Struggling With CHF Test Questions? Use This Simple Pattern to Get Them Right

Intro

“CHF feels like one of those topics you think you know… until the exam asks what to do first, and every answer looks right. Let’s fix that. Today I’m going to show you how to study CHF like a nurse—so you can understand it, not just memorize it.”

By the end of this post, you’ll be able to:

• Identify patients likely experiencing CHF based on symptoms and assessment findings.
• Link CHF pathophysiology to what you see at the bedside (symptoms, vitals, lung sounds, edema, weight changes).
• Differentiate expected CHF findings from red flags that require urgent action.
• Choose the best next step on nursing exams by deciding assess vs implement vs notify provider/rapid response for CHF scenarios.

CHF = pump failure → blood backs up → congestion (lungs or body) → fluid overload.

• Left-sided = pulmonary congestion (lungs)
• Right-sided = systemic congestion (body)

How to Study!!

1. Assessment: “What will I see?” “What will the patient say?”

Organize symptoms by left vs right.

• Left-sided (lungs): Remember symptoms/signs affect ABCs
  • Airway/Breathing- Crackles, Wheezing, Low O2, S3/S4 gallop
  • Circulation- Cyanosis
  • Airway/Breathing- Ability to  =climb flights or stairs without fatigue or dyspnea? Chest pain, cough ( worst at night)-, Dyspnea, orthopnea (sleeps with pillows).
  • Make sure you know alarming findings that require immediate assessment- cough with frothy , pinked tinged sputum-  On exams- Assess these patient’s first
• What will you assess?
• What will the patient say? Ask about ADLs
• Right-sided (body): Remember ABCs
  • Airway/Breathing/Circulation- Jugular distention (how do you know), weight gain
  • Their shoes doesn’t fit anymore, sock removal indentations, diuresis at night
• What will you assess?
• What will the patient say?

Exam tip:
Make sure to differentiate patient symptoms into right or left sided heart failure-  before trying to answer the question. Keeping in mind- what are the unexpected/expected vital signs and labs in a person with Heart failure.

1. Diagnostics: “What tests prove it?”

• BNP/NT-proBNP (stretch/fluid overload marker)- should be <100 pg/ml
• CXR – in patients with heart failure may show pulmonary edema/cardiomegaly.
• Echocardiogram (EF—systolic vs diastolic)- in patients with HeartHF-  EF <55% ( should be >55%). * Gold Standard Test*
• CMP/BMP (Na, K, BUN/Cr—med safety + perfusion)- Na low (<135), K low (<3.5)- too much fluid causes dilution of blood. Hemoglobin/Hematocrit low due to dilution of blood (more water than RBCs).

Exam Tip-

Remember how do you prepare the patient for the test? CXR- removal all metal items, assess for hx of pregnancy, and hx of Pacemaker.

1. Interventions: “What does the nurse do first?”

If your test question asks you what to do next. Remember to stabilize patients first with nursing interventions and then notify provider.

Use priorities:

• Airway/Breathing if respiratory distress-
• Apply Oxygen
• Positioning (High Fowler’s)
• IV access / meds (as ordered)- Furosemide ( Diuretics)-
• Not immediate but important to prevent progression
• Strict I&O + daily weights
• Fluid/Na restriction education

Quick “test rule”:

• Crackles + low O2 = treat breathing first.
• Edema + weight gain but stable breathing = manage fluid- elevate extremities, teach to eat a low sodium diet.

5) Medications: Study by “What problem does this fix?”

Core CHF med buckets

• Diuretics (furosemide): pull off fluid
  Monitor: low K+ (<3.5), BP, dehydration, daily weight, I&O
• ACE/ARB/ARNI ( Lisinopril, Losartan): reduce workload/remodeling
  Monitor: high  K+ (>5.0), BP, kidney function, cough/angioedema (ACE)
• Beta blockers (Metoprolol): slow heart, improve function over time
  Caution: don’t start/uptitrate in acute decompensation, do not give to patients with HR <60
• Aldosterone antagonists (Spironolactone): mild diuresis, K+ saver
  Monitor: hyperkalemia. Do not give to patients with kidney disease ( GFR<60)
• Digoxin (sometimes): stronger squeeze/slower rate
  Monitor: toxicity, apical pulse, low K+. Do not give to patients with HR <60.

“Exam trap” section:

• CHF + low K+ + digoxin = high risk for toxicity
• CHF + kidney dysfunction = watch diuretic/ACE effects closely

 Patient Teaching: The “At Home” Safety Plan

Key teaching points:

• Daily weights (same time, same scale)
  Call provider if 2–3 lb in 1 day or 5 lb in a week
• Low sodium + fluid restriction if ordered
• Take meds even when you feel better
• When to seek help: worsening SOB, chest pain, swelling, rapid weight gain

NCLEX/Exam Question Strategy Section

How to answer CHF “next step” questions

1. Is the patient in respiratory distress?
   → pick positioning/O2/assessment of breathing
2. Do you have enough data in the question to safely implement for next steps? If not
   → choose an assessment answer (assess lung sounds, O2 sat, weight, I&O)
3. If it is asking your which med to give or hold?
   → check BP, K+, kidney function first

Quick Recap (Sticky summary)

Remember this!

Example:

• Left = lungs, Right = body
• Wet lungs? Fix breathing first
• Daily weight is king
• Meds = bucket by purpose + what to monitor

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