A nurse is planning care for a preschooler who has leukemia. After reviewing the child's information, which of the following potential issues should the nurse identify that the child is at risk for developing? (Select all that apply.)

Choice A reason: Administering antibiotic therapy is an anticipated prescription for the client, as it can treat the possible bacterial infection that is causing the fever, anorexia, and shortness of breath. The client may have developed infective endocarditis, a serious condition that affects the heart valves and can lead to heart failure or stroke. Antibiotic therapy can help prevent further complications and reduce the risk of mortality.

Choice B reason: Obtaining an echocardiogram is an anticipated prescription for the client, as it can help diagnose the presence and severity of infective endocarditis. An echocardiogram is a noninvasive test that uses sound waves to create images of the heart and its structures. It can show if there is any damage to the heart valves, vegetation (clumps of bacteria and cells) on the valves, or signs of heart failure.

Choice C reason: Obtaining blood cultures x3 is an anticipated prescription for the client, as it can help identify the causative organism of the infection and guide the appropriate antibiotic therapy. Blood cultures are samples of blood that are taken from different sites and times and tested for the presence of bacteria or other microorganisms. They can confirm the diagnosis of infective endocarditis and determine the sensitivity and resistance of the bacteria to different antibiotics.

Choice D reason: Restricting dental hygiene is a contraindicated prescription for the client, as it can worsen the oral health and increase the risk of infection. Dental hygiene is important for preventing plaque and tartar buildup, which can harbor bacteria and cause dental caries, gingivitis, or periodontitis. These conditions can increase the risk of bacteremia (bacteria in the blood) and infective endocarditis. The nurse should teach the client to maintain good oral hygiene and use a soft-bristled toothbrush and gentle flossing.

Choice E reason: Performing a strenuous exercise regimen twice a day is a contraindicated prescription for the client, as it can increase the cardiac workload and exacerbate the symptoms of infective endocarditis. Strenuous exercise can cause tachycardia (fast heart rate), dyspnea (difficulty breathing), chest pain, and fatigue, which can worsen the condition of the heart and the valves. The nurse should advise the client to avoid strenuous exercise and limit physical activity to a level that does not cause symptoms.

Choice A reason: This statement is correct because patent ductus arteriosus is a condition where the ductus arteriosus, a fetal blood vessel that connects the pulmonary artery and the aorta, fails to close after birth. This allows blood to flow from the aorta to the pulmonary artery, increasing the blood flow to the lungs and causing pulmonary hypertension.

Choice B reason: This statement is incorrect because coarctation of the aorta is a condition where the aorta, the main artery that carries blood from the heart to the body, is narrowed. This causes increased pressure in the upper body and decreased pressure in the lower body, reducing the blood flow to the kidneys and other organs.

Choice C reason: This statement is incorrect because tricuspid atresia is a condition where the tricuspid valve, which separates the right atrium and the right ventricle, is missing or abnormally developed. This prevents blood from flowing from the right atrium to the right ventricle, decreasing the blood flow to the lungs and causing cyanosis.

Choice D reason: This statement is incorrect because tetralogy of Fallot is a condition that involves four defects: a large ventricular septal defect, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy. These defects cause blood to bypass the lungs and mix with oxygen-poor blood in the aorta, decreasing the blood flow to the lungs and causing cyanosis.