The nurse is assessing a client with the diagnosis of left-sided heart failure. Which clinical finding should the nurse expect the client to experience?

Orthopnea

Bradycardia

Diaphoresis

Frequent coughing with yellow sputum

Answer and Explanation

The Correct Answer is A

A. Orthopnea is correct. Left-sided heart failure causes pulmonary congestion, making it difficult for the client to breathe when lying flat. This results in orthopnea, where the client must sit up or use multiple pillows to breathe comfortably.
B. Bradycardia is incorrect. Heart failure typically leads to tachycardia due to the heart compensating for decreased cardiac output.
C. Diaphoresis is incorrect. While excessive sweating can occur in acute decompensated heart failure, it is not a hallmark symptom of left-sided heart failure.
D. Frequent coughing with yellow sputum is incorrect. A client with left-sided heart failure may have a dry or frothy, pink-tinged cough, but yellow sputum suggests infection rather than heart failure.

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Correct Answer is B

Explanation

A. A high-calorie, high-protein diet is recommended to prevent weight loss, but this is not the best answer related to breathing strategies.
B. Pursed-lip breathing helps control shortness of breath by slowing exhalation, preventing airway collapse, and improving oxygenation.
C. Abdominal breathing is helpful, but lying on the stomach is not an appropriate technique for emphysema management.
D. Clients with emphysema should get a flu shot annually to prevent respiratory infections.

A. To prevent bronchospasms and promote bronchodilation B. To monitor blood pressure C. To relieve nasal congestion D. To reduce coughing

Correct Answer is A

Explanation

A. Preventing bronchospasms and promoting bronchodilation is correct. Ipratropium is an anticholinergic bronchodilator that relaxes airway muscles, reducing airway resistance and improving airflow in COPD patients.
B. Monitoring blood pressure is unrelated to ipratropium use. It primarily acts on the respiratory system, not the cardiovascular system.
C. Relieving nasal congestion is incorrect in this context, though ipratropium nasal spray can be used for rhinorrhea.
D. Reducing coughing is not the primary purpose. While bronchodilation may indirectly reduce cough by improving airflow, it is not a cough suppressant.

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The nurse is assessing a client with the diagnosis of left-sided heart failure. Which clinical finding should the nurse expect the client to experience?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Explanation

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Correct Answer is A

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