The nurse is conducting discharge teaching about signs and symptoms of heart failure to parents of an infant with a repaired tetralogy of Fallot. Which signs and symptoms should the nurse include? (Select all that apply.)

Step 1 is converting the child's weight from pounds to kilograms. (42 lb ÷ 2.2) = 19.09090909 kg

Step 2 is calculating the maximum daily dosage using the upper limit of the dosage range (50 mg/kg/day). 19.09090909 kg × 50 mg/kg/day = 954.5454545 mg/day

Step 3 is rounding the result to the nearest tenth. The answer is 954.5

The correct answer is choice A. Meconium ileus.

Choice A rationale:

Meconium ileus. This is the earliest recognizable clinical manifestation of cystic fibrosis (CF). Meconium ileus refers to the blockage of the small intestine by thick, sticky meconium, the earliest stool of a newborn. It occurs in the first 24-48 hours of life and can be a sign of underlying cystic fibrosis.

Choice B rationale:

Foul-smelling, frothy, greasy stools. Foul-smelling, frothy, greasy stools are characteristic of malabsorption, which can occur in cystic fibrosis. However, this manifestation typically appears after meconium ileus and is not the earliest recognizable clinical sign.

Choice C rationale:

History of poor intestinal absorption. While poor intestinal absorption is a common consequence of cystic fibrosis, it is not one of the earliest recognizable clinical manifestations. Meconium ileus takes precedence as the primary early sign.

Choice D rationale:

Recurrent pneumonia and lung infections. Recurrent pneumonia and lung infections are common in later stages of cystic fibrosis due to the buildup of thick mucus in the respiratory tract. However, they are not among the earliest recognizable clinical manifestations of the disease. Meconium ileus is the earliest indicator in this context.