A nurse is assessing a school-age child with a congenital heart defect. Which symptom should the nurse recognize as a potential indicator of worsening heart failure?
"Weight gain and edema in the lower extremities"
"Decreased heart rate and blood pressure within the normal range"
"Improved appetite and increased physical activity level"
"Resolution of cyanosis and pink coloration of the lips and nail beds"
The Correct Answer is A
A) Correct answer. Weight gain and edema in the lower extremities can be signs of worsening heart failure in children with congenital heart defects. Fluid retention occurs due to the heart's inability to effectively pump blood, leading to fluid accumulation in the body.
B) This option is incorrect. While decreased heart rate and blood pressure within the normal range may be indicative of stable heart function, they are not specific indicators of worsening heart failure.
C) This option is incorrect. Improved appetite and increased physical activity level are positive indicators but do not specifically reflect the child's heart failure status.
D) This option is incorrect. Resolution of cyanosis and pink coloration of the lips and nail beds are positive signs of improved oxygenation and may indicate effective management of the heart defect but not the potential worsening of heart failure.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A) Incorrect. While solid foods are introduced around six months of age, the nurse should consider the specific condition of the infant's congenital heart disease before giving feeding recommendations.
B) The answer is B. Infants with congenital heart diseases may tire easily during feeding due to the increased effort required for sucking and swallowing. Feeding small, frequent meals can help prevent fatigue and ensure adequate nutrition.
C) Incorrect. Breastfeeding is generally encouraged, even for infants with congenital heart diseases. However, the nurse should consider any specific feeding challenges the infant may have due to their heart condition and provide appropriate support and guidance.
D) Incorrect. Limiting fluid intake may not be necessary unless specifically advised by the healthcare provider. Infants need sufficient hydration, and fluid intake should be managed based on the infant's overall health and condition.
Correct Answer is B
Explanation
A) This option is incorrect. Difficulty swallowing and poor feeding may indicate other issues, such as gastrointestinal problems, but they are not early symptoms specific to congenital heart diseases.
B) Correct answer. Cyanosis (bluish skin or lips) during crying or feeding is an early clinical finding that may indicate inadequate oxygenation due to heart defects. This symptom is especially prominent in cyanotic congenital heart diseases.
C) This option is incorrect. Persistent cough and recurrent respiratory infections may be related to respiratory issues but are not specific early symptoms of congenital heart diseases.
D) This option is incorrect. Excessive weight gain and a rapid growth rate are not typical early symptoms of congenital heart diseases.
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