Nursing Elites

1. A 2-year-old child with heart failure (HF) is admitted for replacement of a graft for coarctation of the aorta. Prior to administering the next dose of digoxin (Lanoxin), the nurse obtains an apical heart rate of 128 bpm. What action should the nurse take?

• A. Determine the pulse deficit.
• B. Administer the scheduled dose.
• C. Calculate the safe dose range.
• D. Review the serum digoxin level.

Correct answer: B

Rationale: Administering the scheduled dose is appropriate in this scenario since the heart rate of 128 bpm is within an acceptable range for a 2-year-old child with heart failure. Monitoring for signs of digoxin toxicity is important; however, the immediate action required is to administer the scheduled dose as prescribed based on the heart rate assessment.

2. Which nursing intervention is most important to assist in detecting hypopituitarism and hyperpituitarism in children?

• A. Carefully recording the height and weight of children to detect inappropriate growth.
• B. Performing head circumference measurements on infants under one year of age.
• C. Assessing for behavioral problems at home and school by interviewing the parents.
• D. Noting tracked weight gain without a gain in height on a growth chart.

Correct answer: A

Rationale: Recording the height and weight of children is crucial in detecting growth abnormalities like hypopituitarism and hyperpituitarism. Inappropriate growth patterns, such as disproportionate weight gain or stunted height, can be indicative of these conditions. Regular monitoring of height and weight is a fundamental nursing intervention that can aid in the early identification and management of pituitary-related disorders in children.

3. The mother of a 14-year old who had a below-the-knee amputation for osteosarcoma tells the nurse that her child is angry and blaming her for allowing the amputation to occur. Which response is best for the nurse to provide?

• A. I will ask the HCP for a psychiatric consult for your child'
• B. This type of acting out behavior is normal for adolescents'
• C. It is important to focus on your child’s needs at this difficult time'
• D. A reaction of anger is your child’s attempt to cope with this loss'

Correct answer: D

Rationale: Acknowledging the child's anger as part of the coping process helps the mother understand her child's emotional response.

4. A 5-year-old child with leukemia is receiving chemotherapy. The nurse notes that the child’s white blood cell count is low. What is the nurse’s priority intervention?

• A. Administer antibiotics as prescribed
• B. Place the child in protective isolation
• C. Encourage the child to eat a balanced diet
• D. Teach the parents about infection prevention

Correct answer: B

Rationale: The priority intervention for a 5-year-old child with leukemia receiving chemotherapy and having a low white blood cell count is to place the child in protective isolation. This intervention helps reduce the risk of infection, which is crucial in this immunocompromised state. Protective isolation aims to limit the child's exposure to pathogens and promote their safety during a period of increased vulnerability to infections.

5. What intervention should the nurse implement first for a male toddler brought to the emergency center approximately three hours after swallowing tablets from his grandmother’s bottle of digoxin (Lanoxin)?

• A. Administer activated charcoal orally
• B. Prepare gastric lavage
• C. Obtain a 12-lead electrocardiogram
• D. Give IV digoxin immune fab (Digibind)

Correct answer: D

Rationale: In cases of digoxin toxicity, IV digoxin immune fab (Digibind) is the antidote and should be administered first to counteract the effects of digoxin poisoning. This intervention is crucial in managing digoxin overdose and should be initiated promptly to improve patient outcomes. Activated charcoal and gastric lavage are not effective in treating digoxin poisoning and may not be beneficial at this stage. While obtaining an electrocardiogram is important to assess cardiac function, administering the antidote should take precedence to address the immediate life-threatening effects of digoxin toxicity.

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