The nurse provides home care instructions to the parents of a child with heart failure regarding the procedure for administration of digoxin (Lanoxin). Which statement by the parent indicates a need for further instruction?

Correct Answer: A

Rationale: The correct answer is A) “If my child vomits after the medication administration, I will repeat the dose.” Rationale: A) This statement indicates a need for further instruction because if a child vomits after taking digoxin, repeating the dose can lead to overdosing, which can be harmful. It is crucial for parents to understand not to double dose without healthcare provider guidance. B) Mixing digoxin with food can alter its absorption, so it is correct not to mix it with food. C) Taking the child’s pulse before administering digoxin is essential as it helps monitor for signs of digoxin toxicity, so this statement is correct. D) Contacting the healthcare provider if more than one dose is missed is crucial to ensure proper management of the child's condition, making this statement correct. Educational Context: Parents need clear instructions on administering medications like digoxin to avoid potential harm. Understanding the importance of proper dosing, monitoring for side effects, and when to seek medical advice is crucial in managing pediatric cardiovascular disorders effectively. Reinforcing these key points can help parents confidently care for their child at home.

Correct Answer: D

Rationale: The correct answer is D) Polycythemia. In infants with a congenital heart defect (CHD) of decreased pulmonary blood flow, such as Tetralogy of Fallot, there is a right-to-left shunting of blood leading to decreased oxygen saturation in the systemic circulation. This chronic hypoxemia stimulates erythropoiesis, resulting in an increased production of red blood cells, hence causing polycythemia. This compensatory mechanism helps enhance oxygen-carrying capacity in the blood to address the reduced oxygen levels. Regarding why the other options are incorrect: A) Decreased platelet count: Platelet count is not typically affected in infants with CHD of decreased pulmonary blood flow. Platelet count alterations are more commonly associated with conditions like thrombocytopenia or thrombocytosis, which are not directly related to this type of CHD. B) Decreased ferritin level: Ferritin is a marker of iron storage in the body. In the context of decreased pulmonary blood flow, there is no direct relationship between the defect and a decrease in ferritin levels. Iron status may be affected in certain types of anemia but not specifically in this scenario. C) Respiratory alkalosis: While respiratory alkalosis can occur in infants with CHD due to increased respiratory rate to compensate for hypoxemia, it is not the laboratory finding directly associated with decreased pulmonary blood flow. Respiratory alkalosis is a result of hyperventilation and would be a clinical manifestation rather than a laboratory finding. Educational context: Understanding laboratory findings in pediatric cardiovascular disorders is crucial for nurses caring for infants with CHDs. Recognizing the implications of these findings helps in early identification of complications and appropriate intervention. In the case of decreased pulmonary blood flow, recognizing polycythemia as a potential laboratory finding aids in comprehensive patient assessment and management. Regular monitoring of laboratory values is essential to assess the effectiveness of treatment and the overall health status of infants with CHDs.

Correct Answer: C

Rationale: In the context of pediatric cardiovascular disorders nursing, understanding the prevention of rheumatic fever (RF) is crucial for parents. Option C, "If their culture is positive for group A streptococcus, I will give them a full course of their antibiotic," is the correct answer. This response shows an understanding of the importance of treating streptococcal infections promptly to prevent RF, as RF is a complication of untreated streptococcal infections. By treating the infection with a full course of antibiotics, the risk of developing RF is reduced. Option A is incorrect because not all sore throats are caused by streptococcal bacteria, and giving antibiotics unnecessarily can lead to antibiotic resistance. Option B is incorrect as RF is a complication of untreated streptococcal infections, not a viral illness. Option D is incorrect as staphylococcus A is not the causative agent of RF. Educationally, it is important for parents to understand the link between streptococcal infections and RF, as well as the appropriate use of antibiotics in the context of treating such infections. Teaching parents to seek medical attention for sore throats and to follow healthcare provider recommendations regarding antibiotic treatment can help prevent RF in children at risk.

Correct Answer: D

Rationale: In pediatric patients with dehydration and metabolic acidosis, such as the 11-month-old infant in this scenario, tachypnea is a common physiological response. Tachypnea, or rapid breathing, is the body's attempt to compensate for the metabolic acidosis by blowing off carbon dioxide and increasing the pH of the blood. This compensatory mechanism helps restore acid-base balance in the body. Option A, a reduced white blood cell count, is not typically associated with dehydration and metabolic acidosis in pediatric patients. Option B, a decreased platelet count, is also not a typical finding in this scenario. Shallow respirations, as mentioned in option C, would not be expected as the body tries to increase respiratory rate to compensate for the metabolic acidosis. Educationally, understanding the physiological responses to dehydration and metabolic acidosis in pediatric patients is crucial for nurses caring for these vulnerable populations. Recognizing the signs and symptoms of acid-base imbalances and understanding the body's compensatory mechanisms are essential for providing safe and effective care to pediatric patients with these conditions.

Correct Answer: B

Rationale: The correct answer is B) Latex. Preschoolers with spina bifida often have a higher risk of latex allergies due to multiple exposures to latex products during medical procedures. Latex is commonly found in brightly colored balloons and can cause allergic reactions like sneezing and rash upon contact. Moreover, the recent allergic reactions to kiwifruit and bananas suggest a broader latex-fruit syndrome, where individuals allergic to latex may also react to certain fruits like kiwifruit and bananas due to cross-reactivity. Option A) Bananas is incorrect because while the child had an allergic reaction to bananas, the broader pattern of reactions to latex-containing products points more towards latex as the primary allergen. Option C) Kiwifruit is also incorrect as the reaction to kiwifruit, along with bananas, is likely due to cross-reactivity with latex. Option D) Color dyes are not typically associated with the symptoms described by the mother. In an educational context, understanding the relationship between spina bifida, latex allergies, and cross-reactivity with certain fruits is crucial for nurses caring for pediatric patients. Recognizing these patterns can help in providing appropriate care, avoiding triggers, and educating both the child and their caregivers on managing allergies effectively.