A nurse is preparing to administer digoxin at a dosage of 8 mcg/kg/day orally, divided equally every 12 hours, to a preschooler who weighs 33 lbs. Digoxin elixir is available at a concentration of 0.05 mg/mL. How many mL should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

Choice A reason:Lower extremity edema is more commonly associated with right-sided heart failure, as it indicates systemic fluid congestion.

Choice B reason:Crackles in lung bases are expected in left-sided heart failure due to pulmonary congestion from fluid backing up into the lungs².

Choice C reason:Jugular vein distention is typically a sign of right-sided heart failure, reflecting increased central venous pressure.

Choice D reason:Ascites, the accumulation of fluid in the peritoneal cavity, is generally associated with right-sided heart failure or liver disease, not specifically left-sided heart failure.

Choice A reason: Hypophosphatemia refers to an abnormally low level of phosphate in the blood. The normal range for serum phosphate in adults is typically around 2.5 to 4.5 mg/dL. In the context of acute kidney injury (AKI), the kidneys’ ability to excrete phosphate is impaired, which can actually lead to hyperphosphatemia, not hypophosphatemia. Therefore, while phosphate levels are important to monitor in AKI, hypophosphatemia is not typically expected.

Choice B reason: Hypercalcemia is characterized by an elevated level of calcium in the blood, with the normal range being approximately 8.5 to 10.2 mg/dL. AKI can sometimes be associated with hypercalcemia, particularly if there is extensive tissue breakdown or rhabdomyolysis. However, it is not as commonly expected as hyperkalemia. Hypercalcemia in AKI is more often secondary to other underlying conditions rather than a direct result of the kidney injury itself.

Choice C reason: Hyperkalemia is a common electrolyte imbalance in AKI and refers to a high level of potassium in the blood. The normal range for serum potassium is about 3.5 to 5.0 mEq/L. In AKI, the kidneys’ ability to excrete potassium is compromised, leading to an accumulation of potassium in the blood. This can be life-threatening, causing cardiac dysrhythmias and muscle weakness. Hyperkalemia is a key concern in AKI management and is often expected in this condition. While all the listed electrolyte imbalances can occur in various clinical scenarios, hyperkalemia is the most commonly expected electrolyte disturbance in a patient with acute kidney injury. It is crucial for healthcare providers to monitor and manage electrolyte levels carefully in AKI to prevent complications.

Choice D reason: Hypernatremia means an elevated sodium level in the blood, with the normal range being 135 to 145 mEq/L. While sodium balance can be affected in AKI, hypernatremia is not typically expected. It is more commonly associated with conditions that cause a loss of water or an intake of sodium, such as diabetes insipidus or excessive salt ingestion. In AKI, the focus is often on managing fluid overload rather than sodium excess.