Ed4Nurses.com

How would you answer this question?

Ms. Leslie has a Brain-Natiuretic Peptide (BNP) level of 1273 picograms/mL, as her nurse you should suspect:

a. Acute ischemic stroke
b. Acute renal failure
c. Heart failure
d. Hip fracture

The correct answer is "c" heart failure.

Brain-Natiuretic Peptide (BNP) is a protein produced by the heart in response to stretching of the ventricular wall.  Through a variety of mechanisms, BNP improves cardiac function by decreasing fluid overload on the heart.  The level of BNP measured in the blood can alert nurses to the extent of heart failure that exists.  Elevated BNP levels can also help nurses to differentiate between cardiac and noncardiac conditions that cause respiratory distress such as COPD and pulmonary edema.

For most patients a BNP level of >100 pg/mL is considered to be elevated and indicative of acute heart failure.  However, a study by Rogers, et al. recommended using the following cutoff levels in specific patient populations:
>184 pg/mL in patients >75 years of age
>150 pg/mL in patients with atrial fibrillation
>449 pg/mL in patients with an elevated creatinine (>2 mg/dL)
>25 pg/mL in obese patients with a BMI >35 kg/m2

In the question above Ms. Leslie has a BNP level of 1273 which is clearly elevated and would indicate heart failure.  This information would be useful if Ms. Leslie had a complicated symptom presentation, such as what often occurs in patients with multiple cardiac and pulmonary medical conditions.