During the morning assessment, a patient admitted with heart failure complains of feeling tired from a poor night of sleep
She tells the nurse that she has been "up and down all night because I have to urinate every couple of hours." The patient asks the nurse why she urinates so frequently during the night. The nurse responds:
A) "Your frequent urination is caused by your bedtime dose of a diuretic."
B) "It must be related to your excessive intake of fluid before bedtime."
C) "You must have a urinary tract infection and will need an antibiotic."
D) "Your heart is not working as hard while you sleep and your kidneys are filtering better."
Ans: D
Feedback: When the patient with heart failure is sleeping, the cardiac workload is decreased, improving renal perfusion and increasing glomerular filtration rate, which may lead to frequent urination at night (nocturia). Diuretics should not routinely be administered before bedtime, as it will result in interrupted sleep. While the patient may have a urinary tract infection, that is not the most common explanation for nocturia in a patient with heart failure.
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