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:

• Dextrose 5% in sodium chloride with 20 mEq potassium chloride/L at 75 mL/hr: The prescription for dextrose 5% with potassium chloride at 20 mEq/L should be clarified because the child's potassium level is elevated at 6.2 mEq/L (normal range is 3.4 to 4.7 mEq/L). Administering additional potassium could worsen hyperkalemia, which could lead to dangerous complications like arrhythmias.
• Laboratory values: The child's potassium level is already high, and adding more potassium via IV fluids could increase the risk of severe hyperkalemia. The nurse should clarify this prescription to avoid potential harm.

Rationale for Incorrect Choices:

• Piperacillin and tazobactam 4g IV every 8 hr: This antibiotic is appropriate for treating pneumonia in a child with cystic fibrosis. No issues with laboratory values or contraindications are present in this case, so clarification is unnecessary.
• Dornase alfa 2.5 mg inhalation every day: Dornase alfa is used to break down mucus in the lungs of children with cystic fibrosis, and it is prescribed appropriately for this patient. The child’s current condition and medications do not warrant clarification for this prescription.
• Pancrelipase 8,000 units with meals: Pancrelipase is indicated for the child’s cystic fibrosis to assist with digestion, and the prescribed dosage seems appropriate for the child’s weight and condition.
• Albuterol nebulizer 2.5 mg inhalation every 4 hr: Albuterol is used for airway clearance, which is appropriate for managing the child's respiratory symptoms. No clarification is needed for this prescription based on the current findings.
• Vital signs: While the child's heart rate and temperature are elevated, they are within expected ranges for the child’s condition (fever, pneumonia, and cystic fibrosis). There is no immediate need for clarification of medications based on vital signs alone.
• Scheduled therapapy: The child is scheduled for chest physiotherapy and airway clearance therapy, which are standard treatments for cystic fibrosis and pneumonia. There is no issue with the scheduled therapies that requires clarification of the medications.
• Diet: The child has been prescribed a high-protein, high-fat diet to support nutritional needs, especially important in cystic fibrosis. The diet does not require any clarification in relation to the prescribed medications.
• Pre-existing conditions: The child’s pre-existing condition of cystic fibrosis is already taken into account in the prescribed treatments, and no adjustment is needed based on the conditions present.

Point A: Represents the third intercostal space at the right sternal border, which corresponds anatomically to the aortic valve area. This is a key auscultation site used during cardiac assessment to listen for murmurs and abnormalities related to the aortic valve. It is not used for palpation.

Point B: Fourth intercostal space at the left midclavicular line and is the correct location for palpating the point of maximal impulse (PMI) in infants and young children. In this age group, the PMI is typically found here due to the more horizontal position of the heart in the chest.

Point C: This location is at the 2nd or 3rd intercostal space, which is too high to assess the PMI in an infant. This area is used more for evaluating pulmonic valve sounds, not the apex of the heart.