A nurse is assessing an infant who has heart failure. Which of the following findings should the nurse expect? (Select all that apply.)
Increased urinary output
Nasal flaring
Peripheral edema
Bradycardia
Correct Answer : B,C
Choice A reason: Increased urinary output is not typically associated with heart failure. In fact, reduced urinary output may be expected due to decreased kidney perfusion.
Choice B reason: Nasal flaring is a sign of respiratory distress and can be expected in infants with heart failure as they struggle to maintain oxygenation.
Choice C reason: Peripheral edema is a common finding in heart failure due to fluid retention and poor circulation.
Choice D reason: Bradycardia is not a typical sign of heart failure in infants; tachycardia is more common. However, bradycardia can occur in advanced stages due to poor cardiac output.
Choice E reason: Cool extremities are indicative of poor perfusion, which is a consequence of decreased cardiac output in heart failure.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: While the Fowler's position can aid in breathing, it is not the first action to take if the oxygen saturation monitor is reading low.
Choice B reason: Ensuring the proper placement of the sensor probe is the first step, as incorrect placement can lead to inaccurate readings.
Choice C reason: Increasing the oxygen flow rate should only be considered after confirming the accuracy of the oxygen saturation reading.
Choice D reason: Encouraging deep breaths may be helpful, but it is not the first action to take. The priority is to ensure the oxygen saturation reading is accurate.
Correct Answer is ["B","C","E"]
Explanation
Choice A reason: Dornase alfa is used to break down mucus and is beneficial for children with cystic fibrosis, not typically prescribed for asthma.
Choice B reason: Placing a child in an upright position can help ease breathing during an asthma attack by reducing pressure on the diaphragm.
Choice C reason: Bronchodilators are medications that help open the airways and are a mainstay in the treatment of asthma.
Choice D reason: Chest percussion can help loosen mucus in the lungs; however, it is not commonly used in the routine management of asthma.
Choice E reason: Monitoring oxygen saturation is crucial in assessing the severity of an asthma attack and determining the effectiveness of treatment.
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