# A client with chronic HFrEF presents with severe dyspnea, pink frothy sputum, BP 168/98, HR 124, SpO2 84 percent on RA, bilateral crackles to mid-fields. Which interventions should the nurse anticipate? Select all that apply.

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> language: en  
> subject: Pharmacological and Parenteral Therapies  
> category: PPT

## Question

A client with chronic HFrEF presents with severe dyspnea, pink frothy sputum, BP 168/98, HR 124, SpO2 84 percent on RA, bilateral crackles to mid-fields. Which interventions should the nurse anticipate? Select all that apply.

1

Initiate noninvasive positive pressure ventilation (BiPAP) for hypoxia and work of breathing

2

Begin IV nitroglycerin to reduce preload and afterload while BP allows

3

Administer IV furosemide as ordered for fluid removal

4

Place the client in high Fowler with legs dependent to reduce preload

5

Administer 1 L bolus of normal saline to support cardiac output

## Explanation

Acute cardiogenic pulmonary edema treatment: high Fowler position with legs dependent reduces preload; noninvasive positive pressure ventilation (BiPAP/CPAP) improves oxygenation and reduces intubation rates; IV loop diuretic for volume removal; IV nitroglycerin reduces preload AND afterload, especially helpful with hypertension. Morphine is now used SELECTIVELY (concerns about increased mortality). Saline boluses are CONTRAINDICATED — they worsen volume overload. Inotropes are reserved for cardiogenic shock with hypotension.

## In-depth explanation

LMNOP mnemonic: Lasix, Morphine (selective), Nitrates, Oxygen/NIV, Position upright. Watch for cardiogenic shock — these patients may need inotropes plus mechanical support.

## Clinical scenario

Awake but anxious. Echo EF 25 percent. Last loop diuretic 12 hours ago. No prior intubation.

## Key concepts

- **cardiogenic pulmonary edema** — Pulmonary congestion from elevated left-heart pressures.
- **NIV** — Noninvasive positive pressure ventilation; CPAP or BiPAP via face mask.
- **preload** — Volume in ventricle at end of diastole; reduced by nitrates, diuretics, upright position.

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