Question

The nurse provides care for children hospitalized at a local community hospital. Which child requires priority assessment by the nurse?

A. A 2-day-old neonate with a history of patent ductus arteriosus (PDA) with a loud machinery-sounding murmur.
B. A preschool-age child, diagnosed with tetralogy of Fallot (ToF) who presents with clubbing of the fingers and is easily irritated when awake.
C. A 16-year-old male with a history of coarctation of the aorta who has femoral pulses 1+ bilaterally.
D.A 6-week-old infant with a history of ventricular septal defect (VSD) making snorting noises when feeding.

Answer 1

The child who requires priority assessment by the nurse is the preschool-age child with tetralogy of Fallot (ToF) who presents with finger clubbing and irritability when awake.

Step-by-step explanation:

The child who requires priority assessment by the nurse is the preschool-age child with tetralogy of Fallot (ToF) who presents with finger clubbing and irritability when awake. Finger clubbing is a sign of chronic hypoxia and indicates inadequate oxygenation of the blood. This child may be experiencing a decrease in oxygen levels, which requires immediate intervention and assessment by the nurse.