Mr. van Alfin, a 66-year-old admitted with congestive heart failure, develops crackles in the lower lobes and shortness of breath. Which medication would best relieve the priority problem?

• A. Nitroglycerin
• B. Digoxin
• C. Lasix
• D. Morphine

Answer: (C)

In acute congestive heart failure with pulmonary edema, the urgent issue is fluid overload causing pulmonary congestion and dyspnea. A fast-acting loop diuretic like Lasix given IV removes excess fluid quickly, lowers preload, and reduces pulmonary capillary pressure. This rapid diuresis directly relieves the edema and improves breathing, which is why it’s the best choice here. Other drugs may influence preload or symptoms, but they don’t address the rapid fluid removal as effectively: nitrates can reduce preload but don’t eliminate the excess volume; digoxin helps with long-term contractility but doesn’t quickly relieve pulmonary edema; morphine can ease distress but doesn’t treat the fluid overload and carries other risks.