A nurse is providing discharge teaching to the guardian of an infant who had a large myelomeningocele repair in the lumbar area. Which of the following instructions should the nurse include?

A. "I will take my child's pulse for 30 seconds before giving the medication.": Checking the pulse for 1 full minute is crucial before administering digoxin, especially in preschool-age children, because the medication can slow the heart rate. If the pulse is below the prescribed threshold (usually <90–100 bpm in young children), the dose should be held.

B. "I will mix the medication in a glass with 4 ounces of orange juice.": Digoxin can be given with a small amount of liquid, but large volumes of juice are not recommended because excessive liquid may make it difficult for the child to take the full dose. Also, certain juices may interact with absorption; using a small amount of water or juice is safer.

C. "I will repeat the dose if she vomits after taking the medication.": Repeating a dose after vomiting is unsafe because it can result in digoxin toxicity, especially in young children. The parent should contact the healthcare provider for guidance instead of administering a second dose.

D. "I will tell my child to brush her teeth after she takes this medication.": Digoxin elixir is prepared in a high-sugar syrup base to make it more palatable for children. Frequent administration of this sticky, sugary liquid can lead to tooth decay and dental carries. Brushing the teeth (or rinsing the mouth in younger infants) after each dose is an essential measure.

A. Attach the feeding bag tubing to the end of the NG tube: Attaching the feeding bag tubing should occur only after confirming correct tube placement. Connecting the feeding before verification increases the risk of administering formula into the lungs if the tube is misplaced.

B. Flush the tube with water: Flushing helps maintain tube patency, but it should be done after placement has been verified. Flushing an incorrectly placed tube could introduce fluid into the respiratory tract, posing a serious safety risk.

C. Set the administration rate on the feeding pump: Setting the feeding rate is part of the preparation process but is not the priority action. Safety measures, particularly verifying tube placement, must be completed before adjusting pump settings.

D. Check the pH of the gastric secretions: Verifying NG tube placement is the first and most critical step prior to administering enteral feeding. Checking the pH of aspirated gastric contents helps confirm gastric placement and reduces the risk of aspiration or respiratory complications.