A nurse is caring for an infant who has heart failure and vomited following administration of digoxin. Which of the following actions should the nurse take?
Mix the medication with 8 oz of formula.
Give an antiemetic.
Increase fluid intake.
Administer the next dose as prescribed.
The Correct Answer is D
A. Mixing the medication with formula may not be appropriate as the infant has vomited, and re-administering the medication immediately may result in overdosing.
B. Giving an antiemetic is not indicated unless ordered by the healthcare provider. It is important to follow specific orders in this situation.
C. Increasing fluid intake may not be advisable immediately after vomiting, especially in the context of heart failure. The infant may require evaluation for fluid status before increasing intake.
D. Administering the next dose as prescribed is the appropriate action unless contraindicated by specific circumstances or healthcare provider orders.
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Related Questions
Correct Answer is ["A","B","D","E","G"]
Explanation
A. Administer IV fluids intake: Hydration is a key intervention during a vaso-occlusive crisis. IV fluids help reduce blood viscosity and promote better circulation, which decreases the risk of further sickling.
B. Give oral hydroxyurea: Hydroxyurea reduces the frequency of sickling episodes by increasing fetal hemoglobin levels. It is part of long-term therapy and may be continued during acute care.
C. Administer meperidine IV for pain: Meperidine is avoided because its metabolite, normeperidine, can cause neurotoxicity and seizures. Opioids such as morphine or hydromorphone are preferred.
D. Instructing the parent to ensure the pneumococcal vaccine is current: Children with sickle cell disease are functionally asplenic and at high risk for infection. Ensuring vaccines are up to date is an important component of overall care.
E. Place the client on strict bedrest: Limiting activity helps reduce oxygen demand and pain caused by movement during a crisis. Bedrest supports recovery and comfort.
F. Apply cold compresses to the affected joints: Cold therapy causes vasoconstriction, which can worsen sickling. Warm compresses are preferred to improve blood flow and relieve pain.
G. Monitor oxygen saturation continuously: Monitoring oxygen saturation allows for early detection of hypoxia, which can trigger or exacerbate sickling episodes. Prompt intervention helps prevent complications.
Correct Answer is C
No explanation
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