A nurse is assisting with the care of a 2-year-old child.

For each potential provider's prescription, click to specify if the potential prescription is anticipated or contraindicated for the child.

• Ceftriaxone 50 mg/kg/dose IV every 24 hr: The stool sample is positive for Escherichia coli, indicating a bacterial gastroenteritis that may require IV antibiotics due to dehydration and systemic involvement. Ceftriaxone provides broad-spectrum coverage appropriate for pediatric patients with moderate to severe infection. IV administration ensures adequate therapeutic levels while the child is unable to tolerate oral intake.

• Check urine specific gravity every 4 hr: The child shows signs of dehydration: weight loss, concentrated urine, sunken eyes, and poor skin turgor. Monitoring urine specific gravity frequently provides an objective measure of hydration status and kidney perfusion. It allows the nurse to evaluate response to fluid therapy.

• Loperamide PO 1 mg twice daily: Antidiarrheal medications like loperamide are contraindicated in pediatric infectious diarrhea, especially with E. coli. Loperamide slows intestinal motility, which can prolong infection and increase the risk of complications such as hemolytic uremic syndrome. In children, it can also cause central nervous system depression.

• Dextrose 5% sodium chloride IV infusion 60 mL/hr over 6 hr: IV fluid replacement is essential for a child with significant fluid loss from vomiting and diarrhea. Dextrose with sodium chloride provides both hydration and caloric support, correcting dehydration and electrolyte imbalances. Infusion rate is calculated to safely restore intravascular volume without causing fluid overload.

• Obtain arterial blood gases: Arterial blood gas analysis is not necessary in a child with mild to moderate dehydration and stable oxygenation. Vital signs and urine output provide adequate monitoring of perfusion and acid-base status in this context. ABGs are reserved for cases of severe dehydration with respiratory compromise or suspected metabolic derangements.

• Oral rehydration solution 50 mL/kg over 4 hr: Once the child is stable and able to tolerate oral intake, oral rehydration is recommended to maintain fluid and electrolyte balance. ORS replenishes lost sodium and water efficiently and reduces the risk of ongoing dehydration. It is evidence-based for mild to moderate dehydration in pediatric gastroenteritis.