A nurse is caring for a group of toddlers receiving digoxin therapy. For which of the following toddlers should the nurse revise the plan of care?
A toddler who has an apical pulse of 100/min
A toddler who has a potassium level of 4.0 mEq/L (3.4 to 4.7 mEq/L)
A toddler who has a digoxin level of 1.2 ng/mL (0.8 to 2 ng/mL)
A toddler who has vomited 2 times in the last hour
The Correct Answer is D
A. A normal apical pulse for a toddler is around 90-140 beats per minute. This toddler's heart rate is within normal range.
B. This toddler's potassium level is within the normal range.
C. This toddler's digoxin level is within the therapeutic range.
D. Vomiting can be a sign of digoxin toxicity. Digoxin has a narrow therapeutic index, meaning that even small increases in the drug level can lead to toxicity.
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Related Questions
Correct Answer is C
Explanation
A. While this might seem positive, a newborn is not a playmate for a 3-year-old. This can lead to unrealistic expectations and disappointment.
B. This is not necessary and might create additional stress for the older child. Changes can be made gradually as needed.
C. This is a helpful suggestion. A doll can help the child understand the newborn's needs and prepare for their role as a big sibling.
D. While changes might occur, it's important to maintain as much consistency as possible in the older child's routine to provide a sense of security.
Correct Answer is D
Explanation
A. The halo vest immobilizes the cervical spine completely. Any movement that might disturb the alignment of the spine is contraindicated. Using a turning sheet could potentially cause movement and damage the spine.
B. Tightening the screws without medical direction can be harmful. The screws should be checked regularly by healthcare professionals, and adjustments made as needed.
C. The entire purpose of the halo vest is to immobilize the neck. Any movement of the neck could disrupt the healing process and cause further injury.
D. Pin site care is crucial to prevent infection. The nurse should assess the pin sites regularly for signs of infection, such as redness, swelling, drainage, or increased pain.
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