since birth is a positive indicator of growth and development in the infant. Infants typically exhibit rapid weight gain during the first few months of life, with an average weight gain of approximately 0.5 to 1 ounce per day or 1 to 2 pounds per month. This signifies adequate nutritional intake and physiological growth, which are essential for surgical readiness and postoperative recovery. However, while weight gain is an important parameter to monitor in pediatric patients, it does not directly impact the immediate preoperative considerations for a cleft lip repair.

Choice D rationale:

The red blood cell count of 2.3 x 10²/L is the most critical parameter requiring communication with the surgeon before transporting the infant to the surgical suite. A red blood cell count below the normal range can indicate anemia, which may pose risks during surgery, including impaired oxygen delivery to tissues and compromised hemostasis. Normal red blood cell counts in infants typically range from 3.9 to 5.2 x 10^12/L. Anemia in pediatric patients can result from various etiologies, including nutritional deficiencies, hemolytic disorders, or bone marrow suppression. Communicating a low red blood cell count ensures that the surgical team is aware of this potential risk factor and can take appropriate measures, such as transfusion or adjustments to the surgical plan, to mitigate perioperative complications.

Choice A rationale
Juvenile idiopathic arthritis (JIA) is a chronic condition that can cause joint damage and pain. Physical therapy is an essential part of managing JIA, and it often includes a variety of exercises to improve strength, flexibility, and overall joint health. One of the recommended physical activities for JIA patients is exercising in a swimming pool. Water-based exercises, also known as hydrotherapy, are beneficial because the buoyancy, resistance, and warmth of water can help reduce joint stress, increase muscle strength, and improve range of motion.
Choice B rationale
While regular exercise is important for adolescents with JIA, starting a training program that involves weight lifting and running might not be the best option. These activities can put excessive strain on the joints and potentially exacerbate symptoms. It’s crucial to choose low-impact exercises that won’t put too much stress on the joints.
Choice C rationale
Passive range of motion exercises can be beneficial for maintaining joint mobility in JIA patients. However, these exercises alone may not be sufficient for strengthening and mobilizing the joints and surrounding muscles. A comprehensive physical therapy regimen, including a combination of strengthening, stretching, and aerobic exercises, is typically recommended.
Choice D rationale
Splinting can be used in JIA management to help maintain bone and joint alignment and prevent deformities. However, splinting is typically used as an adjunct to other treatments and not as the primary method of encouraging joint mobilization and muscle strengthening. Therefore, while splinting can be beneficial, it should not be the only strategy implemented for physical therapy.