A nurse is assessing a client with left-sided heart failure. For ...

[theo]

A nurse is assessing a client with left-sided heart failure. For which clinical manifestations should the nurse assess? (Select all that apply.)
 
  a. Pulmonary crackles
  b. Confusion, restlessness
  c. Pulmonary hypertension
  d. Dependent edema
  e. Cough that worsens at night

Question 2

A nurse cares for an older adult client with heart failure. The client states, I don't know what to do. I don't want to be a burden to my daughter, but I can't do it alone. Maybe I should die. How should the nurse respond?
 
  a. Would you like to talk more about this?
  b. You are lucky to have such a devoted daughter.
  c. It is normal to feel as though you are a burden.
  d. Would you like to meet with the chaplain?

[triiciiaa]

Answer to Question 1

ANS: A, B, E
Left-sided heart failure occurs with a decrease in contractility of the heart or an increase in afterload. Most of the signs will be noted in the respiratory system. Right-sided heart failure occurs with problems from the pulmonary vasculature onward including pulmonary hypertension. Signs will be noted before the right atrium or ventricle including dependent edema.

Answer to Question 2

ANS: A
Depression can occur in clients with heart failure, especially older adults. Having the client talk about his or her feelings will help the nurse focus on the actual problem. Open-ended statements allow the client to respond safely and honestly. The other options minimize the client's concerns and do not allow the nurse to obtain more information to provide client-centered care.

[theo]

Excellent

[pangili4]

TYSM