Which clinical finding most strongly suggests development of pulmonary edema in a client with left-sided heart failure?
Bounding peripheral pulses.
Increased urinary output at night.
Productive cough with frothy sputum.
Constipation and dry mucous membranes.
The Correct Answer is C
Choice A rationale
Bounding peripheral pulses are usually associated with conditions that increase stroke volume or decrease systemic vascular resistance, such as fever, anemia, or hyperthyroidism. In heart failure, pulses are more likely to be weak, thready, or alternating due to decreased cardiac output and compensatory vasoconstriction. Bounding pulses do not indicate pulmonary edema; in fact, as heart failure worsens and edema develops, peripheral perfusion often declines, leading to diminished rather than strengthened peripheral arterial pulsations.
Choice B rationale
Increased urinary output at night, known as nocturia, is a common early symptom of heart failure. When a patient lies flat, the dependent edema from the legs is redistributed into the circulatory system, increasing renal blood flow and triggering the kidneys to produce more urine. While this indicates fluid volume overload related to heart failure, it is a compensatory mechanism and does not represent the acute respiratory crisis of pulmonary edema, which involves fluid entering the air sacs.
Choice C rationale
A productive cough with frothy, pink-colored sputum is a hallmark sign of acute pulmonary edema. This occurs because the high pressure in the pulmonary capillaries forces fluid and some red blood cells into the alveoli. The mixing of this fluid with air during breathing creates the characteristic frothy appearance. This clinical finding signifies that the left-sided heart failure has progressed to a point where the lungs are severely congested, severely impairing gas exchange and requiring immediate intervention.
Choice D rationale
Constipation and dry mucous membranes are typically signs of dehydration or certain medication side effects rather than pulmonary edema. In pulmonary edema, the body is experiencing fluid overload, not a deficit. The mucous membranes might appear cyanotic due to poor oxygenation, but they would not be characterized as dry in the context of an acute fluid backup. Constipation is unrelated to the acute hemodynamic and respiratory changes that occur when fluid fills the pulmonary interstitial and alveolar spaces.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
The aorta is the largest artery in the body and carries highly oxygenated blood from the left ventricle to the systemic circulation. This blood has just returned from the lungs, where carbon dioxide was exchanged for oxygen. Therefore, the oxygen saturation in the aorta is typically very high, usually around 95% to 100%. Finding deoxygenated blood here would indicate a severe pathological shunt or a failure of the pulmonary gas exchange system.
Choice B rationale
The right side of the heart is responsible for receiving blood that has returned from the systemic circulation after delivering oxygen to the tissues. The right atrium collects this oxygen-poor blood from the superior and inferior vena cava. It then passes into the right ventricle, which pumps it toward the lungs via the pulmonary artery. Consequently, these chambers contain blood with the lowest oxygen saturation levels in the heart, typically around 70% to 75%.
Choice C rationale
The pulmonary veins are unique because, unlike most veins, they carry oxygenated blood. After blood passes through the alveolar capillaries in the lungs and picks up oxygen, it travels through the pulmonary veins to enter the left atrium. Because this blood has just been "refreshed" in the lungs, it is rich in oxygen. Therefore, the pulmonary veins are not a location where you would find more deoxygenated blood under normal physiological conditions.
Choice D rationale
The left atrium and left ventricle comprise the left side of the heart, which receives oxygenated blood from the pulmonary circulation. The left atrium collects the blood from the pulmonary veins, and the left ventricle pumps it out to the rest of the body through the aorta. This blood is highly oxygenated to meet the metabolic demands of the peripheral tissues. Consequently, oxygen levels in these chambers are significantly higher than those in the right-sided chambers.
Correct Answer is A
Explanation
Choice A rationale
Straining during defecation, known as dyschezia, is a primary indicator of constipation. It suggests that the stool is hard, dry, or difficult to pass through the anal canal. This often results from excessive water absorption in the colon due to slow transit time. According to the Rome IV criteria, straining in more than 25 percent of bowel movements is a diagnostic feature of functional constipation, even if the frequency of movements seems somewhat regular.
Choice B rationale
Moving the bowels at least 7 times a week falls within the normal range for bowel frequency. The standard medical definition of normal bowel habits ranges from three times per day to three times per week. A frequency of once daily indicates regular transit and efficient waste elimination. Constipation is generally defined as having fewer than three bowel movements per week. Therefore, this statement suggests healthy colonic function rather than a state of constipation or delayed fecal transit.
Choice C rationale
Soft stools are generally considered a sign of healthy bowel function and adequate hydration. According to the Bristol Stool Form Scale, soft, sausage-shaped stools (Type 4) are the ideal consistency for easy passage. Constipation is characterized by stools that are hard, lumpy, or pebble-like (Types 1 and 2), which occur when fecal matter remains in the large intestine too long. Soft stools indicate that the transit time is appropriate and fiber intake is likely sufficient.
Choice D rationale
The feeling of complete evacuation indicates that the rectal ampulla has been successfully emptied and the defecation reflex is functioning correctly. In contrast, patients with constipation or pelvic floor dyssynergia often report a sensation of incomplete evacuation or anorectal obstruction. Successful and complete emptying is a sign of normal neuromuscular coordination between the colon, rectum, and anal sphincters. This statement confirms the absence of the obstructive symptoms typically associated with chronic constipation.
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