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

Choice A rationale Left-sided heart failure impairs the left ventricle's ability to effectively pump oxygenated blood forward into the systemic circulation. This causes blood to back up into the left atrium and subsequently into the pulmonary veins and capillaries, resulting in increased pulmonary pressure. Fluid then leaks into the alveoli, causing the classic sound of pulmonary crackles (rales). Choice B rationale Jugular vein distension (JVD) is a cardinal sign of increased pressure in the systemic venous circulation, indicating right-sided heart failure. When the right ventricle fails, blood backs up into the right atrium and then into the great veins, causing distension and visibility of the internal and external jugular veins in the neck. Choice C rationale Dependent edema, which is swelling in the lower extremities, is a typical manifestation of right-sided heart failure. The inability of the right ventricle to manage systemic venous return causes blood to pool in the peripheral veins, leading to increased hydrostatic pressure that forces fluid out of the capillaries into the interstitial tissue. Choice D rationale Nocturnal polyuria, or increased urination at night, is a common symptom in heart failure but is more directly related to the movement of pooled dependent edema fluid (from the legs/feet) back into the central circulation when the client lies down. This increases renal blood flow and diuresis, but is not exclusively an assessment finding for left-sided failure.