The nurse provides care for a client admitted one hour ago with the diagnosis of salicylate toxicity. The client has an arterial pH of 7.32. Which finding does the nurse expect to observe?

Choice A reason: Shallow respirations and a smooth, beefy red tongue are not the expected findings because they are signs of pernicious anemia, not acute blood loss. Pernicious anemia is a condition where the body cannot produce enough red blood cells due to a lack of vitamin B12, which is needed for DNA synthesis and cell division. Pernicious anemia can cause shallow respirations due to hypoxia, which is a low level of oxygen in the tissues, and a smooth, beefy red tongue due to atrophy of the tongue papillae, which are the small projections that give the tongue its rough texture.

Choice B reason: Facial flushing with distended neck veins are not the expected findings because they are signs of polycythemia, not acute blood loss. Polycythemia is a condition where the body produces too many red blood cells, which increases the blood volume and the blood viscosity, making the blood thicker and harder to flow. Polycythemia can cause facial flushing due to increased blood flow to the skin, and distended neck veins due to increased pressure in the venous system.

Choice C reason: Bilateral numbness and tingling of the extremities are not the expected findings because they are signs of peripheral neuropathy, not acute blood loss. Peripheral neuropathy is a condition where the nerves that carry signals from the brain and spinal cord to the rest of the body are damaged or impaired, causing sensory and motor disturbances. Peripheral neuropathy can cause bilateral numbness and tingling of the extremities due to reduced nerve conduction and sensation.

Choice D reason: Increased heart rate and decreased mental alertness are the expected findings because they are signs of acute blood loss. Acute blood loss is a condition where the body loses a large amount of blood in a short period of time, which reduces the oxygen-carrying capacity of the blood and the tissue perfusion. Acute blood loss can cause increased heart rate due to the compensatory mechanism of the body to increase the cardiac output and maintain the blood pressure, and decreased mental alertness due to the reduced oxygen delivery to the brain.

Choice A reason: "My feet swell up during the evening." is not a specific statement for systolic heart failure, but a general sign of fluid retention. Fluid retention may occur in both systolic and diastolic heart failure, as well as other conditions such as kidney disease, liver disease, or venous insufficiency.

Choice B reason: "It's harder to breathe during hot and humid weather." is not a specific statement for systolic heart failure, but a common complaint of many people with respiratory problems. Hot and humid weather may increase the workload of the lungs and the heart, but it does not indicate a reduced ejection fraction, which is the hallmark of systolic heart failure.

Choice C reason: "I wake up at night being short of breath." is the best statement for systolic heart failure, as it indicates a condition called paroxysmal nocturnal dyspnea. Paroxysmal nocturnal dyspnea is a sudden onset of breathlessness that occurs during sleep, usually due to fluid accumulation in the lungs. It is a sign of left-sided systolic heart failure, which is a failure of the left ventricle to pump blood effectively to the body.

Choice D reason: "I have stomach pain that is worse after meals." is not a specific statement for systolic heart failure, but a possible symptom of gastrointestinal disorders. Stomach pain may be caused by gastritis, ulcers, gallstones, or pancreatitis, among other conditions. It does not reflect the cardiac function or output, which are impaired in systolic heart failure.