A nurse in a pediatric clinic is providing teaching to the guardian of an infant who has a new prescription for digoxin. Which of the following manifestations should the nurse include as an indication of digoxin toxicity?

A. "Postpone burping the infant until after completing each feeding."Burping should not be postponed. Infants with a cleft palate may have more difficulty with feeding and may need to be burped more frequently to reduce the risk of aspiration and discomfort.

B. "Feed the infant 177.4 ml. (6 oz) of formula three times each day."The amount and frequency of feeding should be individualized based on the infant's needs and growth patterns. Typically, an infant with a cleft palate requires more frequent, smaller feedings, and the total volume needs to be adjusted according to their specific nutritional needs.

C. "Discontinue a feeding if the infant's eyes become watery."Watery eyes during feeding can be a sign of aspiration or feeding difficulties. If this occurs, it is important to stop the feeding and assess the situation, as it may indicate that the infant is not handling the feeding well and could be at risk for aspiration or other complications.

D. "Elevate the infant's head to a 10° angle during feedings."A 10° angle may be too shallow to effectively prevent aspiration. Typically, the head should be elevated to a greater degree, often 30-45°, to help facilitate safer feeding and reduce the risk of aspiration in infants with a cleft palate.

Choice A Reason:

Stretch the perineum taut when applying the bag. Taut stretching might cause discomfort or be unnecessary for applying the collection bag and could potentially disrupt the process.

Choice B Reason:

Apply lidocaine gel to the perineum before attaching the bag. Applying lidocaine gel isn't typically necessary for routine urine collection and might not be appropriate for this procedure in an infant without specific indications for its use.

Choice C Reason:

Place a snug-fitting diaper over the drainage bag. Placing a diaper over the collection bag might interfere with the collection process, cause the bag to shift, or create unnecessary pressure on the area.

Choice D Reason:

Position the opening of the bag over the urethra and the anus. Placing the opening of the collection bag over both the urethra and the anus increases the chances of capturing urine effectively. It allows for the collection of a clean catch urine sample while minimizing the risk of contamination from the anus.