護理師照顧一位有心臟衰竭病史的病人。哪些發現暗示利尿劑治療無效？（選所有適合的）
A nurse is caring for a client with a history of heart failure. Which findings suggest that the prescribed diuretic is not effective? (Select all that apply.)
- APersistent bilateral ankle edema✓ 正解持续性双侧脚踝水肿
- BStable daily weight稳定的每日体重
- CPresence of S3 heart sound✓ 正解出现第三心音 (S3 heart sound)
- DDecrease in blood pressure血压下降
- ECrackles on lung auscultation✓ 正解肺部听诊出现啰音
心臟衰竭（heart failure）病人因心臟泵血功能下降，導致體液滯留和組織灌流不足。利尿劑（diuretic）是治療的重要藥物，旨在促進水分和鈉的排出，減輕心臟負荷，改善症狀。 核心概念：利尿劑的作用是增加腎臟對鈉和水的排泄，從而減少總體液量和血管內容量。若治療有效，應觀察到體液過多的徵象減輕。 臨床思路：評估利尿劑療效時，需從多方面觀察病人的整體情況，包括體液平衡、心肺功能及血行動力學。若體液過多的徵象持續存在，則表示利尿劑可能無效或劑量不足。
In heart failure, reduced cardiac output causes fluid retention and poor tissue perfusion. Diuretics promote sodium and water excretion to relieve cardiac load and improve symptoms. Core concept: Diuretics increase renal excretion of sodium and water, reducing total body fluid and intravascular volume. If therapy is effective, signs of fluid overload should improve. Clinical reasoning: Assessment of diuretic effectiveness considers fluid balance, cardiopulmonary function, and hemodynamics. Persistent signs of fluid overload indicate ineffective therapy or inadequate dose.