A nurse is caring for a pediatric patient with congestive heart failure (CHF). What major goal should the nurse include in the care of this patient?

Prevent contractures of his hips and knees.

Minimize his cardiac output.

Minimize his energy expenditure.

Prevent vomiting.

Answer and Explanation

The Correct Answer is C

Choice A rationale:

Preventing contractures of the hips and knees is not directly related to the care of a pediatric patient with congestive heart failure (CHF). CHF primarily involves impaired cardiac function and fluid retention, not joint contractures.

Choice B rationale:

Minimizing cardiac output would be counterproductive in the care of a patient with CHF. The goal is to optimize cardiac output to meet the body's demands while managing the symptoms of CHF.

Choice C rationale:

Minimizing energy expenditure is a major goal in the care of a pediatric patient with CHF. CHF places an extra workload on the heart, and conserving energy helps prevent additional strain on the heart, allowing it to function more efficiently.

Choice D rationale:

Preventing vomiting is not a specific goal related to the care of a pediatric patient with CHF. Vomiting might be a symptom of CHF, but the primary focus is on managing cardiac function and fluid balance.

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Correct Answer is B

Explanation

Choice A rationale:

The statement about an increased risk for developing obesity is accurate. However, this does not indicate a need for further education about Down syndrome, as obesity is a common concern in the general population as well.

Choice B rationale:

The statement about an increased risk for developing diabetes would indicate a need for further education. Individuals with Down syndrome are indeed at an elevated risk of developing diabetes, often in their early adulthood.

Choice C rationale:

The statement about an increased risk for developing cataracts is accurate. However, it is not a primary concern associated with Down syndrome in infancy.

Choice D rationale:

The statement about skeletal abnormalities is accurate. While individuals with Down syndrome can have certain skeletal features, this is not a critical concern during infancy.

A. Obtaining an order to have an indwelling urinary catheter inserted. B. Weighing the patient's wet diapers prior to discarding them. C. Sitting the patient on the bedpan at least every two hours. D. Applying a pediatric urine collection device over the patient's urinary meatus.

Correct Answer is B

Explanation

Weighing the patient's wet diapers prior to discarding them.

Choice A rationale:

Inserting an indwelling urinary catheter is invasive and not appropriate for a non-toilet-trained 2-year-old unless medically necessary.

Choice B rationale:

Weighing wet diapers is the most accurate way to measure urine output in a young child who isn't toilet trained. This method provides essential information for assessing hydration and kidney function.

Choice C rationale:

Sitting the patient on the bedpan every two hours is suitable for older children but may not be effective or tolerable for a 2-year-old.

Choice D rationale:

Applying a pediatric urine collection device is an option, but it might not be as accurate as weighing wet diapers and may cause discomfort for the child.

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A nurse is caring for a pediatric patient with congestive heart failure (CHF). What major goal should the nurse include in the care of this patient?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Explanation

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Explanation

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