Editing Anatomy and Physiology – RN Practice Questions (section)

==Question 1==
A nurse is caring for four patients at the start of the shift. Which patient should the nurse assess '''first'''?
# A patient with right-sided heart failure who has 2+ pitting edema of both ankles and a 1 kilogram weight gain since yesterday.
# A patient with left-sided heart failure who is sitting upright, is newly restless, and has coarse crackles in both lung bases.
# A patient with chronic obstructive pulmonary disease whose oxygen saturation is 90% on 2 liters per minute by nasal cannula.
# A patient two days after total knee arthroplasty who reports incisional pain rated 6 out of 10.

'''Answer:''' 2 (B). The patient with left-sided heart failure who is restless with bilateral crackles.

''Rationale:'' Left-sided heart failure backs blood up into the pulmonary circulation, so crackles plus new restlessness suggest worsening pulmonary congestion and early hypoxia. Restlessness is an early neurologic sign of inadequate oxygenation and precedes cyanosis and a falling saturation, so this patient has an emerging airway and breathing problem. Option 1 describes expected findings of right-sided failure that warrant monitoring but not immediate action. Option 3 is a saturation commonly accepted in chronic obstructive pulmonary disease and is not an acute change. Option 4 is expected postoperative pain and is a comfort priority, not a physiologic emergency.