RN Nursing · Heart Failure · Practice question
A nurse is assessing a client for signs of right-sided heart failure. Which finding should the nurse expect to observe?
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Pulmonary crackles
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S3 gallop
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✓
Peripheral edema
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Dyspnea on exertion
Answer & explanation
Correct: Peripheral edema
Right-sided heart failure occurs when the right ventricle cannot effectively pump blood to the pulmonary circulation, causing blood to back up into the systemic venous system. This increased venous pressure leads to peripheral edema — swelling typically seen in the dependent areas such as the ankles, feet, and legs — as well as jugular venous distension, hepatomegaly, and ascites. Peripheral edema is therefore the hallmark sign of right-sided heart failure. Pulmonary crackles result from fluid accumulating in the lungs and are characteristic of left-sided heart failure, where the left ventricle fails and blood backs up into the pulmonary circulation. An S3 gallop is an extra heart sound associated with increased ventricular filling pressure and is most classically linked to left ventricular failure and volume overload of the left heart. Dyspnea on exertion, while it can occur in any form of heart failure over time, is primarily a symptom of left-sided failure due to pulmonary congestion. Distinguishing between left- and right-sided heart failure manifestations is essential for clinical assessment, and peripheral edema is the most specific and expected finding indicating right-sided dysfunction.
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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