Editing Pediatric Nursing – RN Practice Questions (section)

==Question 10==
The nurse prepares to administer digoxin to a 5-month-old with heart failure. The apical pulse, counted for one full minute, is 88 beats per minute. Which action is '''correct'''?
# Administer the dose and recheck the apical pulse in 1 hour.
# Hold the dose, document the finding, and notify the provider.
# Administer half the dose and reassess.
# Administer the dose only if the infant is feeding well.

'''Answer:''' 2. Hold the dose, document the finding, and notify the provider.

''Rationale:'' Digoxin is held in an infant when the apical rate is below approximately 90 to 110 beats per minute, and 88 is below that threshold. Bradycardia is often the earliest sign of digoxin toxicity in children, along with vomiting and anorexia. Option 1 administers a drug that may worsen bradycardia. Option 3 alters the prescribed dose. Option 4 uses an irrelevant criterion; in fact poor feeding would be an additional toxicity concern.