Nokea
A 6-month-old infant is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than _______ beats/min.
- A. 60
- B. 70
- C. 90 to 110
- D. 110 to 120
Correct Answer: C
Rationale: If the 1-minute apical pulse is below 90 to 110 beats/min, the digoxin should not be given to a 6-month-old. Sixty beats/min is the cut-off for holding the digoxin dose in an adult; 70 beats/min is the determining heart rate to hold a dose of digoxin for an older child; 110 to 120 beats/min is an acceptable heart rate to administer digoxin to a 6-month-old.
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The patient most probably has
- A. severe aortic stenosis
- B. patent ductus arteriosus
- C. Williams syndrome
- D. none of the above
Correct Answer: A
Rationale: The clinical features suggest severe aortic stenosis with left ventricular hypertrophy.
The following are associated with an increased risk of fetal abnormalities:
- A. Oligohydramnios
- B. A previous sibling with anencephaly
- C. Paternal diabetes
- D. Decreased a-fetoprotein level
Correct Answer: B
Rationale: A previous sibling with anencephaly increases the risk of fetal abnormalities, particularly neural tube defects, in subsequent pregnancies.
An adult female with multiple sclerosis (MS) falls while walking to the bathroom. On transfer to the intensive care unit, she is confused and has had projectile vomiting twice. Which intervention should the nurse implement first?
- A. Determine client's last dose of corticosteroids
- B. Determine neurological baseline prior to the fall
- C. Administer a PRN IV antiemetic as prescribed
- D. Complete head to toe neurological assessment.
Correct Answer: D
Rationale: The symptoms suggest increased intracranial pressure or a neurological emergency. A thorough neurological assessment is necessary to identify the cause and guide further interventions.
How would the nurse caring for an infant with congestive heart failure (CHF) modify feeding techniques to adapt for the child's weakness and fatigue? (Select all that apply.)
- A. Feeding more frequently with smaller feedings
- B. Using a soft nipple with enlarged holes
- C. Holding and cuddling the child during feeding
- D. Substituting glucose water for formula
Correct Answer: A
Rationale: Infants with CHF fatigue easily. Feeding can be given more frequently in smaller amounts through a soft, large-holed nipple. Formulas with a denser caloric content can be offered. The child may be encouraged to nurse if he or she is held.
Benign Rolandic seizures:
- A. Usually occurs at night
- B. Are difficult to control with drugs
- C. Centrotemporal spikes in EEG are a recognised feature
- D. Are more common than petit mal
Correct Answer: C
Rationale: Centrotemporal spikes on EEG are a hallmark feature of benign Rolandic epilepsy, a common childhood epilepsy syndrome.