The correct answer is Choice A.

Choice A rationale

A 13% weight loss indicates severe dehydration. Dehydration is classified based on the percentage of body weight lost, with severe dehydration being more than 10%6.

Choice B rationale

A bulging anterior fontanel is a sign of increased intracranial pressure, not dehydration. In dehydration, the fontanel is typically sunken due to fluid loss.

Choice C rationale

Bradypnea, or slow breathing, is not a common sign of dehydration. Dehydration often leads to tachypnea, or rapid breathing, as the body tries to compensate for fluid loss.

Choice D rationale

A capillary refill time of 3 seconds is within normal limits. In severe dehydration, capillary refill time is usually prolonged, indicating poor perfusion.

The correct answers are Choices B, D, E, and F.

Choice A rationale:

Administering promethazine 50 mg intermittent IV bolus is not typically indicated for managing acute abdominal pain and suspected appendicitis. Promethazine is an antiemetic and antihistamine, but it does not address the underlying cause of the symptoms.

Choice B rationale:

Obtaining informed consent for surgery is crucial as the client’s symptoms and lab results (elevated WBC count and C- Reactive Protein) strongly suggest appendicitis. Surgery, specifically an appendectomy, is the definitive treatment for appendicitis.

Choice C rationale:

Administering acetaminophen 800 mg may help alleviate pain and reduce fever, but it does not address the underlying cause of the symptoms. It is important to manage the pain, but the primary focus should be on diagnosing and treating the appendicitis.

Choice D rationale:

Initiating IV antibiotics is essential in managing suspected appendicitis to prevent infection and complications such as perforation or abscess formation. Antibiotics help control the infection until surgical intervention can be performed.

Choice E rationale:

Maintaining NPO (nothing by mouth) status is important to prepare the client for potential surgery and to prevent exacerbation of symptoms. Keeping the client NPO helps reduce the risk of aspiration during anesthesia and surgery.

Choice F rationale:

Obtaining an abdominal ultrasound is important to confirm the diagnosis of appendicitis. Imaging studies such as ultrasound or CT scan can help visualize the appendix and assess for inflammation or other abnormalities.

Choice G rationale:

Administering enemas until clear is not appropriate in this scenario. Enemas are not indicated for managing acute abdominal pain and suspected appendicitis. They could potentially worsen the condition or mask important symptoms.