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 a correct statement, as assessing the affected extremity for temperature and color can help detect any signs of vascular injury or thrombosis after the cardiac catheterization. The extremity should be warm and pink, indicating adequate blood flow. If the extremity is cold, pale, or cyanotic, it may indicate ischemia or occlusion¹.

Choice B reason: This is not a correct statement, as managing hydration with IV fluids until able to tolerate oral fluids is not a necessary intervention after the cardiac catheterization. The child may be able to resume oral fluids as soon as they are awake and alert, unless there are contraindications such as nausea or vomiting. IV fluids may be given to prevent dehydration or hypotension, but they should be monitored carefully to avoid fluid overload or pulmonary edema¹².

Choice C reason: This is a correct statement, as checking pulses above the catheterization site for equality and symmetry can help detect any signs of arterial injury or spasm after the cardiac catheterization. The pulses should be strong and equal on both sides, indicating normal blood flow. If the pulses are weak, absent, or unequal, it may indicate arterial occlusion or narrowing¹.

Choice D reason: This is a correct statement, as monitoring vital signs frequently can help detect any signs of bleeding, infection, or cardiac complications after the cardiac catheterization. The vital signs should be stable and within normal limits, indicating normal hemodynamic status. If the vital signs are abnormal, such as hypotension, tachycardia, fever, or dysrhythmia, it may indicate hemorrhage, sepsis, or cardiac tamponade¹².

Choice A reason: This is the correct statement, as the knee-chest position can help reduce the cyanosis and hypoxia in infants with tetralogy of Fallot. This position increases the systemic vascular resistance and decreases the right-to-left shunting of blood, improving the pulmonary blood flow and oxygenation¹².

Choice B reason: This is not a correct statement, as the Trendelenburg position can worsen the cyanosis and hypoxia in infants with tetralogy of Fallot. This position decreases the systemic vascular resistance and increases the right-to-left shunting of blood, reducing the pulmonary blood flow and oxygenation¹².

Choice C reason: This is not a correct statement, as feeding the infant every 2 hours around the clock can cause overfeeding and fatigue in infants with tetralogy of Fallot. These infants may have poor appetite and weight gain due to their cardiac condition, and they may need frequent rest periods during feeding. Feeding the infant on demand or every 3 to 4 hours may be more appropriate¹³.

Choice D reason: This is not a correct statement, as adding rice cereal to the formula can increase the risk of aspiration and choking in infants with tetralogy of Fallot. These infants may have difficulty swallowing and coordinating their breathing, and they may need a thin and easily digestible formula. Adding rice cereal to the formula may also increase the caloric density and volume, which can cause overfeeding and fatigue¹³.