A nurse is caring for a school-age child who has heart failure. Which of the following findings should the nurse expect?Select all that apply.
Cyanosis
Weight loss
Bounding peripheral pulses
Dyspnea
Tachycardia
Correct Answer : A,D,E
Rationale:
A. Cyanosis can occur in children with heart failure due to inadequate oxygenation of tissues.
B. Weight gain or fluid retention is more common in children with heart failure.
C. Bounding pulses are more commonly associated with conditions such as hypertension or hyperthyroidism, rather than heart failure.
D. Dyspnea, or difficulty breathing, is a common symptom of heart failure due to fluid buildup in the lungs.
E. Tachycardia, or a rapid heart rate, can occur as a compensatory mechanism in response to decreased cardiac output in heart failure.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
- A) Checking clothing for loose buttons is important because toddlers can easily remove and swallow small objects, which can lead to choking hazards.
- B) Adjusting the water heater temperature to 54° C (129.2° F) is not recommended as it poses a risk of scalding. Safe water temperatures for households with toddlers should be at or below 49° C (120° F).
- C) Placing screens on all windows is a crucial safety measure to prevent toddlers from falling out of open windows, which can lead to serious injuries or fatalities.
- D) Providing balloons for play is not advisable as uninflated or broken balloons can be a choking hazard for toddlers. It is one of the leading causes of choking deaths in children.
Correct Answer is D
Explanation
Rationale:
A. Neck vein distention is not typically associated with acute acetylsalicylic acid poisoning.
B. Polyuria is not a common symptom of acute acetylsalicylic acid poisoning.
C. Jaundice is not typically associated with acute acetylsalicylic acid poisoning.
D. Hyperpyrexia (extremely high fever) is a potential complication of acute acetylsalicylic acid poisoning due to its effects on the central nervous system and metabolism.
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