The nurse is giving instructions to parents of a 4-month-old infant with tetralogy of Fallot. Important teaching points should include:

Choice A reason: This is not a correct statement, as the American Academy of Pediatrics does not recommend avoiding breastfeeding for children with congenital heart disease. On the contrary, it supports breastfeeding as the optimal source of nutrition for infants, including those with special health care needs¹.

Choice B reason: This is the correct statement, as the American Academy of Pediatrics does not recommend avoiding breastfeeding for children with congenital heart disease. Breastfeeding may have several benefits for these infants, such as enhancing their immune system, reducing their risk of infection, and promoting their growth and development¹². However, breastfeeding may also pose some challenges for these infants, such as increased energy expenditure, poor weight gain, and difficulty coordinating sucking, swallowing, and breathing²³. Therefore, breastfeeding should be individualized and monitored for each infant with congenital heart disease, and supplemented with formula or fortified breast milk if needed²³.

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.