A nurse in an emergency department is caring for a client. For each potential provider prescription, click to specify if the prescription is expected or unexpected for the client. There must be at be a selection in least 1 selection in every row.

Rationale for expected: • Serum B-type natriuretic peptide (BNP) level: BNP is released in response to ventricular stretch and volume overload, making it useful in diagnosing heart failure. The client presents with dyspnea, orthopnea, edema, hypotension, and tachycardia, all suggesting cardiac decompensation. Measuring BNP helps differentiate cardiac from noncardiac causes of respiratory distress. This laboratory test supports confirmation of suspected heart failure. • Place client in Trendelenburg position: Trendelenburg positioning increases venous return and can worsen pulmonary congestion in heart failure. The client already exhibits dyspnea and possible fluid overload, and this position may exacerbate respiratory distress. Clients with cardiac compromise benefit more from upright positioning to reduce preload and improve ventilation. • Captopril 25 mg PO now: Captopril is an ACE inhibitor that lowers blood pressure by reducing afterload. The client is already hypotensive with a blood pressure of 84/58 mm Hg. Administering captopril could further decrease perfusion and worsen shock. Initiating antihypertensive therapy is unsafe in the context of acute hypotension. • Educate client about coronary artery bypass surgery: There is no evidence of acute coronary occlusion or ischemia requiring surgical intervention. The client denies chest pain, and the monitor shows sinus tachycardia rather than ischemic changes. Immediate stabilization of hemodynamics is the priority. • Echocardiogram: An echocardiogram evaluates cardiac structure and function, including ejection fraction and wall motion abnormalities. Given the client’s hypotension and signs of possible heart failure, assessing ventricular performance is essential. This imaging study helps determine the severity of dysfunction and guides treatment decisions.