A two-month-old infant is hospitalized for repair of a ventricular septal defect. The infant's admitting diagnosis is moderate congestive heart failure. What signs and symptoms would you expect to see in your assessment?
Bradycardia, bounding pulses, cyanosis
Overdiuresis, increased appetite, increased thirst
Wheezing, pallor, capillary refill time < 2 seconds
Tachypnea, cough, tachycardia
The Correct Answer is D
Choice A reason: This is not a correct statement, as bradycardia, bounding pulses, and cyanosis are not typical signs and symptoms of moderate congestive heart failure. Bradycardia may indicate a heart block or a vagal response, bounding pulses may indicate a patent ductus arteriosus or aortic regurgitation, and cyanosis may indicate a severe right-to-left shunt or a pulmonary embolism¹.
Choice B reason: This is not a correct statement, as overdiuresis, increased appetite, and increased thirst are not typical signs and symptoms of moderate congestive heart failure. Overdiuresis may indicate a renal dysfunction or a diuretic overdose, increased appetite may indicate a normal growth spurt or a metabolic disorder, and increased thirst may indicate dehydration or diabetes¹.
Choice C reason: This is not a correct statement, as wheezing, pallor, and capillary refill time < 2 seconds are not typical signs and symptoms of moderate congestive heart failure. Wheezing may indicate a bronchospasm or an asthma attack, pallor may indicate anemia or shock, and capillary refill time < 2 seconds may indicate a normal or increased peripheral perfusion¹.
Choice D reason: This is the correct statement, as tachypnea, cough, and tachycardia are typical signs and symptoms of moderate congestive heart failure. Tachypnea may indicate a respiratory distress or a pulmonary edema, cough may indicate a fluid accumulation or an infection in the lungs, and tachycardia may indicate a compensatory mechanism or a cardiac arrhythmia¹².
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Giving the toddler planned, frequent, and nutritious snacks is a good way to meet her nutritional needs and respect her natural appetite. Toddlers have small stomachs and high energy levels, so they may not eat much at one sitting. They may also be easily distracted or bored by sitting at the table for too long. Snacks can provide additional calories and nutrients that they may miss at mealtimes. However, the snacks should be healthy, such as fruits, vegetables, cheese, yogurt, or whole-grain crackers. They should also be offered at regular times, not on demand, and not too close to mealtimes.
Choice B reason: Explaining to the toddler in a firm manner what is expected of her is not a helpful or realistic strategy to improve her eating habits. Toddlers are naturally curious and independent, and they may not understand or follow the rules that adults set for them. They may also resist or rebel against pressure or coercion to eat. Instead of lecturing or scolding the toddler, the parents should model good eating behaviors, praise her when she tries new foods, and avoid power struggles or arguments over food.
Choice C reason: Avoiding snacks so the toddler is hungry at mealtimes is not a wise or healthy suggestion. This may backfire and cause the toddler to become more fussy, irritable, or tired. It may also lead to overeating, bingeing, or unhealthy food choices later on. Hunger is not the only factor that influences a toddler's appetite. Other factors include mood, activity level, environment, and preferences. The parents should not use hunger as a tool to manipulate the toddler's eating, but rather respect her hunger and fullness cues.
Choice D reason: Offering rewards for eating at mealtimes is not a beneficial or sustainable method to encourage the toddler to eat. Rewards may be material, such as toys or stickers, or edible, such as sweets or desserts. Rewards may work temporarily, but they may also have negative consequences. They may undermine the toddler's intrinsic motivation to eat, or make her associate eating with external rewards rather than internal satisfaction. They may also create an imbalance in the value of different foods, or make the toddler feel guilty or deprived. The parents should not bribe or bargain with the toddler to eat, but rather make eating a pleasant and enjoyable experience.
Correct Answer is B
Explanation
Choice A reason: This is not the correct cause, as varicella is a viral infection that causes a blister-like rash all over the body, not just in the diaper area. Varicella also causes fever, headache, and malaise.
Choice B reason: This is the correct cause, as Candida albicans is a type of fungus that can cause diaper rash, especially after antibiotic use. Antibiotics can disrupt the normal flora of the skin and allow the fungus to grow. Candida albicans causes red, inflamed skin with small, raised bumps around the edges.
Choice C reason: This is not the correct cause, as impetigo is a bacterial infection that causes honey-colored crusts on the skin, usually around the mouth and nose. Impetigo is contagious and can spread to other parts of the body or other people.
Choice D reason: This is not the correct cause, as bacterial infection is too vague and nonspecific. Bacterial infection can cause different types of skin rashes, depending on the type and location of the bacteria. Bacterial infection may also cause other symptoms, such as fever, pus, or swelling.
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