NSG 430 Exam 2: (Latest 2026/2027 Update) Heart Failure,
Cardiomyopathy, Endocarditis, Valvular Disease, AKI, & Renal Disorders |
Q&A | Grade A | 100% Correct (Verified Answers)
Subject: Advanced Medical-Surgical / Critical Care
Source: NSG 430 Exam 2 – Comprehensive Review Format: Q&A Guide with Clinical Rationale
1: What occurs during acute decompensated heart failure?
Correct Answer: Pulmonary venous pressure increases due to left ventricle failure, leading
to engorgement of the pulmonary vascular system.
1. Left ventricular failure causes backup of blood into pulmonary circulation.
2. Increased pulmonary venous pressure leads to interstitial and alveolar edema.
3. This results in dyspnea, orthopnea, and crackles on auscultation.
2: What diagnostic tests are used to assess heart failure?
Correct Answer: Echocardiogram, ECG, ambulatory heart monitors, chest x-ray, 6-minute
walk test, MUGA scan, cardiac MRI, cardiac catheterization, endomyocardial biopsy, serum
electrolytes, NT-proBNP or BNP.
1. Echocardiogram evaluates ejection fraction and structural abnormalities.
2. BNP/NT-proBNP levels correlate with HF severity.
3. Endomyocardial biopsy is definitive for certain cardiomyopathies.
3: What are early signs and symptoms of acute decompensated heart failure?
Correct Answer: Increased pulmonary venous pressure, mild increase in respiratory rate,
decreased PaO2.
1. Early detection prevents progression to pulmonary edema.
2. Mild tachypnea may be subtle and easily missed.
3. Decreased PaO2 indicates worsening gas exchange.
4: What are later signs and symptoms of acute decompensated heart failure?
Correct Answer: Interstitial pulmonary edema, tachypnea, shortness of breath, respiratory
acidosis.
1. Interstitial edema precedes alveolar edema.
2. Respiratory acidosis develops from hypoventilation and fatigue.
3. Immediate intervention required at this stage.
,5: What are the life-threatening manifestations of pulmonary edema?
Correct Answer: Anxiety, pallor, cyanosis, dyspnea, orthopnea, tachypnea, paroxysmal
nocturnal dyspnea, cough with frothy blood-tinged sputum.
1. Pink frothy sputum is hallmark of alveolar pulmonary edema.
2. Immediate interventions: O2, diuretics, afterload reduction.
3. May require intubation and mechanical ventilation.
6: What are common manifestations of heart failure?
Correct Answer: Fatigue, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, cough,
tachycardia, palpitations, edema, changes in urine output, skin changes, neurological
manifestations.
1. PND occurs due to fluid redistribution when lying flat.
2. Neurological changes (confusion) from decreased cerebral perfusion.
3. Nocturia from improved renal perfusion when supine.
7: What interventions are essential for managing heart failure?
Correct Answer: Assess subjective and objective data, monitor vital signs, implement a low
sodium diet, manage fluid restrictions, and ongoing monitoring of weight and symptoms.
1. Daily weights best indicator of fluid status (1L fluid = 1 kg weight).p>
2. Low sodium diet (<2g/day) reduces fluid retention.
3. Patient self-management critical to avoid hospitalization.
8: What are the treatment groups for heart failure presentations?
Correct Answer: Dry-warm, dry-cold, wet-warm, and wet-cold, with wet and warm being
the most common presentation.
1. Wet-warm: volume overload with adequate perfusion (diuretics first).
2. Wet-cold: volume overload with poor perfusion (inotropes).
3. Dry-cold: hypoperfusion without congestion (fluids).
9: What medications are commonly used in heart failure treatment?
Correct Answer: Diuretics, vasodilators, morphine, positive inotropes (β-agonists,
phosphodiesterase inhibitors, digitalis).
1. Diuretics relieve congestion; vasodilators reduce afterload.
2. Morphine reduces preload and anxiety in pulmonary edema.
3. Inotropes for cardiogenic shock or decompensated HF.
10: What complications can arise from heart failure?
Correct Answer: Pleural effusion, dysrhythmias, activity intolerance, fluid imbalance,
impaired cardiac and respiratory function, inadequate tissue perfusion.
1. Pleural effusions occur from increased systemic venous pressure.
2. Atrial fibrillation is common complication.
3. Cardiogenic shock is end-stage complication.
,11: What is the prognosis for patients with heart failure?
Correct Answer: The 5-year survival rate is a significant concern, necessitating transitional
care programs and comprehensive discharge planning.
1. HF has worse prognosis than many cancers.
2. Transitional care reduces 30-day readmission rates.
3. Palliative care integration improves quality of life.
12: What is cardiomyopathy?
Correct Answer: A group of diseases directly affecting the myocardium's structures and
function, classified as primary (unknown cause) or secondary (known myocardial disease).
1. Primary: dilated, hypertrophic, restrictive, arrhythmogenic RV.
2. Secondary: ischemic, valvular, hypertensive, inflammatory, toxic.
3. Diagnosis requires excluding other causes of dysfunction.
13: What are the signs of worsening heart failure?
Correct Answer: Increased dyspnea, orthopnea, weight gain, and changes in mental status.
1. Weight gain of 2-3 lbs in 24h indicates fluid retention.
2. Orthopnea worsening suggests increased pulmonary congestion.
3. Mental status changes indicate decreased cerebral perfusion.
14: What role does patient education play in heart failure management?
Correct Answer: Extensive education on self-management, exercise, and close home
surveillance follow-up by nurses are critical to avoid re-hospitalization.
1. Teach daily weights, low sodium diet, medication adherence.
2. Recognize early signs of decompensation (dyspnea, edema).p>
3. Follow-up within 7-10 days post-discharge reduces readmissions.
15: What is the significance of advanced directives in heart failure care?
Correct Answer: They facilitate discussions about end-of-life care and advanced heart
failure therapies.
1. Advanced HF therapies include LVAD and transplant.
2. Goals of care discussion should occur early.
3. Palliative care improves symptom management and quality of life.
16: What is the purpose of hemodynamic monitoring in heart failure patients?
Correct Answer: To assess the patient's stability and guide treatment decisions.
1. PA catheter measures filling pressures, cardiac output.
2. Guides diuretic, vasodilator, and inotrope therapy.
3. Used in decompensated HF or cardiogenic shock.
, 17: What is the role of ultrafiltration in heart failure management?
Correct Answer: Used for patients with volume overload and resistance to diuretics.
1. Ultrafiltration removes fluid without affecting electrolytes.
2. Alternative for diuretic-resistant patients.
3. May improve diuretic responsiveness.
18: What are the common side effects of medications used in heart failure?
Correct Answer: Potential for electrolyte imbalances, hypotension, and renal function
changes.
1. Diuretics cause hypokalemia, hyponatremia.
2. ACE inhibitors/ARBs cause hyperkalemia, hypotension.
3. Monitor electrolytes and renal function regularly.
19: What lifestyle modifications are recommended for heart failure patients?
Correct Answer: Low sodium diet, fluid restrictions, regular monitoring of weight, and
physical activity as tolerated.
1. Sodium restriction <2g/day; fluid restriction 1.5-2L/day if severe.
2. Daily weight same time, same scale, after voiding.
3. Exercise improves functional capacity and quality of life.
20: What is the importance of daily weights in heart failure management?
Correct Answer: To monitor fluid retention; a weight gain of 3 pounds over 2 days or 5
pounds over a week should be reported to a healthcare provider.
1. 2-3 lb weight gain in 24h indicates significant fluid retention.
2. Early intervention prevents hospitalization.
3. Patients should weigh themselves daily and record.
21: What is the significance of the 6-minute walk test in heart failure assessment?
Correct Answer: It evaluates functional capacity and response to treatment.
1. Distance walked correlates with prognosis and mortality.
2. Used to assess need for advanced therapies.
3. Improvement indicates positive response to treatment.
22: What is the role of cardiac rehabilitation in heart failure management?
Correct Answer: To improve physical function, reduce symptoms, and enhance quality of
life.
1. Supervised exercise improves functional capacity.
2. Education and psychosocial support are integral.
3. Reduces hospital readmissions and mortality.
Cardiomyopathy, Endocarditis, Valvular Disease, AKI, & Renal Disorders |
Q&A | Grade A | 100% Correct (Verified Answers)
Subject: Advanced Medical-Surgical / Critical Care
Source: NSG 430 Exam 2 – Comprehensive Review Format: Q&A Guide with Clinical Rationale
1: What occurs during acute decompensated heart failure?
Correct Answer: Pulmonary venous pressure increases due to left ventricle failure, leading
to engorgement of the pulmonary vascular system.
1. Left ventricular failure causes backup of blood into pulmonary circulation.
2. Increased pulmonary venous pressure leads to interstitial and alveolar edema.
3. This results in dyspnea, orthopnea, and crackles on auscultation.
2: What diagnostic tests are used to assess heart failure?
Correct Answer: Echocardiogram, ECG, ambulatory heart monitors, chest x-ray, 6-minute
walk test, MUGA scan, cardiac MRI, cardiac catheterization, endomyocardial biopsy, serum
electrolytes, NT-proBNP or BNP.
1. Echocardiogram evaluates ejection fraction and structural abnormalities.
2. BNP/NT-proBNP levels correlate with HF severity.
3. Endomyocardial biopsy is definitive for certain cardiomyopathies.
3: What are early signs and symptoms of acute decompensated heart failure?
Correct Answer: Increased pulmonary venous pressure, mild increase in respiratory rate,
decreased PaO2.
1. Early detection prevents progression to pulmonary edema.
2. Mild tachypnea may be subtle and easily missed.
3. Decreased PaO2 indicates worsening gas exchange.
4: What are later signs and symptoms of acute decompensated heart failure?
Correct Answer: Interstitial pulmonary edema, tachypnea, shortness of breath, respiratory
acidosis.
1. Interstitial edema precedes alveolar edema.
2. Respiratory acidosis develops from hypoventilation and fatigue.
3. Immediate intervention required at this stage.
,5: What are the life-threatening manifestations of pulmonary edema?
Correct Answer: Anxiety, pallor, cyanosis, dyspnea, orthopnea, tachypnea, paroxysmal
nocturnal dyspnea, cough with frothy blood-tinged sputum.
1. Pink frothy sputum is hallmark of alveolar pulmonary edema.
2. Immediate interventions: O2, diuretics, afterload reduction.
3. May require intubation and mechanical ventilation.
6: What are common manifestations of heart failure?
Correct Answer: Fatigue, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, cough,
tachycardia, palpitations, edema, changes in urine output, skin changes, neurological
manifestations.
1. PND occurs due to fluid redistribution when lying flat.
2. Neurological changes (confusion) from decreased cerebral perfusion.
3. Nocturia from improved renal perfusion when supine.
7: What interventions are essential for managing heart failure?
Correct Answer: Assess subjective and objective data, monitor vital signs, implement a low
sodium diet, manage fluid restrictions, and ongoing monitoring of weight and symptoms.
1. Daily weights best indicator of fluid status (1L fluid = 1 kg weight).p>
2. Low sodium diet (<2g/day) reduces fluid retention.
3. Patient self-management critical to avoid hospitalization.
8: What are the treatment groups for heart failure presentations?
Correct Answer: Dry-warm, dry-cold, wet-warm, and wet-cold, with wet and warm being
the most common presentation.
1. Wet-warm: volume overload with adequate perfusion (diuretics first).
2. Wet-cold: volume overload with poor perfusion (inotropes).
3. Dry-cold: hypoperfusion without congestion (fluids).
9: What medications are commonly used in heart failure treatment?
Correct Answer: Diuretics, vasodilators, morphine, positive inotropes (β-agonists,
phosphodiesterase inhibitors, digitalis).
1. Diuretics relieve congestion; vasodilators reduce afterload.
2. Morphine reduces preload and anxiety in pulmonary edema.
3. Inotropes for cardiogenic shock or decompensated HF.
10: What complications can arise from heart failure?
Correct Answer: Pleural effusion, dysrhythmias, activity intolerance, fluid imbalance,
impaired cardiac and respiratory function, inadequate tissue perfusion.
1. Pleural effusions occur from increased systemic venous pressure.
2. Atrial fibrillation is common complication.
3. Cardiogenic shock is end-stage complication.
,11: What is the prognosis for patients with heart failure?
Correct Answer: The 5-year survival rate is a significant concern, necessitating transitional
care programs and comprehensive discharge planning.
1. HF has worse prognosis than many cancers.
2. Transitional care reduces 30-day readmission rates.
3. Palliative care integration improves quality of life.
12: What is cardiomyopathy?
Correct Answer: A group of diseases directly affecting the myocardium's structures and
function, classified as primary (unknown cause) or secondary (known myocardial disease).
1. Primary: dilated, hypertrophic, restrictive, arrhythmogenic RV.
2. Secondary: ischemic, valvular, hypertensive, inflammatory, toxic.
3. Diagnosis requires excluding other causes of dysfunction.
13: What are the signs of worsening heart failure?
Correct Answer: Increased dyspnea, orthopnea, weight gain, and changes in mental status.
1. Weight gain of 2-3 lbs in 24h indicates fluid retention.
2. Orthopnea worsening suggests increased pulmonary congestion.
3. Mental status changes indicate decreased cerebral perfusion.
14: What role does patient education play in heart failure management?
Correct Answer: Extensive education on self-management, exercise, and close home
surveillance follow-up by nurses are critical to avoid re-hospitalization.
1. Teach daily weights, low sodium diet, medication adherence.
2. Recognize early signs of decompensation (dyspnea, edema).p>
3. Follow-up within 7-10 days post-discharge reduces readmissions.
15: What is the significance of advanced directives in heart failure care?
Correct Answer: They facilitate discussions about end-of-life care and advanced heart
failure therapies.
1. Advanced HF therapies include LVAD and transplant.
2. Goals of care discussion should occur early.
3. Palliative care improves symptom management and quality of life.
16: What is the purpose of hemodynamic monitoring in heart failure patients?
Correct Answer: To assess the patient's stability and guide treatment decisions.
1. PA catheter measures filling pressures, cardiac output.
2. Guides diuretic, vasodilator, and inotrope therapy.
3. Used in decompensated HF or cardiogenic shock.
, 17: What is the role of ultrafiltration in heart failure management?
Correct Answer: Used for patients with volume overload and resistance to diuretics.
1. Ultrafiltration removes fluid without affecting electrolytes.
2. Alternative for diuretic-resistant patients.
3. May improve diuretic responsiveness.
18: What are the common side effects of medications used in heart failure?
Correct Answer: Potential for electrolyte imbalances, hypotension, and renal function
changes.
1. Diuretics cause hypokalemia, hyponatremia.
2. ACE inhibitors/ARBs cause hyperkalemia, hypotension.
3. Monitor electrolytes and renal function regularly.
19: What lifestyle modifications are recommended for heart failure patients?
Correct Answer: Low sodium diet, fluid restrictions, regular monitoring of weight, and
physical activity as tolerated.
1. Sodium restriction <2g/day; fluid restriction 1.5-2L/day if severe.
2. Daily weight same time, same scale, after voiding.
3. Exercise improves functional capacity and quality of life.
20: What is the importance of daily weights in heart failure management?
Correct Answer: To monitor fluid retention; a weight gain of 3 pounds over 2 days or 5
pounds over a week should be reported to a healthcare provider.
1. 2-3 lb weight gain in 24h indicates significant fluid retention.
2. Early intervention prevents hospitalization.
3. Patients should weigh themselves daily and record.
21: What is the significance of the 6-minute walk test in heart failure assessment?
Correct Answer: It evaluates functional capacity and response to treatment.
1. Distance walked correlates with prognosis and mortality.
2. Used to assess need for advanced therapies.
3. Improvement indicates positive response to treatment.
22: What is the role of cardiac rehabilitation in heart failure management?
Correct Answer: To improve physical function, reduce symptoms, and enhance quality of
life.
1. Supervised exercise improves functional capacity.
2. Education and psychosocial support are integral.
3. Reduces hospital readmissions and mortality.
