A nurse is caring for a client who is receiving morphine 2 mg subcutaneously every 4 hr for pain. The medication is available in a vial containing 10 mg/mL. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

A. Have the client participate in a group therapy session: Group therapy may be overwhelming and overstimulating for a client in an acute manic episode. Rapid speech, distractibility, and hyperactivity can make it difficult to engage appropriately, potentially increasing agitation rather than providing therapeutic benefit.

B. Recommend the client participate in a basketball game with other clients: High-intensity, competitive activities like basketball can increase stimulation and risk of injury for a client experiencing mania. Physical exertion in a structured, low-stimulation environment is safer than group sports.

C. Encourage the client to ambulate around the unit: Walking or ambulating provides a safe outlet for excess energy while maintaining supervision. Structured, low-stimulation physical activity helps reduce agitation, promotes safety, and supports self-regulation during manic episodes.

D. Instruct the client to avoid napping during the day: Sleep deprivation can exacerbate manic symptoms. Encouraging rest and allowing the client to nap when fatigued is safer and helps stabilize mood. Preventing sleep would be counterproductive in managing mania.

Rationale for correct choices:

• Dehydration: The child has ongoing vomiting and six watery stools within 24 hours, along with fever and decreased activity, all of which increase fluid loss. Clinical findings such as sunken eyes, elevated heart rate, weight loss of 0.5 kg, elevated hemoglobin and hematocrit, and increased urine specific gravity indicate hemoconcentration. Reduced urine output over 24 hours further reflects inadequate fluid balance. These findings support worsening dehydration.
• Bowel elimination: Frequent watery stools secondary to Escherichia coli infection significantly increase fluid and electrolyte losses. Diarrhea accelerates intestinal transit, reducing absorption of water and sodium. Continuous gastrointestinal losses place toddlers at high risk for rapid volume depletion. Altered bowel elimination is the primary contributing factor to dehydration.

Rationale for incorrect choices

• Seizures: Although electrolyte imbalance can contribute to seizure risk, this child’s sodium level remains within normal limits. There is no evidence of neurological irritability, altered consciousness beyond drowsiness from illness, or severe hyponatremia. The primary concern is fluid volume loss rather than neurologic instability.
• Malnutrition: The child has had decreased appetite for two days, but malnutrition develops over a longer period of inadequate intake. The more urgent issue is acute fluid loss rather than caloric deficiency. Short-term decreased intake combined with diarrhea primarily leads to dehydration.
• Respiratory distress: The child’s oxygen saturation remains stable at 95–98% on room air, and respiratory findings do not indicate compromise. Although respiratory rate is mildly elevated, this can be related to fever or metabolic compensation. There are no signs of increased work of breathing or hypoxia. Respiratory distress is not supported by the data.
• Appetite: While decreased appetite contributes to reduced oral intake, it is not the main mechanism causing rapid fluid depletion. The significant losses are occurring through persistent diarrhea and vomiting. Appetite changes alone would not account for the weight loss and concentrated urine. Bowel elimination is the stronger contributing factor.
• Oxygenation status: Oxygen saturation levels are within acceptable limits and do not indicate impaired gas exchange. There is no cyanosis, retractions, or abnormal lung findings reported. Oxygenation does not contribute to the child’s fluid imbalance.