A nurse is planning care for an 8-month-old infant who has heart failure. Which of the following actions should the nurse include in the plan of care?
Place the infant in a prone position.
Repeat a digoxin dosage if the infant vomits within 1 hr. of administration.
Administer cool, humidified oxygen via nasal cannula
Provide less frequent, higher volume feedings
The Correct Answer is C
Choice A Reason:
Placing the infant in a prone position might not be suitable for an infant with heart failure. Typically, an upright or semi-upright position can help reduce the workload on the heart by improving respiratory function and aiding in cardiac output.
Choice B Reason:
Repeating a digoxin dosage if the infant vomits within 1 hour of administration isn't recommended without consulting a healthcare provider. If vomiting occurs within this time frame, giving another dose might result in overdosing.
Choice C Reason:
Administering cool, humidified oxygen via nasal cannula can be beneficial for an infant with heart failure, as it helps in providing supplemental oxygen and maintaining adequate oxygenation levels.
Choice D Reason:
Providing less frequent, higher volume feedings might not be appropriate for an infant with heart failure. These infants often require smaller, more frequent feedings to prevent overloading the digestive system and to manage fluid intake.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A Reason:
Capillary refill of 1 second is within the normal range and might not specifically indicate moderate dehydration.
Choice B Reason:
Weight loss 7% is correct. In cases of moderate dehydration, a significant weight loss, typically around 6-9% of body weight, can occur due to fluid loss. This weight loss reflects the severity of dehydration in the infant.
Choice CReason:
A respiratory rate of 28/min might be slightly elevated but is not a primary indicator of moderate dehydration. Dehydration primarily affects cardiovascular and fluid balance systems rather than respiratory rate.
Choice DReason:
Bradycardia (a slow heart rate) is not typically associated with moderate dehydration. Dehydration often causes an increase in heart rate (tachycardia) as the body attempts to maintain cardiac output.
Correct Answer is B
Explanation
Choice A Reason:
Soak hairbrushes in boiling water for 10 minutes is incorrect. While it's good practice for general hygiene, impetigo is primarily a skin infection and is not typically spread through hairbrushes.
Choice B Reason:
Apply bactericidal ointment to lesions is correct. Topical antibiotics, such as mupirocin, are often recommended as treatment for impetigo. Applying bactericidal ointment to the lesions helps in the healing process and prevents the spread of the infection.
Choice C Reason:
Seal soft toys in a plastic bag for 14 days is incorrect. While cleaning and disinfecting toys is a good practice, impetigo is mainly transmitted through direct skin-to-skin contact or contact with contaminated items, but it does not require sealing toys in plastic bags for a specific duration.
Choice D Reason:
Administer acyclovir PO two times per day is incorrect. Acyclovir is an antiviral medication used to treat viral infections like herpes simplex virus (HSV), not bacterial infections like impetigo. It wouldn't be effective for impetigo treatment.
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