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?

A) Incorrect. Left-sided heart failure typically presents with symptoms such as pulmonary congestion, shortness of breath, and crackles in the lungs, rather than cyanosis and clubbing.

B) Incorrect. Right-sided heart failure can cause peripheral edema and jugular vein distention, but it does not usually lead to cyanosis and clubbing.

C) The answer is C. Cyanosis and clubbing of the fingers are signs of chronic hypoxia, which can occur in pulmonary hypertension. This condition increases pulmonary vascular resistance and impairs oxygenation, leading to these characteristic symptoms.

D) Incorrect. Peripheral vascular disease primarily affects the arteries and veins in the extremities and is not directly related to cyanosis and clubbing of the fingers.

A) The answer is A. The pallor and coolness of the skin may indicate poor cardiac output and impaired circulation commonly seen in congenital heart diseases. These signs are suggestive of reduced oxygen delivery to peripheral tissues.

B) Incorrect. The respiratory rate being within the normal range does not specifically point to a congenital heart disease. Other signs and symptoms should be assessed to confirm the diagnosis.

C) Incorrect. The closure and firmness of the fontanelle are related to the status of the infant's skull bones and do not directly indicate congenital heart disease.

D) Incorrect. Weight gain following the growth chart percentile for age is not directly associated with congenital heart diseases. There are more specific clinical indicators to consider in the assessment of this condition.