A nurse is caring for a child who is postoperative following surgical correction of Tetralogy of Fallot. Which of the following findings should the nurse identify as an indication of heart failure?

Choice A reason: Teaching the child about cast care is important, but it is not the first action to take. Education on cast maintenance and activity restrictions will follow after addressing immediate needs.

Choice B reason: Administering pain medication should be the first action taken by the nurse. After a cast application for a fracture, the child is likely experiencing pain, and managing this pain is a priority to ensure comfort and facilitate healing.

Choice C reason: Elevating the child's leg is a subsequent action that can help reduce swelling and discomfort, but it is not the first action to take. Pain management is the priority before positioning.

Choice D reason: Petaling the edges of the cast, which involves placing soft material around the rough edges to prevent skin irritation, is important but not the first action. The initial focus should be on pain relief.

Choice A reason: Removing the child's pressure dressing after the first 4 hours is not recommended as it may increase the risk of bleeding. The pressure dressing is typically kept in place longer to ensure hemostasis.

Choice B reason: Maintaining the child's NPO status for 4 to 6 hours post-procedure is a standard practice to prevent nausea and vomiting while anesthesia wears off, but it is not the most critical action in this context.

Choice C reason: Keeping the affected extremity straight for at least 6 hours is essential to prevent bleeding from the catheterization site. This is a critical postoperative care step following arterial cardiac catheterization.

Choice D reason: Monitoring output using an indwelling urinary catheter for the first 24 hours is important for assessing kidney function and fluid balance but is not the immediate priority post-cardiac catheterization.