Which of the following interventions should the nurse expect when planning care for this client?

Choice A rationale

Bradycardia, a heart rate slower than normal for a toddler (typically less than 80-100 beats per minute at rest), is not a typical finding in a toddler with heart failure. In heart failure, the heart often compensates for reduced cardiac output by increasing its rate to maintain adequate perfusion, leading to tachycardia. Bradycardia in this context might suggest severe decompensation or other underlying issues.

Choice B rationale

Orthopnea, or difficulty breathing when lying flat, is a common symptom of heart failure, particularly in older children and adults. It occurs due to the redistribution of fluid from the lower extremities to the pulmonary circulation when supine, increasing pulmonary congestion and causing shortness of breath. While toddlers may not articulate this symptom clearly, they may exhibit signs of discomfort or restlessness when lying down, preferring to be held upright or sleep in a semi-Fowler's position to ease breathing.

Choice C rationale

Weight gain, not weight loss, is a more expected finding in a toddler with heart failure due to fluid retention. The compromised pumping action of the heart leads to increased venous pressure and activation of the renin-angiotensin-aldosterone system, resulting in sodium and water retention. This fluid overload manifests as edema, ascites, and weight gain. While poor feeding due to fatigue or respiratory distress can sometimes lead to poor weight gain, significant weight loss is not a primary characteristic of heart failure in toddlers.

Choice D rationale

Decreased urine output, not increased urine output, is a typical finding in heart failure. The reduced cardiac output leads to decreased renal perfusion, triggering the kidneys to retain sodium and water in an attempt to increase circulating volume and improve cardiac output. This compensatory mechanism results in oliguria (reduced urine production). Increased urine output would be more indicative of conditions like diabetes insipidus or the diuretic phase of renal failure, not typically heart failure. .

Choice A rationale

Limiting exercise to 10 minutes, 2 days per week is insufficient for cardiovascular health. Current recommendations generally advise at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity per week, along with muscle-strengthening activities at least two days a week, to reduce the risk of heart disease.

Choice B rationale

Monitoring blood pressure is a crucial preventative measure for heart disease. Hypertension is a major risk factor for cardiovascular diseases, including coronary artery disease, stroke, and heart failure. Regular blood pressure monitoring allows for early detection and management of elevated blood pressure, reducing the risk of these complications. A normal blood pressure is typically considered to be less than 120/80 mmHg.

Choice C rationale

Losing weight if necessary is an important recommendation for preventing heart disease. Obesity and being overweight are significant risk factors for hypertension, dyslipidemia, type 2 diabetes, and sleep apnea, all of which increase the risk of heart disease. Achieving and maintaining a healthy weight through diet and exercise can significantly reduce cardiovascular risk.

Choice D rationale

Eating a diet high in saturated fats increases the risk of heart disease. Saturated fats can raise low-density lipoprotein (LDL) cholesterol levels, which contribute to the formation of atherosclerotic plaques in the arteries, increasing the risk of coronary artery disease and stroke. Dietary guidelines recommend limiting saturated fat intake.

Choice E rationale

Maintaining the current cholesterol level may not be a preventative measure if the current cholesterol level is elevated. High levels of LDL cholesterol are a major risk factor for heart disease. Preventative measures often include lifestyle modifications and, if necessary, medication to lower elevated cholesterol levels to reduce cardiovascular risk. Normal total cholesterol is generally less than 200 mg/dL, LDL cholesterol less than 100 mg/dL, and HDL cholesterol greater than 60 mg/dL.