A nurse is providing care for an infant who has heart failure and is being discharged from the hospital. When providing discharge education. which of the following clinical manifestations should the nurse ensure caregivers are able to identify as signs of worsening heart failure?

Bradycardia, rapid weight gain. and irritability.

Cough. edema. and increased work of breathing.

Abdominal pain. poor appetite. and cough.

Tachypnea and diaphoresis with feeding. poor weight gain, and irritability.

Answer and Explanation

The Correct Answer is D

A. Bradycardia, rapid weight gain, and irritability. – Incorrect. Tachycardia (not bradycardia) is more concerning in worsening heart failure.

B. Cough, edema, and increased work of breathing. – Incorrect. These symptoms can occur but are less specific to worsening heart failure in infants.

C. Abdominal pain, poor appetite, and cough. – Incorrect. While appetite changes may occur, abdominal pain is not a classic sign of heart failure in infants.

D. Tachypnea and diaphoresis with feeding, poor weight gain, and irritability. – Correct. Infants with worsening heart failure experience increased respiratory effort, sweating with feeds (due to exertion), failure to thrive, and fussiness due to poor oxygenation.

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Correct Answer is A

Explanation

A. Keep the child away from areas with ongoing construction or renovation. – Correct. Lead-based paint is often found in older buildings undergoing renovation.

B. Allow the child to play with toys that may contain lead paint. – Incorrect. This increases the risk of lead exposure.

C. Encourage the child to play outside in areas with visible peeling paint. – Incorrect. Peeling paint is a major source of lead poisoning.

D. Ensure the child has a diet rich in iron and calcium. – Incorrect. While this can reduce lead absorption, it does not prevent exposure.

A. is a congenital condition where the layers of the intestinal wall do not form properly. B. results from the twisting of the intestine, causing a blockage in the passage of food." C. occurs when one segment of the intestine slides into another, which can Cut off blood supply. D. is a consequence of weakened abdominal muscles, allowing a portion of the intestine to bulge."

Correct Answer is C

Explanation

A. Is a congenital condition where the layers of the intestinal wall do not form properly. – Incorrect. This describes congenital gastrointestinal disorders like duodenal atresia, not intussusception.

B. Results from the twisting of the intestine, causing a blockage in the passage of food. – Incorrect. This describes volvulus, which is different from intussusception.

C. Occurs when one segment of the intestine slides into another, which can cut off blood supply. – Correct. Intussusception is a telescoping of the intestine, leading to obstruction and ischemia.

D. Is a consequence of weakened abdominal muscles, allowing a portion of the intestine to bulge. – Incorrect. This describes a hernia, not intussusception.

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A nurse is providing care for an infant who has heart failure and is being discharged from the hospital. When providing discharge education. which of the following clinical manifestations should the nurse ensure caregivers are able to identify as signs of worsening heart failure?

Nursing Test Bank

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Correct Answer is A

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Correct Answer is C

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