The nurse is reviewing the patient’s recent symptoms and lab results. Which of the following symptoms or findings suggest worsening heart failure? (Select all that apply)

Oxygen saturation of 92% on room air

Bilateral pulmonary congestion on chest x-ray

Recent 5-lb weight gain

BUN of 28 mg/dL

Potassium of 4.9 mEq/L

Answer and Explanation

Correct Answer : B,C

Choice A reason: Oxygen saturation of 92% is low-normal (95-100%), not specific to worsening heart failure acutely. It may reflect chronic lung issues or mild hypoxia, but alone, it’s not a definitive sign of decompensation.

Choice B reason: Bilateral pulmonary congestion on x-ray shows fluid in alveoli from left heart failure, impairing gas exchange. It’s a classic sign of worsening, as rising pressure backs fluid into lungs, causing dyspnea.

Choice C reason: A 5-lb weight gain over days indicates fluid retention, a hallmark of worsening heart failure. It reflects sodium and water buildup from reduced cardiac output, directly correlating with symptom exacerbation.

Choice D reason: BUN of 28 mg/dL (normal 7-20 mg/dL) suggests mild renal stress, possibly from diuretics. It’s not specific to worsening heart failure without symptoms like dyspnea, as it may reflect dehydration instead.

Choice E reason: Potassium of 4.9 mEq/L is normal (3.5-5.0 mEq/L), not indicating worsening heart failure. It may rise with ACE inhibitors, but this value alone doesn’t signal acute decompensation or symptom progression.

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Correct Answer is B

Explanation

Choice A reason: Daily alcohol use may amplify propranolol’s CNS depression, but it’s not a contraindication. It warrants monitoring for sedation, yet hypertension treatment proceeds, as no direct physiologic conflict exists with beta-blockade.

Choice B reason: Asthma contraindicates propranolol, a non-selective beta-blocker, as it blocks β2 receptors, causing bronchoconstriction. This risks severe airway obstruction in asthmatics, prompting consultation for a cardioselective alternative like atenolol.

Choice C reason: Peptic ulcer disease isn’t affected by propranolol directly; beta-blockers don’t alter gastric acid. It’s not a contraindication, though stress-related hypertension management might consider other factors, not this drug.

Choice D reason: Post-MI, propranolol reduces myocardial demand, aiding recovery. It’s beneficial, not contraindicated, lowering reinfarction risk via β1 blockade, so no consultation is needed unless acute decompensation occurs.

A. The patient is sitting in the tripod position. B. The patient’s pulse oximetry shows a 90% O2 saturation. C. The patient has bibasilar lung crackles. D. The patient’s respiratory rate is 9 breaths/min.

Correct Answer is D

Explanation

Choice A reason: Tripod position aids breathing in COPD by stabilizing accessory muscles, a common adaptation. It signals distress but isn’t immediately life-threatening compared to respiratory rate, as it reflects chronic compensation rather than acute decompensation requiring urgent intervention.

Choice B reason: O2 saturation of 90% is low but typical in COPD due to ventilation-perfusion mismatch. It warrants monitoring, yet it’s less critical than respiratory rate, as supplemental oxygen can correct it, and it’s not an immediate danger sign.

Choice C reason: Bibasilar crackles suggest fluid or infection, uncommon in pure COPD exacerbations, which show wheezing. This finding needs attention but is less urgent than respiratory rate, as it may indicate pneumonia rather than immediate respiratory failure.

Choice D reason: Respiratory rate of 9 breaths/min is alarmingly low in COPD, where tachypnea (20-30 breaths/min) is expected during exacerbation. Bradypnea indicates potential respiratory depression or fatigue, risking CO2 retention and hypoxia, necessitating immediate reporting for intervention.

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The nurse is reviewing the patient’s recent symptoms and lab results. Which of the following symptoms or findings suggest worsening heart failure? (Select all that apply)

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Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is D

Explanation

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