A nurse is preparing to administer digoxin to a pediatric client who has heart failure. Which of the following actions is appropriate?
Instructing the client to eat foods that are low in potassium.
Repeat the dose if the client spits it out.
Measuring apical pulse rate for 30 seconds before administration.
Evaluating the client for nausea, vomiting, and anorexia.
The Correct Answer is C
A. Clients on digoxin should actually have an adequate intake of potassium, as low potassium levels can increase the risk of digoxin toxicity.
B. If a pediatric client spits out digoxin, the dose should not be repeated automatically; instead, the nurse should assess the situation and follow the facility's protocol regarding missed doses.
C. Measuring the apical pulse for one full minute before administering digoxin is critical; if the pulse is below the established threshold (usually <60 bpm for children), the medication should be held and the provider notified.
D. While evaluating for nausea, vomiting, and anorexia is important, it is not an appropriate immediate action before administering the medication. The priority action is to assess the apical pulse.
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Correct Answer is D
Explanation
A. Providing a lecture that encourages taking calculated risks may lead adolescents to underestimate the dangers of certain activities rather than promoting safety.
B. Offering rewards for reporting high-risk behavior may create an environment of distrust and could discourage open dialogue among peers regarding safety issues.
C. Giving pamphlets does not engage adolescents effectively; they may not read or absorb the information thoroughly without interactive discussion.
D. Creating a mock scene of a motor-vehicle crash effectively demonstrates the serious consequences of high-risk behaviors, engaging students in a way that promotes awareness and understanding of safety.
Correct Answer is ["A","B","E"]
Explanation
A. Increased risk-taking behaviors are common as adolescents may feel invulnerable and engage in dangerous activities without considering the consequences.
B. Greater incidence of accidental injuries is often a result of risk-taking behaviors, which can be influenced by feelings of invulnerability.
C. Reduced mental health issues is incorrect as feelings of invulnerability can lead to increased stress and anxiety, negatively impacting mental health.
D. Improved social relationships are not guaranteed; feelings of invulnerability may actually lead to conflict or isolation if risk-taking behaviors are harmful.
E. Higher likelihood of substance abuse can result from a belief in invulnerability, leading adolescents to underestimate the risks associated with drug and alcohol use.
F. Enhanced academic performance is not directly linked to feelings of invulnerability and may suffer due to distractions from risky behaviors.