The nurse is reviewing the laboratory values for the client diagnosed with heart failure and notes the sodium level is 128 mEq/L (normal 135-145mEq/L). How should the nurse interpret this finding?

There is an increased risk for cardiac dysrhythmias

There is dilutional hyponatremia and fluid retention

There is an imbalance in the sodium-potassium pump

The client is in acute renal failure related to heart failure

Answer and Explanation

The Correct Answer is B

A.   Increased risk for cardiac dysrhythmias: While hyponatremia can sometimes contribute to cardiac dysrhythmias, it's not the primary concern in this case. The main issue is fluid overload.
B.   Hyponatremia, or low sodium levels, is often associated with heart failure. In this condition, the heart's reduced pumping ability leads to fluid retention, which dilutes the sodium concentration in the blood.
C.   Imbalance in the sodium-potassium pump: While this can contribute to electrolyte imbalances, it's not the direct cause of hyponatremia in heart failure.
D.   Acute renal failure: While heart failure can lead to acute kidney injury, hyponatremia is primarily a result of fluid overload rather than kidney dysfunction.

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Correct Answer is B

Explanation

A. Serum sodium level of 135 mEq/L (normal 135-145mEq/L) - Although important, sodium levels do not directly assess the effectiveness of furosemide in relieving fluid overload.
B. Respiratory rate of 16/minute - A decrease in respiratory rate following the administration of furosemide indicates that the client is improving, as furosemide works to reduce fluid overload and ease breathing.
C. Blood pressure reading of 120/80 - While blood pressure may be influenced by fluid status, it is not the best indicator for the effectiveness of diuretics in this case.
D. Urine output 120 mL one hour following administration - While urine output is important, a single hour’s output may not show the full effectiveness of the diuretic, and output can vary depending on the client’s hydration status.

A. weigh daily on the same scale at the same time of day B. restrict foods that are high in potassium. C. engage in aerobic activity for one hour each day. D. monitor sugar intake

Correct Answer is A

Explanation

A. Weigh daily on the same scale at the same time of day - Daily weight measurement is critical for clients with heart failure to monitor for fluid retention, which can indicate worsening heart failure.
B. Restrict foods that are high in potassium - This is not recommended unless the client is on certain medications (e.g., potassium-sparing diuretics) that cause high potassium levels. Generally, potassium- rich foods are beneficial for heart health.
C. Engage in aerobic activity for one hour each day - Although exercise is important, the intensity and duration should be individualized, and clients with heart failure may need to start with lower-intensity activity.
D. Monitor sugar intake - While important for diabetes management, monitoring sugar intake is not a primary focus for clients with heart failure unless they also have diabetes.

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The nurse is reviewing the laboratory values for the client diagnosed with heart failure and notes the sodium level is 128 mEq/L (normal 135-145mEq/L). How should the nurse interpret this finding?

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Naxlex Comprehensive Predictor Exams

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