A nurse is assessing the growth and development of a 16-year-old adolescent. Which of the following behaviors or physical changes would the nurse expect to observe in a typical adolescent at this stage? (Select all that apply)

A. Barking cough and inspiratory stridor, especially at night is incorrect because this is characteristic of croup, a respiratory condition, not tetralogy of Fallot. Tetralogy of Fallot primarily affects cardiac blood flow, not the upper airway.

B. Bradycardia and hypotension following minor activity or mild stress is incorrect because children with tetralogy of Fallot typically develop tachycardia in response to hypoxia or stress, rather than bradycardia. Hypotension is not a hallmark sign unless there is shock or severe complications.

C. Cyanosis that worsens during crying or feeding, often relieved by squatting is correct because children with tetralogy of Fallot have right-to-left shunting due to the combination of ventricular septal defect, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy. This shunting reduces pulmonary blood flow, leading to cyanosis, which often becomes more pronounced during periods of increased oxygen demand, such as crying or feeding. Squatting increases systemic vascular resistance, temporarily reducing the shunt and improving oxygenation, which is known as a “Tet spell” relief maneuver.

D. Peripheral edema and hepatomegaly during exertion or prolonged play is incorrect because these signs are more typical of heart failure rather than tetralogy of Fallot in a child without chronic severe heart failure. Tetralogy of Fallot presents primarily with cyanosis and hypoxic spells.

A. A primiparous patient who delivered a 7-pound 10-ounce baby 24 hours ago is at lower risk because primiparous patients generally have a lower risk of postpartum hemorrhage, and moderate birth weight babies rarely cause excessive uterine stretching. The 24-hour postpartum period also allows for initial uterine contraction.

B. A multiparous patient who delivered a 9-pound baby 4 hours ago is correct because multiparity and macrosomia (large baby) increase the risk of uterine atony, which is the leading cause of postpartum hemorrhage. The patient is also in the early postpartum period (first 24 hours), which is when most hemorrhages occur, making this patient the highest risk.

C. A primiparous patient who delivered a late preterm baby 24 hours ago is lower risk because smaller birth weight and primiparity reduce the risk of excessive uterine stretching and atony.

D. A multiparous patient who delivered a 7-pound baby 6 hours ago is at some risk due to multiparity, but the smaller baby size reduces the likelihood of uterine atony compared with a 9-pound infant.