RUHS, Jaipur, PB B.Sc Nursing Entrance-2019
Medical & Surgical Nursing
Hard
Which of the following would the nurse expect to find in a patient experiencing the complication of heart failure from hypertension?
Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2019
Explanation
- Distended jugular veins (JVD) in a semi-upright position are a classic sign of elevated central venous pressure.
- This occurs in right-sided heart failure when the right ventricle fails to pump blood effectively, causing blood to back up into the systemic venous circulation.
- Chronic hypertension primarily causes left-sided heart failure, but this often progresses to right-sided heart failure as pressure backs up through the pulmonary circuit.
- Observing the jugular veins with the patient in a Semi-Fowler's position (30-45 degrees) is a standard nursing assessment for fluid overload and heart failure.
Why Other Options Were Wrong
- Option A: Abnormal hair growth on the face (hirsutism) is a symptom of hormonal or endocrine imbalances, such as Cushing syndrome or PCOS, and is not related to the pathophysiology of heart failure.
- Option C: Pain in the hand when writing points towards a localized musculoskeletal or neurological problem like carpal tunnel syndrome or arthritis. It is not a systemic sign of heart failure.
- Option D: Irritability is a non-specific emotional response. While patients with chronic illnesses like heart failure may feel irritable due to discomfort or anxiety, it is not a direct physiological or diagnostic sign of the condition.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Clinical signs of heart failure secondary to hypertension to guide bedside assessment, documentation, and the next nursing action.
- Assessing for JVD is a critical, non-invasive nursing skill used to estimate a patient's fluid volume status and right atrial pressure at the bedside.
- The presence or worsening of JVD is a key indicator of fluid overload or decompensating heart failure, prompting the nurse to notify the provider and anticipate orders for diuretics or fluid restriction.
- What if? If the patient had distended neck veins only when lying completely flat (supine), but they disappeared when raised to 30-45 degrees, this would be a normal finding and not indicative of heart failure.
How to Approach the Question
- First, identify the core concepts in the question: the complication is 'heart failure' and the cause is 'hypertension'. The question asks for an expected clinical finding.
- Recall the pathophysiology of heart failure. Chronic hypertension leads to left-sided failure, which then causes right-sided failure.
- Differentiate between the signs of left-sided failure (pulmonary symptoms like crackles, dyspnea) and right-sided failure (systemic venous congestion symptoms like JVD, peripheral edema, hepatomegaly).
- Evaluate each option against the known signs of systemic venous congestion.
- Option A (hair growth) is hormonal. Option C (hand pain) is musculoskeletal/neurological. Option D (irritability) is non-specific.
- Option B (distended jugular veins) is a classic sign of increased central venous pressure from systemic fluid backup in right-sided heart failure. This directly matches the pathophysiology.
Concept Tested & Keywords
- Concept Tested: Clinical signs of heart failure secondary to hypertension
- Stem keywords: heart failure, complication, hypertension, nurse, expect to find
- Lead-in keywords: Which of the following
- Negative lead-in flag: false
Question ID
QzA7AZBRxQJ-7c-MecO6W4
Reference Book
E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 652-654
Practise the full RUHS, Jaipur, PB B.Sc Nursing Entrance-2019
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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