Question

Patient Data.

Answer 1

Correct Answers

Blank 1 Correct Option: warm, flushed skin
Blank 2 Correct Option: polydipsia
Blank 3 Correct Option: urine output

Rationale :

warm, flushed skin

💎Warm, flushed skin postpartum can be benign, but it must be followed because it can also signal infection or physiologic stress.

💎This client had rupture of membranes 12 hours before delivery, which increases the risk for ascending infection if symptoms develop.

💎 Her temperature is 99.5°F (37.5°C), which is not a fever, but flushing plus warmth warrants continued temperature trends and assessment.

💎Postpartum complications like endometritis can start subtly and progress, so early recognition matters.

💎Monitoring helps distinguish normal postpartum warmth from early abnormal signs requiring provider notification.

polydipsia

💎 The client reports being extremely thirsty, which is a classic symptom of hyperglycemia (polydipsia).

💎 She has a significant history of poorly controlled gestational diabetes (HbA1c 11.4% at diagnosis) and required insulin, placing her at risk for ongoing glucose instability postpartum.

💎 Her blood glucose is 140 mg/dL, which may be elevated depending on timing and intake, and thirst suggests it may be trending higher.

💎 Polydipsia can also reflect dehydration after labor, but with her diabetes history it must be evaluated alongside glucose checks.

💎 Follow-up prevents missed postpartum hyperglycemia and supports safe medication adjustment after delivery.

urine output

💎Postpartum urine output must be followed because it reflects hydration status, renal perfusion, and bladder function.

💎The client has leg numbness from epidural, increasing risk for urinary retention and incomplete emptying.

💎 She has already voided 400 mL clear yellow, which is reassuring, but ongoing monitoring ensures she maintains adequate output and avoids bladder overdistention.

💎Adequate output also supports uterine involution because a full bladder can contribute to uterine atony and increased bleeding.

💎Trending output helps catch early postpartum complications such as retention, dehydration, or perfusion issues.

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Answer 2

Correct Answers

Abdominal pain [ Hypoglycemia ]
Sweating [ Hypoglycemia ]
Hunger [ Hypoglycemia ]
Headache [ Hypoglycemia ]
Frequent urination [ Hyperglycemia ]
Fatigue [ Hypoglycemia ]
Dry mouth [ Hyperglycemia ]

Rationale :

Abdominal pain → Hypoglycemia

🔷 Hypoglycemia activates the sympathetic nervous system, which can cause abdominal discomfort and cramping.

🔷 Low glucose levels trigger stress hormone release (epinephrine), leading to GI symptoms.

🔷 This client reports hunger and weakness, which commonly accompany hypoglycemic abdominal discomfort.

🔷 Hyperglycemia more often causes polyuria and polydipsia rather than acute cramping pain.

🔷 In the context of postpartum insulin use, abdominal discomfort should prompt glucose evaluation.

Sweating → Hypoglycemia

🔷 Diaphoresis is a classic sign of acute hypoglycemia due to adrenergic stimulation.

🔷 When blood glucose drops, the body releases epinephrine, causing sweating.

🔷 This is an early warning symptom that requires rapid glucose assessment.

🔷 Hyperglycemia does not typically cause sweating unless infection is present.

🔷 In insulin-treated clients, sweating strongly suggests low blood sugar.

Hunger → Hypoglycemia

🔷 Severe hunger is one of the hallmark early symptoms of hypoglycemia.

🔷 The brain depends on glucose, and when levels fall, it stimulates appetite urgently.

🔷 The client specifically states she is very hungry, supporting low glucose suspicion.

🔷 Hyperglycemia may cause increased appetite chronically, but not sudden urgent hunger.

🔷 This finding aligns more with acute insulin-related glucose drop.

Headache → Hypoglycemia

🔷 Hypoglycemia can cause neuroglycopenic symptoms, including headache and blurry vision.

🔷 The brain lacks sufficient glucose, leading to neurological manifestations.

🔷 This client reports both headache and blurred vision, strengthening this association.

🔷 Hyperglycemia can cause headache, but it is more commonly associated with dehydration symptoms.

🔷 Given concurrent hunger and weakness, hypoglycemia is more likely.

Frequent urination → Hyperglycemia

🔷 Polyuria occurs in hyperglycemia because excess glucose pulls water into urine via osmotic diuresis.

🔷 When blood glucose exceeds renal threshold, glucose spills into urine.

🔷 This leads to increased urine output and possible dehydration.

🔷 Hypoglycemia does not cause frequent urination.

🔷 In diabetic clients, frequent urination is a strong sign of elevated glucose.

Fatigue → Hypoglycemia

🔷 Hypoglycemia deprives cells—especially brain cells—of needed glucose, causing weakness and fatigue.

🔷 The client reports feeling weak and tired, supporting possible low glucose.

🔷 Neuroglycopenia commonly presents with fatigue, confusion, and dizziness.

🔷 Hyperglycemia causes fatigue more gradually, often with polyuria and thirst.

🔷 In acute postpartum insulin users, sudden fatigue should raise concern for hypoglycemia.

Dry mouth → Hyperglycemia

🔷 Hyperglycemia causes osmotic diuresis, leading to dehydration.

🔷 Dehydration produces dry mouth and excessive thirst (polydipsia).

🔷 This client reports being extremely thirsty, aligning with hyperglycemia.

🔷 Hypoglycemia typically presents with sweating, not dry mucous membranes.

🔷 Dry mouth combined with polydipsia suggests elevated blood glucose.

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Answer 3

Correct Answers

Blank 1 Correct Option: 24
Blank 2 Correct Option: decrease
Blank 3 Correct Option: hemorrhage

Rationale :

24 hours

🔶In the first 24 hours postpartum, insulin needs typically drop rapidly because the placenta is delivered and placental hormones that cause insulin resistance fall sharply.

🔶This client had poorly controlled gestational diabetes (HbA1c 11.4%) and required insulin, so her insulin sensitivity can change quickly after delivery.

🔶Immediate postpartum glucose swings are common, making the first 24 hours the key window for close monitoring.

🔶Even though her glucose is now 278 mg/dL, the physiologic expectation remains that insulin resistance should lessen soon after birth.

🔶This is why protocols include frequent glucose checks (AC/HS) and reassessment of insulin dosing right away.

decrease

🔶Insulin requirements typically decrease postpartum because human placental lactogen, estrogen, progesterone, and cortisol fall after delivery, reducing insulin resistance.

🔶As insulin sensitivity improves, continuing pregnancy-level insulin doses can cause hypoglycemia if not adjusted.

🔶This client is receiving a consistent carbohydrate diet and scheduled glucose monitoring, supporting careful titration as insulin needs shift.

🔶Her current glucose of 278 mg/dL suggests she may still need insulin coverage now, but overall requirements should trend downward as the postpartum period stabilizes.

🔶Recognizing the expected decrease guides safer dosing decisions and prevents dangerous glucose extremes.

hemorrhage

🔶 Gestational diabetes is associated with macrosomia and uterine overdistention, increasing risk for uterine atony, the leading cause of postpartum hemorrhage.

🔶 This infant weighed 8 lb 6 oz (3,799 g), which supports a higher risk for uterine stretching and reduced uterine tone after delivery.

🔶 She received oxytocin augmentation, and postpartum management includes continued uterine tone monitoring to prevent atony-related bleeding.

🔶 Even though her current lochia is described as light rubra and fundus is firm, her risk profile still warrants close observation.

🔶 Identifying hemorrhage risk ensures the nurse prioritizes fundal checks, lochia assessment, and bladder management.

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Answer 4

Correct Answers

Notify the healthcare provider [ Indicated ]
Administer 8 units regular insulin [ not indicated ]
Encourage the client to breastfeed [ not indicated ]
Administer 60 units glargine insulin [ Indicated ]
Provide the client with milk to drink [ not indicated ]

Rationale :

Notify the healthcare provider — Indicated

🔷 The hemoglobin has dropped to 9.6 g/dL, which is below the normal postpartum range of 12–16 g/dL.

🔷 Although estimated blood loss was 300 mL, anemia combined with increased abdominal and perineal pain warrants provider awareness.

🔷 The glucose level of 278 mg/dL is significantly elevated and requires ongoing evaluation in a postpartum insulin-treated client.

🔷 Postpartum insulin needs typically decrease, so new insulin dosing must be carefully monitored.

🔷 Notifying the provider ensures safe glucose management and evaluation of anemia status.

Administer 60 units glargine insulin — Indicated

🔷 There is a specific provider order at 2235 to administer 60 units glargine subcutaneously.

🔷 Glargine is a long-acting basal insulin and supports 24-hour glucose stability.

🔷 The client’s glucose of 278 mg/dL confirms hyperglycemia requiring insulin therapy.

🔷 Even though postpartum insulin needs decrease, this dosing reflects provider evaluation of her current status.

🔷 Administering ordered basal insulin prevents prolonged hyperglycemia and metabolic instability.

Administer 8 units regular insulin — Not Indicated

🔷 The sliding scale order clearly states that 251–300 mg/dL requires 6 units, not 8 units.

🔷 Giving 8 units would exceed the prescribed dose and increase risk for hypoglycemia.

Encourage the client to breastfeed — Not Indicated

🔷 The client is documented as bottle-feeding, and there is no indication she desires to initiate breastfeeding.

🔷 While breastfeeding can improve glucose metabolism, it is not an immediate priority intervention in this situation.

Provide the client with milk to drink — Not Indicated

🔷 Milk contains carbohydrates and may further increase blood glucose levels in a client already at 278 mg/dL.

🔷 The client is experiencing hyperglycemia symptoms (polydipsia), so hydration with water and insulin management are more appropriate.

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Answer 5

Correct Answers

Blank 1 Correct Option: scrambled eggs
Blank 2 Correct Option: waffles

Rationale :

scrambled eggs

🟣 Scrambled eggs are a high-protein, low-carbohydrate option that helps prevent rapid glucose spikes.

🟣Protein slows gastric emptying and improves post-meal blood sugar stability.

🟣This matters because the client already has hyperglycemia (glucose 200 mg/dL) and an elevated HbA1c 8.8%.

🟣Choosing protein-based foods supports better glycemic control while still meeting postpartum energy needs.

🟣Eggs also help reduce reliance on simple carbohydrate-heavy breakfast items like syrup and sweet baked goods.

waffles

🟣Waffles can fit into a consistent carbohydrate meal plan when eaten in controlled portions and without added syrup or sugary toppings.

🟣Compared with pancakes soaked in syrup, waffles can be managed better when paired with protein (eggs) and a low-sugar beverage.

🟣The goal is to reduce rapid-absorbing sugars, not eliminate carbohydrates completely.

🟣This client’s breakfast included multiple simple carbs (syrup, juice, apple) which likely contributed to elevated glucose trends.

🟣Teaching portion control and choosing less sugar-dense carb options supports safer postprandial glucose patterns.

blueberry muffin

🟣Muffins are often made with refined flour and added sugar, making them a simple carbohydrate source that spikes glucose quickly.

🟣This is not ideal for a client with elevated glucose and high HbA1c.

toast with jam

🟣 Jam is concentrated added sugar, and pairing it with toast increases the glycemic load significantly.

🟣 This combination promotes a rapid post-meal glucose rise, especially in someone with insulin resistance.

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Answer 6

Correct Answers:

Schedule a glucose tolerate test in 6 weeks.
Wear a medical-alert bracelet.
Eat 500 additional calories daily.
Monitor for temperatures greater than 100.4° F (38° C).

Rationale :

“Schedule a glucose tolerance test in 6 weeks.”

🟡 After gestational diabetes, the client must be screened postpartum because she is at high risk for type 2 diabetes.

🟡 A 2-hour oral glucose tolerance test (OGTT) is commonly scheduled at about 4–12 weeks postpartum, making 6 weeks appropriate.

🟡 Her history shows very poor control in pregnancy (HbA1c 11.4%) and ongoing hyperglycemia postpartum (glucose 200 mg/dL, HbA1c 8.8%), increasing urgency for follow-up testing.

🟡 This statement reflects understanding that diabetes risk continues after delivery and needs formal evaluation.

🟡 Early detection supports timely lifestyle changes and treatment if persistent diabetes is confirmed.

“Wear a medical-alert bracelet.”

🟡 The client is using insulin (regular insulin and glargine), which increases risk for hypoglycemia.

🟡 A medical-alert bracelet ensures rapid identification and correct treatment during emergencies (confusion, fainting).

🟡 This is especially important postpartum when sleep deprivation and variable intake can affect glucose levels.

🟡 It also alerts providers about diabetes if she cannot communicate.

🟡 This statement shows understanding of safety planning for insulin therapy.

“Eat 500 additional calories daily.”

🟡 If the client is breastfeeding, she needs additional calories to support milk production and prevent excessive metabolic stress.

🟡 A common teaching point is about ~450–500 extra kcal/day during lactation.

🟡 Adequate caloric intake also reduces risk for hypoglycemia when insulin is used.

🟡 The client agreed to breastfeed and successfully latched, so lactation nutrition teaching applies.

🟡 This statement indicates understanding of postpartum nutritional needs while managing blood glucose.

“Monitor for temperatures greater than 100.4° F (38° C).”

🟡 A postpartum temperature above 100.4°F (38°C) can indicate infection such as endometritis or wound infection.

🟡 This client had rupture of membranes 12 hours before delivery and a perineal laceration repair, which makes infection monitoring essential.

🟡 Diabetes also increases susceptibility to infection and delayed healing, so fever monitoring is especially important.

🟡 Recognizing fever thresholds shows understanding of when to seek medical care urgently.

🟡 This improves safety after discharge and reduces risk of complications.

“Avoid low-dose contraceptives postpartum.”

🟡 Low-dose contraceptives are not universally avoided postpartum; contraceptive choice depends on timing, breastfeeding status, and risk factors.

🟡 This statement is too absolute and does not reflect correct individualized postpartum contraception teaching.

“Check blood sugar before breastfeeding.”

🟡 Routine teaching focuses on checking glucose before meals and at bedtime (AC/HS) unless the client has symptoms or specific instructions.

🟡 Breastfeeding can lower glucose, but the key is recognizing symptoms and having snacks available rather than mandatory checks before every feed.

“Insulin requirements increase with lactation.”

🟡 Lactation generally lowers blood glucose and can decrease insulin requirements due to increased energy use.

🟡 Saying insulin needs increase reflects misunderstanding and could lead to overtreatment.

“Eat 15 grams of carbohydrates if glucose is less than 150 mg/dL (8.3 mmol/L).”

🟡 The “15 grams fast-acting carbohydrate” rule applies to hypoglycemia, usually defined as glucose < 70 mg/dL (3.9 mmol/L).

🟡 Treating at 150 mg/dL would worsen hyperglycemia and is unsafe.

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Answer 7

Correct Answers:

Compliance.

Rationale :

🔷 The biggest challenge with antiretroviral therapy is strict adherence (compliance) to prevent viral replication.

🔷 Missing doses allows the virus to multiply and increases the risk of treatment failure.

🔷 Consistent dosing is essential to maintain an undetectable viral load and protect immune function.

🔷 Complex regimens, side effects, and daily lifelong therapy commonly interfere with adherence.

🔷 Because adherence directly impacts outcomes, it is the primary difficulty nurses frequently observe.

Expense

🔷 Cost can be a barrier, but it varies by insurance and programs and is not the most universal day-to-day issue.

🔷 Even when cost is covered, adherence can still be difficult due to regimen burden and side effects.

Interactions with other medications

🔷 Drug interactions are important, but they are managed through medication reconciliation and monitoring.

🔷 They are not typically the main difficulty compared with consistent daily adherence.

Resistance develops

🔷 Resistance usually develops because of poor adherence, not as the primary initial difficulty.

🔷 Preventing missed doses is the key strategy to reduce resistance development.

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Answer 8

Correct Answers:

Chew food slowly and thoroughly before attempting to swallow.

Rationale :

💎 After gastric bypass, the stomach pouch is small, so large food pieces can cause obstruction, discomfort, and vomiting.

💎 Thorough chewing promotes safe swallowing and better movement through the altered GI tract.

💎 Eating slowly also reduces risk of dumping syndrome and nausea.

💎 This is a foundational skill that supports tolerance of all meals regardless of food choice.

💎 Proper chewing is one of the most critical day-to-day behaviors for safe post-op diet management.

Eliminate or reduce intake of fatty and gas forming foods.

💎 Fatty foods can worsen symptoms, but chewing and slow intake are more essential for preventing blockage and vomiting.

💎 Gas-forming foods vary by person and are not the single highest priority teaching point.

Sip fluids slowly with each meal and between meals.

💎 Fluids should generally be separated from meals (often no liquids with meals) to avoid overfilling and dumping.

💎 This instruction is inaccurate as written for many post-bypass plans.

Plan volume-controlled, evenly-spaced meals throughout the day.

💎 Small frequent meals are important, but safe swallowing through thorough chewing is a more immediate safety priority.

💎 Scheduling helps long-term, but chewing prevents acute complications during each bite.

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Answer 9

Correct Answers:

1.6

Rationale :

🔶Daily dose = 0.5 mg/kg/day × 6.5 kg = 3.25 mg/day.

🔶Dosing is every 12 hours = 2 doses/day.

🔶 Amount per dose = 3.25 mg/day ÷ 2

📌 1.625 mg/dose.

📌Round to the nearest tenth = 1.6 mg/dose.

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Answer 10

Correct Answers:

Avoid the consumption of wine, beer, and coffee.

Rationale :

🟣 Sudden severe ankle pain with inability to bear weight in a client with gouty arthritis suggests an acute gout flare.

🟣 Alcohol—especially beer and wine—can increase uric acid levels and trigger gout attacks.

🟣 Some beverages and dietary patterns can worsen dehydration and contribute to uric acid crystallization in joints.

🟣 Recent weight-loss dietary changes can increase uric acid (ketosis/rapid breakdown), increasing flare risk.

🟣 Avoiding alcohol is a key self-management teaching to reduce recurrence and severity of gout symptoms.

Use electric heating pad when pain is at its worse.

🟣 Heat can worsen inflammation in acute gout; cold packs are often more helpful for swelling and pain.

🟣 Joint protection and anti-inflammatory measures are preferred over heat during flares.

Substitute natural fruit juices for carbonated drinks.

🟣 Many fruit juices are high in fructose, which can increase uric acid and worsen gout.

🟣 Water is a safer recommendation to support hydration and uric acid excretion.

Encourage active range of motion to limit stiffness.

🟣 During an acute gout flare with severe pain, forcing ROM can worsen pain and inflammation.

🟣 Resting the joint and managing inflammation is more appropriate initially.

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Client Findings	Hypoglycemia	Hyperglycemia
Abdominal pain
Sweating
Hunger
Headache
Frequent urination
Fatigue
Dry mouth

Laboratory Test	Results	Reference Range
Hemoglobin	9.6 g/dL (96 g/L)	12 to 16 g/dL (120 to 160 g/L)
Hematocrit	36% (0.36 volume fraction)	30 to 40% (0.3 to 0.4 volume fraction)

Plan of Care Recommendation	Indicated	not indicated
Notify the healthcare provider
Administer 8 units regular insulin
Encourage the client to breastfeed
Administer 60 units glargine insulin
Provide the client with milk to drink

Laboratory Test	Results	Reference Range
Hemoglobin	9.6 g/dL (96 g/L)	12 to 16 g/dL (120 to 160 g/L)
Hematocrit	36% (0.36 volume fraction)	30 to 40% (0.3 to 0.4 volume fraction)

Laboratory Test	Results	Reference Range
Red blood cell count	5.0 × 10⁶/µL (5.0 × 10¹²/µL)	4 to 5.5 × 10⁶/µL (4 to 5.5 × 10¹²/µL)
Hemoglobin	9.5 g/dL (95 g/L)	12 to 16 g/dL (120 to 160 g/L)
Hematocrit	34% (0.34 volume fraction)	30 to 40% (0.3 to 0.4 volume fraction)
Platelet count	200 × 10³/mm³ (200 × 10⁹/L)	150 to 400 × 10³/mm³ (150 to 400 × 10⁹/L)
White blood cell count	6,200/mm³ (6.2 × 10⁹/L)	6,200 to 17,000/mm³ (6.20 to 170 × 10⁹/L)

QLexNursing

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6 :
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Answer Options

7 :
The nurse is working with clients who have been diagnosed with HIV and are prescribed antiretroviral medications. Which is the primary difficulty the nurse observes with clients taking these medications?

8 :
A client who underwent an uncomplicated gastric bypass surgery is having difficulty with diet management. Which dietary instruction is most important for the nurse to explain to the client?

9 :
A toddler who weighs 6.5 kg receives a prescription for medication with a dose of 0.5 mg/kg/day PO in equal doses every 12 hours. How many mg should the nurse administer with each dose? (Enter numerical value. If rounding is required, round to the nearest tenth.)

Laboratory Test	Results	Reference Range
Calcium	9.5 mEq/L (2.38 mmol/L)	8.8 to 10.8 mEq/L (2.2 to 10.8 mmol/L)
Carbon dioxide	26 mEq/L (31 mmol/L)	20 to 28 mEq/L (20 to 28 mmol/L)
Blood urea nitrogen (BUN)	15 mg/dL (0.89 mmol/L)	5 to 18 mg/dL (0.30 to 1.07 mmol/L)
Creatinine	0.6 mg/dL (53.04 µmol/L)	0.3 to 0.7 mg/dL (22.88 to 53.38 µmol/L)
Glucose	200 mg/dL (11.10 mmol/L)	70 to 110 mg/dL (3.89 to 6.11 mmol/L)

Laboratory Test	Results	Reference Range
Calcium	9.5 mEq/L (2.38 mmol/L)	8.8 to 10.8 mEq/L (2.2 to 10.8 mmol/L)
Carbon dioxide	26 mEq/L (31 mmol/L)	20 to 28 mEq/L (20 to 28 mmol/L)
Blood urea nitrogen (BUN)	15 mg/dL (0.89 mmol/L)	5 to 18 mg/dL (0.30 to 1.07 mmol/L)
Creatinine	0.6 mg/dL (53.04 µmol/L)	0.3 to 0.7 mg/dL (22.88 to 53.38 µmol/L)
Glucose	200 mg/dL (11.10 mmol/L)	70 to 110 mg/dL (3.89 to 6.11 mmol/L)

QLexNursing

1 : Patient Data.

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2 : Patient Data.

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3 : Patient Data.

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4 : Patient Data.

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5 : Patient Data.

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6 : Patient Data.

Answer Options

7 : The nurse is working with clients who have been diagnosed with HIV and are prescribed antiretroviral medications. Which is the primary difficulty the nurse observes with clients taking these medications?

8 : A client who underwent an uncomplicated gastric bypass surgery is having difficulty with diet management. Which dietary instruction is most important for the nurse to explain to the client?

9 : A toddler who weighs 6.5 kg receives a prescription for medication with a dose of 0.5 mg/kg/day PO in equal doses every 12 hours. How many mg should the nurse administer with each dose? (Enter numerical value. If rounding is required, round to the nearest tenth.)

1 :
Patient Data.

2 :
Patient Data.

3 :
Patient Data.

4 :
Patient Data.

5 :
Patient Data.

6 :
Patient Data.

7 :
The nurse is working with clients who have been diagnosed with HIV and are prescribed antiretroviral medications. Which is the primary difficulty the nurse observes with clients taking these medications?

8 :
A client who underwent an uncomplicated gastric bypass surgery is having difficulty with diet management. Which dietary instruction is most important for the nurse to explain to the client?

9 :
A toddler who weighs 6.5 kg receives a prescription for medication with a dose of 0.5 mg/kg/day PO in equal doses every 12 hours. How many mg should the nurse administer with each dose? (Enter numerical value. If rounding is required, round to the nearest tenth.)