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: Rheumatoid arthritis is an autoimmune disorder where the immune system attacks synovial joints, causing inflammation and destruction. This altered immune response, driven by autoantibodies like rheumatoid factor, leads to chronic joint damage, aligning with diseases involving immune dysregulation, per rheumatology evidence.

Choice B reason: Emphysema, a COPD subtype, results from alveolar destruction due to smoking or environmental exposures, not immune dysregulation. While inflammation occurs, it is not primarily autoimmune. Emphysema’s pathophysiology involves protease imbalance, not altered immunity, making it incorrect for diseases related to immune system alterations.

Choice C reason: Addison disease involves adrenal insufficiency, often autoimmune, but primarily affects hormone production, not immune system activity. The immune attack on adrenal glands is a cause, not the ongoing disease process. This makes it less directly related to altered immunity compared to RA, T1DM, or GBS.

Choice D reason: Type 1 diabetes mellitus is an autoimmune condition where the immune system destroys pancreatic beta cells, leading to insulin deficiency. This immune-mediated attack, involving T-cells and autoantibodies, directly reflects altered immunity, making it a key example of an immune-related disease, per endocrinology evidence.

Choice E reason: Guillain-Barré syndrome is an autoimmune disorder where the immune system attacks peripheral nerves, causing demyelination and weakness. This post-infectious immune dysregulation, often triggered by molecular mimicry, directly involves altered immunity, aligning with the pathophysiology of immune-related diseases, per neurological evidence.

Choice A reason: Yellow sclera (jaundice) result from bilirubin accumulation in cirrhosis, not high ammonia levels. Ammonia toxicity affects the brain, causing neurological symptoms. While jaundice is common in cirrhosis, it is unrelated to ammonia, making this incorrect for the symptom linked to elevated serum ammonia.

Choice B reason: Shortness of breath on exertion may occur in cirrhosis due to ascites or hepatopulmonary syndrome, but it is not caused by high ammonia levels. Ammonia primarily affects the brain, leading to encephalopathy. This symptom is unrelated to ammonia toxicity, making it an incorrect choice.

Choice C reason: Impaired skin integrity may occur in cirrhosis from pruritus or edema, but it is not directly linked to high ammonia levels. Ammonia causes cerebral toxicity, manifesting as neurological changes. Skin issues are secondary complications, making this incorrect for the primary symptom of elevated ammonia.

Choice D reason: High serum ammonia in cirrhosis leads to hepatic encephalopathy, causing altered consciousness, from confusion to coma. Ammonia crosses the blood-brain barrier, disrupting neurotransmitter function and cerebral metabolism. This is the primary symptom of ammonia toxicity, aligning with cirrhosis’s neurological complications, per hepatology evidence.