The nurse is caring for a client who is in the later stages of left-sided heart failure. Which chief complaint would the nurse expect the client to report?

Marked limitation with physical activity but comfortable at rest

Angioedema and urticaria

Increased urine output

Chest pain during sleep that is relieved with nitroglycerin

Answer and Explanation

The Correct Answer is A

A.   Clients with left-sided heart failure often experience symptoms like shortness of breath, fatigue, and fluid retention, which limit physical activity. However, they may still feel relatively comfortable when resting.
B.   These symptoms are more commonly associated with allergic reactions or side effects of medications (such as ACE inhibitors) rather than heart failure.
C.   This is not typical in the later stages of left-sided heart failure. In fact, clients may experience reduced urine output due to poor kidney perfusion.
D.   Chest pain can occur due to ischemia, but this is not a hallmark symptom of left-sided heart failure, which is more characterized by dyspnea and fatigue.

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Correct Answer is B

Explanation

A. Fine crackles - Fine crackles are short, popping sounds usually heard during inspiration, indicative of fluid in the lungs.
B. Wheezes - Wheezes are continuous, high-pitched musical sounds caused by narrowed airways, often seen in asthma, bronchitis, or other respiratory conditions.
C. Rhonchi - Rhonchi are low-pitched, rattling sounds that occur when air flows through thick mucus or secretions in the larger airways.
D. Vesicular sounds - Vesicular breath sounds are normal lung sounds heard over most lung fields during inspiration. They are not continuous and high-pitched.

A. Administer timolol eye drops to both eyes B. Insert an indwelling catheter C. Administer an antidiarrheal medication D. Provide frequent oral care

Correct Answer is D

Explanation

A. Timolol eye drops are not indicated following the administration of atropine, as atropine has no effect on intraocular pressure.
B. Inserting an indwelling catheter is not necessary for the administration of atropine, which is used to treat bradycardia, not urinary retention.
C. Administering an antidiarrheal medication is unrelated to atropine administration; atropine typically causes dry mouth rather than diarrhea.
D. Atropine is an anticholinergic medication that decreases saliva production, which can lead to dry mouth and discomfort. Frequent oral care is important to prevent oral mucosal irritation and discomfort for the client.

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LAB	Result	Normal Range
Potassium	2.8 mEq/L	3.5-5.3mEq/L
Sodium	133 mEq/L	135-145 mEqL
Chloride	90 mEq/L	97-107 mEqL
Glucose	200 mg/dL	70mg/dL to 110mg/dL
Magnesium	2.5 mg/dL	1.6-2.2 mg/dL

The nurse is caring for a client who is in the later stages of left-sided heart failure. Which chief complaint would the nurse expect the client to report?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is B

Explanation

Correct Answer is D

Explanation

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The nurse is caring for a client who is in the later stages of left-sided heart failure. Which chief complaint would the nurse expect the client to report?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Upon assessment of the client's lungs, the nurse hears continuous, high-pitched, musical sounds. This should be documented as:

Correct Answer is B

Explanation

The nurse administers atropine 0.5 mg IV to a client. Which action should be performed after the client has received this medication?

Correct Answer is D

Explanation

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Labs

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