The nurse is assessing a client who has a history of right-sided heart failure. Which assessment finding(s) is/are most consistent with this client’s diagnosis? (Select all that apply)

Choice A reason: Calcium channel blockers reduce blood pressure by relaxing vascular smooth muscle but are not primary replacements for ACE inhibitors in heart failure. They do not address the renin-angiotensin system or the cough side effect mechanism, making them less suitable for this scenario.

Choice B reason: Beta blockers reduce heart rate and myocardial oxygen demand in heart failure but do not directly replace ACE inhibitor effects on the renin-angiotensin system. They are often used adjunctively, not as replacements, and do not address the cough side effect.

Choice C reason: Potassium-sparing diuretics manage fluid retention in heart failure but do not inhibit the renin-angiotensin system like ACE inhibitors. They are not a direct replacement and do not address the cough, which is specific to ACE inhibitor intolerance.

Choice D reason: ARBs block angiotensin II receptors, providing similar benefits to ACE inhibitors in heart failure by reducing vascular resistance and cardiac workload. They are less likely to cause cough, as they do not increase bradykinin levels, making them the expected replacement medication.

Choice A reason: Incentive spirometry improves lung expansion but is not the priority in acute heart failure with pulmonary edema. Crackles and dyspnea indicate fluid overload, requiring immediate positioning to reduce respiratory distress, making this intervention less urgent than optimizing breathing mechanics.

Choice B reason: Coughing and deep breathing may help clear airways but do not address the underlying pulmonary edema in left-sided heart failure. Fluid in the alveoli causes crackles and dyspnea, requiring positioning to reduce venous return and improve oxygenation, making this less effective initially.

Choice C reason: Elevating the head of the bed to 45 degrees can reduce venous return and ease breathing in heart failure. However, high Fowler’s position (60–90 degrees) is more effective for severe dyspnea and pulmonary edema, as it maximizes lung expansion and oxygenation.

Choice D reason: High Fowler’s position (60–90 degrees) reduces venous return to the heart, decreasing pulmonary congestion in left-sided heart failure. This alleviates dyspnea and crackles by improving lung expansion and oxygenation, making it the most effective initial intervention for acute respiratory distress in this condition.