A patient is very short of breath. Which finding should cause the nurse to be concerned that the shortness of breath might be due to heart failure?
1. An echocardiogram that reflected increased right ventricular wall thickening
2. A B-type natriuretic peptide (BNP) of 300 pg/mL
3. A left ventricular ejection fraction (VEF) of 50%
4. A serum sodium of 135
2
Rationale 1: Echocardiogram would reflect left ventricular hypertrophy, not right ventricular enlargement.
Rationale 2: A BNP greater than 100 pg/mL suggests heart failure as a cause of dyspnea.
Rationale 3: Many patients with heart failure will have a reduced ejection fraction of less than 40%.
Rationale 4: Hyponatremia is commonly found in the patient with heart failure.
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