A nurse is caring for a school-age child who has heart failure. Which of the following findings should the nurse expect?Select all that apply.
Cyanosis
Weight loss
Bounding peripheral pulses
Dyspnea
Tachycardia
Correct Answer : A,D,E
Rationale:
A. Cyanosis can occur in children with heart failure due to inadequate oxygenation of tissues.
B. Weight gain or fluid retention is more common in children with heart failure.
C. Bounding pulses are more commonly associated with conditions such as hypertension or hyperthyroidism, rather than heart failure.
D. Dyspnea, or difficulty breathing, is a common symptom of heart failure due to fluid buildup in the lungs.
E. Tachycardia, or a rapid heart rate, can occur as a compensatory mechanism in response to decreased cardiac output in heart failure.
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Related Questions
Correct Answer is D
Explanation
Rationale:
A. While informing the client to contact the pharmacy is appropriate, it does not address the immediate need for understanding the medication.
B. Providing instructions to the client's parent may not respect the adolescent's autonomy and privacy regarding their healthcare.
C. Instructing the client's parents to write down the information may not involve the adolescent in the learning process or address their individual needs.
D. Asking how the client prefers to learn new information demonstrates respect for the adolescent's autonomy and preferences, facilitating effective communication and understanding.
Correct Answer is B
Explanation
Rationale:
A. This is not a common adverse effect associated with morphine.
B. Nausea is a common adverse effect of morphine and should be monitored for, particularly in pediatric patients.
C. Stevens-Johnson syndrome is a severe allergic reaction and is not typically associated with morphine.
D. While morphine can cause urinary retention, it is not typically associated with renal failure.
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