AANP Family Nurse Practitioner (FNP) Certification ExamEvaluationMedium
A 65-year-old male with chronic heart failure (CHF) and ejection fraction of 30% is on furosemide 40 mg daily, lisinopril 10 mg daily, and metoprolol succinate 50 mg daily. He reports increasing shortness of breath, 2 lb weight gain over 2 days, and new ankle edema. His blood pressure is 110/70 mmHg, and heart rate is 68 bpm. What is the most appropriate modification to his treatment plan?
- ADiscontinue lisinopril due to worsening symptoms.
- BIncrease furosemide to 60 mg daily.
- CAdd spironolactone 25 mg daily.
- DIncrease metoprolol succinate to 75 mg daily.
Show answer & explanationAnswer & explanation
Correct answer: B. Increase furosemide to 60 mg daily.
The patient's symptoms (shortness of breath, weight gain, edema) are consistent with fluid overload, indicating a need for increased diuretic therapy. Increasing furosemide is the most direct and appropriate intervention.
Why the other options are wrong
- A. Lisinopril is a cornerstone of CHF management; discontinuing it without a clear indication (e.g., severe hypotension, hyperkalemia, renal failure) would be detrimental.
- C. Spironolactone is a potassium-sparing diuretic and aldosterone antagonist, beneficial in CHF, but a direct increase in loop diuretic is more effective for acute volume overload.
- D. Increasing metoprolol could worsen heart failure symptoms by further reducing contractility, especially in a patient with signs of fluid overload.
CHF Fluid Overload Management
In chronic heart failure patients experiencing symptoms and signs of fluid overload (e.g., dyspnea, weight gain, edema), the most appropriate initial intervention is to increase the dose of the loop diuretic.
- Fluid overload is a common cause of CHF decompensation.
- Loop diuretics (e.g., furosemide) are essential for symptom control.
- Titrate diuretics based on clinical signs and symptoms of congestion.
Memory trick: When the heart is struggling and fluid is high, boost the diuretic, and watch it fly.