A nurse is caring for a client with a diagnosis of left-sided heart failure. The nurse expects what assessment findings associated with left-sided heart failure? (Select All that Apply.)

Ascites

Edema in the legs and feet

Crackles in the lungs

Confusion

Exertional dyspnea

Answer and Explanation

Correct Answer : C,D,E

A. Ascites is more commonly associated with right-sided heart failure. Right-sided failure leads to systemic congestion, causing fluid accumulation in the abdomen.
B. Edema in the legs and feet is a symptom of right-sided heart failure. Left-sided failure primarily affects the lungs, while right-sided failure leads to peripheral edema.
C. Crackles in the lungs are expected in left-sided heart failure. Pulmonary congestion results from blood backing up into the lungs, leading to fluid accumulation in the alveoli.
D. Confusion can occur due to decreased cardiac output and poor oxygenation to the brain. Clients with severe heart failure may experience cognitive changes or altered mental status.
E. Exertional dyspnea is a hallmark of left-sided heart failure. The inability of the left ventricle to pump effectively leads to pulmonary congestion, making breathing difficult during physical activity.

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Correct Answer is ["B","C","D"]

Explanation

A. Massaging the calves is incorrect. This action can dislodge a deep vein thrombus (DVT), increasing the risk of a pulmonary embolism.
B. Applying elastic compression stockings is correct. These help promote venous return, reducing the risk of blood stasis and clot formation.
C. Performing passive range of motion exercises is correct. These exercises prevent venous stasis, which is a major risk factor for DVT and PE.
D. Assessing legs for redness is correct. Redness, swelling, and warmth can indicate DVT formation, allowing for early intervention before it leads to PE.
E. Placing pillows under the client's knees is incorrect. This can impair circulation and increase the risk of clot formation by promoting venous stasis.

A. Annual Influenza immunization B. Regular moderate exercise C. Smoking cessation D. Maintenance of ideal weight

Correct Answer is C

Explanation

A. Annual Influenza immunization is important for individuals with chronic bronchitis but does not directly prevent the disorder from occurring. It helps reduce respiratory infections, which can exacerbate symptoms.
B. Regular moderate exercise improves overall lung function but does not specifically prevent chronic bronchitis.
C. Smoking cessation is the most effective measure in preventing chronic bronchitis. Chronic bronchitis is strongly linked to long-term cigarette smoking, which causes inflammation and excessive mucus production in the airways.
D. Maintenance of ideal weight supports overall health but is not a primary factor in preventing chronic bronchitis.

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A nurse is caring for a client with a diagnosis of left-sided heart failure. The nurse expects what assessment findings associated with left-sided heart failure? (Select All that Apply.)

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