The follow questions refer to the patient described below:
A 9 yr. old child with both hydrocephalus and a cardiac defect weighs 55 pounds. He requires digoxin by mouth once daily, the dose should be held if there are any symptoms of toxicity.
Pediatric maintenance dose is 5 mcg/kg daily given as a single dose. After listening to the apical rate for one full minute, you note it is only 50. Should you administer the digoxin as ordered?
NO
Just administer it without checking
instruct mom to give it
Yes
The Correct Answer is A
Digoxin is a medication commonly used to treat certain heart conditions, including some congenital heart defects. It's important to monitor the heart rate and other signs of toxicity when administering digoxin, especially in pediatric patients. Let's break down the information given:
The pediatric maintenance dose of digoxin is 5 mcg/kg daily.
The child weighs 55 pounds (approximately 25 kg).
Given these values, the total daily dose for this child would be:
Total daily dose = 5 mcg/kg × 25 kg = 125 mcg
This total daily dose is usually given as a single dose. However, the child's heart rate is noted to be only 50 beats per minute (bpm). A heart rate of 50 bpm in a child could potentially indicate bradycardia (slow heart rate), which can be a sign of digoxin toxicity. Bradycardia is a known adverse effect of digoxin, and it's important to assess for other signs of toxicity as well, such as nausea, vomiting, and changes in color vision.
In this case, it would be prudent to withhold the digoxin and assess the child further for signs of toxicity or bradycardia. The dose should not be administered until the healthcare provider is consulted and appropriate action is determined.
So, the correct answer is indeed NO. Administering the digoxin without considering the slow heart rate and the potential for toxicity could be unsafe for the child.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
a. Allow for adjustment of rules to correlate with the child's behavior: While flexibility can be important, allowing rules to be adjusted based on behavior can lead to inconsistency and confusion for the child. Consistent rules and expectations are crucial for children with ASD, as they thrive on predictability and structure.
b. Allow for imaginative play with peers without supervision: Children with ASD may have difficulties with social interactions and imaginative play. Supervision is important to ensure that play is safe, appropriate, and supportive of social skill development. Unsupervised play might not be beneficial if it leads to misunderstandings or conflicts.
c. Provide a flexible schedule that adjusts to the child's interests: Children with ASD generally benefit from a structured and predictable schedule rather than a flexible one that changes based on their interests. Predictability helps them feel secure and reduces anxiety. A flexible schedule could lead to increased stress and difficulty in transitioning between activities.
d. Establish a reward system for positive behavior: A reward system is an effective strategy for encouraging positive behavior in children with ASD. Reinforcement of desired behaviors helps to build and maintain new skills and can provide motivation. This approach aligns well with behavioral interventions commonly used with children on the autism spectrum.
Correct Answer is C
Explanation
A) A story book about a child who has diabetes:
While a story book about a child with diabetes can be informative and reassuring, it might not directly address the child's distress after an insulin injection. The child needs an interactive play activity that mimics the experience to help them cope with the distress.
B) A period of play in the playroom:
Playing in a general playroom might be enjoyable, but it may not directly address the child's specific distress related to the insulin injection. To address the distress, a play activity directly related to the injection experience is more appropriate.
C) A needleless syringe and a doll.
Explanation:
Using a needleless syringe and a doll allows the child to engage in therapeutic play that simulates the experience of receiving an insulin injection. This type of play, known as medical play or therapeutic medical play, allows children to gain a sense of control and understanding over medical procedures in a non-threatening and imaginative way. By allowing the child to "give" the doll an injection using the needleless syringe, the child can process their feelings and fears related to their own injections, helping to reduce anxiety and distress.
D) A video game:
Playing a video game can be engaging and distracting, but it doesn't directly help the child process their feelings or fears about the insulin injection. Therapeutic play involving a needleless syringe and a doll provides a more hands-on and interactive way for the child to work through their emotions.
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