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

Answer and Explanation

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.

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Correct Answer is D

Explanation

Choice A reason: Mechanical ventilation does not necessarily increase the fluid requirements of a child. Mechanical ventilation is a method of providing artificial breathing support to a child who has respiratory failure or insufficiency. Mechanical ventilation may affect the fluid balance of a child by altering the insensible losses, the renal function, or the hemodynamics. However, the net effect may vary depending on the type, mode, and settings of the ventilator, as well as the underlying condition of the child. Therefore, the fluid requirements of a child on mechanical ventilation should be individualized and monitored closely¹.

Choice B reason: Increased intracranial pressure (ICP) does not increase the fluid requirements of a child. Increased ICP is a condition in which the pressure inside the skull is higher than normal, due to various causes such as head injury, brain tumor, infection, or hydrocephalus. Increased ICP may affect the fluid balance of a child by impairing the cerebral blood flow, the cerebrospinal fluid drainage, or the hypothalamic-pituitary axis. However, the net effect may vary depending on the severity, duration, and cause of the increased ICP, as well as the presence of other complications such as cerebral edema or diabetes insipidus. Therefore, the fluid requirements of a child with increased ICP should be individualized and monitored closely².

Choice C reason: Congestive heart failure does not increase the fluid requirements of a child. Congestive heart failure is a condition in which the heart is unable to pump enough blood to meet the body's needs, due to various causes such as congenital heart defects, cardiomyopathy, or infection. Congestive heart failure may affect the fluid balance of a child by causing fluid retention, edema, or pulmonary congestion. However, the net effect may vary depending on the type, severity, and stage of the heart failure, as well as the presence of other complications such as renal failure or liver failure. Therefore, the fluid requirements of a child with congestive heart failure should be individualized and monitored closely³.

Choice D reason: Fever increases the fluid requirements of a child. Fever is a condition in which the body temperature is higher than normal, due to various causes such as infection, inflammation, or immunization. Fever increases the fluid requirements of a child by increasing the metabolic rate, the insensible losses, and the urine output. The amount of fluid loss due to fever depends on the degree and duration of the fever, as well as the ambient temperature and humidity. A general rule of thumb is that for every degree Celsius increase in body temperature, the fluid requirements increase by 10%⁴. Therefore, the fluid requirements of a child with fever should be adjusted and monitored closely.

A. IV fluids at 2x maintenance, oxygen, medication to support cardiac function B. Oxygen, medication to support cardiac function, IV fluid bolus of 20 ml/kg C. Oxygen, IV fluid bolus of 20 ml/kg, medications to support cardiac function D. Oxygen, IV fluid bolus of 10 ml/kg, medication to support cardiac function

Correct Answer is C

Explanation

Choice A reason: This is not the correct order, as IV fluids at 2x maintenance are not enough to restore the blood volume and perfusion in hypovolemic shock. The child needs a rapid IV fluid bolus of 20 ml/kg to replace the fluid losses and improve the hemodynamic status¹.

Choice B reason: This is not the correct order, as medication to support cardiac function should be given after the IV fluid bolus, not before. The fluid bolus is the first priority to increase the preload and cardiac output in hypovolemic shock. Medications such as inotropes or vasopressors may be needed if the fluid bolus is not effective or causes adverse effects¹².

Choice C reason: This is the correct order, as oxygen, IV fluid bolus of 20 ml/kg, and medications to support cardiac function are the appropriate interventions for hypovolemic shock. Oxygen is given to improve the oxygen delivery and tissue perfusion. IV fluid bolus of 20 ml/kg is given to restore the blood volume and improve the hemodynamic status. Medications such as inotropes or vasopressors are given to support the cardiac function and maintain the blood pressure¹².

Choice D reason: This is not the correct order, as IV fluid bolus of 10 ml/kg is not enough to restore the blood volume and perfusion in hypovolemic shock. The child needs a rapid IV fluid bolus of 20 ml/kg to replace the fluid losses and improve the hemodynamic status¹.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Nurses must be alert for increased fluid requirements when a child has:

Correct Answer is D

Explanation

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Correct Answer is C

Explanation

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