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(Select all that apply):.
A nurse is performing a nursing assessment on a child with a congenital heart defect.
Which aspects should the nurse include in the assessment? Select all that apply.

Physical examination.

Growth and development assessment.

Oxygen saturation monitoring.

Feeding assessment.

Genetic testing.

Answer and Explanation

Correct Answer : A,B,C,D

Choice A rationale:

A physical examination is an essential part of the nursing assessment for a child with a congenital heart defect.

It helps the nurse identify physical signs and symptoms that may be indicative of the heart defect.

Choice B rationale:

Assessing growth and development is crucial when caring for a child with a congenital heart defect.

This helps monitor the child's overall health and well-being and can detect any developmental delays or issues related to the heart condition.

Choice C rationale:

Oxygen saturation monitoring is important for children with congenital heart defects as it helps assess the effectiveness of their oxygen delivery and may indicate the need for interventions or adjustments in their care.

Choice D rationale:

A feeding assessment is necessary for children with congenital heart defects as they may experience difficulties with feeding due to limited energy and respiratory issues.

Ensuring adequate nutrition is essential for their growth and development.

Choice E rationale:

Genetic testing is not typically a part of the routine nursing assessment for a child with a congenital heart defect.

While some heart defects may have a genetic component, this is not a standard part of the assessment process.

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Correct Answer is C

Explanation

Choice A rationale:

The statement, "I need to make sure my child takes their medications on time," indicates the client's awareness of the importance of medication adherence.

This statement reflects responsible medication management and does not indicate a need for further education.

Choice B rationale:

The statement, "Are there any side effects I should watch out for with these medications?" reflects a responsible and informed approach to medication management.

It shows that the client is concerned about potential side effects and is willing to monitor for them, which is a positive sign of medication education.

Choice C rationale:

The statement, "I can give my child herbal supplements to enhance the effect of the medication," indicates a need for further education about medication management.

Herbal supplements can interact with medications and may have unpredictable effects.

Combining them without medical guidance can be dangerous and is not recommended.

Choice D rationale:

The statement, "I should keep a record of all the medications my child is taking," is a responsible and proactive approach to medication management.

Keeping a record helps ensure that the child is receiving The correct medications and doses and can be helpful in case of any emergencies.

It indicates a good understanding of the importance of medication management.

A. "My baby's skin and lips have turned bluish.” B. "My baby has difficulty feeding and is not gaining weight properly.” C. "My baby gets tired quickly during physical activity.” D. "I can hear abnormal heart sounds during the check-up.”

Correct Answer is A

Explanation

Choice A rationale:

The patient's statement, "My baby's skin and lips have turned bluish," is a classic symptom of cyanosis.

Cyanosis is a bluish or purple discoloration of the skin and mucous membranes, which occurs due to a lack of oxygen in the blood.

In this case, it's associated with a ventricular septal defect (VSD), which is a congenital heart defect that allows oxygen-poor blood from the right side of the heart to mix with oxygen-rich blood from the left side.

Choice B rationale:

The statement, "My baby has difficulty feeding and is not gaining weight properly," may be related to the VSD, but it is not a typical symptom of cyanosis.

This symptom can occur due to congestive heart failure in infants with VSD.

Choice C rationale:

"My baby gets tired quickly during physical activity" can also be associated with VSD and congestive heart failure, but it is not a direct symptom of cyanosis.

Choice D rationale:

"I can hear abnormal heart sounds during the check-up" is not a symptom but rather a sign of a ventricular septal defect.

Abnormal heart sounds, like a loud holosystolic murmur, may be heard on auscultation.

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(Select all that apply):.A nurse is performing a nursing assessment on a child with a congenital heart defect.Which aspects should the nurse include in the assessment? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client has a child with a congenital heart defect and is concerned about the child's medication.What statement by the client indicates a need for further education about medication management?

Correct Answer is C

Explanation

A nurse is caring for an infant with cyanosis and a ventricular septal defect (VSD).The nurse should expect which of the following symptoms in this patient?

Correct Answer is A

Explanation

A client asks the nurse, "How can I optimize my child's respiratory function?" What should the nurse's response include?

Select all the symptoms that may be associated with cyanotic congenital heart disease (CCHD) in children.

A nurse caring for a child with a congenital heart defect is performing a physical examination.Which statement reflects an appropriate action during the assessment?

A nurse is providing nursing interventions for a child with a congenital heart defect.What is an example of a medication that may be administered as prescribed to this child?

A client diagnosed with Tetralogy of Fallot (TOF) presents with cyanosis that worsens with crying or feeding; clubbing of fingers and toes; poor feeding, weight gain, or growth; polycythemia; hypercyanotic spells (“tet spells”).What should be the nurse's immediate response?

A nurse is caring for a child with a suspected congenital heart defect.Which diagnostic test is most appropriate for assessing the size and shape of the heart and detecting associated abnormalities?

A client is inquiring about the long-term management of their child's congenital heart defect.What information should the nurse provide regarding follow-up care?

A nurse is assisting with the post-operative care of a child who has undergone heart surgery to repair a septal defect.What is a key nursing intervention during this time?

(Select all that apply):.
A nurse is performing a nursing assessment on a child with a congenital heart defect.
Which aspects should the nurse include in the assessment? Select all that apply.