The nurse is conducting discharge teaching about signs and symptoms of heart failure to parents of an infant with a repaired tetralogy of Fallot. Which signs and symptoms should the nurse include? (Select all that apply.)
Decreased urinary output.
Sweating (inappropriate).
Warm flushed extremities.
Anorexia.
Weight loss.
Correct Answer : A,B,D
The correct answers are choices A, B, and D.
Choice A rationale:
Decreased urinary output can be a sign of heart failure, especially in infants. In heart failure, the heart's ability to pump effectively can lead to decreased blood flow to the kidneys, resulting in decreased urine production.
Choice B rationale:
Sweating (inappropriate) is a symptom of heart failure in infants. Infants with heart failure might sweat excessively, especially while feeding or crying, due to the effort required by the heart to pump blood effectively.
Choice C rationale:
Warm flushed extremities are not typically associated with heart failure in infants. In heart failure, extremities might actually become cool and pale due to poor circulation.
Choice D rationale:
Anorexia, or a lack of appetite, is a common sign in infants with heart failure. The increased effort required for feeding due to compromised cardiac function can lead to poor feeding and decreased appetite.
Choice E rationale:
Weight loss can occur in infants with heart failure due to inadequate caloric intake, difficulty with feeding, and increased metabolic demands associated with heart failure. However, it's not as specific a sign as decreased urinary output, sweating, and anorexia.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
The correct answer is Choice C: Epispadias.
Choice A rationale:
Chordee is not the correct term to identify when the meatal opening is located on the dorsal surface of the penis. Chordee refers to the downward curvature or bending of the penis, often associated with hypospadias or other congenital conditions.
Choice B rationale:
Hypospadias is not the correct term for this condition. Hypospadias refers to a congenital condition where the opening of the urethra is located on the underside of the penis rather than at the tip. It is not related to the meatal opening being on the dorsal surface.
Choice C rationale:
Epispadias. This is the correct choice. Epispadias is a congenital malformation where the meatal opening is located on the dorsal (upper) surface of the penis. It is a rare condition and requires surgical intervention for correction.
Choice D rationale:
Phimosis is not the correct term for this condition. Phimosis refers to the tightness of the foreskin that prevents it from being pulled back over the tip of the penis. It does not relate to the positioning of the meatal opening.
Correct Answer is C
Explanation
The correct answer is choice C. The child needs opportunities to play with peers.
Choice A rationale:
While it's important for children with congenital heart disease to understand their limitations, it's not the primary concern in this scenario. Allowing the child to interact and play with peers is essential for their social, emotional, and psychological development.
Choice B rationale:
While parents play a crucial role in a child's care, completely isolating the child from peers is not ideal. Overprotectiveness can lead to social isolation and hinder the child's ability to develop important social skills.
Choice C rationale:
Children with congenital heart disease should be encouraged to engage in age-appropriate physical activities and play with peers. Of course, the level of activity should be discussed with the child's healthcare provider, but limiting the child's interactions could have negative consequences on their overall development and emotional well-being.
Choice D rationale:
While supervision is important for any child's safety, constant parental supervision to avoid overexertion might not be necessary or feasible. Educating the child about their limitations and providing opportunities for play while monitoring their comfort level is a more balanced approach.
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