RN Nursing · Heart Failure · Practice question
Medications to use cautiously or avoid in acute decompensated cardiogenic pulmonary edema:
-
✓
Large IV crystalloid boluses
-
✓
Nonselective beta-blocker initiation in the acute episode
-
✓
Routine opioids for dyspnea
-
Aspirin by mouth
-
Respiratory treatments
Answer & explanation
Correct: Large IV crystalloid boluses · Nonselective beta-blocker initiation in the acute episode · Routine opioids for dyspnea
In acute decompensated cardiogenic pulmonary edema, certain interventions can worsen the clinical picture and must be used cautiously or avoided. Large intravenous crystalloid boluses are harmful because the failing heart cannot accommodate additional volume load; administering large fluid boluses increases preload, worsens pulmonary venous congestion, and can deepen the edema. Nonselective beta-blocker initiation during an acute episode is contraindicated because beta-blockers reduce heart rate and myocardial contractility; while they are beneficial long-term in chronic heart failure, starting them during acute decompensation can precipitate further hemodynamic deterioration. Routine opioids for dyspnea, once commonly used, are now discouraged in cardiogenic pulmonary edema because evidence shows they do not reliably reduce dyspnea, may suppress respiratory drive, and are associated with increased mortality and longer ICU stays. Aspirin, when clinically indicated for underlying coronary artery disease, is not specifically contraindicated in this setting. Respiratory treatments such as bronchodilators or non-invasive positive pressure ventilation (CPAP/BiPAP) are therapeutic, not harmful — BiPAP in particular reduces preload, improves oxygenation, and is a cornerstone of acute management. Therefore the three correct cautions are large IV crystalloid boluses, nonselective beta-blocker initiation, and routine opioids. The keyed answer is correct.
Study note
Heart Failure: A Nursing Overview
What heart failure is, how left-sided and right-sided failure differ, and the nursing priority that catches fluid overload earliest.
Read the study note →Practise Heart Failure questions
Work through full question sets with instant rationales, timed exams, and progress tracking.
Start practising freeRelated practice questions
- Which of the following are potential adverse effects of using osmotic diuretics in a patient with CHF? (Select all that apply)
- A nurse is preparing to care for an 84-year-old male client who is being admitted to a medical unit from a provider's office. The nurse reviews the client's medical records to prepare the client's plan of care. Complete the diagram by select from the choices below to specify what condition____ the client is most likely experiencing, 2 actions____ and ____ the nurse should take to address that condition, and 2 parameters____ and____ the nurse should monitor to assess the client's progress.
- When caring for a client with heart failure, the nurse administers furosemide 60 mg IV as ordered for shortness of breath and crackles in the lungs. Two hours later, the client states they are still short of breath and crackles are still auscultated in the lungs and they do not feel any better. Which nursing action is most appropriate at this time?
- A nurse on a medical-surgical unit is caring for a client who has a history of congestive heart failure (CHF). Complete the diagram by select from the choices below to specify what condition____ the client is most likely experiencing, 2 actions____ and ____ the nurse should take to address that condition, and 2 parameters____ and____ the nurse should monitor to assess the client’s progress.