The nurse is assessing a patient who is demonstrating dyspnea, orthopnea, cyanosis, clammy skin, crackles, and a productive cough with pink, frothy sputum. The nurse realizes that the patient likely has which condition?
1. Chronic heart failure
2. Pulmonary edema
3. Endocarditis
4. Angina
2
Rationale 1: Not all patients with chronic heart failure have pink, frothy sputum. The presence of this symptom differentiates pulmonary edema from chronic heart failure.
Rationale 2: Dyspnea, orthopnea, cyanosis, clammy skin, productive cough with pink frothy sputum, and crackles are signs and symptoms of pulmonary edema, which is considered a medical emergency.
Rationale 3: Endocarditis would manifest with pain and possibly fever.
Rationale 4: Angina is chest pain.
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