A child is admitted with a suspected diagnosis of Wilms tumor. The nurse should place a sign with which of the following warnings over the child's bed?

A. Cleanse the skin prior to the procedure: Cleansing the skin before applying the transdermal analgesic cream is essential to remove any dirt, oils, or contaminants that could interfere with its absorption. This step helps ensure optimal drug delivery and effectiveness.
B. Apply the medication an hour before the procedure begins: Applying the transdermal analgesic cream an hour before the procedure allows sufficient time for the medication to be absorbed through the skin and reach its therapeutic effect. This timing ensures that the analgesic properties are in place when the IV insertion procedure starts.
C. Use a visual pain rating scale to evaluate the effectiveness of the treatment: Using a visual pain rating scale can help assess the child's pain level before and after applying the transdermal analgesic cream. This evaluation provides valuable feedback on the cream's effectiveness in providing pain relief.
D. Apply to intact skin: Transdermal medications are designed to be absorbed through intact skin. Applying the cream to intact skin ensures proper absorption and effectiveness of the analgesic medication.
E. Spread the cream over the lateral surface of both forearms. This option might not be necessary or appropriate for the intended purpose. The choice of application site for transdermal analgesic cream depends on the specific medication and the area of pain. While the lateral surface of the forearms can be a suitable site, it may not always be necessary or feasible to apply the cream to both forearms, especially if the intended IV insertion site is on one arm.

Let's calculate the amount of amoxicillin suspension the nurse should administer.

Steps:

1. Convert toddler's weight to kilograms (kg):
   • Weight (kg) = Weight (lb) / 2.2 lb/kg
   • Weight (kg) = 33 lb / 2.2 lb/kg
   • Weight (kg) ≈ 15 kg
2. Calculate total daily dose of amoxicillin:
   • Total dose (mg/day) = Dose per kg/day x Weight (kg)
   • Total dose (mg/day) = 30 mg/kg/day x 15 kg
   • Total dose (mg/day) = 450 mg/day
3. Calculate amoxicillin needed per dose (since it's given every 12 hours, we need half the daily dose):
   • Dose per administration (mg) = Total daily dose (mg/day) / Number of doses/day
   • Dose per administration (mg) = 450 mg/day / 2 doses/day
   • Dose per administration (mg) = 225 mg
4. Calculate the volume (mL) of suspension based on the concentration:
   • Concentration (mg/mL) = Amount of amoxicillin (mg) / Volume (mL)
   • We need to rearrange the formula to find the volume (mL): Volume (mL) = Amount of amoxicillin (mg) / Concentration (mg/mL)
   • Known values:
     • Amount of amoxicillin (mg) = 225 mg (calculated in step 3)
     • Concentration (mg/mL) = 200 mg/5 mL (from available suspension)
   • Volume (mL) = 225 mg / (200 mg/5 mL)
   • To simplify the calculation, divide both numerator and denominator by 25: Volume (mL) = (225 mg / 25) / (200 mg/5 mL / 25) Volume (mL) = 9 mL / 4 mL/mL. Pay attention here, dividing by mL/mL is the same as multiplying by 1)
   • Volume (mL) = 9 mL
5. Round the answer to the nearest tenth:
   • Volume (mL) ≈ 5.6 mL

Therefore, the nurse should administer approximately 5.6 mL of amoxicillin suspension per dose.