Which nursing assessments are important when evaluating an infant with heart failure?
(Select All that Apply.)

Monitoring for tachycardia

Observing for diaphoresis during feeding

Monitoring for polyuria

Checking for hyperthermia

Assessing for hepatomegaly

Evaluating feeding difficulties

Answer and Explanation

Correct Answer : A,B,E,F

A. Monitoring for tachycardia – Correct. Tachycardia is an early sign of heart failure as the heart attempts to compensate for decreased cardiac output.

B. Observing for diaphoresis during feeding – Correct. Infants with heart failure often exhibit sweating while feeding due to increased effort and oxygen demand.

C. Monitoring for polyuria – Incorrect. Infants with heart failure are more likely to have oliguria due to poor perfusion, not excessive urination.

D. Checking for hyperthermia – Incorrect. Fever is not a primary sign of heart failure unless an infection is present.

E. Assessing for hepatomegaly – Correct. Hepatomegaly occurs due to systemic venous congestion, a hallmark of right-sided heart failure.

F. Evaluating feeding difficulties – Correct. Poor feeding and failure to thrive are common in infants with heart failure due to fatigue and respiratory distress.

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Correct Answer is C

Explanation

A. Resume playing on their soccer team next year. – Incorrect. Contact sports pose a risk of injury to the remaining kidney and should be avoided.

B. Only participate in nonphysical activities from now on. – Incorrect. While high-impact sports should be avoided, moderate noncontact physical activity is encouraged for overall health.

C. Participate in noncontact sports like swimming as they grow. – Correct. Noncontact sports like swimming, running, or cycling are safe options.

D. Engage in any sports once the incision heals. – Incorrect. Some sports pose a risk of kidney injury and should be avoided.

A. Amblyopia B. Hypotropia C. Otorrhea D. Exotropia

Correct Answer is A

Explanation

A. Amblyopia – Correct. Strabismus can lead to amblyopia (lazy eye) if left untreated.

B. Hypotropia – Incorrect. Hypotropia is a type of strabismus, not a complication.

C. Otorrhea – Incorrect. Otorrhea (ear drainage) is unrelated to strabismus.

D. Exotropia – Incorrect. Exotropia is another form of strabismus rather than a complication.

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Which nursing assessments are important when evaluating an infant with heart failure? (Select All that Apply.)

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Which nursing assessments are important when evaluating an infant with heart failure?
(Select All that Apply.)