The nurse is caring for a patient, age 68, who is receiving digoxin (Lanoxin) 0.125 mg qd for cardiac myopathy. Which of the following assessments of the patient would indicate that he is experiencing a side effect of digoxin that requires follow-up?

Correct Answer: B

Rationale: Anorexia, or loss of appetite, is a common side effect of digoxin. It can lead to weight loss, weakness, and fatigue. Monitoring for anorexia is important because it may indicate digoxin toxicity, which can be serious and require intervention. Skin flushing is not a common side effect of digoxin. Hypertension is also not associated with digoxin use. Constipation is generally not a common side effect of digoxin. Therefore, anorexia is the assessment that indicates a potential side effect of digoxin that requires follow-up.

Correct Answer: E

Rationale: Clients with immune system disorders may receive treatments such as immunoglobulin therapy or biologic agents through infusions. It is essential for the nurse to monitor the client for infusion reactions, which can include symptoms such as fever, chills, nausea, and allergic reactions. Early recognition of infusion reactions is crucial for prompt intervention to prevent complications and ensure the client's safety. By closely monitoring the client during and after the infusion, the nurse can detect and address any adverse reactions promptly.

Correct Answer: C

Rationale: In the context of pharmacology and pediatric nursing, understanding the modes of transmission of HIV is crucial for providing safe and effective care to pediatric patients. In this question from Wongs Essentials of Pediatric Nursing test bank, the correct answer is C) Tears and F) Breastmilk. Tears and breastmilk can transmit HIV because they can contain the virus in certain situations. Tears can transmit HIV if they come into contact with mucous membranes or open wounds. Breastmilk can also transmit HIV from an infected mother to her child during breastfeeding. The other options, A) Saliva, B) Sweat, D) Blood, and G) Urine, are not established routes of HIV transmission. Saliva, sweat, and urine do not typically contain enough of the virus to transmit HIV, and blood can transmit HIV but it is not through established body fluids like tears and breastmilk. Educationally, this question helps reinforce the importance of understanding the specific modes of transmission of HIV to prevent its spread, especially in pediatric populations where proper precautions and knowledge are essential in providing care. It also highlights the significance of evidence-based practice in healthcare to ensure accurate information is utilized in patient care decisions.

Correct Answer: C

Rationale: It is important for the nurse to clarify to the student that donating blood does not put them at risk for getting AIDS. Blood donation centers follow strict protocols to ensure that donated blood is safe for transfusion, including screening for infectious diseases like HIV. It is admirable to donate blood as it can save lives without putting the donor at risk for acquiring HIV. It is crucial to dispel any misconceptions or fears surrounding blood donation to encourage people to participate in this important act of altruism.

Correct Answer: A

Rationale: The nurse should determine if the client keeps diphenhydramine hydrochloride (Benadryl) on hand because it is an antihistamine medication commonly used to treat allergic reactions, including those caused by bee stings. In the event of a bee sting reaction, diphenhydramine can help reduce itching, swelling, and other symptoms associated with the allergy. It is important for individuals who are allergic to bee stings to have diphenhydramine readily available for prompt treatment in case of an allergic reaction.