The nurse on a cardiac unit is caring for a client admitted with an acute exacerbation of heart failure. The nurse concludes that the client’s condition is worsening after noting which client data during assessment. (SELECT ALL THAT APPLY)

A. Maintaining a diet high in dairy to increase protein necessary to prevent organ damage

Explanation: This statement is not accurate. While a balanced diet is important, there is no specific recommendation to maintain a diet high in dairy to prevent organ damage related to hypertension.

B. Use of strategies to prevent falls stemming from postural hypotension

Explanation: This is a correct and important consideration. Beta-blockers can cause postural hypotension (a drop in blood pressure upon standing), and strategies to prevent falls, such as rising slowly from a sitting or lying position, are crucial.

C. Limiting exercise to avoid injury that can be caused by increased intracranial pressure

Explanation: This statement is not accurate. Exercise is generally beneficial for individuals with hypertension, and beta-blockers do not cause increased intracranial pressure.

D. Increasing fluids to avoid extracellular volume depletion from the diuretic effects of the beta-blocker

Explanation: This statement is not accurate. Beta-blockers are not typically associated with diuretic effects. Diuretics are a different class of medications commonly used for hypertension.

A. Limit physical activity

Limiting physical activity is not a primary goal in heart failure care. In fact, promoting appropriate and monitored physical activity is often part of the overall management plan. Exercise, when tailored to the client's condition, can improve functional status and quality of life.

B. Prevent endocarditis

While preventing endocarditis is important for individuals with certain cardiac conditions, it is not a primary goal in the care of heart failure. The focus is typically on optimizing cardiac function and managing heart failure symptoms.

C. Relieve the patient’s symptoms

Managing and relieving symptoms, such as dyspnea, fatigue, and fluid retention, are crucial goals in heart failure care. This includes optimizing medication management and other therapeutic interventions.

D. Extend survival

While heart failure is a chronic condition, the goal is to optimize treatment to improve the client's prognosis and overall survival. This involves the use of evidence-based therapies to address the underlying causes and contributing factors.

E. Improve functional status

Enhancing the client's ability to perform activities of daily living and improving functional capacity are important goals. This can involve a combination of medications, lifestyle modifications, and rehabilitation.