The nurse provides care for a client diagnosed with pulmonary emphysema. The nurse observes the following: respiratory rate 20 breaths/minute, use of intercostal muscles, and decreased mental alertness. Which is the best explanation for these observations?

Choice A reason: Facial muscle atrophy is not the expected finding because it is a condition where the facial muscles lose their mass and strength, which can be caused by various factors, such as aging, nerve damage, or muscular dystrophy. Facial muscle atrophy is not a common manifestation of myxedema, which is a severe form of hypothyroidism, which is a condition where the thyroid gland does not produce enough thyroid hormones, which regulate the metabolism and growth of the body.

Choice B reason: Facial and periorbital edema is the expected finding because it is a characteristic manifestation of myxedema, which is caused by the accumulation of mucopolysaccharides, which are complex carbohydrates that are normally found in the connective tissues. Mucopolysaccharides can attract water and cause swelling of the tissues, especially in the face and around the eyes. Facial and periorbital edema can also cause the facial features to appear coarse and puffy, and the eyelids to droop.

Choice C reason: Facial muscle twitching is not the expected finding because it is a condition where the facial muscles contract involuntarily, which can be caused by various factors, such as stress, fatigue, or caffeine. Facial muscle twitching is not a common manifestation of myxedema, which can cause the facial muscles to become weak and slow, and the facial expressions to become dull and flat.

Choice D reason: Unilateral ptosis is not the expected finding because it is a condition where one eyelid droops lower than the other, which can be caused by various factors, such as nerve damage, stroke, or tumor. Unilateral ptosis is not a common manifestation of myxedema, which can cause bilateral ptosis, which is the drooping of both eyelids, due to the edema and weakness of the eyelid muscles.

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.