A nurse is caring for a client who has heart failure and a prescription for digoxin 125 mcg PO daily. Available is digoxin PO 0.25 mg/tablet. How many tablets should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

Inspection:This is the first step because it allows the nurse to gather information through observation without causing any discomfort to the child. It involves looking at the child's abdomen for any visible abnormalities like distension, asymmetry, masses, or discoloration.

Auscultation:After inspection, the nurse listens to the bowel sounds using a stethoscope. This helps assess peristalsis (movement of food through the intestines) and identify potential problems like bowel obstruction or decreased motility.

Superficial Palpation:This gentle palpation helps assess muscle tone, tenderness, and masses. It's performed after auscultation to avoid altering bowel sounds. Since children are often apprehensive about abdominal exams, starting with a gentler touch can help them feel more comfortable.

Deep Palpation (if necessary):Deep palpation is reserved for last as it can be more uncomfortable for the child. It's used to assess for organomegaly (enlarged organs) or masses that may not be palpable with superficial palpation. It's only performed if there are indications from the first three steps.

Here's a breakdown of why this order is important:

Minimize Discomfort:Starting with non-invasive methods like inspection and auscultation helps establish trust and reduces anxiety in the child, making the overall assessment more cooperative.

Maintain Baseline Bowel Sounds:Palpation can alter bowel sounds, so it's important to listen to them first to get an accurate baseline.

Gradual Progression:Moving from gentle to deeper palpation allows the child to adjust to the sensation and helps the nurse identify potential areas of tenderness before applying deeper pressure.

A. Bleeding: While haloperidol can rarely cause agranulocytosis, which may lead to bleeding, it is not a common adverse effect associated with the medication. However, clients taking antipsychotic medications like haloperidol should be monitored for any signs of bleeding, such as petechiae or bruising.
B. Cataracts: Haloperidol is not typically associated with the development of cataracts. However, long-term use of certain antipsychotic medications, including haloperidol, may increase the risk of developing metabolic side effects such as weight gain and dyslipidemia, which could indirectly contribute to the risk of cataract formation.
C. Dysrhythmias: This is the correct answer. Haloperidol has the potential to prolong the QT interval, leading to a type of dysrhythmia known as torsade’s de pointes. Therefore, clients taking haloperidol should be monitored for signs of QT prolongation, such as palpitations, syncope, or sudden cardiac arrest.
D. Pancreatitis: While rare, haloperidol has been associated with pancreatitis as a potential adverse effect. However, dysrhythmias are a more common and immediate concern, especially with acute administration or in clients with predisposing factors for QT prolongation, such as electrolyte imbalances or concurrent use of other medications known to prolong the QT interval.