# Situation: A nurse trained in Integrated Management of Childhood Illness (IMCI) sees sick children at the under-five clinic of a Rural Health Unit (RHU). An 11-month-old infant weighing 8 kg is classified as having SEVERE DEHYDRATION with no other severe classification. The nurse can give intravenous fluid at once and starts Ringer's lactate by IMCI Plan C. The first phase has just been completed, and the infant's radial pulse is now easily felt. At what rate should the remaining Plan C fluid now run? Round off to the nearest whole mL per hour.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=627156  
> language: ko  
> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: A nurse trained in Integrated Management of Childhood Illness (IMCI) sees sick children at the under-five clinic of a Rural Health Unit (RHU).

An 11-month-old infant weighing 8 kg is classified as having SEVERE DEHYDRATION with no other severe classification. The nurse can give intravenous fluid at once and starts Ringer's lactate by IMCI Plan C. The first phase has just been completed, and the infant's radial pulse is now easily felt. At what rate should the remaining Plan C fluid now run? Round off to the nearest whole mL per hour.

## 보기

1. 224 mL per hour
2. 133 mL per hour
3. 112 mL per hour **✔ 정답**
4. 93 mL per hour

**정답: 3**

## 해설

Plan C gives 100 mL/kg of intravenous fluid, and its timing depends on age. For infants under 12 months, 30 mL/kg is given in 1 hour and then 70 mL/kg in 5 hours; for children 12 months and older, the same volumes are given in 30 minutes and 2½ hours. This infant is 11 months old, so the second phase is 70 × 8 = 560 mL over 5 hours: 560 ÷ 5 = 112 mL per hour. The first 30 mL/kg is repeated only if the radial pulse is still very weak or not detectable; here it is easily felt.

## 심화 해설

Plan C timing depends on age
IMCI Plan C treats severe dehydration with intravenous fluid when the nurse can start it at once. The total volume is 100 mL/kg of Ringer's lactate (or normal saline if Ringer's lactate is not available), given in two phases. For infants under 12 months, 30 mL/kg is given in 1 hour, then 70 mL/kg in 5 hours. For children 12 months up to 5 years, the same volumes are given faster: 30 mL/kg in 30 minutes, then 70 mL/kg in 2½ hours. This infant is 11 months old, so the slower infant timing applies.

Working out the rate
The infant weighs 8 kg. The first phase was 30 × 8 = 240 mL over 1 hour and has just been completed. The second phase is 70 × 8 = 560 mL over 5 hours. The rate is 560 ÷ 5 = 112 mL per hour. The first phase is repeated only if the radial pulse is still very weak or not detectable after it; here the pulse is easily felt, so the nurse proceeds directly to the second phase.

| Age | First phase: 30 mL/kg | Second phase: 70 mL/kg |
| --- | --- | --- |
| Under 12 months | 1 hour | 5 hours |
| 12 months up to 5 years | 30 minutes | 2½ hours |
| This infant (8 kg) | 240 mL in 1 hour (done) | 560 mL in 5 hours = 112 mL/hour |

How the distractors were built
224 mL per hour uses the timing for children 12 months and older (560 mL over 2½ hours), an age error that makes the fluid run too fast for an infant. 133 mL per hour spreads the whole 800 mL evenly over 6 hours, ignoring the two-phase design that gives a faster initial bolus. 93 mL per hour divides the second-phase volume by the total 6 hours instead of its own 5 hours. Watch out! The infant is 11 months old, not 12; the age line is drawn at 12 months, so check the age before choosing the timing.

Monitoring during Plan C
Reassess the infant every 15 to 30 minutes, and start oral rehydration solution at about 5 mL/kg per hour as soon as the infant can drink. After 6 hours for an infant, the nurse reclassifies the dehydration and chooses Plan A, B, or C accordingly. If hydration is not improving, the drip rate is increased. Throughout, the mother is encouraged to continue breastfeeding once the infant can drink, and the infant is observed for at least 6 hours after rehydration to make sure the mother can maintain hydration with ORS.

## 임상 시나리오

IMCI Plan C for an InfantSecond-phase rate for severe dehydration
Total: 100 mL/kg Ringer's lactate. Under 12 months: 30 mL/kg in 1 hour, then 70 mL/kg in 5 hours.

For this 8 kg infant: second phase 70 × 8 = 560 mL over 5 hours = 112 mL per hour.

Repeat the first phase only if the radial pulse remains very weak or undetectable. Reassess often and start ORS when the infant can drink.

CautionUse the infant timing for anyone under 12 months; the faster timing for older children would run the fluid too quickly.

## 핵심 개념

- **IMCI Plan C** — The IMCI treatment plan for severe dehydration, using rapid intravenous fluids or nasogastric ORS.
- **Severe dehydration** — IMCI classification for signs such as lethargy, sunken eyes, inability to drink, and very slow skin pinch.
- **Ringer's lactate** — A balanced intravenous crystalloid solution used to replace fluid and electrolytes.
- **Radial pulse** — The pulse felt at the wrist, used in Plan C to judge whether circulation has improved.

## 같은 주제 문제

- [Situation: A nurse handles the under-five clinic of a Barangay Health Station (BHS).An inf…](https://mymerci.kr/pages/nclex_q.php?qn_id=627053)
- [Situation: A nurse handles the under-five clinic of a Barangay Health Station (BHS).At the…](https://mymerci.kr/pages/nclex_q.php?qn_id=627054)
- [Situation: A nurse handles the under-five clinic of a Barangay Health Station (BHS).A 4-mo…](https://mymerci.kr/pages/nclex_q.php?qn_id=627055)
- [Situation: A nurse handles the under-five clinic of a Barangay Health Station (BHS).An 11-…](https://mymerci.kr/pages/nclex_q.php?qn_id=627056)
- [Situation: A public health nurse works at a Rural Health Unit (RHU) that has a basic emerg…](https://mymerci.kr/pages/nclex_q.php?qn_id=627058)
- [Situation: A public health nurse works at a Rural Health Unit (RHU) that has a basic emerg…](https://mymerci.kr/pages/nclex_q.php?qn_id=627059)
- [Situation: A public health nurse works at a Rural Health Unit (RHU) that has a basic emerg…](https://mymerci.kr/pages/nclex_q.php?qn_id=627060)
- [Situation: During the twice-yearly Garantisadong Pambata week, a nurse at a Barangay Healt…](https://mymerci.kr/pages/nclex_q.php?qn_id=627061)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._