A nurse is preparing to measure an infant’s vital signs.
The nurse should use which of the following sites to assess a heart rate?

Apex of the heart.

Brachial artery.

Radial artery.

Carotid artery.

Answer and Explanation

The Correct Answer is A

The correct answer is Choice A.

Choice A rationale

The apex of the heart (apical pulse) is the preferred site for assessing the heart rate in infants. It is located at the point of maximal impulse (PMI) and provides the most accurate measurement of the heart rate in this age group.

Choice B rationale

The brachial artery is not the preferred site for assessing the heart rate in infants. While it can be used for blood pressure measurement, it is not as accurate as the apical pulse for heart rate assessment.

Choice C rationale

The radial artery is not typically used for assessing the heart rate in infants. It is more commonly used in older children and adults.

Choice D rationale

The carotid artery is not recommended for assessing the heart rate in infants due to the risk of compressing the airway and causing discomfort.

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Correct Answer is B

Explanation

The correct answer is Choice B.

Choice A rationale

Isosorbide dinitrate is a nitrate used to treat angina and heart failure. It does not have contraindications for patients with asthma.

Choice B rationale

Carvedilol is a beta-blocker that can exacerbate asthma symptoms because it blocks beta-2 receptors in the lungs, leading to bronchoconstriction.

Choice C rationale

Captopril is an ACE inhibitor used to treat hypertension and heart failure. It does not have contraindications for patients with asthma.

Choice D rationale

Fluticasone is a corticosteroid used to manage asthma and does not have contraindications for patients with heart failure.

A. Place the child on a no-salt-added diet. B. Educate the parents about potential complications. C. Check the child’s daily weight. D. Maintain a saline-lock.

Correct Answer is C

Explanation

The correct answer is Choice C.

Choice A rationale

Placing the child on a no-salt-added diet is important for managing fluid retention and hypertension in acute glomerulonephritis, but it is not the immediate priority.

Choice B rationale

Educating the parents about potential complications is essential for long-term management, but it is not the immediate priority in an acute setting.

Choice C rationale

Checking the child’s daily weight is the priority action because it helps monitor fluid balance and detect any signs of fluid retention or worsening condition. Accurate daily weight measurements are crucial for assessing the effectiveness of treatment and making necessary adjustments.

Choice D rationale

Maintaining a saline-lock is important for intravenous access, but it is not the immediate priority compared to monitoring fluid balance through daily weight checks.

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A nurse is preparing to measure an infant’s vital signs.The nurse should use which of the following sites to assess a heart rate?

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A nurse is preparing to measure an infant’s vital signs.
The nurse should use which of the following sites to assess a heart rate?