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The nurse is caring for a client who was diagnosed with left-sided heart failure and states, "I do not understand why I have so much trouble breathing if I have heart failure.”. Which of the following responses should the nurse make?

"I am going to notify the healthcare provider because you should not have trouble breathing with left-sided heart failure.”.

"The right side of your heart fails first and causes a back-up of blood in the left side of the heart and then the lungs.”.

"When the left side of your heart does not pump enough blood out, it gets backed up in your lungs and causes shortness of breath.”.

"Typically, clients with left-sided heart failure have difficulty breathing with exertion, but not when resting.”.

Answer and Explanation

The Correct Answer is C

Choice A rationale

Trouble breathing is a hallmark symptom of left-sided heart failure. Suggesting that it should not occur would be inaccurate. The failure of the left ventricle leads to blood accumulation in the pulmonary vessels, creating pulmonary congestion and shortness of breath. Prompt provider notification may be necessary but does not address the underlying pathophysiology. Pulmonary symptoms are expected in this type of heart failure.

Choice B rationale

While left-sided heart failure can eventually lead to right-sided heart failure, the initial problem is with left ventricular dysfunction. This causes reduced forward blood flow and pulmonary congestion due to backflow of blood into the lungs. Right-sided heart failure is not the primary event leading to pulmonary symptoms in left-sided heart failure.

Choice C rationale

The left ventricle's inability to pump effectively results in blood backing up into the pulmonary circulation, causing pulmonary congestion and symptoms like shortness of breath. This is consistent with the hemodynamics of left-sided heart failure. Pulmonary capillary pressure increases, leading to fluid leakage and impaired gas exchange, explaining the client's breathing difficulty.

Choice D rationale

Although difficulty breathing with exertion (dyspnea on exertion) is common, resting symptoms, including orthopnea and paroxysmal nocturnal dyspnea, can also occur in left-sided heart failure due to fluid redistribution. Limiting symptoms to exertion inaccurately portrays the clinical presentation and disregards other significant pulmonary signs.

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Correct Answer is B

Explanation

Choice A rationale

Lower extremity edema is often associated with right-sided heart failure rather than left ventricular failure. Right-sided failure leads to systemic venous congestion, causing fluid accumulation in peripheral tissues like the legs. Left ventricular failure predominantly affects pulmonary circulation, making edema of the lower extremities a less expected finding.

Choice B rationale

Pulmonary crackles are a hallmark finding in left ventricular failure due to fluid accumulation in the alveoli. This occurs because reduced cardiac output causes blood to back up into pulmonary veins and capillaries, increasing hydrostatic pressure and leading to pulmonary congestion. Crackles indicate the presence of interstitial or alveolar fluid, a direct result of left-sided dysfunction.

Choice C rationale

Ascites results from portal hypertension and systemic venous congestion, typically seen in right-sided heart failure or advanced liver disease. Left ventricular failure impacts the pulmonary system rather than the abdominal cavity, making ascites an unlikely finding during assessment for this condition.

Choice D rationale

Jugular vein distention is indicative of systemic venous congestion caused by right-sided heart failure. In left ventricular failure, pulmonary congestion dominates, and jugular vein distention is not a primary finding. Assessments should focus on symptoms directly linked to pulmonary effects such as crackles or dyspnea.

A. Explain that the client should return in one month to be reevaluated. B. Assess the client's adherence to lifestyle modifications and medication therapy. C. Explain to the client that the health care provider will increase the dose of one of the medications already prescribed. D. Discuss adding a prescribed calcium-channel blocker to the client's medication regimen.

Correct Answer is B

Explanation

Choice A rationale

Delaying follow-up without immediate intervention may result in the client's blood pressure remaining uncontrolled, increasing the risk of complications like cardiovascular events. Reevaluation in one month without assessing adherence neglects the urgent need for optimizing management.

Choice B rationale

Assessing adherence to both lifestyle modifications and medication therapy is crucial as noncompliance may explain the suboptimal blood pressure control. Ensuring adherence and addressing any barriers are necessary steps in evaluating the effectiveness of treatment.

Choice C rationale

Increasing medication dosage without first assessing the client's adherence to current prescriptions or lifestyle modifications may be premature. Nonadherence to therapy could render dosage adjustments ineffective, leading to unnecessary changes to the regimen.

Choice D rationale

Adding a calcium-channel blocker without assessing adherence disregards the importance of compliance. Treatment should be optimized based on existing therapy before considering additional pharmacological interventions. .

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The nurse is caring for a client who was diagnosed with left-sided heart failure and states, "I do not understand why I have so much trouble breathing if I have heart failure.”. Which of the following responses should the nurse make?

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