The practical nurse (PN) administers digoxin to a 9-month-old infant with an apical heart rate of 160 beats/minute.
Which apical heart rate indicates that the therapeutic effect of the medication has been achieved?
60 beats/minute.
120 beats/minute.
80 beats/minute.
180 beats/minute.
The Correct Answer is B
Choice A rationale
A heart rate of 60 beats/minute for a 9-month-old infant is significantly below the normal physiological range (90-140 beats/minute). Digoxin primarily acts to slow the heart rate and increase contractility, but such a low rate indicates severe bradycardia, a potentially dangerous adverse effect of digoxin toxicity due to excessive parasympathetic stimulation and impaired atrioventricular conduction.
Choice B rationale
A heart rate of 120 beats/minute is within the normal resting range for a 9-month-old infant, which typically falls between 90-140 beats/minute. Digoxin’s therapeutic effect in infants with cardiac conditions often aims to bring the heart rate to a more efficient and less tachycardic rate, thereby improving cardiac output without causing bradycardia.
Choice C rationale
A heart rate of 80 beats/minute is below the typical normal range for a 9-month-old infant (90-140 beats/minute). While digoxin can decrease heart rate, 80 beats/minute suggests an excessive therapeutic effect, potentially indicating mild bradycardia which could compromise cardiac output and tissue perfusion.
Choice D rationale
A heart rate of 180 beats/minute is significantly above the normal physiological range for a 9-month-old infant (90-140 beats/minute). This elevated rate indicates persistent tachycardia, suggesting that the digoxin has not achieved its therapeutic effect of slowing the heart rate, or that the underlying cardiac issue is not adequately controlled.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Assessing elimination hygiene habits is important for preventing recurrent UTIs, but it does not directly address the immediate goal of minimizing complications of vesicoureteral reflux (VUR) in an acute febrile UTI. While good hygiene reduces bacterial entry, VUR involves retrograde urine flow.
Choice B rationale
Completing post-void bladder scans helps assess bladder emptying and residual urine, which are risk factors for UTIs. However, in the context of VUR and a febrile UTI, it's a diagnostic tool rather than a primary intervention to actively minimize the reflux itself during the infection.
Choice C rationale
Implementing a frequent voiding schedule minimizes the volume of urine in the bladder and reduces the duration of bladder distention. This decreases the likelihood of vesicoureteral reflux and helps to flush out bacteria, thus minimizing the risk of renal parenchymal damage during a febrile UTI.
Choice D rationale
Encouraging adequate oral fluid intake helps flush bacteria from the urinary tract and prevents dehydration, which is beneficial for overall health and UTI management. However, while important, it does not directly impact the mechanics of vesicoureteral reflux as effectively as frequent bladder emptying.
Correct Answer is D
Explanation
Choice A rationale
Cheese is a good source of calcium and protein, but it is not a primary source of iron. Iron is essential for hemoglobin synthesis, and the client's hemoglobin and hematocrit levels are below normal ranges [Hemoglobin, pregnant female > 11 g/dL ( > 110 g/L); Hematocrit, pregnant female > 33% ( > 0.33 volume fraction)], indicating iron deficiency anemia.
Choice B rationale
Cauliflower is a cruciferous vegetable rich in vitamin C and fiber, but its iron content is relatively low. While vitamin C aids in iron absorption, cauliflower itself does not provide a significant amount of dietary iron to effectively address the client's anemic status.
Choice C rationale
Carrots are well-known for their beta-carotene content, a precursor to vitamin A, and provide fiber. However, carrots are not a significant source of iron. To combat iron deficiency anemia during pregnancy, foods rich in heme iron or non-heme iron with good bioavailability are required.
Choice D rationale
Chicken, particularly the dark meat, is a good source of heme iron, which is more readily absorbed by the body compared to non-heme iron found in plant-based foods. Given the client's anemic status, increasing dietary intake of iron-rich foods like chicken is crucial for improving hemoglobin and hematocrit levels.
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