A nurse is assessing a toddler who has heart failure.
Which of the following findings should the nurse expect?

Choice A rationale

Bradycardia, a heart rate slower than normal for a toddler (typically less than 80-100 beats per minute at rest), is not a typical finding in a toddler with heart failure. In heart failure, the heart often compensates for reduced cardiac output by increasing its rate to maintain adequate perfusion, leading to tachycardia. Bradycardia in this context might suggest severe decompensation or other underlying issues.

Choice B rationale

Orthopnea, or difficulty breathing when lying flat, is a common symptom of heart failure, particularly in older children and adults. It occurs due to the redistribution of fluid from the lower extremities to the pulmonary circulation when supine, increasing pulmonary congestion and causing shortness of breath. While toddlers may not articulate this symptom clearly, they may exhibit signs of discomfort or restlessness when lying down, preferring to be held upright or sleep in a semi-Fowler's position to ease breathing.

Choice C rationale

Weight gain, not weight loss, is a more expected finding in a toddler with heart failure due to fluid retention. The compromised pumping action of the heart leads to increased venous pressure and activation of the renin-angiotensin-aldosterone system, resulting in sodium and water retention. This fluid overload manifests as edema, ascites, and weight gain. While poor feeding due to fatigue or respiratory distress can sometimes lead to poor weight gain, significant weight loss is not a primary characteristic of heart failure in toddlers.

Choice D rationale

Decreased urine output, not increased urine output, is a typical finding in heart failure. The reduced cardiac output leads to decreased renal perfusion, triggering the kidneys to retain sodium and water in an attempt to increase circulating volume and improve cardiac output. This compensatory mechanism results in oliguria (reduced urine production). Increased urine output would be more indicative of conditions like diabetes insipidus or the diuretic phase of renal failure, not typically heart failure. .