A 72-year-old female has a history of right heart failure caused by a right ventricular myocardial infarction. Which of the following symptoms are specifically related to her right heart failure?

Choice A reason: Exudative fluid is not the type of fluid drained from the patient. Exudative fluid is a high-protein fluid that results from inflammation or infection of the pleura. It is usually cloudy and contains white blood cells, bacteria, or blood.

Choice B reason: Purulent fluid is not the type of fluid drained from the patient. Purulent fluid is a thick, yellow-green fluid that results from a bacterial infection of the pleura. It is also known as empyema and contains pus and dead tissue.

Choice C reason: Transudative fluid is the type of fluid drained from the patient. Transudative fluid is a low-protein fluid that results from increased hydrostatic pressure or decreased oncotic pressure in the pleural space. It is usually clear and contains few cells or organisms. It can be caused by conditions such as heart failure, cirrhosis, or nephrotic syndrome.

Choice D reason: Infectious fluid is not the type of fluid drained from the patient. Infectious fluid is a general term that can refer to any fluid that contains microorganisms that cause disease. It can be exudative or purulent, depending on the type and severity of the infection.

Choice A reason: This is not a symptom that would indicate withholding a nonselective beta-adrenergic blocker. Hyperglycemia is a high level of glucose in the blood, which can be caused by diabetes or other conditions. Nonselective beta-adrenergic blockers do not affect blood glucose levels directly, but they may mask the signs of hypoglycemia (low blood glucose) in diabetic patients.

Choice B reason: This is not a symptom that would indicate withholding a nonselective beta-adrenergic blocker. Dizziness is a common side effect of many medications, especially those that lower blood pressure. Nonselective beta-adrenergic blockers can cause dizziness by reducing the heart rate and cardiac output, but this is usually mild and transient.

Choice C reason: This is not a symptom that would indicate withholding a nonselective beta-adrenergic blocker. Peripheral edema is swelling of the ankles, feet, or legs, which can be caused by heart failure, kidney disease, or venous insufficiency. Nonselective beta-adrenergic blockers do not cause peripheral edema, but they may worsen it in patients with heart failure.

Choice D reason: This is a symptom that would indicate withholding a nonselective beta-adrenergic blocker. Wheezing is a high-pitched sound that occurs when breathing is obstructed, usually due to asthma or chronic obstructive pulmonary disease (COPD). Nonselective beta-adrenergic blockers can aggravate or cause wheezing by blocking the beta-2 receptors in the lungs, which normally cause bronchodilation (widening of the airways). Therefore, nonselective beta-adrenergic blockers are contraindicated in patients with asthma or COPD.