Heart Failure

Which of the following patients should be prioritized for immediate intervention by the nurse?

• A patient with chronic heart failure reporting fatigue.

• A patient with left-sided heart failure and bibasilar crackles

• A patient with heart failure and 2+ pitting edema in the ankles

• A patient with new-onset confusion and systolic BP of 80 mmHg

Answer explanation

Rationale: New-onset confusion and hypotension suggest decreased cerebral perfusion and possible cardiogenic shock, which is life-threatening and requires immediate intervention.

A nurse is evaluating the effectiveness of diuretic therapy in a patient with heart failure. Which outcome best supports continuation of the current regimen?

• Weight gain of 2 pounds

• Heart rate of 110 bpm

• Decreased peripheral edema and stable weight

• Decreased appetite and fatigue

Answer explanation

Rationale: Reduction in edema and stable weight indicate improved fluid balance, suggesting that the diuretic therapy is effective.

A patient with heart failure is prescribed a new ACE inhibitor. Which assessment best determines the safety of continuing this medication?

• Heart rate of 100 bpm

• Serum potassium level of 5.6 mEq/L

• Blood pressure of 130/80 mmHg

• Complaints of dry mouth

Answer explanation

Rationale: Hyperkalemia (K+ >5.5 mEq/L) is a potentially serious side effect of ACE inhibitors. This patient may be at risk for cardiac arrhythmias, and the medication should be re-evaluated.

A patient with heart failure is prescribed carvedilol. What assessment indicates this treatment should be held?

• BP 104/68 mmHg

• Pulse 48 bpm

• Temperature 99.0°F

• Respirations 20/min

Answer explanation

Rationale: Beta-blockers like carvedilol can lower heart rate. A pulse under 50 bpm may indicate bradycardia, requiring the dose to be held and the provider notified.

A provider is considering whether to increase a heart failure patient's furosemide dose. Which finding would most justify this change?

• Increased urine output

• Decreased blood pressure

• Weight gain of 4 pounds in 2 days

• Elevated serum sodium

Answer explanation

Rationale: Sudden weight gain is a hallmark of fluid retention, indicating worsening heart failure. An increased diuretic dose would help remove excess fluid.

Which dietary recommendation should the nurse evaluate as most effective for a heart failure patient at risk for fluid overload?

• High-protein diet

• Increased water intake

• Low-sodium diet

• Gluten-free diet

Answer explanation

Rationale: Sodium promotes water retention. A low-sodium diet helps prevent fluid accumulation and is a cornerstone of heart failure management.

Which lab value best indicates that heart failure treatment is effective?

• BNP decreased from 900 to 300 pg/mL

• Troponin increased from 0.01 to 0.08 ng/mL

• Hemoglobin decreased from 14 to 10 g/dL

• Potassium increased from 4.5 to 5.8 mEq/L

Answer explanation

Rationale: BNP levels correlate with the severity of heart failure. A significant drop in BNP suggests improved cardiac function and fluid status.

A heart failure patient reports improved breathing but has a creatinine increase from 1.1 to 2.0 mg/dL. How should this be evaluated?

• Treatment is successful; no further action needed
  
  

• Indicates worsening heart failure; increase diuretics

• Renal function may be impaired due to aggressive diuresis

• This is expected and not concerning

Answer explanation

Rationale: Creatinine elevation suggests possible renal hypoperfusion, often from over-diuresis. Although symptoms improve, kidney function must be monitored, and the treatment plan reassessed.