The nurse has admitted a child with a ventricular septal defect (VSD) to the unit. An appropriate nursing diagnosis for this child is
1. impaired gas exchange related topulmonary congestion secondary to the increased pulmonary blood flow.
2. deficient fluid volume related tohyperthermia secondary to the congenital heart defect.
3. acute pain related to the effects of acongenital heart defect.
4. hypothermia related to decreasedmetabolic state.
Answer:1
Rationale:Because of the increased pulmonary congestion,impaired gas exchange would be an appropriate nursing diagnosis. Ventricular septal defects do not cause pain,fever,or deficient fluid volume.
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