Heart Failure Exam Study Guide Questions And
Answers Verified 100% Correct
A patient with acute decompensated heart failure (ADHF) experiences severe
pulmonary edema. The nurse identifies that what intervention will increase the
percentage of O 2 in inspired air and is effective in decreasing preload?
Providing O 2 at 2-4 liters/NC
Placing the patient in Trendelenburg position
Providing bilevel positive airway pressure (BiPAP)
Advising the patient to take physical and emotional rest - ANSWER- Providing bilevel
positive airway pressure (BiPAP)
In severe pulmonary edema, the patient may need noninvasive positive pressure
ventilation (e.g., BiPAP) or intubation and mechanical ventilation. BiPAP is also effective
in decreasing preload. When a patient has dyspnea, the patient should be placed in
high Fowler's position. Oxygen therapy delivered at 2-4 liters/minute via nasal cannula
will not be adequate for a patient experiencing severe pulmonary edema. Taking
physical and emotional rest helps in conserving energy; it does not increase the
percentage of inspired O 2, and it does not decrease preload. p. 744
What events occur as a result of ventricular remodeling? Select all that apply.
1. Increased contractility
2. Increased wall tension
3. More effective pumping
4. Increased ventricular mass
5. Increased O 2 consumption - ANSWER- 2, 4, 5
Increased wall tension
Increased ventricular mass
Increased O 2 consumption
Remodeling involves hypertrophy of the ventricular myositis. This results in large,
abnormally shaped contractile cells. This altered shape of the ventricles eventually
leads to increased ventricular mass, increased wall tension, increased O 2consumption,
and impaired contractility. Although the ventricles become larger, they become less
effective pumps. p. 740
The nurse reviews the pathophysiology of heart failure. Which compensatory
mechanism results in increased heart rate, increased myocardial contractility, and
peripheral vasoconstriction?
Ventricular dilation
Ventricular hypertrophy
,Neurohormonal response
Sympathetic nervous system (SNS) activation - ANSWER- Sympathetic nervous
system (SNS) activation
SNS activation is often the first mechanism triggered in low-cardiac output states. In
response to an inadequate stroke volume and cardiac output, SNS activation increases,
resulting in the increased release of catecholamines (epinephrine and norepinephrine).
This results in increased heart rate, increased myocardial contractility, and peripheral
vasoconstriction. Initially, this increase in heart rate and contractility improves cardiac
output. However, over time these factors are harmful because they increase the already
failing heart's workload and need for oxygen. Ventricular dilation, ventricular
hypertrophy, and neurohormonal response do not cause increased heart rate, increased
myocardial contractility, and peripheral vasoconstriction.
pp. 739-740
While performing cardiac assessment, the nurse finds that a patient's right atrial
pressure is 12 mm Hg. Which other findings will the nurse most likely observe? Select
all that apply.
1. Distended neck veins
2. Enlarged cardiac muscle
3. Engorged or enlarged liver
4. Decreased afterload in the ventricle
5. Decreased resistance to blood ejection - ANSWER- 1. Distended neck veins
2. Enlarged cardiac muscle
3. Engorged or enlarged liver
The normal right atrial pressure is in the range of 2 to 6 mm Hg. A right atrial pressure of
12 mm Hg is elevated. The veins of the neck reflect venous tone, blood volume, and
right atrial pressure. Therefore distention of neck veins is indicative of elevated right
atrial pressure. Elevated arterial blood pressure gives the ventricles increased
resistance to eject blood and thus increases the work demand, resulting in ventricular
hypertrophy, an enlargement of the cardiac muscle tissue without an increase in cardiac
output. Elevated right atrial pressure increases resistance to blood flow and can result in
liver engorgement. Elevated right atrial pressure can increase afterload and resistance
to blood ejection pp. 737-739
The nurse is caring for a patient with chronic heart failure. What is appropriate to be
included on the patient's plan of care?
Ultrafiltration (UF)
Hemodynamic monitoring
Intraaortic balloon pump (IABP)
Cardiac resynchronization therapy (CRT) - ANSWER- Cardiac resynchronization
therapy (CRT)
,In chronic HF, neurohormonal effects and cardiac remodeling can result in
dyssynchrony of the left ventricle (LV) and the right ventricle (RV). This contributes to
poor cardiac output (CO). CRT is ventricular pacing. During the procedure, an extra
lead is placed, which allows for normal electrical conduction between the RV and LV,
which increases left ventricular function and CO. Hemodynamic monitoring, UF, and
IABP are included in the plan of care for patients with acute decompensated heart
failure (ADHF). Patients with ADHF need continuous monitoring and assessment. The
patient may have hemodynamic monitoring, including arterial BP and pulmonary artery
pressure. The ideal patients for UF are those with major pulmonary or systemic volume
overload. The IABP is helpful in hemodynamically unstable patients.
pp. 744, 746
A patient is diagnosed with heart failure. The nurse identifies that which factors may
influence the patient's cardiac output? Select all that apply.
1. Stroke volume
2. Portal pressure
3. Respiratory rate
4. Myocardial contractility
5. Decreased filling of the ventricles - ANSWER- 1. Stroke volume
4. Myocardial contractility
5. Decreased filling of the ventricles
Cardiac output depends on various factors such as stroke volume, decreased filling of
the ventricles, and myocardial contractility. Stroke volume x heart rate = cardiac output
(CO). Decreased filling of the ventricles decreases cardiac output. Impaired myocardial
contractility decreases cardiac output. Respiratory rate and portal pressure do not alter
cardiac output. pp. 738, 740
A patient's apical heart rate is 45 beats/minute. The nurse should withhold which
scheduled medication?
Morphine
Metoprolol
Furosemide
Rosuvastatin - ANSWER- Metoprolol, which is a β-adrenergic blocker, inhibits the
sympathetic nervous system, causing a decrease in heart rate; therefore, this drug
should be withheld and the primary health care provider notified. Diuretics, such as
furosemide, are used to reduce edema, pulmonary venous pressure, and preload; pulse
rate is not affected. Morphine is used to reduce pain and anxiety, and it also decreases
preload and afterload; it may be given if the patient is in pain and has a heart rate of 45.
Antihyperlipidemic drugs, such as rosuvastatin, are used to help control cholesterol in
the patient; a heart rate of 45 does not indicate that it should be withheld. P. 745
A nurse is caring for a patient with pleural effusion who is not responding to
conventional medical treatment. Assessment findings include S 3 and S 4 heart sounds,
, crackles, and an increased heart rate. Which condition is most likely affecting the
patient? Cor pulmonale
Pulmonary edema
Left-sided heart failure
Right-sided heart failure - ANSWER- Manifestations of left-sided heart failure include
pleural effusion, S 3 and S 4 heart sounds, crackles, and increased heart rate. These
symptoms indicate a low cardiac output. Cor pulmonale is the dilation of the right
ventricle caused by pulmonary diseases. It manifests as right heart failure. Right-sided
heart failure causes edema, murmurs, and jugular vein distention. Pulmonary edema
manifests as dyspnea, orthopnea, anxiety, and cold and clammy skin. p. 742
The nurse reviews the assessment findings of a patient with acute decompensated
heart failure (ADHF) and notes a pulmonary artery wedge pressure (PAWP) of 28 mm
Hg, an intake of 1000 mL more than the output in 24 hours, and resistance to diuretics.
The nurse anticipates a prescription for which clinical intervention?
Oxygen therapy
Ultrafiltration (UF)
Biventricular pacing
Cardiac transplantation - ANSWER- Ultrafiltration (UF)
In a patient with acute decompensated heart failure, the pulmonary artery wedge
pressure (PAWP) can be as high as 30 mm Hg. A normal PAWP is generally between
18 and 12mm Hg. The ideal patients for ulrafiltration (UF) are those with major
pulmonary or systemic overload who have shown resistance to diuretics and are
hemodynamically stable. UF helps decrease the fluid overload in the lungs and,
therefore, decreases the pulmonary artery wedge pressure. Oxygen therapy may
improve perfusion, but it does not cause a decrease in pulmonary artery wedge
pressure (PAWP). Biventricular pacing and cardiac transplantation are preferred in
cases of chronic heart failure but are not the best options in cases of ADHF.
pp. 744-745
The nurse is assessing a patient with a diagnosis of left-sided heart failure (HF). The
nurse should monitor the patient for which characteristic symptom that occurs
exclusively with this disorder?
Fatigue
Anxiety
Anorexia
Frothy, pink-tinged sputum - ANSWER- Frothy, pink-tinged sputum
Frothy, pink-tinged sputum is a characteristic symptom associated with left-sided HF.
Fatigue and anxiety are present as a common symptom both in right-sided and leftsided
HF. Anorexia is exclusively a symptom of right-sided HF. P.742
Answers Verified 100% Correct
A patient with acute decompensated heart failure (ADHF) experiences severe
pulmonary edema. The nurse identifies that what intervention will increase the
percentage of O 2 in inspired air and is effective in decreasing preload?
Providing O 2 at 2-4 liters/NC
Placing the patient in Trendelenburg position
Providing bilevel positive airway pressure (BiPAP)
Advising the patient to take physical and emotional rest - ANSWER- Providing bilevel
positive airway pressure (BiPAP)
In severe pulmonary edema, the patient may need noninvasive positive pressure
ventilation (e.g., BiPAP) or intubation and mechanical ventilation. BiPAP is also effective
in decreasing preload. When a patient has dyspnea, the patient should be placed in
high Fowler's position. Oxygen therapy delivered at 2-4 liters/minute via nasal cannula
will not be adequate for a patient experiencing severe pulmonary edema. Taking
physical and emotional rest helps in conserving energy; it does not increase the
percentage of inspired O 2, and it does not decrease preload. p. 744
What events occur as a result of ventricular remodeling? Select all that apply.
1. Increased contractility
2. Increased wall tension
3. More effective pumping
4. Increased ventricular mass
5. Increased O 2 consumption - ANSWER- 2, 4, 5
Increased wall tension
Increased ventricular mass
Increased O 2 consumption
Remodeling involves hypertrophy of the ventricular myositis. This results in large,
abnormally shaped contractile cells. This altered shape of the ventricles eventually
leads to increased ventricular mass, increased wall tension, increased O 2consumption,
and impaired contractility. Although the ventricles become larger, they become less
effective pumps. p. 740
The nurse reviews the pathophysiology of heart failure. Which compensatory
mechanism results in increased heart rate, increased myocardial contractility, and
peripheral vasoconstriction?
Ventricular dilation
Ventricular hypertrophy
,Neurohormonal response
Sympathetic nervous system (SNS) activation - ANSWER- Sympathetic nervous
system (SNS) activation
SNS activation is often the first mechanism triggered in low-cardiac output states. In
response to an inadequate stroke volume and cardiac output, SNS activation increases,
resulting in the increased release of catecholamines (epinephrine and norepinephrine).
This results in increased heart rate, increased myocardial contractility, and peripheral
vasoconstriction. Initially, this increase in heart rate and contractility improves cardiac
output. However, over time these factors are harmful because they increase the already
failing heart's workload and need for oxygen. Ventricular dilation, ventricular
hypertrophy, and neurohormonal response do not cause increased heart rate, increased
myocardial contractility, and peripheral vasoconstriction.
pp. 739-740
While performing cardiac assessment, the nurse finds that a patient's right atrial
pressure is 12 mm Hg. Which other findings will the nurse most likely observe? Select
all that apply.
1. Distended neck veins
2. Enlarged cardiac muscle
3. Engorged or enlarged liver
4. Decreased afterload in the ventricle
5. Decreased resistance to blood ejection - ANSWER- 1. Distended neck veins
2. Enlarged cardiac muscle
3. Engorged or enlarged liver
The normal right atrial pressure is in the range of 2 to 6 mm Hg. A right atrial pressure of
12 mm Hg is elevated. The veins of the neck reflect venous tone, blood volume, and
right atrial pressure. Therefore distention of neck veins is indicative of elevated right
atrial pressure. Elevated arterial blood pressure gives the ventricles increased
resistance to eject blood and thus increases the work demand, resulting in ventricular
hypertrophy, an enlargement of the cardiac muscle tissue without an increase in cardiac
output. Elevated right atrial pressure increases resistance to blood flow and can result in
liver engorgement. Elevated right atrial pressure can increase afterload and resistance
to blood ejection pp. 737-739
The nurse is caring for a patient with chronic heart failure. What is appropriate to be
included on the patient's plan of care?
Ultrafiltration (UF)
Hemodynamic monitoring
Intraaortic balloon pump (IABP)
Cardiac resynchronization therapy (CRT) - ANSWER- Cardiac resynchronization
therapy (CRT)
,In chronic HF, neurohormonal effects and cardiac remodeling can result in
dyssynchrony of the left ventricle (LV) and the right ventricle (RV). This contributes to
poor cardiac output (CO). CRT is ventricular pacing. During the procedure, an extra
lead is placed, which allows for normal electrical conduction between the RV and LV,
which increases left ventricular function and CO. Hemodynamic monitoring, UF, and
IABP are included in the plan of care for patients with acute decompensated heart
failure (ADHF). Patients with ADHF need continuous monitoring and assessment. The
patient may have hemodynamic monitoring, including arterial BP and pulmonary artery
pressure. The ideal patients for UF are those with major pulmonary or systemic volume
overload. The IABP is helpful in hemodynamically unstable patients.
pp. 744, 746
A patient is diagnosed with heart failure. The nurse identifies that which factors may
influence the patient's cardiac output? Select all that apply.
1. Stroke volume
2. Portal pressure
3. Respiratory rate
4. Myocardial contractility
5. Decreased filling of the ventricles - ANSWER- 1. Stroke volume
4. Myocardial contractility
5. Decreased filling of the ventricles
Cardiac output depends on various factors such as stroke volume, decreased filling of
the ventricles, and myocardial contractility. Stroke volume x heart rate = cardiac output
(CO). Decreased filling of the ventricles decreases cardiac output. Impaired myocardial
contractility decreases cardiac output. Respiratory rate and portal pressure do not alter
cardiac output. pp. 738, 740
A patient's apical heart rate is 45 beats/minute. The nurse should withhold which
scheduled medication?
Morphine
Metoprolol
Furosemide
Rosuvastatin - ANSWER- Metoprolol, which is a β-adrenergic blocker, inhibits the
sympathetic nervous system, causing a decrease in heart rate; therefore, this drug
should be withheld and the primary health care provider notified. Diuretics, such as
furosemide, are used to reduce edema, pulmonary venous pressure, and preload; pulse
rate is not affected. Morphine is used to reduce pain and anxiety, and it also decreases
preload and afterload; it may be given if the patient is in pain and has a heart rate of 45.
Antihyperlipidemic drugs, such as rosuvastatin, are used to help control cholesterol in
the patient; a heart rate of 45 does not indicate that it should be withheld. P. 745
A nurse is caring for a patient with pleural effusion who is not responding to
conventional medical treatment. Assessment findings include S 3 and S 4 heart sounds,
, crackles, and an increased heart rate. Which condition is most likely affecting the
patient? Cor pulmonale
Pulmonary edema
Left-sided heart failure
Right-sided heart failure - ANSWER- Manifestations of left-sided heart failure include
pleural effusion, S 3 and S 4 heart sounds, crackles, and increased heart rate. These
symptoms indicate a low cardiac output. Cor pulmonale is the dilation of the right
ventricle caused by pulmonary diseases. It manifests as right heart failure. Right-sided
heart failure causes edema, murmurs, and jugular vein distention. Pulmonary edema
manifests as dyspnea, orthopnea, anxiety, and cold and clammy skin. p. 742
The nurse reviews the assessment findings of a patient with acute decompensated
heart failure (ADHF) and notes a pulmonary artery wedge pressure (PAWP) of 28 mm
Hg, an intake of 1000 mL more than the output in 24 hours, and resistance to diuretics.
The nurse anticipates a prescription for which clinical intervention?
Oxygen therapy
Ultrafiltration (UF)
Biventricular pacing
Cardiac transplantation - ANSWER- Ultrafiltration (UF)
In a patient with acute decompensated heart failure, the pulmonary artery wedge
pressure (PAWP) can be as high as 30 mm Hg. A normal PAWP is generally between
18 and 12mm Hg. The ideal patients for ulrafiltration (UF) are those with major
pulmonary or systemic overload who have shown resistance to diuretics and are
hemodynamically stable. UF helps decrease the fluid overload in the lungs and,
therefore, decreases the pulmonary artery wedge pressure. Oxygen therapy may
improve perfusion, but it does not cause a decrease in pulmonary artery wedge
pressure (PAWP). Biventricular pacing and cardiac transplantation are preferred in
cases of chronic heart failure but are not the best options in cases of ADHF.
pp. 744-745
The nurse is assessing a patient with a diagnosis of left-sided heart failure (HF). The
nurse should monitor the patient for which characteristic symptom that occurs
exclusively with this disorder?
Fatigue
Anxiety
Anorexia
Frothy, pink-tinged sputum - ANSWER- Frothy, pink-tinged sputum
Frothy, pink-tinged sputum is a characteristic symptom associated with left-sided HF.
Fatigue and anxiety are present as a common symptom both in right-sided and leftsided
HF. Anorexia is exclusively a symptom of right-sided HF. P.742
