A nurse is caring for an older adult client who has left-sided heart failure. Which of the following findings should the nurse expect?

Choice A rationale Nocturnal polyuria is more frequently associated with right-sided heart failure or chronic venous insufficiency. When a client lies flat at night, fluid that has pooled in the lower extremities during the day is redistributed into the vascular space and filtered by the kidneys, increasing urine output. While left-sided failure can eventually lead to right-sided failure, the immediate hallmark of left-sided dysfunction is pulmonary congestion rather than systemic diuresis. Choice B rationale Left-sided heart failure occurs when the left ventricle cannot effectively pump blood into the systemic circulation. This causes blood to back up into the pulmonary veins and capillaries. The increased hydrostatic pressure forces fluid into the alveoli, leading to pulmonary edema. When this fluid mixes with air and RBCs, it creates a pink, frothy sputum. This is a classic, high-priority sign of acute respiratory distress in heart failure. Choice C rationale Jugular venous distention is a primary sign of right-sided heart failure. It occurs because the right atrium and ventricle cannot handle the venous return, causing blood to back up into the superior vena cava and the jugular veins. In isolated left-sided heart failure, the pressure is concentrated in the pulmonary circuit. While chronic left-sided failure often leads to right-sided failure, jugular distention is technically a systemic venous congestion sign. Choice D rationale Dependent edema, which typically manifests in the feet, ankles, and pretibial areas, is a classic sign of right-sided heart failure. It results from systemic venous hypertension and fluid extravasation into the interstitial tissues of the lower body due to gravity. Left-sided heart failure is characterized by "backward" failure into the lungs, producing symptoms like crackles, dyspnea, and orthopnea rather than the peripheral swelling seen in right-sided dysfunction.