The follow questions refer to the patient described below:
A 9 yr. old child with both hydrocephalus and a cardiac defect weighs 55 pounds. He requires digoxin by mouth once daily, the dose should be held if there are any symptoms of toxicity.
Pediatric maintenance dose is 5 mcg/kg daily given as a single dose. After listening to the apical rate for one full minute, you note it is only 50. Should you administer the digoxin as ordered?
NO
Just administer it without checking
instruct mom to give it
Yes
The Correct Answer is A
Digoxin is a medication commonly used to treat certain heart conditions, including some congenital heart defects. It's important to monitor the heart rate and other signs of toxicity when administering digoxin, especially in pediatric patients. Let's break down the information given:
The pediatric maintenance dose of digoxin is 5 mcg/kg daily.
The child weighs 55 pounds (approximately 25 kg).
Given these values, the total daily dose for this child would be:
Total daily dose = 5 mcg/kg × 25 kg = 125 mcg
This total daily dose is usually given as a single dose. However, the child's heart rate is noted to be only 50 beats per minute (bpm). A heart rate of 50 bpm in a child could potentially indicate bradycardia (slow heart rate), which can be a sign of digoxin toxicity. Bradycardia is a known adverse effect of digoxin, and it's important to assess for other signs of toxicity as well, such as nausea, vomiting, and changes in color vision.
In this case, it would be prudent to withhold the digoxin and assess the child further for signs of toxicity or bradycardia. The dose should not be administered until the healthcare provider is consulted and appropriate action is determined.
So, the correct answer is indeed NO. Administering the digoxin without considering the slow heart rate and the potential for toxicity could be unsafe for the child.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Levothyroxine
Correct Answer: Levothyroxine should be administered before breakfast.
Explanation: Levothyroxine is a synthetic thyroid hormone used to treat hypothyroidism. It needs to be taken on an empty stomach, at least 30 minutes before eating, to ensure proper absorption. Food can interfere with its absorption, especially foods containing calcium, iron, and fiber.
B. Digoxin
Incorrect Explanation: Digoxin does not need to be administered before breakfast.
Explanation: Digoxin is a medication used to treat heart conditions like congestive heart failure and atrial fibrillation. It doesn't have specific instructions regarding administration in relation to meals. It's important to administer digoxin consistently at the same time every day, but it doesn't need to be taken specifically before or after breakfast.
C. Divalproex
Incorrect Explanation: Divalproex does not need to be administered before breakfast.
Explanation: Divalproex is used to treat conditions like epilepsy and bipolar disorder. It can be taken with or without food. While taking it with food might reduce the likelihood of stomach upset, there's no requirement to take it specifically before breakfast.
D. Mycostatin Mouthwash
Incorrect Explanation: Mycostatin mouthwash is not related to breakfast timing.
Explanation: Mycostatin is an antifungal medication used to treat fungal infections in the mouth (oral thrush). Its administration is not linked to meal times. It's typically swished around in the mouth and then swallowed or spit out, depending on the specific instructions provided by the healthcare provider.
Correct Answer is D
Explanation
a. Allow for adjustment of rules to correlate with the child's behavior: While flexibility can be important, allowing rules to be adjusted based on behavior can lead to inconsistency and confusion for the child. Consistent rules and expectations are crucial for children with ASD, as they thrive on predictability and structure.
b. Allow for imaginative play with peers without supervision: Children with ASD may have difficulties with social interactions and imaginative play. Supervision is important to ensure that play is safe, appropriate, and supportive of social skill development. Unsupervised play might not be beneficial if it leads to misunderstandings or conflicts.
c. Provide a flexible schedule that adjusts to the child's interests: Children with ASD generally benefit from a structured and predictable schedule rather than a flexible one that changes based on their interests. Predictability helps them feel secure and reduces anxiety. A flexible schedule could lead to increased stress and difficulty in transitioning between activities.
d. Establish a reward system for positive behavior: A reward system is an effective strategy for encouraging positive behavior in children with ASD. Reinforcement of desired behaviors helps to build and maintain new skills and can provide motivation. This approach aligns well with behavioral interventions commonly used with children on the autism spectrum.
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