A 65-year-old patient with congestive heart failure has been on diuretic therapy for the past two weeks. During a follow-up appointment, which of the following findings would indicate that the diuretic therapy is effective?

Increase in blood pressure and heart rate

Significant weight gain over the past two weeks

Reduction in peripheral edema and improved breathing

Development of muscle cramps and weakness

Answer and Explanation

The Correct Answer is C

Rationale:
A. This would indicate possible fluid retention or worsening heart function, not effective diuretic therapy. Effective diuretics usually help reduce fluid overload, which may lower blood pressure in hypertensive patients.

B. Rapid weight gain is a sign of fluid retention, which suggests diuretic therapy is not effective or the patient’s heart failure is worsening.

C. These findings indicate that excess fluid is being successfully removed from the body. Decreased swelling in the extremities and improved respiratory status reflect effective diuresis and improved cardiac function, which is the goal of therapy.

D. While these can occur due to electrolyte imbalances caused by diuretics, they are adverse effects rather than indicators of effectiveness.

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Correct Answer is A

Explanation

Rationale:
A. In acute heart failure, especially following an MI, clients are at risk for fluid volume overload. Administering a relatively large volume of isotonic fluid could exacerbate pulmonary edema and worsen heart failure. This prescription requires clarification with the provider before administration.

B. Furosemide is a loop diuretic commonly prescribed to reduce fluid overload in heart failure. This prescription is appropriate for managing pulmonary congestion and edema.

C. Monitoring electrolytes, particularly potassium, is essential in heart failure patients receiving diuretics. This helps prevent dysrhythmias and is appropriate.

D. Morphine may be used in acute heart failure to relieve anxiety and dyspnea; this prescription is appropriate as ordered.

A. Serum calcium levels B. White blood cell count C. Thyroid hormone levels D. Serum potassium levels

Correct Answer is D

Explanation

Rationale:

A. Spironolactone is a potassium-sparing diuretic and does not typically affect calcium levels. Monitoring calcium is not a priority unless the client has another condition affecting calcium metabolism.

B. Spironolactone does not directly affect WBC counts. Monitoring WBCs is unrelated to this medication unless the client is taking additional drugs that impact bone marrow or immune function.

C. Spironolactone does not influence thyroid function, so assessing TSH or thyroid hormone levels is not necessary for routine follow-up.

D. Spironolactone is a potassium-sparing diuretic, which can increase serum potassium, potentially leading to hyperkalemia, a life-threatening condition. Monitoring potassium levels is essential to ensure safe use, particularly in clients with kidney impairment or those taking other potassium-increasing medications.

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A 65-year-old patient with congestive heart failure has been on diuretic therapy for the past two weeks. During a follow-up appointment, which of the following findings would indicate that the diuretic therapy is effective?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is admitting a client who has acute heart failure following myocardial infarction (MI). The nurse recognizes that which of the following prescriptions by the provider requires clarification?

Correct Answer is A

Explanation

A patient taking spironolactone has a follow-up appointment. Which of the following laboratory values would be most important to monitor?

Correct Answer is D

Explanation

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