# A client with heart failure calls the clinic and reports gaining 2.7 kg in 3 days and sleeping on three pillows because of shortness of breath. Which instruction is most appropriate?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=394052&lang=en  
> language: en  
> subject: Illness Management  
> category: PA

## Question

A client with heart failure calls the clinic and reports gaining 2.7 kg in 3 days and sleeping on three pillows because of shortness of breath. Which instruction is most appropriate?

## Option

1. Increase oral fluid intake for the next 24 hours.
2. Skip the next clinic appointment if ankle swelling is absent.
3. Contact the provider today for possible worsening heart failure. **✔ Correct answer**
4. Start vigorous exercise to remove excess fluid.

**Correct answer: 3**

## Explanation

Rapid weight gain and orthopnea suggest fluid overload and worsening heart failure. The client should contact the provider promptly for evaluation and possible medication adjustment. Increasing fluid intake or delaying care is unsafe.

## In-depth explanation

Clinical Judgment
Weight gain is an early heart failure signal before severe respiratory distress develops.

Memory Tip
Heart failure: daily weight tells the story.

## Clinical scenario

Clinical Practice Guide
Heart failure self-care includes daily weights, symptom monitoring, medication adherence, and reporting rapid weight gain or worsening dyspnea.

Caution
Absence of ankle swelling does not rule out pulmonary fluid overload.

## Key concepts

- **Heart Failure** — A condition in which the heart cannot pump enough blood to meet body needs.
- **Orthopnea** — Shortness of breath while lying flat that improves when upright.
- **Fluid Overload** — Excess fluid volume that can worsen edema and breathing.

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