AANP Family Nurse Practitioner (FNP) Certification ExamEvaluationMedium
A 65-year-old male with chronic heart failure (CHF) and an ejection fraction of 30% is on furosemide 40 mg daily. He presents with increasing shortness of breath, bilateral pitting edema to his mid-shin, and a 5-pound weight gain over the past 3 days. His blood pressure is 130/80 mmHg. Which of the following is the most appropriate initial adjustment to his medication regimen?
- AInitiate a beta-blocker.
- BIncrease lisinopril dose.
- CAdd spironolactone 25 mg daily.
- DIncrease furosemide to 80 mg daily.
Show answer & explanationAnswer & explanation
Correct answer: D. Increase furosemide to 80 mg daily.
The patient is presenting with signs and symptoms of fluid overload despite being on a loop diuretic. The most direct and appropriate initial step is to increase the dose of his loop diuretic (furosemide) to promote diuresis and reduce fluid volume.
Why the other options are wrong
- A. Initiating a beta-blocker is appropriate for CHF management but is generally done after fluid status is optimized and in a hemodynamically stable patient, not during acute decompensation with fluid overload.
- B. Increasing lisinopril (an ACE inhibitor) would not immediately resolve fluid overload and could worsen hypotension or renal function in this context.
- C. Spironolactone is a potassium-sparing diuretic used in CHF for its mortality benefit, but it has a less potent natriuretic effect and is not the primary intervention for acute fluid overload.
CHF Fluid Overload Management
Acute fluid overload in chronic heart failure (CHF) is primarily managed by increasing the dose of loop diuretics to enhance diuresis and reduce intravascular volume.
- Symptoms include dyspnea, edema, weight gain, orthopnea.
- Loop diuretics (e.g., furosemide) are cornerstone of treatment.
- Dose adjustment is based on clinical response and renal function.
Memory trick: When CHF is 'WET', more 'FURO' will make it 'BET'!