A nurse is caring for a child who is postoperative following surgical correction of Tetralogy of Fallot. Which of the following findings should the nurse identify as an indication of heart failure?

Choice A reason: Rhinorrhea, or a runny nose, is a common symptom of RSV and, while it should be monitored, it is not typically an urgent concern that requires immediate reporting to a provider.

Choice B reason: Pharyngitis, or a sore throat, is another symptom that can be associated with RSV. Like rhinorrhea, it should be monitored but does not usually necessitate immediate reporting.

Choice C reason: Coughing is a typical symptom of RSV and is expected. It should be monitored for changes in character or severity but is not generally an urgent concern for immediate reporting.

Choice D reason: Tachypnea, or rapid breathing, is a sign of respiratory distress and is a critical finding in an infant with RSV. It indicates that the infant's ability to breathe effectively is compromised and requires immediate attention from a healthcare provider.

Choice A reason: Assessing vital signs every 4 hours is important, but it is not specific to the care of an infant post-cardiac catheterization. Vital signs should be monitored according to the infant's condition and hospital policy.

Choice B reason: Monitoring the color of the affected extremity is crucial after cardiac catheterization to ensure there is no compromise in blood flow, which could indicate a vascular injury or thrombosis at the catheterization site.

Choice C reason: Maintaining NPO (nothing by mouth) status for 8 hours may be necessary before the procedure, but post-catheterization care typically includes gradual reintroduction of fluids and then food as tolerated.

Choice D reason: Keeping the affected extremity flexed is not recommended post-cardiac catheterization. The limb should be kept straight to avoid bending at the catheterization site, which could lead to bleeding or clot formation.