A client diagnosed with heart failure presents with the following assessment data: temperature 99.1° F, pulse 100 beats/minute, respirations 42 breaths/minute, BP 110/50 mm Hg; crackles in both lung bases; nausea; pulse oximeter reading of 89%. Following the completion of your assessment, you prioritize your findings. Which findings indicate a need for immediate attention?

A client diagnosed with heart failure presents with the following assessment data: temperature 99.1° F, pulse 100 beats/minute, respirations 42 breaths/minute, BP 110/50 mm Hg; crackles in both lung bases; nausea; pulse oximeter reading of 89%. Following the completion of your assessment, you prioritize your findings. Which findings indicate a need for immediate attention?

A client diagnosed with heart failure presents with the following assessment data: temperature 99.1° F, pulse 100 beats/minute, respirations 42 breaths/minute, BP 110/50 mm Hg; crackles in both lung bases; nausea; pulse oximeter reading of 89%. Following the completion of your assessment, you prioritize your findings. Which findings indicate a need for immediate attention?


a) Blood pressure

b) Lung congestion

c) Nausea

d) Temperature



Answer: Lung congestion