A nurse is caring for a group of toddlers receiving digoxin therapy. For which of the following toddlers should the nurse revise the plan of care?

A toddler who has an apical pulse of 100/min

A toddler who has a potassium level of 4.0 mEq/L (3.4 to 4.7 mEq/L)

A toddler who has vomited 2 times in the last hour

A toddler who has a digoxin level of 1.2 ng/mL (0.8 to 2 ng/mL)

Answer and Explanation

The Correct Answer is C

A. An apical pulse of 100/min is within the normal range for a toddler. Digoxin should be administered cautiously if the heart rate is too low (below 90-100/min for young children), but 100/min is not a concern.

B. A potassium level of 4.0 mEq/L is within the normal range for toddlers (3.4-4.7 mEq/L), so there is no indication to revise the plan of care.

C. Vomiting is a sign of digoxin toxicity, and it requires immediate attention. The nurse should reassess the digoxin dose and check for other signs of toxicity, such as nausea, bradycardia, and arrhythmias.

D. A digoxin level of 1.2 ng/mL is within the therapeutic range for a toddler (0.8-2 ng/mL), so there is no need to revise the plan of care based on this finding.

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Correct Answer is A

Explanation

A. A 5-year-old child should receive the varicella vaccine if they have not already received it in earlier years.

B. Haemophilus influenzae type b (Hib) is given earlier in life, not at age 5.

C. The rotavirus vaccine is given to infants, not at age 5.

D. Hepatitis B is given at birth and 1–2 months, not at age 5.

Correct Answer is []

Explanation

Condition Most Likely Experiencing: C

Actions to Take: A, B

Parameters to Monitor: B, C

Rationale:

Condition Most Likely Experiencing

A. Pyloric stenosis causes projectile vomiting, dehydration, and hunger.

B. Cystic fibrosis causes chronic respiratory infections, steatorrhea, and failure to thrive.

C. The condition that the infant is most likely experiencing is congestive heart failure, which can cause poor weight gain, tachypnea, decreased appetite, and periorbital edema.

D. Respiratory syncytial virus bronchiolitis causes wheezing, coughing, and respiratory distress.

Actions to Take

A. Digoxin is a medication commonly prescribed to manage congestive heart failure in infants by improving cardiac contractility and reducing heart rate.

B. Elevating the head of the bed helps reduce venous return to the heart, thereby decreasing preload and relieving symptoms of congestion in congestive heart failure.

C. Contact precautions are not indicated for congestive heart failure, but for infections that are transmitted by direct or indirect contact.

D. Chest physiotherapy and postural drainage are not indicated for congestive heart failure, but for conditions that cause excessive mucus production and retention.

Parameters to Monitor

A. Number of steatorrhea stools is not relevant for congestive heart failure, but for cystic fibrosis or other malabsorption disorders.

B. Monitoring intake and output is crucial in assessing fluid balance, especially in congestive heart failure where fluid retention can lead to volume overload.

C. Monitoring respiratory status is essential in congestive heart failure to assess for signs of pulmonary congestion and respiratory distress, such as tachypnea, retractions, and crackles.

D. Presence of periorbital edema is not a parameter to monitor, but a sign of fluid overload.

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A nurse is caring for a group of toddlers receiving digoxin therapy. For which of the following toddlers should the nurse revise the plan of care?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Explanation

Correct Answer is []

Explanation

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