A client with congestive heart failure presents with swollen ankles, legs, and abdomen. The nurse should document these findings as:

Clubbing

Peripheral edema

Pitting edema

Ascites

Answer and Explanation

The Correct Answer is B

A) This choice is incorrect because clubbing refers to the enlargement of the fingertips and nails due to chronic hypoxia, which is not related to the client's reported symptoms.

B) This choice is correct. Peripheral edema refers to swelling in the legs, ankles, and feet, which is a common symptom of congestive heart failure. The client's symptoms of swollen ankles, legs, and abdomen indicate peripheral edema.

C) This choice is incorrect because pitting edema is a specific type of edema where pressure on the skin leaves an indentation or "pit." While the client's edema may indeed be pitting, the question does not provide enough information to confirm this.

D) This choice is incorrect because ascites is the accumulation of fluid in the abdominal cavity and is not specific to the client's reported symptoms of swollen ankles and legs.

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Correct Answer is B

Explanation

A) This choice is incorrect because a high-pitched, scratchy sound heard during inhalation is called a pleural friction rub and is associated with pleuritis or inflammation of the pleura, not congestive heart failure.

B) This choice is correct. An S3 heart sound is an extra heart sound heard immediately after S1 and S2, often described as a "ventricular gallop." It is associated with congestive heart failure and indicates increased fluid volume and strain on the ventricles.

C) This choice is incorrect because a prolonged, whooshing sound heard during systole is a heart murmur, which can be caused by various conditions, but it is not specific to the presence of an S3 sound.

D) This choice is incorrect because an irregular heart rhythm with varying intensity is characteristic of cardiac arrhythmias or irregular heartbeats and is not specific to the presence of an S3 sound.

A. Alcohol abuse B. Malnutrition C. Sedentary lifestyle D. Occupational exposure to toxins

Correct Answer is A

Explanation

A) This choice is correct. Alcohol abuse can lead to dilated cardiomyopathy, a condition in which the heart becomes enlarged and weakened, contributing to congestive heart failure. Chronic alcohol consumption can cause toxic effects on the heart muscle, leading to impaired pumping function.

B) This choice is incorrect because malnutrition, while it can impact overall health, is not a direct precipitating cause of congestive heart failure. However, malnutrition can exacerbate heart failure symptoms and weaken the heart further.

C) This choice is incorrect because a sedentary lifestyle can be a risk factor for heart disease, including congestive heart failure, but it is not a direct precipitating cause of the client's condition in this scenario.

D) This choice is incorrect because occupational exposure to toxins can have health implications, but it is not directly related to the client's signs and symptoms of congestive heart failure in this case.

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A client with congestive heart failure presents with swollen ankles, legs, and abdomen. The nurse should document these findings as:

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Naxlex Comprehensive Predictor Exams

A nurse is auscultating a client's heart sounds and hears a third heart sound (S3). Which finding is consistent with the presence of an S3 sound in a client with congestive heart failure?

Correct Answer is B

Explanation

A client with a history of alcohol abuse and malnutrition is admitted with signs and symptoms of congestive heart failure. Which factor is likely a precipitating cause of the client's condition?

Correct Answer is A

Explanation

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A client with congestive heart failure is prescribed digoxin. The nurse should monitor the client for which common side effect of this medication?

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A nurse is caring for a client with congestive heart failure who is prescribed a loop diuretic. The nurse should monitor the client for which potential electrolyte imbalance associated with this medication?

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