A nurse is collecting data from a client who has right-sided heart failure. Which of the following findings should the nurse expect?

Orthopnea

Peripheral edema

Frothy sputum

Dyspnea

Answer and Explanation

The Correct Answer is B

a. Orthopnea: Orthopnea is more commonly associated with left-sided heart failure, where fluid backs up into the lungs, making it difficult to breathe when lying down.

b. Peripheral edema: Right-sided heart failure can lead to systemic venous congestion, resulting in peripheral edema, often evident in the lower extremities.

c. Frothy sputum: Frothy sputum is more indicative of pulmonary edema, which is associated with left-sided heart failure.

d. Dyspnea: While dyspnea can occur with right-sided heart failure, it is more characteristic of left-sided heart failure.

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Correct Answer is C

Explanation

a. Serum chloride 99 mEq/L: Serum chloride within the reference range is not an adverse effect of spironolactone.

b. Serum calcium 10.5 mg/dL: Serum calcium within the reference range is not an adverse effect of spironolactone.

c. Serum potassium 5.2: Spironolactone is a potassium-sparing diuretic, and an elevated serum potassium level is an adverse effect that requires monitoring. The nurse should assess for

hyperkalemia.

d. Serum sodium 140 mEq/L: Serum sodium within the reference range is not an adverse effect of spironolactone.

A. "The pain radiates down to my lower back." B. "I feel so much better after eating." C. "My pain is relieved by having a bowel movement." D. "The pain is worse after I eat a meal high in fat."

Correct Answer is D

Explanation

a. "The pain radiates down to my lower back." This statement is not typical of peptic ulcer

disease. Radiation of pain to the lower back may suggest other abdominal or musculoskeletal issues.

b. "I feel so much better after eating." Relief of pain after eating is more indicative of gastric ulcer rather than peptic ulcer disease. Peptic ulcers are often associated with pain that worsens after eating.

c. "My pain is relieved by having a bowel movement." Relief of pain with bowel movements is

not a characteristic finding of peptic ulcer disease. This may suggest other gastrointestinal issues.

d. "The pain is worse after I eat a meal high in fat." This statement is consistent with peptic ulcer disease. High-fat meals stimulate gastric acid secretion, potentially exacerbating the pain

associated with peptic ulcers.

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A nurse is collecting data from a client who has right-sided heart failure. Which of the following findings should the nurse expect?

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