The recommended children's dosage of Keflex is 25 to 50 mg/kg/day in divided doses. The maximum daily safe dosage for a child weighing 42 lb is: Round to the nearest tenth.

(Number Only, do not enter mg, kg, or day with your answer)

The correct answer is Choice A: Surgical removal of the affected section of bowel.

Choice A rationale:

Surgical removal of the affected section of bowel is the primary therapeutic management for most children with Hirschsprung's disease. Hirschsprung's disease is a congenital condition where there is a lack of nerve cells in a segment of the colon, leading to obstruction and dilation of the bowel. Surgical resection of the affected segment and reconnection of healthy bowel portions is the standard treatment to alleviate the obstruction and restore normal bowel function.

Choice B rationale:

Daily enemas might be used in some cases to manage symptoms temporarily, but they are not the primary therapeutic management for Hirschsprung's disease. Surgery is the mainstay of treatment.

Choice C rationale:

Permanent colostomy might be considered if the affected portion of bowel is extensive and cannot be safely reconnected after resection, but it's not the primary option for most children with Hirschsprung's disease.

Choice D rationale:

A low-fiber diet is not a therapeutic management for Hirschsprung's disease. Surgical intervention is necessary to address the underlying cause of obstruction, and diet modifications alone wouldn't resolve the condition.

The correct answer is choice A: Administer pancreatic enzymes between meals if at all possible.

Choice A rationale:

Administer pancreatic enzymes between meals if at all possible. This is the correct choice. When educating the parents and child with cystic fibrosis about the administration of pancreatic enzymes, it's important to emphasize that these enzymes should be given between meals whenever feasible. Administering them between meals, when the stomach is less acidic and less likely to release the enzymes prematurely, ensures optimal digestion of food and absorption of nutrients. This approach aligns with the physiological need to supplement pancreatic enzyme function due to the inadequate natural enzyme production in cystic fibrosis.

Choice B rationale:

Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal. This choice is a valid option for administering pancreatic enzymes. While it's true that the enzymes can be taken either by swallowing the capsules whole or by opening them and sprinkling the contents on a small amount of food at the start of a meal, this method can vary based on individual preferences and abilities. However, the primary focus should be on timing (between meals) to achieve the best enzymatic action.

Choice C rationale:

Do not administer pancreatic enzymes if the child is receiving antibiotics. This statement is not accurate. There is no general contraindication to administering pancreatic enzymes while a child is on antibiotics. However, it's important for the healthcare provider to be aware of all the medications the child is taking to ensure there are no potential drug interactions or effects on absorption. Always consult with the healthcare team before adjusting the administration of any medication.

Choice D rationale:

Decrease the dose of pancreatic enzymes if the child is having frequent, bulky stools. This statement is not consistent with typical practice. If a child is experiencing frequent, bulky stools, it may actually indicate that the pancreatic enzyme dosage needs adjustment (increasing the dose rather than decreasing). Bulky stools can suggest poor digestion and absorption, which might require more enzymes to properly break down nutrients. Dosage adjustments should always be made under the guidance of the healthcare provider based on factors such as stool consistency, weight gain, and nutritional status.