74. A nurse gets a report that a client will be admitted with an ejection fraction of 58%. Which history and physical finding should the nurse anticipate?
74. A nurse gets a report that a client will be admitted with an ejection fraction of 58%. Which history and physical finding should the nurse anticipate?
. Inspiratory wheezing in upper lobes, bilaterally.
. O2 saturation that increases from 90% to 99% when head of bed is lowered to a flat position.
. Crackles in the lung bases that clear with deep breathing.
. A client is unable to walk up two flights of stairs without dyspnea.
Test-Taking Tip
Know the average ejection fraction (60% to 70%). Select a finding that would be consistent with mild heart failure.
Content Area: Adult Health, Cardiology; Integrated Process: Nursing Process, Analysis; Cognitive Level: Analysis; Client Need/Subneed: Physiological Integrity/Physiological Adaptation/Pathophysiology
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Answer 1 is correct because bilateral adventitious sounds are heard early in left-sided failure. The ejection fraction is below the normal for a health heart (60% to 70%). Answer 2 is incorrect because the low O2 saturation is related to pulmonary congestion and heart failure. A flat position may aggravate the client's condition. Answer 3 is incorrect because crackles due to heart failure would not clear with deep breathing and coughing. Answer 4 is incorrect because the ejection fraction is on the low side of normal (60% to 70% for a healthy heart). Fatigue would be more common. This degree of activity intolerance would increase as heart failure progressed.