The medical record indicates that a patient being treated for a low back strain is taking Lasix for the management of heart failure. During ambulation activities, the patient complains of lightheadedness, fatigue, and weakness. The therapist measures the patient’s vital signs and identifies an irregular pulse. What is the MOST likely explanation?

1. Dehydration
2. Angina
3. Hypernatremia
4. Renal failure

Welcome back to the Scorebuilders’ Question and Answer Podcast! This podcast provides members of the Scorebuilders’ team with the opportunity to explore challenging multiple-choice examination questions with students actively preparing for the licensing examination. My name is Scott Giles and I will be your host for today’s journey.

Ready? Let’s go!

The medical record indicates that a patient being treated for a low back strain is taking Lasix for the management of heart failure. During ambulation activities, the patient complains of lightheadedness, fatigue, and weakness. The therapist measures the patient’s vital signs and identifies an irregular pulse. What is the MOST likely explanation?

1. Dehydration
2. Angina
3. Hypernatremia
4. Renal failure

Therapists often have to make clinical judgements about the relevance of subjective and objective information gathered during physical therapy sessions. In this particular case, the patient experiences lightheadedness, fatigue, and weakness during ambulation which prompts the therapist to assess the patient’s vital signs. The question goes on to ask, what is the most likely explanation for the observed irregular pulse.

There are three pieces of relevant information that must be considered:

1. The patient is being treated for a low back strain
2. The patient has a history of heart failure
3. The patient has been taking Lasix

It should be relatively easy to disregard the low back strain. I say this since this medical condition would be unlikely to have any influence on the patient’s pulse.

Heart failure and Lasix appear to be more relevant factors that could influence pulse regularity. Let’s take a deeper dive into these areas.

Heart Failure
Heart failure is a progressive condition in which the heart cannot maintain a normal cardiac output to meet the body’s demands for blood and oxygen. Heart failure often develops after other conditions have damaged or weakened the heart. The ventricles weaken and dilate to the point that the heart can’t pump efficiently.

In most cases, treatment is a balance of medications, devices, and lifestyle changes to help the heart contract normally.

Lasix
Lasix (furosemide) is a commonly used loop diuretic to treat heart failure. It works by inhibiting the reabsorption of salts, such as sodium and chloride, in the proximal and distal tubules, and the loop of Henle. This action significantly increases urination.

Side effects include dehydration, hypotension, electrolyte imbalance, polyuria, increased low-density lipoproteins, and arrhythmias.

Let’s explore each of the options.

Option 1 - Dehydration
Diuretics reduce intravascular volume, leading to a decrease in central venous pressure, right and left heart filling pressures, and pulmonary vascular pressures. As a result, dehydration is often a persistent side effect.

Symptoms associated with dehydration are commonly observed during physical activity and other forms of active exercise. These symptoms often include lightheadedness, fatigue, and weakness.

Survey Says… pretty, pretty good since the patient’s symptoms are occurring with ambulation and arrythmias are a known side effect of Lasix. That was a terrible Larry David imitation, I apologize for that.

Option 2 - Angina
Angina is a transient precordial sensation of pressure or discomfort resulting from myocardial ischemia.

Patients typically describe angina as pressure, heaviness, fullness, squeezing, burning or aching behind the sternum.

The sensation may be associated with difficulty breathing, nausea or vomiting, sweating, and anxiety or fear.

Survey says…No dice, without some evidence of pressure or discomfort in the chest.

Option 3 - Hypernatremia
Hypernatremia is characterized by a high concentration of sodium in the blood.

Signs and symptoms of hypernatremia can include hypertension, tachycardia, excessive weight gain, intense thirst, agitation, confusion, ataxia, and seizures.

Survey says…Not feeling it – The diverse signs and symptoms discussed with hypernatremia don’t align with the presented clinical scenario.

Option 4 - Renal failure
Renal failure is a condition where the kidneys experience a decrease in glomerular filtration rate and fail to adequately filter toxins and waste from the blood.

Symptoms vary based on the severity of the condition and can include nausea, vomiting, lethargy, anorexia, peripheral neuropathy, pulmonary edema, seizures, and coma.

Survey says…Don’t pass Go and collect $200 – Like with option 3 - The signs and symptoms simply do not align with renal failure.

The correct answer is Option 1

Let’s explore the all student data:
62% of students selected Option 1, dehydration, the correct response
9% of students selected Option 2, angina
26% of students selected Option 3, hypernatremia
3% of students selected Option 4, renal failure

System Classification
This question is a Cardiovascular and Pulmonary Systems question which represents approximately 14% of all exam items.

Content Outline Classification
This question is a Foundations for Evaluation, Differential Diagnosis, and Prognosis question which represents approximately 33% of all exam items.

Level Classification
This question is a Level 2 question since the question requires students to integrate numerous pieces of information or to apply knowledge in a given clinical scenario. Remediation of Level 2 questions occurs by increasing flexibility with academic content and by carefully analyzing decision making processes when answering applied examination questions.

Academic Focus Area
Looking to review related academic content? Check out pages 413, 426 and 466-467 in PTEXAM: The Complete Study Guide.

Thanks for joining us on the Scorebuilders Q and A podcast! See you next week!

Watch the video version of this Q&A episode on YouTube – https://youtu.be/sv5ZBiO7Gcs