The physician orders Lanoxin elixir 80 micrograms by mouth for a patient with congestive heart failure.

Available: 50 micrograms per milliliter.

How many milliliters will the nurse administer.

Round to the tenths or first decimal place.

Choice A rationale

Administering 6 L of oxygen is an important intervention in sickle cell crisis to address tissue hypoxia. However, a severe headache in a child with vaso-occlusive crisis may signal a more critical complication like a cerebrovascular accident (stroke), which necessitates immediate neurological assessment before other routine interventions.

Choice B rationale

A severe headache in a child experiencing a sickle cell vaso-occlusive crisis is a red flag for central nervous system complications, most critically a stroke, which requires immediate and detailed neurological assessment. Establishing the baseline status is the priority to rapidly detect changes and initiate emergency stroke protocol and treatment.

Choice C rationale

Administering a narcotic analgesic is crucial for pain management in a vaso-occlusive crisis. However, giving an opioid before assessing neurological status could potentially mask or alter signs of a life-threatening stroke or increased intracranial pressure, delaying critical interventions for a neurological emergency.

Choice D rationale

Increasing the IV rate is an appropriate intervention to promote hydration and hemodilution, which can help reverse the sickling process. While important, addressing the severe headache requires first ruling out or confirming a serious neurological event through a focused assessment, making assessment the immediate priority.

Choice A rationale

While a shunt insertion for hydrocephalus aims to drain excess cerebrospinal fluid and reduce intracranial pressure, thereby minimizing brain damage, it does not completely eliminate the risk of developmental problems. The extent of pre-existing neurological damage influences long-term outcomes, and some children may still experience learning disabilities or motor deficits requiring ongoing therapy and support.

Choice B rationale

The risk of shunt infection is present throughout the device's life, although the greatest risk does occur in the early post-operative period, typically within the first few months. Infections can be caused by skin flora introduced during surgery and can lead to serious complications like ventriculitis or septicemia, often requiring shunt removal and IV antibiotics.

Choice C rationale

Shunts have a fixed length; as the child grows, the distal catheter (the end draining the fluid) may no longer reach the peritoneal cavity or atrium, leading to shunt malfunction. Furthermore, components can fail over time due to wear or blockage, necessitating surgical revisions or replacement throughout the individual's lifetime to maintain proper cerebrospinal fluid drainage.

Choice D rationale

A ventriculoperitoneal or ventriculoatrial shunt is a palliative measure that manages the primary complication of hydrocephalus, which is increased intracranial pressure. However, shunts are prone to complications such as malfunction due to blockage, disconnection, or infection, and they do not cure the underlying cause, meaning that further complications remain a possibility.