A 3-year-old child diagnosed with congestive heart failure is receiving maintenance doses of digoxin and furosemide (Lasix). She is rubbing her eyes when she is looking at the lights in the room and her heart rate is 65 beats per minute. The nurse expects which laboratory finding?

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Hypokalemia. When a patient is on digoxin and furosemide (Lasix), both medications can lead to potassium loss through different mechanisms. Digoxin toxicity is more likely to occur in the presence of hypokalemia as potassium is essential for proper cardiac function. The child's symptoms of visual disturbances and bradycardia are indicative of digoxin toxicity, which is exacerbated by low potassium levels. Now, let's analyze why the other options are incorrect: B) Hypomagnesemia: While hypomagnesemia can also potentiate digoxin toxicity, the symptoms presented in the child are more indicative of hypokalemia. C) Hypocalcemia: Hypocalcemia can cause muscle cramps and tetany but is not directly related to the symptoms described in the child. D) Hypophosphatemia: While furosemide can lead to phosphorus wasting, the symptoms and presentation in the child are more suggestive of hypokalemia in this case. Educationally, understanding the electrolyte imbalances associated with specific medications is crucial in pediatric nursing, especially when managing conditions like congestive heart failure. Monitoring and addressing electrolyte levels are essential to prevent complications and ensure optimal patient outcomes.

Correct Answer: C

Rationale: In pediatric nursing, understanding fontanel assessment is crucial as it provides valuable information about an infant's intracranial pressure and brain development. In this case, the correct answer is C) Closed anterior and posterior fontanels for a 19-month-old toddler. The anterior fontanel typically closes around 18 months of age, which is consistent with the child's age in this scenario. The closure of the anterior fontanel indicates proper brain growth and development. The posterior fontanel, located at the back of the head, closes much earlier in infancy. Option A) Closed anterior fontanel and open posterior fontanel is incorrect because the posterior fontanel should be closed by this age. Option B) Open anterior fontanel and closed posterior fontanel is also incorrect as both fontanels should be closed at 19 months. Option D) Open anterior and posterior fontanels is incorrect as both fontanels should be closed in a toddler of 19 months. Understanding fontanel closure timelines is essential in pediatric nursing to monitor normal growth and development, identify abnormalities early, and provide appropriate care and interventions.

Correct Answer: B

Rationale: In pediatric nursing, administering TPN through a peripheral I.V. line requires careful consideration of the glucose concentration to prevent vein irritation or damage. The correct answer is B) 10% glucose because it is the smallest concentration that provides adequate nutrition without causing irritation to small veins. Option A) 5% glucose is too dilute to provide sufficient TPN support, especially for a school-age child who may have higher nutritional needs. Option C) 15% and D) 17% glucose concentrations are too concentrated and can be caustic to small veins, leading to phlebitis or thrombophlebitis. Educationally, understanding the appropriate glucose concentration for TPN in pediatric patients is crucial for safe and effective nursing practice. Nurses must be aware of the potential complications of incorrect glucose concentrations to ensure optimal patient outcomes. This knowledge helps in providing quality care and preventing harm to pediatric patients receiving TPN through peripheral lines.

Correct Answer: D

Rationale: In pediatric CPR, using the heel of one hand for sternal compressions (Option D) is correct because it allows for appropriate force and depth while minimizing the risk of causing injury to the child. This technique is recommended by the American Heart Association for infants and children. Option A is incorrect because using both hands for compressions is preferred in adult CPR, not pediatric CPR. Option B is incorrect as the recommended compression-to-ventilation ratio for pediatric CPR is 30:2. Option C is incorrect as one-person CPR is standard practice in pediatric resuscitation unless another trained rescuer is available. Educationally, it is crucial for nurses to understand the nuances of pediatric CPR to provide effective and safe care to children in emergency situations. Proper technique ensures optimal outcomes and reduces the risk of complications during resuscitation efforts. Training and practice in pediatric CPR are essential for healthcare providers working with pediatric populations.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Gown, gloves, mask, and eye goggles or eye shield. The primary mode of transmission for severe acute respiratory syndrome (SARS) is through respiratory droplets. Therefore, it is crucial for the nurse to wear comprehensive personal protective equipment to prevent exposure. Option A) Gloves alone are not sufficient to protect against respiratory droplets that could potentially transmit SARS. Option B) Gown and gloves provide some protection, but a mask and eye protection are necessary due to the airborne nature of the virus. Option C) Gown, gloves, and mask offer good protection, but eye protection is also essential to prevent exposure through the mucous membranes of the eyes. Educationally, understanding the appropriate personal protective equipment for different infectious diseases is crucial for healthcare professionals to ensure their safety and the safety of their patients. In pediatric nursing, where children may not always exhibit typical symptoms, it is especially important to take all necessary precautions to prevent the spread of infectious diseases.