The nurse is assessing a client with the diagnosis of left-sided heart failure. Which clinical finding should the nurse expect the client to experience?
Orthopnea
Bradycardia
Diaphoresis
Frequent coughing with yellow sputum
The Correct Answer is A
A. Orthopnea is correct. Left-sided heart failure causes pulmonary congestion, making it difficult for the client to breathe when lying flat. This results in orthopnea, where the client must sit up or use multiple pillows to breathe comfortably.
B. Bradycardia is incorrect. Heart failure typically leads to tachycardia due to the heart compensating for decreased cardiac output.
C. Diaphoresis is incorrect. While excessive sweating can occur in acute decompensated heart failure, it is not a hallmark symptom of left-sided heart failure.
D. Frequent coughing with yellow sputum is incorrect. A client with left-sided heart failure may have a dry or frothy, pink-tinged cough, but yellow sputum suggests infection rather than heart failure.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Stress testing evaluates cardiac function and ischemia but is not used to diagnose a pulmonary embolism (PE).
B. D-Dimer is correct. D-Dimer is a blood test that detects fibrin degradation products, which are elevated when a blood clot forms and breaks down, making it a useful screening test for pulmonary embolism. However, a positive D-Dimer is not diagnostic, and further imaging (e.g., CT pulmonary angiography) is required.
C. Electrocardiogram (ECG) may show changes (e.g., sinus tachycardia, right heart strain) but does not confirm PE.
D. Pulmonary function testing assesses lung diseases like COPD or asthma but is not used to diagnose PE.
Correct Answer is C
Explanation
A. Increased mucus production blocking the alveoli is incorrect. While mucus production can be an issue in COPD, it is more characteristic of chronic bronchitis rather than emphysema.
B. Infections decreasing ventilation is incorrect. Although infections can worsen emphysema symptoms, they are not the primary cause of chronic hypoxia in these clients.
C. Lack of adequate surface area for aeration is correct. Emphysema leads to alveolar destruction and loss of elasticity, reducing the surface area available for gas exchange, which causes chronic hypoxia.
D. Inflammation of the bronchioles decreasing breathing capacity is incorrect. While airway inflammation is seen in conditions like asthma and chronic bronchitis, emphysema is primarily characterized by alveolar damage rather than airway inflammation.
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