AANP Family Nurse Practitioner (FNP) Certification ExamEvaluationMedium
A 68-year-old male with a history of heart failure presents for a follow-up visit. He reports increased shortness of breath with exertion, 2+ pitting edema in his ankles, and a 5-pound weight gain over the past week. His current medication regimen includes furosemide 40 mg daily. Which of the following is the most appropriate initial modification to his treatment plan?
- ASchedule for inpatient admission for diuresis.
- BIncrease furosemide to 80 mg daily.
- CInitiate lisinopril 5 mg daily.
- DAdd spironolactone 25 mg daily.
Show answer & explanationAnswer & explanation
Correct answer: B. Increase furosemide to 80 mg daily.
The patient is showing clear signs of fluid overload despite being on a diuretic. The most direct and immediate intervention to address this is to increase the dose of his existing loop diuretic, furosemide, to enhance diuresis and reduce fluid retention.
Why the other options are wrong
- A. While inpatient admission might be necessary if outpatient management fails, it is not the initial most appropriate modification. An attempt to optimize outpatient diuresis should be made first.
- C. Initiating lisinopril, an ACE inhibitor, is important for heart failure management but will not address the acute fluid overload as effectively as increasing the diuretic.
- D. Adding spironolactone, an aldosterone antagonist, is useful for long-term management and potassium sparing, but increasing the loop diuretic is more effective for acute fluid overload.
Diuretic Dose Adjustment in Heart Failure
Adjusting diuretic dosage is a primary strategy for managing fluid overload in heart failure patients, guided by symptoms and signs of congestion.
- Loop diuretics are first-line for symptomatic fluid retention.
- Dose adjustments are based on patient weight, edema, and respiratory status.
- Goal is to achieve euvolemia with minimal side effects.
Memory trick: Fluid Overload: Diuretic Dose, Not just a guess!