A client with left-sided heart failure complains of increasing shortness of breath and is agitated and coughing up pink-tinged, foamy sputum. The nurse should recognize these findings as signs and symptoms of:

a) acute pulmonary edema.

b) right-sided heart failure.

c) cardiogenic shock.

d) pneumonia.

Answer: acute pulmonary edema.

Eighty six-year-old Susan Matthews has been rushed to the ED with pulmonary edema during your shift. She is going to need oxygen immediately. Which oxygen delivery system do you use first?

a) Mechanical ventilation

b) Intubation

c) A mask

d) A nasal cannula

Answer: A mask

A client is admitted to the hospital with systolic left-sided heart failure. The nurse knows to look for which of the following assessment findings for this client?

a) Jugular venous distention

b) Nausea

c) Pulmonary congestion

d) Pedal edema

Answer: Pulmonary congestion

The nurse is preparing to administer hydralazine and isosorbide dinitrate (Dilatrate). When obtaining vital signs, the nurse notes that the blood pressure is 90/60. What is the priority action by the nurse?

a) Hold the medication and call the physician.

b) Administer the hydralazine and hold the dinitrate.

c) Administer a saline bolus of 250 mL and then administer the medication.

d) Administer the medication and check the blood pressure in 30 minutes.

Answer: Hold the medication and call the physician.