Treatment for congestive heart failure (CHF) in an infant began 3 days ago and has included digoxin and furosemide. The child no longer has retractions, lungs are clear, and HR is 96 beats per minute while sleeping. The nurse is confident that the child has diuresed successfully and has good renal perfusion when the nurse notes the child's urine output is:

Correct Answer: B

Rationale: In this scenario, the correct answer is B) 1 cc/kg/hr. A urine output of 1 cc/kg/hr indicates adequate renal perfusion and successful diuresis in an infant being treated for congestive heart failure with digoxin and furosemide. This level of urine output signifies that the kidneys are effectively eliminating excess fluid and waste from the body, helping to alleviate the symptoms of CHF. Option A) 0.5 cc/kg/hr would indicate inadequate diuresis and may suggest ongoing fluid retention and poor renal perfusion, which is not ideal for a child with CHF. Option C) 30 cc/hr and Option D) 1 oz/hr do not account for the infant's weight, which is crucial in determining appropriate urine output in pediatrics. Using weight-based calculations ensures that the urine output is tailored to the individual needs of the child. Educationally, this question highlights the importance of monitoring urine output as an indicator of renal function and the effectiveness of treatment in pediatric patients with CHF. Understanding the significance of urine output in assessing renal perfusion and diuresis is essential for nurses caring for infants with cardiac conditions.

Correct Answer: D

Rationale: The correct answer is D) "I will mix the digoxin in some formula to make it taste better." This statement indicates the need for further education because digoxin should not be mixed with food as it can affect the absorption and effectiveness of the medication. It is important to administer digoxin on an empty stomach to ensure proper absorption and consistent blood levels. Option A) "I will give the medication at regular 12-hour intervals" is correct as digoxin should be administered at regular intervals to maintain therapeutic levels in the body. Option B) "If he vomits, I will not give a make-up dose" is also correct because administering a double dose due to vomiting can lead to overdose and toxicity. Option C) "If I miss a dose, I will not give an extra dose" is correct since doubling the dose to make up for a missed one can result in digoxin toxicity. Educationally, it is crucial to emphasize to parents the proper administration techniques for medications, especially in pediatric patients with CHF. Providing clear instructions on medication administration can prevent errors and ensure the child's safety and treatment effectiveness. It is important for parents to understand the rationale behind each instruction to promote adherence to the treatment plan and optimize the child's health outcomes.

Correct Answer: B

Rationale: In pediatric patients with congenital heart defects (CHD) characterized by decreased pulmonary blood flow, such as Tetralogy of Fallot, the nurse would expect to see polycythemia as a laboratory finding. Polycythemia is the body's compensatory mechanism to increase red blood cell production in response to chronic hypoxia, which is common in CHD patients with decreased pulmonary blood flow. The increased red blood cell count helps improve oxygen-carrying capacity in an attempt to meet the body's oxygen demands. Regarding the other options: A) Decreased platelet count: This is not typically associated with CHD of decreased pulmonary blood flow. Platelet count is more related to clotting disorders or certain medications. C) Decreased ferritin level: Ferritin is a marker for iron storage in the body and is not directly related to the pathophysiology of CHD with decreased pulmonary blood flow. D) Shift to the left: This term refers to an increase in immature white blood cells and is usually seen in cases of infection or inflammation, not specifically in CHD patients with decreased pulmonary blood flow. Understanding these laboratory findings in the context of pediatric patients with CHD is crucial for nurses caring for these vulnerable populations. Monitoring laboratory values helps in assessing the patient's response to treatment and identifying any complications early on. It also aids in providing holistic care tailored to the individual needs of each pediatric patient with a congenital heart defect.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) tetralogy of Fallot. Left ventricular hypertrophy with a superior QRS axis typically indicates right ventricular hypertrophy, a common finding in tetralogy of Fallot due to the right ventricular outflow tract obstruction. This condition leads to unequal pressures between the right and left ventricles, causing the left ventricle to become hypertrophied. Option A) tricuspid atresia is incorrect because it typically presents with right axis deviation on ECG due to right ventricular hypertrophy. Option B) Ebstein anomaly is incorrect as it is characterized by a low voltage QRS complex and right axis deviation on ECG. Option C) pulmonary atresia is incorrect as it would show right axis deviation on ECG due to right ventricular hypertrophy. Educationally, understanding the ECG findings in different congenital heart defects is crucial for pediatric nurses to provide appropriate care and interventions. Recognizing specific ECG patterns can aid in the early identification of potential cardiac issues in pediatric patients, leading to timely interventions and improved outcomes.

Correct Answer: B

Rationale: In pediatric nursing, understanding cardiovascular disorders like coarctation of the aorta is crucial. The correct answer for the most common clinical sign of coarctation of the aorta in older children being notching of the inferior border of the ribs (Option B) is due to the pathophysiology of this condition. Coarctation of the aorta causes a narrowing of the aorta, leading to increased pressure proximal to the constriction and decreased pressure distally. This pressure difference results in collateral circulation formation, which leads to rib notching due to dilated intercostal arteries. Option A, cardiac enlargement, is less common in coarctation of the aorta compared to other congenital heart defects. Option C, a systolic ejection click or thrill in the suprasternal notch, is more indicative of aortic stenosis. Option D, differential blood pressure with higher readings in the arms than the legs, is a classic finding in coarctation of the aorta but is not as specific or commonly seen as rib notching. Educationally, it is essential for nursing students to grasp the unique clinical manifestations of different cardiovascular conditions to provide accurate assessments and interventions. Understanding the specific signs and symptoms of coarctation of the aorta aids in timely diagnosis and management, ultimately improving patient outcomes.