Nursing 101 CHF Simulation Preparation Questions and Answers
CHF Simulation: Preparation Questions
1. List the risk factors for chronic left-sided heart failure related to coronary artery
disease.
Non-modifiable risk factors include increasing age, gender (men more than women until
age 65), ethnicity, genetic predisposition and family history of heart disease. Modifiable risk
factors are hypertension, elevated serum lipids, tobacco use, physical inactivity, psychologic
state, obesity, diabetes.
2. Explain the cause of the compensations for chronic heart failure.
HF can occur quickly with the onset from acute MI and rapid A-fib, or it can be an
insidious process from slow, progressive changes. The overloaded heart will resort to
compensatory mechanisms trying to maintain adequate CO. The main compensatory
mechanisms include:
❖ Sympathetic Nervous System Activation:
● First mechanism triggered is low CO states (least effective).
● In response to inadequate stroke volume and CO, there is increased the release of
catecholamines (epinephrine and norepinephrine) to increase HR which increases
myocardial contractility and peripheral vasoconstriction.
❖ Neurohormonal response:
● As CO decreases, the blood flow to the kidneys decreases.The kidneys respond by
releasing rennin, which helps change angiotensinogen to angiotensin I. It then is
subsequently converted to angiotensin II. Angiotensin II stimulates the release of
aldosterone, thus resulting in retention of sodium and water, and vasoconstriction.
Thus causing increase BP.
❖ The activation of the SNS and the neurohormonal response causes an increased cardiac
workload , myocardial dysfunction, ventricular remodeling (ventricles becomes larger
and less effective pumps)
❖ Dilation results in enlargement of chambers of the heart. It starts as an adaptive
mechanism to cope with increasing blood volume. Eventually this mechanism becomes
inadequate and can no longer contract effectively thereby decreasing the CO.
❖ Hypertrophy increases the muscle mass and cardiac wall thickness in response to
overwork and strain. Hypertrophic heart muscles have poor contractility and requires
more oxygen to perform work. Also poor coronary artery circulation and are prone to
dysrhythmias.
3. Describe the manifestations and effects of right-sided and left-sided heart failure.
Right-sided HF Left-sided HF
- Right ventricle heaves - Left Ventricle heaves
- Murmurs - Pulsus alternans (Alternating pulses, strong,
- JVD weak)
- Edema (pedal, scrotum, sacrum) - Increased HR
- Weight gain - Point of maximum displaced inferiorly and
- Increased HR posteriorly ( LV hypertrophy)
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, - Ascites - Decreased PaO2, slight increase PaO2 (poor
- Anarsaca ( Massive generalizd body edema) O2 exchange)
- Hepatomegaly (liver enlargement) - crackles (pulmonary edema)
- Fatigue - S3 and S4 heart sound
- Anxiety and depression - pleural effusion
- Dependent, bilateral edema - Change in mental status
- Right upper quadrant pain - Restlessness, confusion
- Anorexia and GI bloating - Weakness, fatigue
- Nausea - Anxiety, depression
- Shallow respirations up to 32-40/min
- Paroxysmal nocturnal dyspea
- Orthopnea ( SOB in recumbent position)
- dry, hacking cough
- nocturia
- frothy, pink-tinged sputum ( advanced
pulmonary edema)
4. List the goals in the interdisciplinary care of a patient with chronic heart failure
❖ Treat underlying cause and contributing factors
❖ Maximize CO
❖ Provide treatment to alleviate symptoms
❖ Improve ventricular function
❖ Improve quality of life
❖ Preserve target organ function
❖ Improve mortality and morbidity risks
5. List the two hormones released by the heart muscle in response to changes in blood
volume.
A- type Natriuretic Peptide (ANP) and B-type Natriuretic Peptide (BNP). Both hormones lower
BP by relaxing arterioles, inhibiting the secretion of rennin and aldosterone, inhibiting the
reabsorption of sodium ions by the kidneys.
6. Explain the nursing implications for the client receiving echocardiography with
Doppler flow studies.
Echocardiography may show ventricular hypertrophy, dilation of chambers and abnormal
wall motion. Place patient in a supine position on left side facing equipment. Then instruct the
patient about the procedure and sensations that might occur like pressure and mechanical
movement from head of transducer. No contraindications to procedure exist.
7. Define refractory heart failure.
Pt with severe symptoms at rest despite maximal medical therapy
8. List the nursing implications and education needs for each of the following
categories of medication related to heart failure:
Angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB)
● ACE inhibitors (Captopril): Primary drug choice for blocking the RAAS system.
This study source was downloaded by 100000841689952 from CourseHero.com on 04-24-2022 11:13:27 GMT -05:00
https://www.coursehero.com/file/12468094/CHF-Sim-Questions/
CHF Simulation: Preparation Questions
1. List the risk factors for chronic left-sided heart failure related to coronary artery
disease.
Non-modifiable risk factors include increasing age, gender (men more than women until
age 65), ethnicity, genetic predisposition and family history of heart disease. Modifiable risk
factors are hypertension, elevated serum lipids, tobacco use, physical inactivity, psychologic
state, obesity, diabetes.
2. Explain the cause of the compensations for chronic heart failure.
HF can occur quickly with the onset from acute MI and rapid A-fib, or it can be an
insidious process from slow, progressive changes. The overloaded heart will resort to
compensatory mechanisms trying to maintain adequate CO. The main compensatory
mechanisms include:
❖ Sympathetic Nervous System Activation:
● First mechanism triggered is low CO states (least effective).
● In response to inadequate stroke volume and CO, there is increased the release of
catecholamines (epinephrine and norepinephrine) to increase HR which increases
myocardial contractility and peripheral vasoconstriction.
❖ Neurohormonal response:
● As CO decreases, the blood flow to the kidneys decreases.The kidneys respond by
releasing rennin, which helps change angiotensinogen to angiotensin I. It then is
subsequently converted to angiotensin II. Angiotensin II stimulates the release of
aldosterone, thus resulting in retention of sodium and water, and vasoconstriction.
Thus causing increase BP.
❖ The activation of the SNS and the neurohormonal response causes an increased cardiac
workload , myocardial dysfunction, ventricular remodeling (ventricles becomes larger
and less effective pumps)
❖ Dilation results in enlargement of chambers of the heart. It starts as an adaptive
mechanism to cope with increasing blood volume. Eventually this mechanism becomes
inadequate and can no longer contract effectively thereby decreasing the CO.
❖ Hypertrophy increases the muscle mass and cardiac wall thickness in response to
overwork and strain. Hypertrophic heart muscles have poor contractility and requires
more oxygen to perform work. Also poor coronary artery circulation and are prone to
dysrhythmias.
3. Describe the manifestations and effects of right-sided and left-sided heart failure.
Right-sided HF Left-sided HF
- Right ventricle heaves - Left Ventricle heaves
- Murmurs - Pulsus alternans (Alternating pulses, strong,
- JVD weak)
- Edema (pedal, scrotum, sacrum) - Increased HR
- Weight gain - Point of maximum displaced inferiorly and
- Increased HR posteriorly ( LV hypertrophy)
This study source was downloaded by 100000841689952 from CourseHero.com on 04-24-2022 11:13:27 GMT -05:00
https://www.coursehero.com/file/12468094/CHF-Sim-Questions/
, - Ascites - Decreased PaO2, slight increase PaO2 (poor
- Anarsaca ( Massive generalizd body edema) O2 exchange)
- Hepatomegaly (liver enlargement) - crackles (pulmonary edema)
- Fatigue - S3 and S4 heart sound
- Anxiety and depression - pleural effusion
- Dependent, bilateral edema - Change in mental status
- Right upper quadrant pain - Restlessness, confusion
- Anorexia and GI bloating - Weakness, fatigue
- Nausea - Anxiety, depression
- Shallow respirations up to 32-40/min
- Paroxysmal nocturnal dyspea
- Orthopnea ( SOB in recumbent position)
- dry, hacking cough
- nocturia
- frothy, pink-tinged sputum ( advanced
pulmonary edema)
4. List the goals in the interdisciplinary care of a patient with chronic heart failure
❖ Treat underlying cause and contributing factors
❖ Maximize CO
❖ Provide treatment to alleviate symptoms
❖ Improve ventricular function
❖ Improve quality of life
❖ Preserve target organ function
❖ Improve mortality and morbidity risks
5. List the two hormones released by the heart muscle in response to changes in blood
volume.
A- type Natriuretic Peptide (ANP) and B-type Natriuretic Peptide (BNP). Both hormones lower
BP by relaxing arterioles, inhibiting the secretion of rennin and aldosterone, inhibiting the
reabsorption of sodium ions by the kidneys.
6. Explain the nursing implications for the client receiving echocardiography with
Doppler flow studies.
Echocardiography may show ventricular hypertrophy, dilation of chambers and abnormal
wall motion. Place patient in a supine position on left side facing equipment. Then instruct the
patient about the procedure and sensations that might occur like pressure and mechanical
movement from head of transducer. No contraindications to procedure exist.
7. Define refractory heart failure.
Pt with severe symptoms at rest despite maximal medical therapy
8. List the nursing implications and education needs for each of the following
categories of medication related to heart failure:
Angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB)
● ACE inhibitors (Captopril): Primary drug choice for blocking the RAAS system.
This study source was downloaded by 100000841689952 from CourseHero.com on 04-24-2022 11:13:27 GMT -05:00
https://www.coursehero.com/file/12468094/CHF-Sim-Questions/
