The nurse is preparing to administer medications for an eight-month-old infant with heart failure. The infant has a blood pressure of 114/66 mm Hg, apical pulse of 88 beats/minute, and respirations of 30 breaths/minute.
Which medication should the nurse withhold until the healthcare provider is notified?
Digoxin.
Furosemide.
Hydralazine.
Enalapril.
The Correct Answer is A
For an eight-month-old infant with heart failure, the nurse should withhold digoxin if the infant's apical pulse is less than 90 beats/minute and notify the healthcare provider. In this case, the infant's apical pulse is 88 beats/minute, so the nurse should withhold the digoxin and notify the healthcare provider.
Furosemide ( B), hydralazine (C), and enalapril (D) do not have specific parameters for withholding based on the infant's vital signs.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
The nurse should recognize that the statement "high-calorie formula encourages increased growth" is an appropriate understanding of interventions for an infant with FTT. High-calorie formula can help infants who are not gaining weight adequately to increase their calorie intake and promote growth.
Breast milk provides adequate nutrition for most infants, but in cases of FTT, the infant may require a higher calorie intake than breast milk can provide. Regular syringe feedings and fruit juice are not recommended interventions for FTT. Syringe feedings can cause aspiration and fruit juice does not provide the appropriate balance of nutrients needed for an infant's growth and development.
Correct Answer is C
Explanation
The nurse should reassure the parents that febrile seizures typically decrease in frequency as the child grows older. Most children outgrow febrile seizures by the age of 5 years.
Ibuprofen is not typically used prophylactically to prevent febrile seizures.
Providing the child with a sponge bath for temperatures over 100.6°F (38.1° C) can help to lower the fever, but it will not necessarily prevent febrile seizures.
Avoiding excessive visual stimuli is not necessary for children with febrile seizures, as this type of seizure is triggered by a fever rather than visual stimuli.
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