A nurse is collecting data from a toddler who has heart failure. Which of the following findings should the nurse expect?

Weight loss of 0.9 kg (2 lb)

Heart rate 65/min

Bounding peripheral pulses

Decreased urine output

Answer and Explanation

The Correct Answer is D

Rationale:

A) Weight loss is not typically expected in heart failure; fluid retention and weight gain are more common.

B) A heart rate of 65/min may be within the normal range for a toddler and does not specifically indicate heart failure.

C) Bounding peripheral pulses are not typically associated with heart failure; weak pulses may be more indicative.

D) Decreased urine output can occur in heart failure due to reduced cardiac output and poor renal perfusion.

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Correct Answer is D

Explanation

Rationale:

A. Skin turgor assessment is important in assessing dehydration, but the priority is addressing the tachycardia first.

B. Potassium level is important in managing electrolyte imbalance in gastroenteritis, but the priority is addressing the elevated heart rate first.

C. Capillary refill is an important assessment for circulation, but the priority is addressing the elevated heart rate first.

D. The elevated heart rate (tachycardia) indicates increased workload on the heart, likely due to dehydration or other complications of gastroenteritis. This requires immediate attention to stabilize the infant's condition.

A. "My child should use their index finger to obtain blood samples." B. "My child should hold their finger under warm water before obtaining a sample." C. "My child should puncture the center of their finger pad when obtaining a sample." D. "My child should hold their finger against a table when obtaining a sample."

Correct Answer is B

Explanation

Rationale:

A) Using the index finger is a common site for blood glucose monitoring, but it does not specifically address minimizing pain.

B) Holding the finger under warm water can increase blood flow and make blood glucose monitoring less painful.

C) Puncturing the center of the finger pad is a common technique for obtaining a blood sample, but it does not specifically address minimizing pain.

D) Holding the finger against a table is not a recommended method for minimizing pain during blood glucose monitoring and may increase discomfort.

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A nurse is collecting data from a toddler who has heart failure. Which of the following findings should the nurse expect?

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Naxlex Comprehensive Predictor Exams

Correct Answer is D

Explanation

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Correct Answer is B

Explanation

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