A nurse assesses a client admitted to the cardiac unit. Which statement by the client alerts the nurse to the possibility of right-sided heart failure?

A. "I wake up coughing every night.": Nocturnal cough is more characteristic of left-sided heart failure, where pulmonary congestion from fluid backup causes irritation of the airways. This symptom reflects pulmonary involvement rather than systemic venous congestion seen in right-sided heart failure. B. "I sleep with 2 pillows at night.": Orthopnea, or difficulty breathing when lying flat, is also a classic sign of left-sided heart failure due to pulmonary venous congestion. Using multiple pillows to sleep upright relieves dyspnea but does not indicate right-sided heart failure specifically. C. "My shoes fit really tight lately.": Peripheral edema, such as swelling in the feet, ankles, and lower extremities, is a hallmark of right-sided heart failure. Fluid accumulates in systemic tissues due to elevated venous pressure, making shoes and clothing feel tight. This statement directly reflects systemic fluid retention associated with right-sided cardiac dysfunction. D. "I have trouble catching my breath.": Dyspnea can occur in both left- and right-sided heart failure, but when generalized without pulmonary congestion, it is less specific. Shortness of breath alone does not pinpoint right-sided failure as accurately as peripheral edema does.