A patient with left heart failure starts to have a cough and dyspnea. Pulmonary symptoms common to left heart failure are a result of:

Choice A reason: This is not an adverse effect of ACE inhibitors. Insomnia is a common side effect of stimulant medications, such as caffeine or amphetamine, which increase the activity of the central nervous system and cause difficulty falling or staying asleep.

Choice B reason: This is not an adverse effect of ACE inhibitors. Bradycardia is a slow heart rate, usually below 60 beats per minute. ACE inhibitors do not cause bradycardia, but rather lower the blood pressure by blocking the formation of angiotensin II, a potent vasoconstrictor.

Choice C reason: This is not an adverse effect of ACE inhibitors. Chest pain is a sign of angina or myocardial infarction, which are caused by reduced blood flow to the heart muscle. ACE inhibitors can actually prevent or treat these conditions by improving the blood flow and reducing the workload of the heart.

Choice D reason: This is an adverse effect of ACE inhibitors. Hyperkalemia is a high level of potassium in the blood, which can cause cardiac arrhythmias and muscle weakness. ACE inhibitors can cause hyperkalemia by reducing the secretion of aldosterone, a hormone that regulates the sodium and potassium balance in the body.

Choice A reason: Decrease in wheezing present on auscultation indicates that albuterol was effective. Albuterol is a bronchodilator that relaxes the smooth muscles of the airways and reduces the airway resistance. This improves the airflow and reduces the wheezing sound that is caused by the turbulent flow of air through the narrowed airways.

Choice B reason: Respiratory rate increased to 38 breaths/min does not indicate that albuterol was effective. It indicates that the patient is still experiencing respiratory distress and hypoxia. The normal respiratory rate for adults is 12 to 20 breaths/min. A high respiratory rate can also be a side effect of albuterol, as it can stimulate the sympathetic nervous system and increase the heart rate and blood pressure.

Choice C reason: Sputum production is clear and watery does not indicate that albuterol was effective. It indicates that the patient has a productive cough and is expelling mucus from the lungs. Sputum production is not directly affected by albuterol, as it does not have anti-inflammatory or mucolytic properties.

Choice D reason: Use of neck muscles does not indicate that albuterol was effective. It indicates that the patient is using accessory muscles to breathe and is exerting more effort to inhale. This is a sign of severe respiratory distress and airway obstruction. Albuterol should relieve the bronchospasm and reduce the need for accessory muscle use.