The nurse is caring for an older adult client with heart failure (HF) and multiple comorbidities. Which finding(s) in the client’s history are consistent with the client developing HF? (Select all that apply)

Choice A reason: Acute lymphoblastic leukemia (ALL) is an aggressive malignancy of lymphoid cells, often achieving complete remission with intensive chemotherapy, especially in children. Suppression without remission is not typical, as ALL responds well to treatment, targeting rapidly dividing blast cells. CLL, a slower-progressing disease, better fits the description of suppression without complete cure.

Choice B reason: Chronic lymphocytic leukemia (CLL) is a low-grade malignancy of mature B-lymphocytes, often managed with chemotherapy to suppress disease progression rather than achieve complete remission. CLL’s indolent nature means it can be controlled, but residual disease persists due to slow cell turnover, aligning with the question’s description of suppression.

Choice C reason: Acute myelogenous leukemia (AML) is an aggressive malignancy of myeloid cells, requiring intensive chemotherapy or stem cell transplant for potential remission. Suppression without remission is less common, as AML treatment aims for complete response. CLL’s chronic nature makes it more likely to result in disease control rather than cure.

Choice D reason: Hairy-cell leukemia is a rare, indolent B-cell malignancy highly responsive to purine analogs, often achieving long-term remission or near-cure. Suppression without remission is not characteristic, as treatment typically yields durable responses. CLL’s partial response to chemotherapy better matches the scenario of ongoing disease suppression.

Choice A reason: An incompetent lower esophageal sphincter causes GERD, leading to heartburn, not lower left quadrant pain or fever. Diverticulitis involves inflamed intestinal outpouchings, unrelated to esophageal function. This choice is incorrect, as it does not explain the client’s abdominal and systemic symptoms.

Choice B reason: Esophagitis from gastric reflux causes epigastric or chest pain, not lower left quadrant pain or fever. Diverticulitis results from inflamed diverticula in the colon, causing localized pain and infection. This choice is incorrect, as it misaligns with diverticulitis’s colorectal pathophysiology.

Choice C reason: A weakened diaphragm may cause hiatal hernia, leading to reflux symptoms, not lower left quadrant pain or fever. Diverticulitis involves colonic diverticula inflammation, unrelated to diaphragmatic issues. This choice is incorrect, as it does not account for the client’s localized abdominal presentation.

Choice D reason: Diverticulitis results from inflammation of diverticula, outpouchings at weak points in the intestinal wall, typically in the sigmoid colon. These become infected, causing lower left quadrant pain and fever. This mechanism directly supports the client’s presentation, aligning with gastrointestinal pathophysiology evidence.