A 22-year-old patient presents with fatigue, chest discomfort, and palpitations. Vital signs show HR 112 bpm. BP 98/5, and low-grade fever. The nurse notes irregular heart sounds and severe pedal edema. Which condition should the nurse suspect? (Select All that Apply.)
Pneumonia
Heart failure
COPD
Atrial fibrillation
Pulmonary embolism
Correct Answer : B,D
Rationale:
A. While pneumonia can cause fever, fatigue, and chest discomfort, it is less likely to cause severe pedal edema, irregular heart rhythms, or palpitations. The presence of edema and irregular heart sounds points toward a cardiac origin rather than a primary pulmonary infection.
B. Fatigue, chest discomfort, irregular heart sounds, pedal edema, and low blood pressure are classic signs of heart failure, particularly in a young adult who may have acute or chronic cardiac dysfunction. Heart failure can also contribute to the development of arrhythmias.
C. COPD primarily presents with chronic cough, dyspnea, and sputum production. While it can strain the heart over time, COPD alone would not account for the acute irregular heart rate, edema, and chest discomfort in this patient.
D. The irregular heart rate (HR 112 bpm) and irregular heart sounds are indicative of atrial fibrillation, which is common in patients with underlying heart disease or heart failure. Atrial fibrillation can also worsen cardiac output, contributing to edema and fatigue.
E. Pulmonary embolism typically presents with acute dyspnea, pleuritic chest pain, tachypnea, and sometimes hemoptysis. Edema and irregular heart rhythms are not primary features, making this less likely than heart failure and atrial fibrillation.
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Related Questions
Correct Answer is D
Explanation
Rationale:
A. In a patient with asystole, a pulse check is not performed repeatedly in 30-second intervals; the rhythm is already pulseless, so delaying intervention to check the pulse wastes critical time.
B. Epinephrine is an important medication in asystole management, but it is administered after initiating CPR, not as the first step. Immediate medication without circulation is ineffective.
C. Defibrillation is ineffective in asystole because there is no organized electrical activity to reset. Defibrillation is reserved for shockable rhythms such as ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT).
D. This is the correct initial step because asystole represents a complete absence of cardiac electrical activity, and immediate high-quality CPR is essential to maintain circulation and oxygen delivery to vital organs. Early initiation of chest compressions increases the chance of survival while advanced life support measures (airway, epinephrine) are prepared.
Correct Answer is B
Explanation
Rationale:
A. Typically causes pulmonary symptoms, such as dyspnea, orthopnea, and pulmonary edema, rather than peripheral edema and hepatomegaly.
B. Right-sided HF leads to systemic venous congestion, causing peripheral edema, jugular venous distention, hepatomegaly, and abdominal discomfort. Weight gain from fluid retention is also common.
C. Can cause ascites and hepatomegaly, but usually accompanied by stigmata of chronic liver disease (jaundice, spider angiomas) and not jugular venous distention due to cardiac causes.
D. May cause generalized edema and weight gain, but jugular venous distention and hepatomegaly are less specific, and lab findings (BUN, creatinine) would help distinguish.
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