RN Nursing · Heart Failure · Practice question
A client with chronic heart failure reports worsening shortness of breath over the past week. Which respiratory finding(s) should the nurse expect to observe in this clerit? Select all that apply
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✓
Fine crackles in the lower lung fields
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Hyper resonant percussion notes
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✓
Orthopnea requiring three pillows
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Symmetrical chest expansion
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✓
Decreased breath sounds at the lung bases
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Jugular venous distention
Answer & explanation
Correct: Fine crackles in the lower lung fields · Orthopnea requiring three pillows · Decreased breath sounds at the lung bases · Jugular venous distention
Chronic heart failure with worsening shortness of breath indicates decompensated left-sided (and often biventricular) heart failure, producing pulmonary and systemic venous congestion. Fine crackles in the lower lung fields result from fluid transudation into the alveoli due to elevated pulmonary capillary pressure — these are a hallmark of pulmonary edema from left-sided failure. Orthopnea requiring multiple pillows occurs because lying flat redistributes fluid from the dependent tissues back into the pulmonary circulation, worsening dyspnea; needing three pillows to breathe comfortably is clinically significant and expected. Decreased breath sounds at the lung bases indicate pleural effusions, which are common in heart failure due to elevated capillary hydrostatic pressure causing fluid accumulation in the pleural space. Jugular venous distention reflects elevated central venous pressure from right-sided congestion, frequently accompanying biventricular failure. Hyperresonant percussion notes would indicate air trapping as seen in COPD or pneumothorax, not fluid overload in heart failure — dullness on percussion at the lung bases is what would be expected with pleural effusion. Symmetrical chest expansion is a normal finding and would not be specifically associated with heart failure exacerbation. These four findings together form a coherent clinical picture of decompensated heart failure.
Study note
Heart Failure: A Nursing Overview
What heart failure is, how left-sided and right-sided failure differ, and the nursing priority that catches fluid overload earliest.
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