A seven-year-old child is rushed into the emergency room after being stung by a yellow jacket.

The child is nauseated and vomiting and is experiencing itching and swelling on the arm where stung.

The child is having trouble breathing.

Which type of response is the child experiencing?

Choice A rationale

Digoxin is a cardiac glycoside that slows and strengthens the heart rate and is commonly used in infants with heart failure. For an infant, the normal apical pulse rate typically ranges from 100 to 160 beats per minute. A rate of 80 beats per minute is significantly below the acceptable lower limit, indicating potential digoxin toxicity or an existing underlying bradycardia, requiring the nurse to hold the dose and notify the physician immediately to prevent serious adverse effects.

Choice B rationale

A heart rate of 140 beats per minute is within the normal physiological range for an infant, which is generally 100 to 160 beats per minute. This rate is considered acceptable and does not warrant holding the prescribed dose of digoxin, assuming other parameters and clinical signs of toxicity are absent. Digoxin aims to improve cardiac contractility and may slightly slow the rate but 140 is a safe rate.

Choice C rationale

An apical pulse rate of 100 beats per minute sits at the lower boundary of the normal range for an infant, which spans from 100 to 160 beats per minute. While close to the cutoff, it is still technically acceptable for administering digoxin. The nurse would monitor closely, but the dose would generally not be withheld unless the rate was less than 90 or 100, depending on the facility policy.

Choice D rationale

A heart rate of 120 beats per minute is well within the expected and safe normal range for an infant, which typically extends from 100 to 160 beats per minute. This rate is adequate and does not suggest bradycardia or pose any immediate concern regarding digoxin administration. The dose should be given as scheduled, and continued monitoring should take place.

Choice A rationale

Diabetes mellitus, a disorder of glucose metabolism (normal blood glucose 70-100 mg/dL), is not a direct or common complication of bulimia nervosa, which is characterized by binging and compensatory behaviors like purging, although weight fluctuations can impact metabolic health.

Choice B rationale

Severe erosion of teeth, specifically dental enamel, is a common and severe complication of bulimia nervosa, primarily caused by repeated self-induced vomiting where gastric acid bathes the teeth, leading to demineralization and loss of protective structure.

Choice C rationale

Hypertension (normal blood pressure varies by age, generally <120/80 mm Hg in adults) is not typically a direct complication of bulimia nervosa; instead, fluid and electrolyte imbalances (e.g., hypokalemia) and cardiovascular issues like arrhythmias are more characteristic concerns.

Choice D rationale

Atherosclerosis, which involves the hardening and narrowing of arteries due to plaque buildup, is a long-term cardiovascular risk generally associated with conditions like hyperlipidemia, obesity, and diabetes, not an immediate or direct complication of bulimia nervosa.