ATI LPN Pediatrics Exam

Extract:

Question 1 of 5

Which intervention should be included in the plan of care for an infant with the nursing diagnosis of Excess Fluid Volume related to congestive heart failure?

A. Weigh the infant every day on the same scale at the same time. B. Notify the physician when weight gain exceeds more than 20 g/day. C. Put the infant in a car seat to minimize movement. D. Administer digoxin as ordered by the physician.

Correct Answer: A

Rationale: Weighing the infant every day on the same scale at the same time is crucial in monitoring excess fluid volume in congestive heart failure. Sudden weight gain can indicate fluid retention, a common sign of worsening heart failure. Daily weight monitoring helps in early detection and timely intervention. Notifying the physician when weight gain exceeds more than 20 g/day might be too late for intervention. Daily weight monitoring is essential to detect trends and intervene promptly to manage excess fluid volume. Placing the infant in a car seat to minimize movement is not directly related to managing excess fluid volume in congestive heart failure. It is essential for safety during transportation but does not address the nursing diagnosis. Administering digoxin as ordered by the physician is a medical intervention for congestive heart failure. While important, the nursing diagnosis is related to excess fluid volume, and the focus should be on nursing interventions such as monitoring daily weights.

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ATI LPN Pediatrics Exam | Nurselytic

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