Which of the following is an early sign of congestive heart failure that the nurse should recognize?
Increased urine output
Tachypnea
Bradycardia
Inability to sweat
The Correct Answer is B
A. Increased urine output is not typical in early congestive heart failure (CHF); in fact, decreased urine output can occur due to reduced kidney perfusion.
B. Tachypnea (rapid breathing) is an early and key sign of CHF in children. It occurs due to pulmonary congestion and decreased cardiac output, leading to poor oxygenation and compensatory increased respiratory rate.
C. Bradycardia is a late and often ominous sign of cardiac deterioration in children, not an early indicator.
D. Inability to sweat is not a recognized clinical indicator of CHF. On the contrary, diaphoresis (especially during feeding in infants) can be an early sign.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Physical abuse typically presents with visible signs of injury, inconsistent explanations for trauma, or fearfulness around caregivers. While abuse may coexist, the pattern here involves medical fabrication rather than physical harm.
B. Munchausen by proxy (also known as factitious disorder imposed on another) occurs when a caregiver—usually a parent—exaggerates, fabricates, or induces illness in a child to gain attention or sympathy. The repeated vague complaints, specialist seeking, and now unconscious presentation strongly raise this concern.
C. Severe organic failure to thrive results from an underlying physical condition affecting growth and development, not from caregiver behavior. It also doesn't typically include extensive medical seeking behavior for vague, shifting symptoms.
D. Ingestion of a toxin is possible in any unconscious child, but in this context, without clear evidence of accidental exposure, it may actually be a result of the caregiver's actions in Munchausen by proxy. Thus, it is a potential symptom, not the root concern.
Correct Answer is A
Explanation
A. Frequent swallowing is a classic sign of post-tonsillectomy hemorrhage, as the child may be swallowing blood that is draining down the throat. This can be a subtle but early indicator of bleeding and requires immediate evaluation.
B. Increased pain is expected in the immediate postoperative period and not specific to hemorrhage.
C. Drooling may be due to throat pain or refusal to swallow but is not a key indicator of bleeding.
D. Poor fluid intake is common after tonsillectomy due to pain and discomfort, but not specific to hemorrhage.
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