A 45-year-old man is in the clinic for a routine physical examination. During the recording of his health history, the patient states that he has been having difficulty sleeping. "
I'll be sleeping great, and then I wake up and feel like I can't get my breath." The nurse's best response to this would be:
a.
"When was your last electrocardiogram?"
b.
"It's probably because it's been so hot at night."
c.
"Do you have any history of problems with your heart?"
d.
"Have you had a recent sinus infection or upper respiratory infection?"
ANS: C
Paroxysmal nocturnal dyspnea (shortness of breath generally occurring at night) occurs with heart failure. Lying down increases the volume of intrathoracic blood, and the weakened heart cannot accommodate the increased load. Classically, the person awakens after 2 hours of sleep, arises, and flings open a window with the perception of needing fresh air.
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