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.
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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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Minimize crying.
Choice A rationale:
Encouraging attachment might be important for the child's emotional well-being, but in the immediate postoperative period after cleft lip repair, minimizing crying takes priority. Crying can place stress on the suture line and disrupt the healing process.
Choice B rationale:
Minimizing crying is crucial to prevent tension on the suture line and ensure proper healing of the cleft lip repair. Excessive crying can lead to increased pressure on the surgical site and potential complications. Elbow restraints are applied to prevent the child from touching the surgical site, so minimizing crying helps to maintain the effectiveness of these restraints.
Choice C rationale:
Restricting oral intake is not a priority in this case. While it's important to ensure the child doesn't consume anything that might harm the surgical site, it's not the highest priority action compared to preventing tension on the suture line.
Choice D rationale:
Initiating range of motion is not the priority postoperative intervention for a cleft lip repair. The primary concern at this stage is to prevent disruption of the surgical site and ensure proper healing, making minimizing crying a higher priority.
Correct Answer is D
Explanation
Choice A rationale:
Wet diapers are a sign of hydration, not necessarily nutrition sufficiency.
Choice B rationale:
Introducing solids too early can lead to various issues; it's not linked to sleep improvement.
Choice C rationale:
Cow's milk isn't suitable for a newborn's consumption due to the potential for allergies and digestive issues.
Choice D rationale:
This choice accurately reflects hunger cues in a newborn, demonstrating an understanding of proper feeding.
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