An infant age 2 months has a tentative diagnosis of congenital heart defect. During physical assessment, the nurse notes that the infant has a pulse rate of 168 beats/minute and a respiratory rate of 72 breaths/minute. In which position should the nurse place the infant?

Correct Answer: B

Rationale: The correct answer is B: Lying on the back. Placing the infant in a supine position is recommended for infants with congenital heart defects to prevent overloading the heart by reducing the workload. This position promotes better oxygenation and cardiac output, as gravity assists in venous return. Placing the infant upright in an infant seat (choice A) may increase the workload on the heart due to increased venous return. Lying on the abdomen (choice C) may compromise breathing and reduce oxygenation. Sitting in high Fowler's position (choice D) may also increase the workload on the heart and compromise respiratory function.

Correct Answer: B

Rationale: The correct answer is B: Maintaining proper caloric intake. In a child with transposition of the great vessels, ensuring adequate nutrition is critical for growth and development. Without proper caloric intake, the child's health and recovery may be compromised. Providing comfort for parents (A) is important but not the highest priority. Reducing stressors for the infant (C) is valuable but not as crucial as ensuring proper nutrition. Documenting vital signs (D) is essential but does not directly address the immediate physiological needs of the child. Maintaining proper caloric intake should be the priority to support the child's overall well-being and aid in their recovery.

Correct Answer: A

Rationale: The correct answer is A: BNP of 1000 pg/mL. B-type natriuretic peptide (BNP) is released by the heart in response to increased pressure and volume overload, which commonly occurs in heart failure. A BNP level of 1000 pg/mL indicates significant HF. Choice B: Sodium of 150 is not specific to HF and may indicate dehydration or other electrolyte imbalances. Choice C: Potassium of 5.7 mEq/L is high but not specific to HF. It could result from kidney dysfunction or medication use. Choice D: pH of 7.30 may indicate acidosis, which can occur in various conditions, not just HF. In summary, BNP is a more specific marker for HF compared to the other choices.

Correct Answer: C

Rationale: The correct answer is C because in a VVIR mode pacemaker: 1. Ventricular pacing: The pacemaker paces the ventricle. 2. Atrial sensing: It senses the atrial activity for timing. 3. Triggered response to sensing: It responds by pacing the ventricle after sensing an event. 4. Rate modulated: It can adjust the pacing rate based on the patient's physiological needs. Therefore, choice C accurately describes the characteristics of a VVIR mode pacemaker. Incorrect choices: A: Incorrect because it mentions atrial pacing, which is not a feature of VVIR mode. B: Incorrect because it includes ventricular sensing, which is not a feature of VVIR mode. D: Incorrect because it mentions ventricular sensing and inhibited response to sensing, which are not characteristics of VVIR mode pacemaker.

Correct Answer: C

Rationale: Step-by-step rationale: 1. Heparin is known to increase the risk of bleeding when used concomitantly with streptokinase. 2. Both drugs have anticoagulant properties, leading to a synergistic effect on bleeding risk. 3. Streptokinase enhances the activity of heparin, potentially causing excessive bleeding in the client. 4. This interaction highlights the importance of monitoring clotting parameters when these drugs are used together. Summary of incorrect choices: A: Cimetidine - Not known to interact significantly with streptokinase in terms of bleeding risk. B: Theophylline - Does not have a direct pharmacological interaction with streptokinase. D: Digoxin - Does not impact the bleeding risk associated with streptokinase.