NR 452 Simulation Questions with Answers
1. What key priority assessment findings are usually seen in left-sided heart
failure? How do these findings differ from right-sided heart failure?
Left sided heart failure: the left side of the heart cannot pump the blood out
of the heart so blood starts to back up into the lungs.
Left-sided heart failure or left ventricular failure have different
manifestations with right-sided heart failure.
Pulmonary congestion occurs when the left ventricle cannot effectively pump
blood out of the ventricle into the aorta and the systemic circulation.
Pulmonary venous blood volume and pressure increase, forcing fluid from
the pulmonary capillaries into the pulmonary tissues and alveoli, causing
pulmonary interstitial edema and impaired gas exchange.
Right-Sided Heart Failure
When the right ventricle fails, congestion in the peripheral tissues and the
viscera predominates.
The right side of the heart cannot eject blood and cannot accommodate all
the blood that normally returns to it from the venous circulation.
Increased venous pressure leads to JVD and increased capillary hydrostatic
pressure throughout the venous system.
2. Identify two common medication classes used to treat left-sided heart
failure. What are two nursing considerations for each identified classification
of medication?
ACE Inhibitors and Beta-blockers (caution with asthmas, blood pressure,
heart rate, hold less than 60), Digoxin can both be used. Nursing
considerations when giving medications such as ACE Inhibitors nursing
interventions are;
Take complete health history of patient.
Monitor blood pressure and pulse frequently to avoid initial dose
hypotension.
Daily check the weight and fluid overload.
Check the s/s of angioedema (swelling of face and extremities)
Monitor BUN, serum potassium, creatinine, AST, ALT, serum bilirubin
level
ACE inhibitors may cause false urine acetone level
Monitor kidney function
1. What key priority assessment findings are usually seen in left-sided heart
failure? How do these findings differ from right-sided heart failure?
Left sided heart failure: the left side of the heart cannot pump the blood out
of the heart so blood starts to back up into the lungs.
Left-sided heart failure or left ventricular failure have different
manifestations with right-sided heart failure.
Pulmonary congestion occurs when the left ventricle cannot effectively pump
blood out of the ventricle into the aorta and the systemic circulation.
Pulmonary venous blood volume and pressure increase, forcing fluid from
the pulmonary capillaries into the pulmonary tissues and alveoli, causing
pulmonary interstitial edema and impaired gas exchange.
Right-Sided Heart Failure
When the right ventricle fails, congestion in the peripheral tissues and the
viscera predominates.
The right side of the heart cannot eject blood and cannot accommodate all
the blood that normally returns to it from the venous circulation.
Increased venous pressure leads to JVD and increased capillary hydrostatic
pressure throughout the venous system.
2. Identify two common medication classes used to treat left-sided heart
failure. What are two nursing considerations for each identified classification
of medication?
ACE Inhibitors and Beta-blockers (caution with asthmas, blood pressure,
heart rate, hold less than 60), Digoxin can both be used. Nursing
considerations when giving medications such as ACE Inhibitors nursing
interventions are;
Take complete health history of patient.
Monitor blood pressure and pulse frequently to avoid initial dose
hypotension.
Daily check the weight and fluid overload.
Check the s/s of angioedema (swelling of face and extremities)
Monitor BUN, serum potassium, creatinine, AST, ALT, serum bilirubin
level
ACE inhibitors may cause false urine acetone level
Monitor kidney function
