A nurse is assessing an infant in the cardiology clinic. Which of the following sets of clinical manifestations is consistent with a ventricular septal defect?

Rationale:

A. "Avoid triggers that cause an attack" is correct because identifying and avoiding asthma triggers, such as allergens, smoke, pollution, or respiratory infections, is a fundamental component of asthma management. Trigger avoidance helps prevent exacerbations and reduces the need for rescue medications.

B. "Use the peak expiratory flow meter once per week" is incorrect because a peak flow meter should be used daily or as directed by a provider, particularly during periods of worsening asthma, to monitor airflow and detect early signs of obstruction. Using it only once per week is insufficient for effective asthma management.

C. "Take cromolyn sodium at the first sign of breathing difficulty" is incorrect because cromolyn sodium is a controller medication, not a rescue inhaler. It is used regularly to prevent inflammation, not for acute symptoms. Using it during an attack will not provide immediate relief.

D. "You should stop playing basketball, but you can swim instead" is incorrect because children with asthma should not be restricted from physical activity if their condition is controlled. Exercise is encouraged, and proper pre-exercise use of a rescue inhaler or warm-up strategies can help prevent exercise-induced bronchospasm. Limiting activities unnecessarily can affect physical and social development.

Rationale for correct choices:
• Hemorrhage: The client demonstrates a boggy fundus that requires repeated massage to maintain firmness, a midline fundus with heavy lochia containing small clots, and increasing heart rate, all classic signs of postpartum hemorrhage. These findings indicate the uterus is not contracting effectively, placing the client at risk for excessive blood loss.
• Amount of lochia: The moderate to heavy lochia rubra with clots indicates ongoing uterine bleeding. Monitoring the amount and characteristics of lochia is critical for early recognition of hemorrhage.

Rationale for incorrect choices:
• Mastitis: The client’s breasts are soft, warm, and only mildly tender, with no signs of infection (redness, localized heat, or systemic symptoms), making mastitis unlikely.
• Endometritis: The client has a mildly elevated temperature but no significant fever, foul-smelling lochia, or severe uterine tenderness, so endometritis is less likely at this time.
• Temperature: While slightly elevated, the temperature is not high enough to indicate infection, and it does not correlate with the immediate risk of hemorrhage.
• Breast findings: The breast assessment shows normal postpartum changes without infection, making this less relevant to the acute risk.