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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","D","E"]
Explanation
Choice A rationale
Frontal bossing (prominent forehead) is a sign of long-standing, chronic increased intracranial pressure (ICP), as the cranial sutures separate to accommodate the increased volume. In infants, the cranium can enlarge, but frontal bossing is generally a later sign, not an early indicator of acutely rising ICP.
Choice B rationale
A bulging fontanel is an early and crucial sign reflecting an acute rise in intracranial pressure (ICP) due to excess cerebrospinal fluid accumulation within the ventricles. The fontanel's tenseness indicates pressure transmission, as the open sutures allow expansion, which is a key compensatory mechanism in the infant skull.
Choice C rationale
Poor feeding is a non-specific but common early sign of increased intracranial pressure (ICP), which affects the brainstem centers controlling appetite and satiety. The pressure can also induce nausea and vomiting due to direct stimulation of the emetic center, contributing to decreased oral intake.
Choice D rationale
Dilated scalp veins are an early compensatory response to increased intracranial pressure (ICP). The rising pressure impedes venous return from the brain through the dural sinuses, causing a backup that manifests as visibly engorged and dilated veins on the scalp.
Choice E rationale
Bradycardia is a component of the Cushing's triad (along with widening pulse pressure and irregular respirations), signifying a critical, though sometimes early, response to severe elevation of intracranial pressure (ICP), primarily through stimulation of the vagus nerve.
Correct Answer is B
Explanation
Choice A rationale
A mild headache is a very common and expected symptom following a concussion, resulting from the temporary biomechanical injury to brain tissue or surrounding structures. This symptom alone typically does not indicate an immediate neurological deterioration or an expanding intracranial lesion, provided it doesn't rapidly worsen in severity or become refractory to simple analgesics. Management generally involves rest and observation.
Choice B rationale
Vomiting, especially if persistent or projectile, suggests a significant increase in intracranial pressure (ICP) due to brain swelling or an intracranial hemorrhage. This pressure irritates the vomiting center in the medulla, a critical area of the brainstem. Given that normal ICP is 5-15 mmHg in adults and slightly lower in children, new or worsening emesis warrants prompt clinical and possibly neuroimaging reevaluation.
Choice C rationale
Alertness indicates an intact reticular activating system (RAS), which is crucial for consciousness. Maintaining an alert mental status is a positive sign that suggests the primary brain centers are functioning adequately and the ICP is not critically elevated. A decreased level of consciousness would be a much more concerning indicator of neurological decline.
Choice D rationale
A normal gait reflects proper coordination of motor, sensory, and cerebellar functions. Gross neurological integrity suggests that the cerebral and cerebellar pathways, which govern balance and movement, are not significantly compromised. An abnormal gait, like ataxia, would be a sign of focal neurological deficit or severe intracranial pressure.
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