A nurse is admitting a client who has a history of heart failure.

Exhibits

Check the 5 findings that require immediate follow-up.

A. Vital signs . The client has tachycardia (HR 138/min) and tachypnea (RR 28/min), which may indicate worsening heart failure or fluid overload. The low blood pressure (96/75 mmHg) is also concerning, especially with rapid ventricular response (RVR).
B. Respiratory assessment . The presence of a frequent cough with pink-tinged sputum suggests pulmonary congestion or pulmonary edema, a sign of worsening left-sided heart failure.
C. Renal function . The BUN of 28 mg/dL (elevated) and creatinine of 1.5 mg/dL (borderline high) suggest possible kidney impairment due to decreased cardiac output and poor perfusion.
D. Cardiac enzymes . The client denies chest pain or discomfort, so cardiac enzymes are not the immediate priority.
E. BNP (B-type natriuretic peptide) . BNP is a key marker of heart failure severity and helps guide treatment decisions.
F. ECG results . The atrial fibrillation with RVR increases the risk of hemodynamic instability and potential thromboembolic events, requiring urgent intervention.
G. Neurologic status . The client is alert, oriented, and following commands, so no immediate neurologic concerns are present.

A. Weight gain is more commonly associated with right-sided heart failure due to fluid retention and peripheral edema, not left-sided heart failure.
B. Shortness of breath (dyspnea) is correct. Left-sided heart failure causes pulmonary congestion, leading to dyspnea, orthopnea, and pulmonary edema as blood backs up into the lungs.
C. Pulmonary embolism is not a direct manifestation of left-sided heart failure. While heart failure increases the risk of clot formation, a pulmonary embolism is a separate condition.
D. Anorexia is more common in right-sided heart failure, as systemic venous congestion can lead to gastrointestinal edema and poor appetite.