The provider orders a Heparin infusion to run 950 units/hr. The medication is supplied as 25,000 units/250 mL NSS.

At what rate would the infusion pump be set at?

Condition: Spasmodic croup
2 actions: Administer a single dose of oral dexamethasone; Position the child upright and provide humidified air
2 parameters: Respiratory rate and oxygen saturation; Stridor and work of breathing

Rationale for correct condition
Spasmodic croup presents in toddlers with sudden onset of nighttime barking cough without fever. It is often associated with atopy, such as eczema. The child is playful and afebrile with no daytime distress. Lungs are clear with normal oxygen saturation (98%) and respiratory rate (28/min; normal 20–40/min for toddlers). No infectious signs are present, supporting a diagnosis of spasmodic croup.

Rationale for correct actions
Oral dexamethasone reduces airway inflammation in croup and decreases symptom duration through corticosteroid-mediated cytokine inhibition. A single dose is effective in mild-to-moderate cases, reducing subglottic edema.
Positioning the child upright and using humidified air improves airflow by decreasing upper airway narrowing and soothing inflamed mucosa. It is a first-line supportive measure to alleviate nocturnal symptoms.

Rationale for correct parameters
Monitoring respiratory rate and oxygen saturation assesses oxygenation and ventilation status. Tachypnea or desaturation may signal worsening airway obstruction.
Stridor and work of breathing are key signs of upper airway compromise. Increased inspiratory effort or stridor at rest requires escalation of care.

Rationale for incorrect conditions
Respiratory syncytial virus causes wheezing, fever, and lower respiratory symptoms, which are absent here.
Epiglottitis presents with high fever, drooling, and toxic appearance, not seen in this playful child.
Acute laryngitis lacks the barking cough and is uncommon in toddlers.

Rationale for incorrect actions
Preparing for intubation is reserved for airway obstruction, which is not present.
Broad-spectrum antibiotics are ineffective in non-bacterial etiologies like croup.
Ribavirin targets RSV, which this child does not have.

Rationale for incorrect parameters
Swallowing ability and drooling assess epiglottitis, not croup.
Fever and WBC count are normal and nonspecific.
Wheezing and lung sounds assess lower airway disease, not upper airway croup.

Take-home points:

• Spasmodic croup causes nighttime barking cough without fever in toddlers.
• Differentiate from RSV (wheezing), epiglottitis (drooling), and laryngitis (hoarseness).
• Steroids and humidified air reduce symptoms in mild croup.
• Key assessments include stridor and respiratory status, not fever or wheezing.

Choice A rationale

A normal serum sodium level ranges from 135 to 145 mEq/L. A value of 120 mEq/L is significantly below the normal range, indicating hyponatremia, not an elevated level. Therefore, reporting it as elevated would be incorrect.

Choice B rationale

While laboratory errors can occur, a serum sodium level of 120 mEq/L in a client with chronic renal failure is a plausible finding due to impaired fluid and electrolyte balance, making a repeat analysis not the immediate primary interpretation without further clinical context.

Choice C rationale

While electrolyte abnormalities are common in chronic renal failure, a serum sodium of 120 mEq/L is a low sodium level (hyponatremia), not necessarily an "expected" abnormality in the sense of being benign or typical without specific context. It reflects a significant imbalance.

Choice D rationale

Chronic renal failure often leads to fluid retention due to impaired kidney excretion. This excessive water retention dilutes the body's sodium concentration, leading to a condition known as dilutional hyponatremia, where the total body sodium may be normal or even elevated, but its concentration is lowered by the excess fluid.