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“The vaccination must be administered in two doses.”: This assumes a hepatitis C vaccine exists and has a two-dose schedule; no licensed hepatitis C vaccine exists to have any dosing schedule.

“Have you received the hepatitis B vaccination?”: Hepatitis B does have a vaccine (so asking about it can be useful), but it does not answer the client’s request about hepatitis C. This response redirects rather than directly addressing the client’s statement.

"Why are you interested in receiving this vaccine?": Acceptable as a follow-up question (explores risk/exposure), but it does not first correct the factual misunderstanding; best practice is to answer the factual question first, then explore motivations.

Lactated Ringers (LR): LR is an isotonic crystalloid (used for extracellular volume replacement), not hypotonic.

0.9% sodium chloride (NS): 0.9% NS is isotonic, not hypotonic.

29% NaCl: Concentrations like 3% NaCl are hypertonic and used cautiously for specific indications (e.g., severe hyponatremia or intracranial hypertension); anything much above 0.9% is hypertonic, not hypotonic.

12 hours: that would reflect long-acting insulin duration, not the short/regular insulin peak.

1/2 hour: ~30 minutes is the onset of regular insulin, not the peak; hypoglycemia risk is greater at peak.

8 hours: that’s longer than the typical peak/duration for regular insulin (NPH peaks later).

Bumetanide and diltiazem: Generally acceptable -a loop diuretic (bumetanide) plus a calcium-channel blocker (diltiazem) are from different classes and may be combined if clinically indicated (monitoring required).

Metolazone and valsartan: Use with caution -this combination (a thiazide-like diuretic and an ARB) is sometimes used but requires monitoring of electrolytes and renal function (risk of potassium/volume/electrolyte changes); not an automatic contraindication.

Captopril and furosemide: Commonly used together -an ACE inhibitor plus a loop diuretic is a frequently used and accepted combination for hypertension/volume control (monitor blood pressure and renal function).

Administer subcutaneous Calcitonin via a tuberculin syringe: Calcitonin is not used for acute asthma/airway compromise; it’s used in hypercalcemia or some bone disorders and is irrelevant here.

Administer IV methylprednisolone: Appropriate for severe asthma but not the immediate first action -corticosteroids reduce inflammation but have a delayed onset (hours) and do not immediately reverse bronchospasm.

Administer albuterol via nebulizer: Important and often given urgently in acute asthma to relieve bronchospasm, but if the child has passed out (suggesting immediate airway compromise/hypoxia), airway/oxygenation take absolute priority.

Peripheral edema: Lactulose is an osmotic laxative acting in the gut; peripheral edema is not a typical direct effect.

Dry mouth: Dry mouth is not a common or primary effect of lactulose.

Headache: Headache is not a characteristic expected effect of lactulose therapy.

Serum sodium 140 mEq/L: Normal serum sodium (≈135–145 mEq/L); not an expected adverse effect of spironolactone.

Serum calcium 10.5 mg/dL: Mildly high calcium is not a characteristic adverse effect of spironolactone.

Serum chloride 99 mEq/L: Chloride ~99 mEq/L is within normal limits (≈98–106) and not specific to spironolactone toxicity.