A nurse is caring for a client who has heart failure.

After reviewing the findings, which of the following actions should the nurse take?

For each potential provider's prescription, click to specify if the prescription is anticipated, nonessential, or contraindicated for the client.

• Decrease the client’s oxygen to 1 L/min via nasal cannula: The client’s oxygen saturation has decreased to 90% on 2 L/min, indicating hypoxemia. Reducing oxygen flow could worsen tissue hypoxia and increase the risk of organ dysfunction. Oxygen therapy should be maintained or adjusted to achieve adequate saturation, not reduced without medical indication.

• Hold the client’s metoprolol: Metoprolol is a beta-blocker essential for rate control in atrial fibrillation and for improving heart failure outcomes. Holding the medication could worsen tachycardia, reduce cardiac output, and exacerbate heart failure symptoms. Continuation is necessary unless contraindications such as severe bradycardia or hypotension develop.

• Restrict the client’s fluid intake to 2 L per day: The client’s weight has increased by 1.8 kg (4 lb) in one day, indicating fluid retention due to worsening heart failure. Limiting fluid intake helps reduce preload and manage edema. Fluid restriction is a standard intervention in acute decompensated heart failure to prevent further fluid overload and pulmonary congestion.

• Weigh the client daily: Daily weights are critical for monitoring fluid status in clients with heart failure. Rapid weight gain signals worsening fluid retention, guiding diuretic adjustments and other interventions. This allows early detection of exacerbations and reduces the risk of hospitalization.

• Increase the dosage of furosemide: The client exhibits signs of fluid overload: weight gain, decreased oxygen saturation, elevated BNP, and atrial fibrillation. Increasing the loop diuretic helps remove excess fluid, reduce pulmonary congestion, and improve oxygenation. Adjustments must be guided by the client’s renal function, electrolytes, and blood pressure.

• Begin a 24-hour urine collection for the client: A 24-hour urine collection is not immediately necessary for acute fluid management in heart failure. While it may provide data on kidney function, daily weights, intake/output monitoring, and electrolytes are more practical for assessing volume status and guiding treatment in this context.

A. Constipation: This is not typically a concern when discontinuing TPN. The primary issues relate to metabolic changes rather than gastrointestinal motility.

B. Hypoglycemia: Gradual discontinuation of TPN is necessary to prevent hypoglycemia. Sudden cessation of TPN can cause a rapid drop in blood glucose because the body has been receiving a continuous source of intravenous glucose. Tapering allows endogenous insulin and glucose regulation to adjust.

C. Diarrhea: This is not a common risk associated with stopping TPN. Fluid and electrolyte shifts can occur, but gastrointestinal upset is not the primary concern during discontinuation.

D. Hyperglycemia: This is more likely during TPN administration or if TPN is infused too rapidly. Gradually tapering TPN prevents hypoglycemia rather than hyperglycemia, which is the main metabolic risk when stopping therapy abruptly.