The nurse is assessing a 5-year-old child. In checking the heart rate, the nurse finds an increase of 25 beats then the child changes from a lying to a standing position. This increase in heart rate is indicative of:

a. hypovolemia c. normal findings
b. hypervolemia d. left-sided heart failure


A

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A Correct: The nurse is assessing a 5-year-old child. In checking the heart rate, the nurse finds an increase of 25 beats then the child changes from a lying to a standing position. This increase in heart rate is indicative of hypovolemia. A postural change in heart rate is a useful cue in assessing fluid status in children over 4 years of age.
B Incorrect: This increase in heart rate is not indicative of hypervolemia.
C Incorrect: This increase in heart rate is not indicative of normal findings.
D Incorrect: This increase in heart rate is not indicative of left-sided heart failure.

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