A nurse is caring for a preschooler who has heart failure and a new prescription for furosemide 4 mg/kg every 8 hr. The child weighs 16 kg (35 lb). Available is furosemide oral solution 40 mg/5 mL. How many mL should the nurse administer with each dose? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

Rationale for Correct Choices:

• Check the child's oropharynx: The child has had a tonsillectomy and is showing signs of possible bleeding, indicated by the small amount of bleeding in the posterior pharynx and bright red emesis (vomiting of blood). The nurse should check the oropharynx to assess the amount and source of the bleeding, as this could indicate a complication post-surgery.
• Obtaining a set of vital signs: After vomiting bright red emesis, it is crucial to assess the child's vital signs to monitor for signs of bleeding or shock. Changes in vital signs, especially increased heart rate or decreased blood pressure, could indicate significant blood loss.

Rationale for Incorrect Choices:

• Offer the child a red popsicle: Red-colored foods are generally avoided post-tonsillectomy as they can obscure or be mistaken for blood. More importantly, offering anything by mouth is contraindicated during active bleeding due to the risk of aspiration and potentially dislodging clots.
• Place the child in a supine position: The child should be positioned in a way that allows for the drainage of blood and secretions, ideally with the head elevated. Placing the child in a supine position could cause blood to pool in the throat, increasing the risk of aspiration.
• Encouraging the child to cough and deep breathe: Encouraging coughing and deep breathing immediately after tonsillectomy is not recommended, as it could dislodge a clot or exacerbate bleeding.
• Requesting a prescription for codeine: Although the child is experiencing some pain (rated 3/10), the primary concern at this point is bleeding, not pain. Pain management should be adjusted but the focus should be on addressing the bleeding first.

A. “I’m guessing your other parent did not do anything to stop this from happening.”
This statement makes assumptions about the other parent's actions and could lead to further conflict or discomfort for the adolescent. It’s important to avoid making judgments and focus on providing support.
B. “Your parent was wrong to hit you for coming home late.” This statement may come across as judgmental or accusatory, which could hinder communication and trust with the adolescent. It's important to validate their feelings first and address the situation appropriately.
C. “It is not your fault that this happened to you.” This response is empathetic and supportive. It reassures the adolescent, which is an important step in helping them feel safe and understood. It also provides an opportunity for further discussion about their safety.
D. “I won’t tell anyone else about this unless you say it’s okay.” While privacy is important, this could be misleading. In cases of abuse, the nurse is required to report the situation to protect the adolescent, even if they don't consent.