Which of the following statements by an eighteen-year-old best illustrates their developmental stage?

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.

Choice A reason: This is the correct statement, as the knee-chest position can help reduce the cyanosis and hypoxia in infants with tetralogy of Fallot. This position increases the systemic vascular resistance and decreases the right-to-left shunting of blood, improving the pulmonary blood flow and oxygenation¹².

Choice B reason: This is not a correct statement, as the Trendelenburg position can worsen the cyanosis and hypoxia in infants with tetralogy of Fallot. This position decreases the systemic vascular resistance and increases the right-to-left shunting of blood, reducing the pulmonary blood flow and oxygenation¹².

Choice C reason: This is not a correct statement, as feeding the infant every 2 hours around the clock can cause overfeeding and fatigue in infants with tetralogy of Fallot. These infants may have poor appetite and weight gain due to their cardiac condition, and they may need frequent rest periods during feeding. Feeding the infant on demand or every 3 to 4 hours may be more appropriate¹³.

Choice D reason: This is not a correct statement, as adding rice cereal to the formula can increase the risk of aspiration and choking in infants with tetralogy of Fallot. These infants may have difficulty swallowing and coordinating their breathing, and they may need a thin and easily digestible formula. Adding rice cereal to the formula may also increase the caloric density and volume, which can cause overfeeding and fatigue¹³.