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A nurse is assessing an infant who has congestive heart failure. Which of the following findings should the nurse expect?

A.

Increased urine output

B.

Bradycardia

C.

Increased blood pressure

D.

Tachypnea

Answer and Explanation

The Correct Answer is D

A. Increased urine output. Infants with congestive heart failure (CHF) often have decreased urine output due to reduced kidney perfusion caused by poor cardiac function.
B. Bradycardia. CHF is more likely to cause tachycardia as the heart compensates for poor circulation.
C. Increased blood pressure. CHF in infants typically leads to hypotension or normal blood pressure rather than an increase.
D. Tachypnea. Increased respiratory rate (tachypnea) is a common sign of CHF in infants because of fluid overload and pulmonary congestion, which make breathing difficult.


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Related Questions

Correct Answer is ["A","B","C","D","E","F","G","H","I","J"]

Explanation

  • Heart rate 104/min – The heart rate has decreased from 114/min on Day 1, indicating improvement.
  • Respiratory rate 24/min – The respiratory rate has decreased from 26/min, showing stabilization.
  • SpO₂ 98% on room air – Oxygen saturation remains stable and adequate.
  • Mucous membranes pink and moist – Indicates improved hydration.
  • Radial pulse 2+ bilateral – Stronger pulse compared to the previous day’s 1+, suggesting better circulation.
  • Capillary refill less than 2 seconds – Improved from the previous day’s delayed refill (4 seconds), showing better perfusion.
  • Extremities warm and dry to touch – Indicates adequate circulation and hydration.
  • Good skin turgor – Suggests the child is well-hydrated.
  • Bowel sounds active in all 4 quadrants – Indicates normal gastrointestinal function.
  • Breath sounds clear anterior and posterior bilaterally – No respiratory distress or abnormal findings.

Findings that do not indicate improvement:

  • Temperature 38.9°C (102°F) – Slightly higher than the previous day (38.7°C), suggesting persistent fever.
  • Drowsy and lethargic – The child is still lethargic, which may indicate ongoing illness.
  • Nuchal rigidity present – No improvement in meningitis-related symptoms.
  • Cervical lymph slightly enlarged – Indicates ongoing immune response.

Correct Answer is {"dropdown-group-1":"D","dropdown-group-2":"A","dropdown-group-3":"B"}

Explanation

Gastrointestinal: Iron is better absorbed when the stomach is empty, so administering it between meals is the best approach to enhance its effectiveness.

Dental: Iron supplements can cause staining of the teeth, so brushing after taking the supplement will help prevent this issue.

Hematological: After a month of treatment with iron supplements, a follow-up blood test is necessary to evaluate the improvement in hemoglobin levels and to ensure the treatment is effective.

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