Your patient weighs 59 pounds. What is the daily fluid requirement in mL for this patient? —

Choice A rationale

Trust versus mistrust is the first stage of Erikson's psychosocial development, occurring from birth to about 18 months. Successful completion results in confidence and security, while failure leads to anxiety and mistrust of the world. This stage is not relevant to the adolescent's struggle for social acceptance and self-image among peers.

Choice B rationale

Autonomy versus shame and doubt is Erikson's second stage, typically seen in the toddler period (18 months to 3 years). This stage focuses on gaining independence in basic self-care activities, such as toilet training and walking. The conflict is centered on self-control and the ability to act on one's own, which differs from the adolescent need for peer identity.

Choice C rationale

Identity versus role confusion is Erikson's fifth stage, which is the central developmental task of adolescence. During this stage, the teenager is trying to figure out "who they are" and where they fit in the world, often through experimentation with different roles, values, and peer groups. The desire to dress like others reflects the search for a sense of belonging and a unified self-concept.

Choice D rationale

Initiative versus inferiority is Erikson's fourth stage, usually seen in school-age children (6 to 12 years). This stage focuses on developing a sense of competence and pride in schoolwork and other activities, comparing their abilities with peers. While peer interaction is important, the core conflict is about competence and achievement, not the broader self-identity search seen in the teenage years.

Step 1 is: Calculate the minimum safe dose for 24 hours. 5 mcg/kg/24 hr × 16.1 kg = 80.5 mcg/24 hr.

Step 2 is: Calculate the maximum safe dose for 24 hours. 6 mcg/kg/24 hr × 16.1 kg = 96.6 mcg/24 hr.

Step 3 is: Compare the ordered dose to the safe range. The ordered dose is 150 mcg. The safe dose range is 80.5 mcg to 96.6 mcg. The ordered dose (150 mcg) is higher than the maximum safe dose (96.6 mcg). The ordered dose is NOT safe, so the initial answer is B. However, the question choices are A. Yes, B. No, C. The dose is too low for the client's weight, D. The safe dose range is too narrow to determine. Since the ordered dose is too high, the most accurate choice indicating it is NOT safe is "No".

Choice A rationale

The statement "Yes" is incorrect because the ordered dose of 150 mcg is significantly above the calculated safe range maximum of 96.6 mcg/24 hr. Administering an overdose of levothyroxine can lead to hyperthyroidism symptoms like tachycardia, heat intolerance, and anxiety, which is not a safe practice.

Choice B rationale

The statement "No" is correct because the ordered dose of 150 mcg is not within the therapeutic and safe range of 80.5 mcg to 96.6 mcg for a 16.1 kg child. Dosing levothyroxine accurately is crucial as it has a narrow therapeutic index, and excess dosage carries risks of serious cardiac side effects.

Choice C rationale

The statement "The dose is too low for the client's weight" is incorrect. The maximum safe dose is 96.6 mcg, and the ordered dose is 150 mcg, which makes the ordered dose too high, not too low. Giving an excessively high dose can cause adverse effects due to drug toxicity or an induced hypermetabolic state in the body systems.

Choice D rationale

The statement "The safe dose range is too narrow to determine" is incorrect. The safe dose range is clearly defined by the provided parameters as 80.5 mcg to 96.6 mcg/24 hr. The calculation provides a precise and sufficient range to determine that the ordered dose of 150 mcg is clearly unsafe and should be questioned by the nurse.