Practice Question
The nurse provides prescribed treatments for a client with fluid volume excess related to heart failure. What finding indicates to the nurse that the client's condition is worsening?
Answer Choices:
Correct Answer:
Decreased sodium level
Rationale:
🟦 A decreased sodium level (hyponatremia) in a client with heart failure indicates worsening fluid volume excess, because excess water dilutes sodium concentration in the blood.
🟦 This condition, called dilutional hyponatremia, reflects advancing heart failure due to increased secretion of antidiuretic hormone (ADH) and renin–angiotensin–aldosterone system (RAAS) activation, both of which cause the body to retain more water.
🟦 As fluid volume continues to rise, the failing heart becomes unable to manage the increased workload, leading to pulmonary congestion and declining perfusion.
🟦 Hyponatremia in heart failure is strongly associated with poor prognosis, worsening cardiac output, and increased risk of hospitalization.
🟦 Unlike weight and edema changes that may fluctuate with treatment, a falling sodium level is a biochemical marker of deteriorating neurohormonal regulation and more severe disease progression.
🟦 This finding indicates that the client’s compensatory mechanisms are failing, and advanced medical interventions may be required.
🟦 Therefore, among the given options, a decreased sodium level is the most concerning indicator of worsening heart failure.
❌ Incorrect Answers
Decreased blood pressure
❌ A decrease in blood pressure can occur with diuresis and may reflect effective fluid removal, not worsening status.
❌ Mild improvement in vascular congestion often leads to lowered systemic pressure as fluid overload resolves.
Decreased peripheral edema
❌ Reduced edema typically signals effective treatment, especially after diuretic therapy.
❌ This finding reflects improved fluid movement and decreased venous congestion.
Decreased weight
❌ Weight loss in heart failure usually indicates successful fluid removal, suggesting improvement, not deterioration.
❌ Daily weights are one of the most accurate indicators of effective volume management.
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This question is from W4 NR324 NR329 Exam which contains 49 questions.
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Question Details
- Category: RN Nursing Exam(s)
- Subcategory: Examplify Exam(s)
- Domain: Medical-Surgical
- Answer Choices: 4