A nurse is assessing a client who has a sliding hiatal hernia.
Which of the following findings should the nurse expect?

Choice A rationale

Digoxin slows the heart rate by inhibiting the sodium-potassium pump, which increases intracellular calcium and enhances myocardial contractility. Tachycardia is an increase in heart rate, which is the opposite of the expected effect of digoxin. Bradycardia is a more common sign of digoxin toxicity.

Choice B rationale

Insomnia is not a recognized or common side effect of digoxin toxicity. The central nervous system effects of digoxin toxicity typically include confusion, fatigue, and lethargy. Digoxin does not directly interfere with the sleep-wake cycle in a way that would cause insomnia.

Choice C rationale

Hearing loss is not a known symptom of digoxin toxicity. The drug's primary effects are on the cardiovascular and gastrointestinal systems, and to a lesser extent, the central nervous system. Auditory disturbances are not a typical finding associated with the toxic effects of digoxin.

Choice D rationale

Digoxin toxicity often affects the central nervous system and sensory organs. The drug can cause visual disturbances such as blurred vision, photophobia, and a characteristic yellow-green halo around objects (xanthopsia), which is an early sign of toxicity. This effect is a result of digoxin's impact on neural pathways

Choice A rationale

Varying a child's scheduled activities each day is counterproductive for a child with ADHD. Children with this condition benefit significantly from structured routines and predictable schedules. A consistent daily structure minimizes the need for the child to process new information and adapt to changes, which can be overwhelming and lead to decreased concentration and increased impulsivity.

Choice B rationale

Encouraging a child with ADHD to read a book during an outdoor school activity period is not a suitable strategy. This situation places the child in an environment filled with external stimuli, such as other children playing, sounds, and visual distractions. This highly stimulating setting is precisely the opposite of what is needed to improve focus and attention in a child with ADHD.

Choice C rationale

Children with ADHD have difficulty filtering out irrelevant stimuli from their environment. Providing a designated, quiet space with minimal distractions directly addresses this core challenge. This environment reduces the number of competing sensory inputs, allowing the child to direct their limited attention resources more effectively toward a single task, such as homework, thereby improving concentration.

Choice D rationale

The mode of completing homework, whether by hand or using a computer, is less critical than the environmental context. While a computer might offer some interactive benefits, it also presents numerous potential distractions, such as internet access, games, and notifications. Having a child write by hand in a distracting environment would not be as effective as using a computer in a distraction-free zone. *.