Which environmental factor is most significant when planning care for a client with osteomalacia?

Choice A: Obtaining postoperative vital signs for a client one day following unilateral knee arthroplasty is a nursing action that the nurse can assign to the PN, as this is a basic skill that does not require complex judgment or intervention by the registered nurse. Therefore, this is a correct choice.

Choice B: Starting the second blood transfusion for a client twelve hours following a below knee amputation is not a nursing action that the nurse should assign to the PN, as this is an advanced skill that requires close monitoring and evaluation by the registered nurse. This is an incorrect choice.

Choice C: Initiating patient controlled analgesia (PCA. pumps for two clients immediately postoperatively is not a nursing action that the nurse should assign to the PN, as this involves administering controlled substances and assessing pain levels, which are beyond the scope of practice of the PN. This is another incorrect choice.

Choice D: Performing daily surgical dressing change for a client who had an abdominal hysterectomy is a nursing action that the nurse can assign to the PN, as this is a routine task that can be done under the supervision and direction of the registered nurse. Therefore, this is another correct choice.

Choice E: Administering a dose of insulin per sliding scale for a client with type 2 diabetes mellitus (DM) is a nursing action that the nurse can assign to the PN, as this is an established protocol that can be followed by the PN with appropriate documentation and reporting. Therefore, this is another correct choice.

Choice A: Administering a half dose now is not advisable, because it may result in underdosing or overdosing of digoxin. Digoxin has a narrow therapeutic range and a high risk of toxicity, especially in infants and children. The amount of digoxin absorbed by the infant before vomiting is unknown, so giving a partial dose may not achieve therapeutic levels or may exceed safe levels.

Choice B: Giving another dose is not advisable, because it may result in overdosing of digoxin. Digoxin has a narrow therapeutic range and a high risk of toxicity, especially in infants and children. The amount of digoxin absorbed by the infant before vomiting is unknown, so giving a full dose may exceed safe levels and cause adverse effects such as nausea, vomiting, bradycardia, arrhythmias, or visual disturbances.

Choice C: Mixing the next dose with food is not advisable, because it may affect the absorption and bioavailability of digoxin. Digoxin should be taken on an empty stomach or at least one hour before or two hours after meals, because food can interfere with its absorption from the gastrointestinal tract and reduce its effectiveness.

Choice D:Withholding the dose is the safest option. If vomiting occurs within 30 minutes of administration, it’s generally advised to skip that dose to avoid the risk of overdose.The next dose should be given as scheduled Digoxin has a long half-life and accumulates in tissues, so missing one dose will not significantly affect its therapeutic effect. Withholding this dose will avoid overdosing and toxicity of digoxin, which can be life-threatening in infants and children. The nurse should also advise the mother to resume the regular dosing schedule and monitor the infant's pulse rate and signs of digoxin toxicity.