A nurse is collecting data from an infant who has heart failure and is taking digoxin. The nurse should identify which of the following findings as an indication of digoxin toxicity?
Edema
Jaundice
Purulent sputum
Bradycardia
The Correct Answer is D
A. Edema: Edema can occur with heart failure, but it is not specifically an indication of digoxin toxicity. Digoxin helps improve heart function and reduce edema, so it is not a direct sign of toxicity.
B. Jaundice: Jaundice may indicate liver dysfunction, but it is not a common sign of digoxin toxicity. Liver function issues can arise from various causes, but jaundice is not typically associated with digoxin toxicity.
C. Purulent sputum: Purulent sputum suggests an infection, such as pneumonia, and is not related to digoxin toxicity. This symptom requires further evaluation for respiratory infections, not digoxin-related issues.
D. Bradycardia: Bradycardia (a slow heart rate) is a classic sign of digoxin toxicity. Digoxin can slow the heart rate by affecting the electrical conduction system of the heart, and bradycardia is a key indicator of overdose or toxicity in infants and children taking this medication.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Collect a stool specimen for occult blood: A stool specimen for occult blood is typically used to check for hidden blood in the stool, which might suggest conditions like gastrointestinal bleeding or certain infections. It is not the primary test for diagnosing C. difficile infection.
B. Draw a blood culture: Blood cultures are used to identify bacteria or other pathogens in the blood, but they are not appropriate for diagnosing Clostridium difficile infection, which primarily affects the gastrointestinal system.
C. Conduct a tape test: A tape test is used for diagnosing pinworm infections, not for Clostridium difficile. It involves placing a piece of tape on the child's anal area to collect eggs for examination under a microscope. It is not relevant to the suspicion of C. difficile.
D. Obtain a stool specimen for culture: The most appropriate action is to collect a stool specimen for culture to identify C. difficile. The diagnosis of C. difficile infection is typically confirmed by stool testing, which may include testing for toxins produced by the bacteria.
Correct Answer is B
Explanation
Point A: Represents the third intercostal space at the right sternal border, which corresponds anatomically to the aortic valve area. This is a key auscultation site used during cardiac assessment to listen for murmurs and abnormalities related to the aortic valve. It is not used for palpation.
Point B: Fourth intercostal space at the left midclavicular line and is the correct location for palpating the point of maximal impulse (PMI) in infants and young children. In this age group, the PMI is typically found here due to the more horizontal position of the heart in the chest.
Point C: This location is at the 2nd or 3rd intercostal space, which is too high to assess the PMI in an infant. This area is used more for evaluating pulmonic valve sounds, not the apex of the heart.
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