A nurse is caring for a client with pulmonary edema. Which finding is indicative of severe pulmonary edema and impaired gas exchange?
Pink, frothy sputum
Low-grade fever
Clear breath sounds throughout the lung fields
Absence of peripheral edema
The Correct Answer is A
A) Correct. Pink, frothy sputum, often described as "pink froth," is indicative of severe pulmonary edema with the presence of blood-tinged fluid in the alveoli.
B) Incorrect. A low-grade fever is not a typical sign of pulmonary edema and may indicate another underlying condition.
C) Incorrect. Clear breath sounds throughout the lung fields are not indicative of severe pulmonary edema, which often presents with crackles.
D) Incorrect. The absence of peripheral edema does not necessarily reflect the severity of pulmonary edema; it may be related to factors other than heart failure.
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Related Questions
Correct Answer is D
Explanation
A) Incorrect. Limiting fluid intake should be based on the client's specific medical recommendations and should not be a general guideline.
B) Incorrect. Avoiding all physical activity is not necessary and can lead to deconditioning. Clients should engage in appropriate physical activity as advised by their healthcare provider.
C) Incorrect. Blood pressure should be regularly monitored as directed by the healthcare provider, not only when symptoms worsen.
D) Correct. Taking prescribed medications as directed, especially diuretics and medications to manage underlying conditions, is crucial in preventing recurrence of pulmonary edema.
Correct Answer is B
Explanation
A) Incorrect. The supine position with legs elevated is not recommended for clients with pulmonary edema, as it can worsen fluid retention.
B) Correct. High Fowler's position allows for optimal lung expansion and improved gas exchange in clients with pulmonary edema.
C) Incorrect. The left lateral recumbent position may be used in some cases, but it is not the primary position for managing pulmonary edema.
D) Incorrect. The prone position is not typically recommended for clients with pulmonary edema.
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