The physician orders Zithromax 500 mg IVPB every 24 hours.

The medication is supplied in 500 mg/250 mL to infuse over 90 minutes.

Calculate the flow rate in milliliters per hour.

(ROUND TO WHOLE NUMBER: LABEL CORRECTLY TO RECEIVE CREDIT)

Choice A rationale

Determining areas of tenderness is typically done through palpation, which should follow auscultation to avoid altering bowel sounds. Performing palpation first could elicit guarding or muscle rigidity, making subsequent auscultation less accurate and potentially increasing patient discomfort.

Choice B rationale

Auscultation precedes percussion and palpation of the abdomen to ensure that bowel sounds are not artificially stimulated or inhibited. Mechanical manipulation of the abdomen through percussion and palpation can alter the frequency and character of bowel sounds, leading to inaccurate assessment of intestinal motility.

Choice C rationale

While patient comfort is important, the primary reason for the sequence of abdominal assessment is scientific accuracy. Manipulating the abdomen prior to auscultation can stimulate peristalsis, creating false-positive bowel sounds or increasing existing ones, thus obscuring the true baseline activity.

Choice D rationale

Distortion of vascular sounds like bruits and hums is less likely to be significantly affected by percussion and palpation compared to bowel sounds. Vascular sounds originate from blood flow dynamics, which are not as readily influenced by external mechanical manipulation as the peristaltic activity of the intestines.

Choice A rationale

Positioning a school-aged child in the supine position with the head tilted backward during nose drop administration allows gravity to assist the medication in flowing into the nasal cavity and reaching the intended mucosal surfaces. This anatomical alignment ensures optimal distribution and absorption of the drug, maximizing its therapeutic effect on the nasal passages.

Choice B rationale

Instructing the child to breathe deeply through the nose immediately after drop insertion could cause the medication to be inhaled into the lungs or swallowed, reducing its intended topical effect on the nasal mucosa. Proper technique involves maintaining the head position for a few moments to allow absorption.

Choice C rationale

Returning unused nose drops from the dropper to the medication bottle is an unsafe practice that can lead to contamination of the entire medication supply. The dropper tip, once it has touched the patient's nostril, is no longer sterile and can introduce microbes into the sterile solution.

Choice D rationale

Positioning the tip of the medication dropper within a nostril can cause discomfort, irritation, or even injury to the delicate nasal mucosa. The dropper should be held just above the nostril, allowing the drops to fall into the nasal passage without direct contact, ensuring patient safety and comfort.