Hf

Question 1

What are the two main priority concepts related to Heart Failure?

Answer 1

Perfusion and Gas Exchange.

Question 2

What is ejection fraction (EF) and its normal range?

Answer 2

Percentage of blood ejected from the ventricle during systole; normal range 50–70%. EF <50% indicates heart failure.

Question 3

Define preload.

Answer 3

The degree of stretch in the ventricles at the end of diastole, just before contraction.

Question 4

Define afterload.

Answer 4

The pressure or resistance the ventricles must overcome to eject blood through the semilunar valves and into circulation.

Question 5

What is heart failure (HF)?

Answer 5

The inability of the heart to pump effectively to meet the body’s metabolic needs. It leads to inadequate tissue perfusion and fluid overload.

Question 6

What are common causes of left-sided heart failure?

Answer 6

Hypertension, coronary artery disease (CAD), and valvular disease.

Question 7

What are common causes of right-sided heart failure?

Answer 7

Left ventricular failure, right ventricular MI, and pulmonary hypertension.

Question 8

What are the three types of heart failure?

Answer 8

Left-sided, right-sided, and high-output failure.

Question 9

How does the body initially compensate for decreased cardiac output?

Answer 9

Baroreceptor activation increases HR and vasoconstriction; kidneys retain sodium and water via the RAAS; ADH increases water retention.

Question 10

What is ventricular remodeling?

Answer 10

Structural changes in the ventricles (dilation, hypertrophy) that reduce the heart’s pumping efficiency.

Question 11

List key signs of left-sided heart failure.

Answer 11

Dyspnea, orthopnea, fatigue, pulmonary congestion (crackles, frothy pink sputum), cough, decreased perfusion.

Question 12

List key signs of right-sided heart failure.

Answer 12

Jugular vein distention, dependent edema, ascites, hepatomegaly, weight gain, and increased abdominal girth.

Question 13

What is the most reliable indicator of fluid gain or loss?

Answer 13

Daily weight.

Question 14

What are key assessments for suspected HF?

Answer 14

History of cardiac disease, activity tolerance, dyspnea, urinary patterns, psychosocial factors.

Question 15

What laboratory tests help diagnose HF?

Answer 15

BNP (elevated when ventricles are stretched), serum electrolytes, urinalysis, renal function tests.

Question 16

What imaging is most useful in diagnosing HF?

Answer 16

Echocardiogram (determines ejection fraction).

Question 17

What is the normal BNP value?

Answer 17

<100 pg/mL. Elevated BNP indicates worsening HF.

Question 18

What ECG findings may occur in HF?

Answer 18

Dysrhythmias such as atrial fibrillation or ventricular ectopy.

Question 19

Using the Clinical Judgment Model, what are key hypotheses for HF?

Answer 19

1. Decreased gas exchange due to ventilation/perfusion imbalance. 2. Potential for decreased perfusion due to inadequate cardiac output. 3. Potential for pulmonary edema due to left-sided HF.

Question 20

What interventions promote gas exchange in HF?

Answer 20

Auscultate breath sounds, provide oxygen therapy, position upright (high-Fowler’s), monitor SpO₂, consider CPAP if needed.

Question 21

What are signs of pulmonary edema?

Answer 21

Crackles, dyspnea at rest, tachycardia, cough with frothy pink sputum, anxiety, low SpO₂, reduced urine output.

Question 22

How is pulmonary edema treated?

Answer 22

Administer diuretics (furosemide), nitrates (nitroglycerin), morphine to reduce anxiety and preload, and provide oxygen. Ultrafiltration may be used for severe fluid overload.

Question 23

What is the goal of drug therapy for HF?

Answer 23

Improve cardiac output, reduce preload and afterload, and enhance contractility.

Question 24

What are the main drug classes used for HF?

Answer 24

ACE inhibitors, ARBs, ARNIs, beta-blockers, diuretics, nitrates, and digoxin.

Question 25

What do ACE inhibitors do?

Answer 25

Vasodilate and reduce afterload; improve survival. Watch for dry cough and hyperkalemia.

Question 26

When are ARBs used in HF?

Answer 26

As alternatives for patients who cannot tolerate ACE inhibitors (e.g., due to cough).

Question 27

What is the purpose of ARNI (sacubitril/valsartan)?

Answer 27

Combines RAAS blockade with neprilysin inhibition to improve outcomes and reduce mortality.

Question 28

Why are diuretics used in HF?

Answer 28

They reduce preload by promoting sodium and water excretion; loop diuretics (furosemide) are most common.

Question 29

What should be monitored with furosemide use?

Answer 29

Monitor potassium levels and for signs of dehydration or orthostatic hypotension.

Question 30

What is digoxin’s mechanism of action?

Answer 30

Increases contractility (positive inotrope) and decreases HR. Watch for toxicity (blurred vision, halos, bradycardia).

Question 31

What are signs of digoxin toxicity?

Answer 31

Bradycardia, nausea, vomiting, blurred or yellow vision (halos), and confusion.

Question 32

What role do beta-blockers play in HF?

Answer 32

Reduce HR and myocardial workload, improve ventricular filling time (e.g., metoprolol, carvedilol).

Question 33

What is the function of nitrates in HF?

Answer 33

Vasodilate veins to decrease preload and relieve pulmonary congestion.

Question 34

What dietary recommendations are given to HF patients?

Answer 34

Low sodium (<2 g/day), fluid restriction (<2 L/day), small frequent meals, and referral to a dietician.

Question 35

What is the purpose of weight monitoring in HF?

Answer 35

Detect fluid retention early; report gain of >2–3 lbs in 24 hours.

Question 36

What education should HF patients receive for self-management?

Answer 36

Daily weights, medication adherence, activity pacing, avoiding smoking/alcohol, and recognizing worsening symptoms (e.g., dyspnea, swelling, weight gain).

Question 37

What are symptoms of worsening HF that should be reported immediately?

Answer 37

Increased shortness of breath, swelling, rapid weight gain (>2–3 lbs in 24 hr), or reduced urine output.

Question 38

Why is psychosocial support important in HF management?

Answer 38

HF is a chronic, progressive disease that can lead to depression and anxiety; addressing mental health improves adherence and outcomes.

Question 39

What surgical options exist for advanced HF?

Answer 39

Heart transplant, left ventricular reconstruction surgery, or a ventricular assist device (VAD).

Question 40

How does the nurse evaluate improvement in HF?

Answer 40

Improved gas exchange (SpO₂ ≥ 92%), stable weight, decreased edema, no crackles, patient verbalizes understanding of management plan.

Question 41

What is the expected outcome for a patient with controlled HF?

Answer 41

Maintains adequate perfusion, stable weight, no pulmonary congestion, adheres to medication and lifestyle regimen.

Question 42

CJM Case: Recognize cues for HF.

Answer 42

History of cardiac disease, activity intolerance, dyspnea, weight gain, fluid retention, abnormal BNP, low EF.

Question 43

CJM Case: Analyze cues and prioritize hypotheses.

Answer 43

1. Decreased gas exchange. 2. Decreased perfusion. 3. Risk for pulmonary edema.

Question 44

CJM Case: Generate solutions and take action.

Answer 44

Administer meds (ACEI, diuretics, digoxin), promote oxygenation, monitor weights, teach self-management.

Question 45

CJM Case: Evaluate outcomes.

Answer 45

Improved perfusion and gas exchange; patient reports decreased dyspnea and understands management plan.