ESTUDYR
NCLEX-RN Case Study: Heart Failure (HF) &
Pulmonary Edema
Client Scenario
0700 Nurses' Notes: A 74-year-old female with a history of Chronic Heart Failure and
Hypertension is admitted to the cardiac unit. She reports she woke up at 0200 feeling like
she was "suffocating." She has been sleeping in a recliner for the last week because she
cannot breathe when lying flat. She notes her shoes have been feeling very tight.
Physical Assessment:
Respiratory: Tachypnea with a non-productive, hacking cough. Bilateral crackles
(rales) audible halfway up the posterior lung fields.
Cardiovascular: S3 gallop noted on auscultation. Jugular Venous Distention (JVD) is
present. 3+ pitting edema in bilateral lower extremities.
Vital Signs: BP 162/94, HR 104, RR 26, SpO2 89% on Room Air.
Item 1: Recognizing Cues
Question: Click to highlight the findings that are most indicative of Left-Sided Heart Failure.
Findings: Woke up feeling like she was "suffocating"; Sleeping in a recliner; Shoes feeling
tight; Bilateral crackles; JVD; SpO2 89%; 3+ pitting edema.
Correct Selections:
✅Suffocating feeling/Sleeping in recliner (Orthopnea/Paroxysmal Nocturnal
Dyspnea)
✅Bilateral crackles (Pulmonary congestion)
✅SpO2 89% (Impaired gas exchange)
Rationale: Left-sided HF affects the lungs ("Left = Lungs"). Crackles, orthopnea, and low
SpO2 are all pulmonary symptoms. Tight shoes, JVD, and pitting edema are signs of Right-
Sided HF (systemic congestion). This client has Biventricular Failure.
NCLEX-RN Case Study: Heart Failure (HF) &
Pulmonary Edema
Client Scenario
0700 Nurses' Notes: A 74-year-old female with a history of Chronic Heart Failure and
Hypertension is admitted to the cardiac unit. She reports she woke up at 0200 feeling like
she was "suffocating." She has been sleeping in a recliner for the last week because she
cannot breathe when lying flat. She notes her shoes have been feeling very tight.
Physical Assessment:
Respiratory: Tachypnea with a non-productive, hacking cough. Bilateral crackles
(rales) audible halfway up the posterior lung fields.
Cardiovascular: S3 gallop noted on auscultation. Jugular Venous Distention (JVD) is
present. 3+ pitting edema in bilateral lower extremities.
Vital Signs: BP 162/94, HR 104, RR 26, SpO2 89% on Room Air.
Item 1: Recognizing Cues
Question: Click to highlight the findings that are most indicative of Left-Sided Heart Failure.
Findings: Woke up feeling like she was "suffocating"; Sleeping in a recliner; Shoes feeling
tight; Bilateral crackles; JVD; SpO2 89%; 3+ pitting edema.
Correct Selections:
✅Suffocating feeling/Sleeping in recliner (Orthopnea/Paroxysmal Nocturnal
Dyspnea)
✅Bilateral crackles (Pulmonary congestion)
✅SpO2 89% (Impaired gas exchange)
Rationale: Left-sided HF affects the lungs ("Left = Lungs"). Crackles, orthopnea, and low
SpO2 are all pulmonary symptoms. Tight shoes, JVD, and pitting edema are signs of Right-
Sided HF (systemic congestion). This client has Biventricular Failure.
