A nurse is caring for a client who has fluid volume excess (FVE) due to heart failure (HF). Which of the following manifestations should the nurse associate with FVE? (Select all that apply.)

Rationale:

A. LDL cholesterol levels are used to assess a patient’s long-term risk for atherosclerosis and cardiovascular disease, but they do not rise acutely during myocardial infarction and therefore are not useful for diagnosing an MI in the emergency setting.

B. Myoglobin is a small heme protein released rapidly from damaged cardiac and skeletal muscle. It can appear in the blood within 1–4 hours after myocardial injury, making it useful for early detection of myocardial infarction. However, it is not specific to cardiac muscle, so elevations could also occur with skeletal muscle injury. Myoglobin is often used in conjunction with other cardiac biomarkers.

C. Blood urea nitrogen reflects renal function and may increase in kidney disease or dehydration, but it does not indicate myocardial injury and is not part of the standard diagnostic workup for acute MI.

D. Troponin I and T are structural proteins of cardiac muscle, and their levels rise within 3–6 hours after myocardial injury and remain elevated for up to 10–14 days. They are highly sensitive and specific for cardiac injury, making troponin the gold standard for confirming myocardial infarction.

E. Creatinine measures kidney function and may be monitored in patients receiving contrast dye or nephrotoxic drugs, but it does not aid in diagnosing an acute MI.

Rationale:

A. These tiny red or purple spots are caused by microvascular emboli or vascular fragility associated with infective endocarditis. While they indicate ongoing infection, they are primarily diagnostic and usually do not pose an immediate threat to the patient’s airway, breathing, or circulation.

B. Fever reflects the systemic inflammatory response to the bacterial infection and is a common finding in endocarditis. While it needs monitoring and management with antipyretics or antibiotics, it does not require emergent action unless accompanied by hemodynamic instability or signs of sepsis.

C. These linear, dark streaks are a classic sign of embolic events in infective endocarditis. They are important diagnostic clues but are not acutely dangerous, and immediate intervention is usually not required.

D. This is the priority finding because it may indicate acute complications of infective endocarditis such as heart failure from valvular dysfunction, pulmonary embolism from septic emboli, or pneumonia secondary to infection. Dyspnea reflects compromised oxygenation or cardiac function, which can quickly become life-threatening. According to the ABC principle (Airway, Breathing, Circulation), respiratory distress takes precedence over other manifestations and requires prompt assessment and intervention.