A six-month-old infant is hospitalized for repair of a ventricular septal defect. As you are doing his physical exam, you note that the infant's extremities are cool, he has weak peripheral pulses, and his urine output is diminished. These clinical findings are suggestive of which of the following?

Choice A reason: This statement is correct, as suctioning the mouth and nasopharyngeal passages is the most important priority for airway care in an infant who has had a cleft palate repair. The nurse should suction the infant frequently and gently to remove any blood, mucus, or secretions that may obstruct the airway or cause aspiration. The nurse should also monitor the infant's respiratory rate, oxygen saturation, and signs of distress.

Choice B reason: This statement is incorrect, as giving IV morphine for pain is not the most important priority for airway care in an infant who has had a cleft palate repair. Although pain management is essential for the infant's comfort and recovery, it is not the first intervention for airway care. The nurse should assess the infant's pain level and administer the prescribed analgesics as needed, but only after ensuring the airway is clear and patent.

Choice C reason: This statement is incorrect, as cleaning the suture line with normal saline is not the most important priority for airway care in an infant who has had a cleft palate repair. Although wound care is important for the prevention of infection and the promotion of healing, it is not the first intervention for airway care. The nurse should clean the suture line with sterile saline or water as ordered, and avoid using cotton swabs or hydrogen peroxide that may damage the tissue or cause bleeding.

Choice D reason: This statement is incorrect, as elevating the head of the bed 30 degrees is not the most important priority for airway care in an infant who has had a cleft palate repair. Although elevating the head of the bed can help reduce the swelling and improve the drainage, it is not the first intervention for airway care. The nurse should position the infant on the side or abdomen, with the head slightly elevated, and avoid placing the infant on the back or putting pressure on the operative site.

Choice A reason: Slowing the heart rate does not increase diastolic filling time. Diastolic filling time is the time during which the ventricles are relaxed and filling with blood. Slowing the heart rate would decrease the cardiac output and worsen the heart failure.

Choice B reason: Increasing urine output does decrease pulmonary congestion, but it is not the primary effect of Captopril. Captopril is an angiotensin-converting enzyme (ACE) inhibitor, which blocks the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. This reduces the blood pressure and the afterload on the heart. Diuretics are the drugs that increase urine output and reduce fluid overload.

Choice C reason: This is the correct choice. Decreasing the afterload means reducing the resistance that the heart has to overcome to pump blood to the body. This lowers the blood pressure and the workload on the heart, which improves the cardiac function and reduces the symptoms of heart failure.

Choice D reason: Increasing serum potassium does not improve cardiac performance. In fact, high levels of potassium can cause cardiac arrhythmias and cardiac arrest. Captopril can cause hyperkalemia (high potassium) as a side effect, which is why patients on this drug need to monitor their potassium levels and avoid potassium supplements or salt substitutes.