A nurse is preparing to administer a dexamethasone 1.5 mg/kg/day PO to divide equally every 6 hr to a preschool-age child who weighs 22 lb. Available is dexamethasone oral solution 1 mg/mL. How many mL should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

A. "Give her acetaminophen, not aspirin." This is the appropriate response. Acetaminophen is commonly recommended for treating fever in children as it is safer and does not carry the risk of Reye's syndrome, a rare but serious condition associated with aspirin use in children and adolescents, particularly when they have viral infections. This response provides a safe alternative and addresses the immediate concern of fever treatment.

B. "You'll have to call your physician." While consulting a physician is generally good advice, this response does not provide immediate guidance or address the potential risks of giving aspirin to a toddler. It leaves the parent without immediate and necessary information to prevent harm.

C. "Follow the directions on the aspirin bottle for her age and weight." This response is inappropriate and potentially harmful. Aspirin should not be given to children, especially without a physician's guidance, due to the risk of Reye's syndrome. Following dosage directions on an aspirin bottle is unsafe for a toddler, as aspirin is not recommended for children in this age group for fever treatment.

D. "Give her no more than three baby aspirin every 4 hours." This is incorrect and dangerous advice. Giving any amount of aspirin to a toddler is not recommended because of the risk of Reye's syndrome. Suggesting a specific dosage implies that it's safe to give aspirin to a child, which it is not in this context.

Increased seizure activity

• Finding: Phenytoin level

The child's phenytoin level is 6 mcg/mL, which is below the therapeutic range of 10-20 mcg/mL. Subtherapeutic levels of phenytoin mean the medication is not providing adequate seizure control, increasing the risk of more seizures. The recent seizure history and the low drug level indicate a direct correlation between insufficient phenytoin levels and increased seizure activity.

Pneumonia

• Finding: Cough

A harsh, non-productive cough that worsens with activity and at night can be indicative of respiratory conditions, including asthma exacerbations. However, in the context of this child's history and symptoms, there is no evidence of a productive cough, fever, or other signs of infection that would typically suggest pneumonia. Hence, pneumonia is not the primary concern.

Liver failure

• Finding: Skin rash

Liver failure is usually associated with jaundice, elevated liver enzymes, and systemic symptoms like fatigue or confusion. The child’s liver function tests are within normal ranges, and there are no signs of jaundice or systemic illness. The skin rash is more likely related to eczema or a possible drug reaction rather than indicating liver failure.

Steven-Johnson syndrome

• Finding: Liver enzymes

Steven-Johnson syndrome (SJS) is a severe skin reaction typically triggered by medications, including anticonvulsants. Elevated liver enzymes can be seen in SJS, but the child’s liver enzymes are within normal ranges. The rash described does not match the characteristics of SJS, which typically presents with widespread, painful, blistering rashes, not localized eczema patches. Therefore, SJS is unlikely in this scenario.

Pneumothorax

• Finding: Lung sounds

A pneumothorax would usually present with decreased breath sounds, possibly on one side, along with signs of respiratory distress such as tachypnea and cyanosis. The child has slight end expiratory wheezes but normal respiratory rates and oxygen saturation, which suggests asthma rather than pneumothorax. Therefore, pneumothorax is not a primary concern here.