After administering furosemide to a school-aged child with congestive heart failure secondary to a ventricular septal defect, which finding indicates improvement?
Urine output decreased to 0.5 mL/kg/hr.
Weight increased by 1.5 kg.
Respiratory rate decreased from 50 to 32 breaths per minute.
Heart rate increased to 160 bpm.
The Correct Answer is C
Choice A rationale
Furosemide is a loop diuretic that promotes the excretion of sodium and water, reducing fluid overload and pulmonary congestion associated with congestive heart failure. A decreased urine output of 0.5 mL/kg/hr is a sign of worsening status, as the target output for adequate diuresis is generally 1-3 mL/kg/hr for children.
Choice B rationale
Furosemide therapy is intended to reduce fluid volume, which should result in weight loss. An increase in weight of 1.5 kg indicates fluid retention and ineffective or inadequate diuretic therapy, signaling a deterioration or lack of improvement in the child's congestive heart failure.
Choice C rationale
A decrease in respiratory rate from 50 to 32 breaths per minute indicates a reduction in tachypnea. Tachypnea in congestive heart failure is caused by fluid backup into the lungs (pulmonary congestion), which decreases lung compliance. The reduction in rate suggests that the diuretic has successfully lowered the pulmonary fluid volume, improving respiratory function.
Choice D rationale
An increase in heart rate to 160 bpm (tachycardia) in a school-aged child (normal resting heart rate ≈ 70-110 bpm) is a compensatory mechanism for decreased stroke volume, often seen in worsening heart failure or dehydration. This finding indicates deterioration or a negative effect of the diuretic, such as volume depletion.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
An oxygen saturation SpO_2 of 88% indicates significant hypoxemia (low blood oxygen), which is the most critical physiological derangement in respiratory distress. Sustained hypoxemia can rapidly lead to cerebral hypoxia, increasing intracranial pressure, and cardiac arrest, necessitating immediate intervention. Normal is ≥ 94-95% in most children.
Choice B rationale
A heart rate of 160 beats per minute in a school-age child (6-12 years) is tachycardia (normal is 75-115 bpm), often an initial compensatory response to hypoxemia and increased work of breathing. While concerning, it is an attempt to maintain cardiac output, making the SpO_2 decline a more immediate life threat.
Choice C rationale
A temperature of 100.4°F is a low-grade fever, which can increase metabolic demand and O_2 consumption, potentially worsening respiratory status. While it warrants management, it is not the most immediate life-threatening sign compared to severe hypoxemia (SpO_2 of 88%). Normal is 97.7°F to 99.5°F.
Choice D rationale
A respiratory rate of 40 breaths per minute in a toddler (1-3 years) is near the upper limit of normal (25-35 bpm) and indicates tachypnea, a compensatory mechanism to improve gas exchange. While significant, it is a sign of compensation, whereas the low SpO_2 suggests decompensation.
Correct Answer is D
Explanation
Choice A rationale
Periorbital edema (swelling around the eyes) is a common sign of nephrotic syndrome or other systemic fluid overload states, such as congestive heart failure. While heart failure can be a complication of severe infective endocarditis (IE), periorbital edema is a non-specific finding and not a primary, classic physical finding of the infection itself.
Choice B rationale
Bounding pulses in the lower extremities are most characteristic of a condition causing a wide pulse pressure, such as a large patent ductus arteriosus (PDA) or aortic regurgitation. While aortic valve damage can occur in IE, the bounding pulse is not a hallmark finding directly resulting from the infectious process.
Choice C rationale
A high-pitched cry is a non-specific sign of neurological distress or pain in an infant. While systemic infection and potential septic emboli from infective endocarditis could affect the central nervous system, this symptom is not a primary or expected clinical manifestation of the localized heart valve infection.
Choice D rationale
Splinter hemorrhages are small, linear, dark-red streaks that appear under the nails. They are a classic peripheral sign of infective endocarditis caused by microemboli (tiny fragments of the infected vegetation) lodging in the distal capillaries of the nail bed, making this a highly indicative finding.
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