The nurse is reviewing the health history and physical examination of a child diagnosed with heart failure. The nurse would expect to find all of the following except:

Choice A rationale Shortness of breath, or dyspnea, particularly during physical activity like playing, is a classic sign of heart failure in children. This occurs due to pulmonary congestion and increased pulmonary venous pressure caused by the heart's inability to pump blood efficiently, leading to fluid backup into the lungs and reduced gaseous exchange capacity. Choice B rationale Crackles (rales) heard on lung auscultation are indicative of fluid accumulation in the alveoli and small airways, which results from pulmonary edema due to left-sided heart failure. This finding is a direct manifestation of the increased hydrostatic pressure in the pulmonary capillaries, causing transudation of fluid into the lung tissue. Choice C rationale Tiring easily when eating, often described as poor feeding or difficulty sucking, is a common symptom of heart failure in infants. This fatigue is due to the increased metabolic demands and energy expenditure required for sucking and the effort associated with early pulmonary congestion and tachypnea. Choice D rationale Bradycardia, an abnormally slow heart rate (normal heart rate for a school-age child is 60-100 beats/min), is generally not an expected finding in pediatric heart failure. Tachycardia (fast heart rate) is the body's compensatory mechanism to maintain adequate cardiac output in the presence of poor contractility or high volume load, and it is a typical finding.