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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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Rationale:
A. Crackles are more commonly associated with left-sided heart failure, due to pulmonary congestion from fluid backing up into the lungs.
B. While a murmur can be present in some cardiac conditions, it is not a hallmark finding specific to right-sided heart failure.
C. Chest pain may occur with ischemic heart disease or myocardial infarction but is not a classic symptom of right-sided heart failure.
D. Right-sided heart failure leads to systemic venous congestion, causing fluid accumulation in dependent areas such as the legs, ankles, and feet, which is a hallmark sign of right-sided heart failure.
Correct Answer is A
Explanation
Rationale:
A. Hypokalemia (low potassium levels) can significantly affect skeletal and cardiac muscle function, leading to generalized fatigue, muscle weakness, cramping, and in severe cases, paralysis or life-threatening arrhythmias. Clients taking loop diuretics (e.g., furosemide) or thiazide diuretics are particularly at risk, as these medications increase potassium excretion in the urine. Monitoring for early signs of hypokalemia allows timely intervention with dietary potassium or supplementation.
B. Shortness of breath is more indicative of pulmonary congestion or fluid overload associated with heart failure rather than low potassium levels. While hypokalemia can indirectly affect cardiac function, dyspnea is not a primary manifestation.
C. Reduced urine output is associated with renal insufficiency, dehydration, or hypovolemia, not directly with hypokalemia from diuretic use.
D. Edema results from excess fluid retention in the interstitial space, often related to heart failure or renal disease, and is not a direct sign of hypokalemia.
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