NCLEX Practice Quiz on Heart Failure Assessment Nursing Quiz: Assessing Heart Failure Symptoms – What’s the Next Move? The nurse is assessing a client with a diagnosis of heart failure and observes that the client has a heart rate of 127 beats per minute and an altered level of consciousness. Which action should the nurse take next? 1. Assess the client for jugular vein distention. 2. Evaluate the client's peripheral pulses. 3. Administer the prescribed diuretic medication. 4. Notify the HCP of the status change. Δ