A nurse is caring for a client who has multiple sclerosis and reports a tightening feeling around their torso. Which of the following conditions should the nurse recognize this finding indicates?

A. Adventitious breath sounds:

Adventitious breath sounds refer to abnormal lung sounds heard upon auscultation of the chest. These sounds include crackles (rales), wheezes, rhonchi, and pleural friction rubs. In the context of fluid volume excess, particularly in the acute phase of a cerebrovascular accident (CVA) or stroke, adventitious breath sounds such as crackles are indicative of pulmonary edema. Pulmonary edema occurs when there is an excessive accumulation of fluid in the lungs, impairing gas exchange and leading to symptoms such as shortness of breath and respiratory distress.

B. Weak pulse:

A weak pulse may suggest poor perfusion or decreased cardiac output rather than fluid volume excess. While decreased cardiac output can be a consequence of heart failure, which may be associated with fluid volume excess, a weak pulse is not a direct indicator of fluid overload. In the acute phase of a CVA, a weak pulse may prompt further assessment for other cardiovascular complications or neurogenic shock.

C. Hypotension:

Hypotension, or low blood pressure, is not typically associated with fluid volume excess. Instead, hypotension may indicate hypovolemia, shock, or other underlying cardiovascular conditions. While hypotension can occur secondary to severe heart failure or fluid overload in some cases, it is not a direct indicator of fluid volume excess in the acute phase of a CVA.

D. Poor skin turgor:

Poor skin turgor is a clinical finding associated with dehydration rather than fluid volume excess. In dehydration, the skin loses its elasticity and becomes less resilient when pinched. In contrast, fluid volume excess is characterized by edema, which may manifest as pitting or non-pitting edema, rather than poor skin turgor. However, in fluid volume excess, the skin may appear stretched or taut due to the accumulation of fluid in the interstitial spaces.

A. Difficulty initiating speech

This is a characteristic symptom of expressive aphasia. Individuals with expressive aphasia have difficulty initiating speech and may produce speech that is slow, effortful, and lacking in grammatical structure.

B. Difficulty understanding the written and spoken word

This symptom is not typically associated with expressive aphasia. Instead, difficulty understanding language, both written and spoken, is more commonly seen in receptive aphasia, also known as Wernicke's aphasia.

C. Total inability to communicate

While expressive aphasia can severely impair verbal communication, it does not result in a total inability to communicate. Individuals with expressive aphasia may still be able to communicate to some extent using nonverbal means, gestures, or writing.

D. Stuttering and spitting

Stuttering and spitting are not characteristic symptoms of expressive aphasia. Stuttering is a speech disorder characterized by interruptions in the flow of speech, while spitting is not typically associated with aphasia.