A client experiencing acute congestive heart failure (CHF) is likely t

A client experiencing acute congestive heart failure (CHF) is likely to present with which of the following clinical signs? (Select all that apply.)

1. Flat neck veins
2. Bilateral crackles
3. +2 ankle edema bilaterally
4. Urine output of 790 mL in 24 hours
5. History of a 5-pound weight gain in 3 days
6. Systemic blood pressure 15 mm Hg above usual baseline

ANSWER

ANS: 2, 3, 5, 6
Physical examination of a client experiencing CHF may reveal rapid weight gain, edema (espe-cially in dependent areas), hypertension, polyuria (if renal mechanisms are normal), neck vein distention, increased blood and venous pressure, crackles in lungs, and confusion. The remaining options are not reflective of CHF.