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Educate the patient about low-sodium diet and daily weight monitoring: Education is essential but not the priority in an acute exacerbation of heart failure. Immediate symptom relief is needed before addressing lifestyle changes.

Draw blood for B-type natriuretic peptide (BNP) and electrolyte levels: While lab tests provide useful diagnostic information, they do not address the immediate symptoms. The patient is in acute distress, and interventions to relieve fluid overload are the priority.

Place the patient on continuous cardiac monitoring: Cardiac monitoring is necessary but does not address the acute symptoms of fluid overload. Immediate relief from symptoms is the priority to stabilize the patient. Monitoring should occur simultaneously but is not the first action.

I will make an appointment to see the health care provider twice a year: Clients with heart failure need regular follow-ups, more frequent than every six months. Heart failure requires close monitoring to manage symptoms and prevent worsening.

I will walk only when necessary: Physical activity is crucial for heart failure patients to maintain strength and improve circulation. Limiting walking suggests a misunderstanding of the importance of regular exercise for managing heart failure. Daily physical activity is recommended.

"The nitroglycerin patch will be used for any chest pain that develops.": Nitroglycerin is not the primary treatment for heart failure. Heart failure requires a comprehensive approach, including diuretics, ACE inhibitors, and lifestyle modifications, not just nitroglycerin for chest pain.

Dry cough: A dry cough is a known side effect of ACE inhibitors, not a sign of ineffectiveness. It occurs due to bradykinin accumulation and does not reflect failure in treating heart failure.

Skin rash: A skin rash can be an adverse effect of captopril, but it doesn’t indicate the therapy’s effectiveness. It may signal an allergic reaction but is not a direct reflection of how well the medication is managing heart failure.

Postural hypotension: Postural hypotension is a common side effect of captopril due to blood pressure reduction. It does not indicate that the medication is ineffective in treating heart failure.

The client's treatment regimen is ineffective, and more aggressive treatment is indicated: The decreased weight, heart rate, and lung crackles indicate the treatment is having a positive effect, so more aggressive treatment is not necessary at this point.

The healthcare provider should reassess the client: While reassessment is always important, the current findings show positive changes in the patient's condition. There is no immediate indication that the healthcare provider needs to reassess the treatment plan.

The client's condition is unchanged from admission: The client’s condition has improved, as evidenced by weight loss, a decreased heart rate, and improved lung sounds. This is a positive response to treatment, indicating progress, not no change.

"I will wait for two hours after eating to exercise.": Exercising immediately after eating can cause discomfort or interfere with digestion. Waiting for at least two hours before exercising is recommended for comfort and safety.

"I will start with a warm-up activity": A warm-up is essential to prepare the body for physical activity, especially in heart failure patients, to prevent injury and optimize cardiovascular function. It’s important to gradually increase activity.

"I will stop exercising if I feel short of breath or dizzy.": If a client with heart failure feels short of breath or dizzy during exercise, they should stop immediately. These symptoms could indicate overexertion or worsening of their condition.

Notify the health care provider of weight gain of 1 pound in a week: This weight gain is not significant enough to require immediate notification. Clients with heart failure should be instructed to notify the healthcare provider if they gain 2-3 pounds in a day or 5 pounds in a week, which indicates fluid retention.

Take diuretics early in the morning and before bedtime: Diuretics should generally be taken early in the morning to avoid nocturia, or frequent urination at night. Taking them before bedtime can disrupt sleep and affect fluid balance, so this is not recommended.

Take naproxen for generalized discomfort: NSAIDs like naproxen can worsen heart failure by causing fluid retention and increasing blood pressure. NSAIDs should generally be avoided in heart failure patients, and alternatives for pain management should be considered.

Educate the patient on fluid restriction and daily weights: While education on fluid restriction and daily weights is important, this is not the most urgent concern in this acute setting. The priority is to address the current symptoms of fluid overload and respiratory distress.

Prepare the patient for synchronized cardioversion: This may be needed if the atrial fibrillation causes significant hemodynamic instability or other complications. However, the immediate concern is addressing the symptoms of fluid overload and respiratory distress

Notify the physician of the new-onset atrial fibrillation: While the physician should be informed, the immediate focus should be on stabilizing the patient by addressing fluid overload and respiratory distress.

Anorexia with weight loss of 3 pounds in one week: While anorexia can occur in heart failure, weight loss is not a typical finding, acute heart failure is primarily characterized by fluid retention, leading to weight gain due to edema.

Increased urinary output, especially during waking hours: In acute heart failure, reduced cardiac output often leads to decreased renal perfusion, resulting in decreased urinary output as the kidneys try to conserve fluid.

Periorbital and facial edema: While edema is common in heart failure, periorbital (around the eyes) and facial edema is not a typical finding in acute heart failure. Edema in heart failure usually presents in the lower extremities or abdomen due to fluid accumulation.

Encourage fluid intake of at least 3 liters per day: In heart failure, fluid intake is usually restricted to prevent fluid overload. Encouraging 3 liters of fluid intake per day could worsen fluid retention and exacerbate heart failure symptoms.

Restrict sodium intake to less than 5 grams per day: Sodium intake should be restricted in heart failure, but a limit of 5 grams per day might be too high. The general recommendation is to limit sodium to 2 grams per day or less to help control fluid retention.

Monitor oxygen saturation every 4 hours: While monitoring oxygen saturation is important in assessing respiratory status, it is not the most effective way to monitor fluid status. Daily weight checks provide more specific information regarding fluid balance.

Notify the health care provider: While it's important to inform the healthcare provider if symptoms worsen, the nurse’s first step should be to assess the client’s current condition. Immediate action like weighing the client or checking for fluid retention is a priority to address the symptom.

Take the client's pulse rate: Taking the pulse rate is useful in assessing heart function but doesn’t address the patient's complaint of tight shoes and potential fluid retention. The nurse should first assess for signs of fluid overload by weighing the patient.

Perform Osler's maneuver while checking blood pressure: Osler's maneuver is used to assess blood pressure accuracy, not fluid status. While blood pressure monitoring is important, the client’s complaint of tight shoes suggests fluid retention.