Upon admission to the ICU, a client with a history of cor pulmonale will likely be exhibiting which clinical manifestations of right-sided heart failure? Select all that apply. (Select All that Apply.)
Expectorating copious amounts of frothy, pink sputum
Fine crackles throughout both lung fields
+pitting edema in lower extremities
Altered level of consciousness
Jugular vein distention
Correct Answer : C,D,E
A. Expecting copious amounts of frothy, pink sputum: This symptom is typically associated with left-sided heart failure or pulmonary edema, where fluid accumulates in the lungs, leading to the production of frothy, pink sputum. It is not a classic manifestation of right-sided heart failure.
B. Fine crackles throughout both lung fields: Fine crackles are more indicative of left-sided heart failure due to fluid accumulation in the lungs (pulmonary congestion). In right-sided heart failure, the primary issues relate more to systemic congestion rather than pulmonary congestion.
C. +pitting edema in lower extremities: Right-sided heart failure often leads to fluid retention and peripheral edema due to increased venous pressure. Pitting edema in the lower extremities is a common clinical manifestation in patients with cor pulmonale and right-sided heart failure.
D. Altered level of consciousness: This can occur due to decreased cardiac output and resulting reduced cerebral perfusion. In right-sided heart failure, especially in advanced stages, fluid overload can lead to increased intracranial pressure, contributing to altered mental status.
E. Jugular vein distention: Jugular vein distention is a classic sign of right-sided heart failure. Increased pressure in the right atrium due to fluid overload results in distended neck veins, indicating elevated venous pressure.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Aortic stenosis: Aortic stenosis can lead to heart failure due to left ventricular outflow obstruction, but it is not the most direct cause of pulmonary edema. This condition may present with other symptoms, such as chest pain or syncope, rather than fluid accumulation in the lungs.
B. Left-sided heart failure: Left-sided heart failure is a primary cause of pulmonary edema, as it leads to increased pressure in the pulmonary circulation and fluid leakage into the alveoli. Assessing for this condition is crucial, as it directly contributes to the patient's pulmonary edema and requires immediate management.
C. Mitral valve prolapse: Mitral valve prolapse can cause mitral regurgitation and lead to heart failure, but it is less commonly associated with acute pulmonary edema compared to left-sided heart failure. While assessment is important, it is not the priority in this scenario.
D. Right-sided heart failure: Right-sided heart failure typically leads to systemic congestion and peripheral edema rather than pulmonary edema. While it can coexist with left-sided heart failure, it is not the primary concern when assessing a patient specifically for pulmonary edema.
Correct Answer is B
Explanation
A. Thoracotomy: Thoracotomy involves opening the chest cavity to access the heart and lungs; this surgical approach is not the first-line treatment for pericardial effusion and is more invasive than necessary, potentially leading to increased recovery time and complications.
B. Pericardiocentesis: Pericardiocentesis involves inserting a needle into the pericardial space to remove excess fluid; this procedure is a common and effective treatment for symptomatic large pericardial effusions, providing rapid relief of symptoms such as dyspnea and chest pain while also allowing for diagnostic evaluation of the fluid.
C. Heart catheterization: Heart catheterization involves a diagnostic procedure to assess heart function and blood flow through the coronary arteries; while it provides valuable information regarding cardiac conditions, it is not indicated for treating pericardial effusion and does not address the underlying fluid accumulation.
D. Pericardiectomy: Pericardiectomy involves removing part or all of the pericardium; this surgical procedure is typically reserved for chronic cases or constrictive pericarditis, as it is more invasive and not the immediate treatment option for an acute pericardial effusion, where less invasive options are preferred.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.
