A nurse is caring for a client with congestive heart failure (CHF). Which of the following symptoms would indicate worsening of the condition?

Choice A rationale
Enlarged liver (hepatomegaly) and peripheral edema are common clinical manifestations of right heart failure (RHF). RHF leads to congestion of systemic circulation, causing fluid accumulation in the liver and peripheral tissues.
Choice B rationale
Crackles in the lungs are more commonly associated with left-sided heart failure, where fluid backs up into the pulmonary circulation, leading to pulmonary edema.
Choice C rationale
A dry hacking cough is not a typical symptom of right heart failure. It is more commonly associated with respiratory conditions such as asthma or bronchitis.
Choice D rationale
Altered mentation with pinpoint pupils is not a characteristic of right heart failure. These symptoms are more indicative of neurological conditions or opioid overdose.

Choice A rationale
The tripod position helps to improve breathing by allowing the diaphragm to expand more effectively. This position reduces the work of breathing and helps to increase lung capacity, which is beneficial for patients with emphysema.
Choice B rationale
Pursed lip breathing is a technique that helps to keep the airways open longer, allowing more air to escape and reducing the work of breathing. This method helps to improve ventilation and oxygenation in patients with emphysema.
Choice C rationale
Staying current with yearly vaccinations is important for overall health, but it is not a specific strategy for better breathing in emphysema patients. Vaccinations help prevent respiratory infections, which can exacerbate emphysema symptoms.
Choice D rationale
Taking an antihistamine every day is not a recommended strategy for better breathing in emphysema patients. Antihistamines are typically used to treat allergies and may have side effects that could worsen breathing difficulties.
Choice E rationale
Inhaling slowly and deeply helps to maximize lung expansion and improve oxygenation. This technique can help to reduce shortness of breath and improve overall breathing efficiency in patients with emphysema.
Choice F rationale
Sleeping with 2 pillows to prop oneself up helps to reduce the work of breathing by preventing the diaphragm from being compressed. This position can help to improve breathing and reduce shortness of breath during sleep.
Choice G rationale
Measuring peak flow is a useful tool for monitoring lung function, but it is not a specific strategy for better breathing in emphysema patients. Peak flow measurements can help to track the progression of the disease and adjust treatment plans accordingly.
Choice H rationale
Taking a leukotriene inhibitor every day is not a recommended strategy for better breathing in emphysema patients. Leukotriene inhibitors are typically used to treat asthma and may not be effective for emphysema.