Back-to-School Nursing Exam Prep September
2025/2026 | Unfolding Clinical Reasoning Case Study
on Heart Failure | 220+ Verified NCLEX Next Gen
Questions with Detailed Rationales | Comprehensive
Test Bank & Study Guide for RN, BSN, and Nursing
Students Mastering Heart Failure and Clinical
Judgment
QUESTION 1: A patient with heart failure presents with shortness of breath and
edema. What is the priority nursing assessment?
A) Heart rate and rhythm
B) Oxygen saturation levels
C) Lung sounds (CORRECT)
D) Weight
RATIONALE :Assessing lung sounds is crucial in heart failure as it helps identify fluid
overload and pulmonary congestion, which can lead to respiratory distress.
QUESTION 2: The nurse notes crackles in the lung bases during the assessment of a
heart failure patient. What does this finding indicate?
A) Increased lung compliance
B) Pulmonary edema (CORRECT)
C) Decreased blood flow to the lungs
D) Normal lung function
RATIONALE :Crackles, or rales, are indicative of fluid in the alveoli, characteristic of
pulmonary edema due to heart failure.
QUESTION 3: What is the most appropriate nursing intervention for a patient
experiencing acute heart failure exacerbation?
A) Administering oral diuretics
B) Encouraging increased fluid intake
C) Positioning the patient in high Fowler’s position (CORRECT)
D) Providing supplemental oxygen via nasal cannula
RATIONALE :Positioning the patient in high Fowler’s position helps alleviate
shortness of breath and promotes better lung expansion.
QUESTION 4: A patient with heart failure is prescribed a low-sodium diet. What is
the rationale for this dietary restriction?
,A) To increase fluid retention
B) To enhance taste in meals
C) To prevent fluid retention (CORRECT)
D) To promote weight gain
RATIONALE :A low-sodium diet helps prevent fluid retention, which is critical in
managing heart failure and reducing workload on the heart.
QUESTION 5: The nurse is educating a patient with heart failure about daily
weights. What should the patient be instructed to do?
A) Weigh themselves only once a week
B) Weigh themselves at different times of the day
C) Weigh themselves at the same time each day (CORRECT)
D) Weigh themselves after exercise
RATIONALE :Weighing at the same time each day helps accurately monitor fluid
retention and weight gain, which are important indicators of heart failure status.
QUESTION 6: A patient with heart failure asks about the purpose of their prescribed
ACE inhibitor. What is the nurse's best response?
A) "It will help you sleep better."
B) "It helps relax your blood vessels and lowers blood pressure." (CORRECT)
C) "It will increase your heart rate."
D) "It will help prevent blood clots."
RATIONALE :ACE inhibitors help relax blood vessels, reduce blood pressure, and
decrease the workload on the heart, which is essential in heart failure management.
QUESTION 7: The patient reports feeling weak and dizzy after taking their diuretic.
What should the nurse assess first?
A) Electrolyte levels
B) Blood pressure (CORRECT)
C) Heart rate
D) Urine output
RATIONALE :Assessing blood pressure is critical as dizziness could indicate
hypotension, especially after diuretic therapy, which can lead to dehydration and
electrolyte imbalances.
,QUESTION 8: A patient with heart failure is being discharged with a prescription for
furosemide (Lasix). What should the nurse include in the discharge teaching?
A) Monitor for signs of electrolyte imbalance, such as muscle cramps.
(CORRECT)
B) Take the medication only when symptoms worsen.
C) Drink more fluids to avoid dehydration.
D) Avoid all physical activity.
RATIONALE :Patients on diuretics should be aware of signs of electrolyte imbalance,
as these can lead to serious complications.
QUESTION G: The patient’s heart failure is classified as NYHA Class II. What does
this classification indicate?
A) No symptoms with normal activity
B) Symptoms with moderate exertion (CORRECT)
C) Symptoms at rest
D) Severe limitations in activity
RATIONALE :NYHA Class II indicates that patients experience symptoms with
moderate exertion but are comfortable at rest.
QUESTION 10: A nurse is caring for a heart failure patient who is experiencing
anxiety. What is the most appropriate nursing intervention?
A) Administering sedatives as ordered
B) Ignoring the patient’s concerns
C) Providing reassurance and information (CORRECT)
D) Encouraging the patient to stay alone
RATIONALE :Providing reassurance and clear information helps alleviate anxiety by
addressing the patient’s concerns and improving their understanding of their condition.
QUESTION 11: A patient with heart failure is being monitored for fluid overload.
What is the most reliable indicator of fluid retention?
A) Daily weight
B) Blood pressure
C) Peripheral edema (CORRECT)
D) Heart rate
RATIONALE :Daily weight is the most reliable indicator of fluid retention, as even
small increases can signify fluid overload in heart failure patients.
, QUESTION 12: The nurse notes that the patient’s heart failure is exacerbated by
noncompliance with medications. What is the best approach to address this issue?
A) Increase medication dosage
B) Schedule more frequent follow-up appointments
C) Educate the patient on the importance of adherence (CORRECT)
D) Refer the patient to a specialist
RATIONALE :Educating the patient on the importance of medication adherence can
improve compliance and help manage heart failure more effectively.
QUESTION 13: A patient with heart failure is experiencing nocturnal dyspnea. What
is the best nursing intervention?
A) Encourage daytime napping
B) Administer bronchodilators
C) Elevate the head of the bed at night (CORRECT)
D) Limit fluid intake before bedtime
RATIONALE :Elevating the head of the bed can help alleviate nocturnal dyspnea by
reducing venous return and pulmonary congestion during sleep.
QUESTION 14: A nurse is teaching a patient about the signs of worsening
heart failure. Which symptom should the nurse emphasize?
A) Increased appetite
B) Mild fatigue
C) Sudden weight gain (CORRECT)
D) Occasional cough
RATIONALE :Sudden weight gain can indicate fluid retention and worsening heart
failure, making it a critical symptom for patients to monitor.
QUESTION 15: A patient with heart failure asks about the role of beta-blockers in
their treatment. What is the best response from the nurse?
A) "They will help you sleep better."
B) "They decrease heart rate and help the heart pump more efficiently."
(CORRECT)
C) "They will increase your blood pressure."
D) "They are used to relieve shortness of breath."
RATIONALE :Beta-blockers decrease heart rate and improve cardiac output, which is
beneficial in managing heart failure.
2025/2026 | Unfolding Clinical Reasoning Case Study
on Heart Failure | 220+ Verified NCLEX Next Gen
Questions with Detailed Rationales | Comprehensive
Test Bank & Study Guide for RN, BSN, and Nursing
Students Mastering Heart Failure and Clinical
Judgment
QUESTION 1: A patient with heart failure presents with shortness of breath and
edema. What is the priority nursing assessment?
A) Heart rate and rhythm
B) Oxygen saturation levels
C) Lung sounds (CORRECT)
D) Weight
RATIONALE :Assessing lung sounds is crucial in heart failure as it helps identify fluid
overload and pulmonary congestion, which can lead to respiratory distress.
QUESTION 2: The nurse notes crackles in the lung bases during the assessment of a
heart failure patient. What does this finding indicate?
A) Increased lung compliance
B) Pulmonary edema (CORRECT)
C) Decreased blood flow to the lungs
D) Normal lung function
RATIONALE :Crackles, or rales, are indicative of fluid in the alveoli, characteristic of
pulmonary edema due to heart failure.
QUESTION 3: What is the most appropriate nursing intervention for a patient
experiencing acute heart failure exacerbation?
A) Administering oral diuretics
B) Encouraging increased fluid intake
C) Positioning the patient in high Fowler’s position (CORRECT)
D) Providing supplemental oxygen via nasal cannula
RATIONALE :Positioning the patient in high Fowler’s position helps alleviate
shortness of breath and promotes better lung expansion.
QUESTION 4: A patient with heart failure is prescribed a low-sodium diet. What is
the rationale for this dietary restriction?
,A) To increase fluid retention
B) To enhance taste in meals
C) To prevent fluid retention (CORRECT)
D) To promote weight gain
RATIONALE :A low-sodium diet helps prevent fluid retention, which is critical in
managing heart failure and reducing workload on the heart.
QUESTION 5: The nurse is educating a patient with heart failure about daily
weights. What should the patient be instructed to do?
A) Weigh themselves only once a week
B) Weigh themselves at different times of the day
C) Weigh themselves at the same time each day (CORRECT)
D) Weigh themselves after exercise
RATIONALE :Weighing at the same time each day helps accurately monitor fluid
retention and weight gain, which are important indicators of heart failure status.
QUESTION 6: A patient with heart failure asks about the purpose of their prescribed
ACE inhibitor. What is the nurse's best response?
A) "It will help you sleep better."
B) "It helps relax your blood vessels and lowers blood pressure." (CORRECT)
C) "It will increase your heart rate."
D) "It will help prevent blood clots."
RATIONALE :ACE inhibitors help relax blood vessels, reduce blood pressure, and
decrease the workload on the heart, which is essential in heart failure management.
QUESTION 7: The patient reports feeling weak and dizzy after taking their diuretic.
What should the nurse assess first?
A) Electrolyte levels
B) Blood pressure (CORRECT)
C) Heart rate
D) Urine output
RATIONALE :Assessing blood pressure is critical as dizziness could indicate
hypotension, especially after diuretic therapy, which can lead to dehydration and
electrolyte imbalances.
,QUESTION 8: A patient with heart failure is being discharged with a prescription for
furosemide (Lasix). What should the nurse include in the discharge teaching?
A) Monitor for signs of electrolyte imbalance, such as muscle cramps.
(CORRECT)
B) Take the medication only when symptoms worsen.
C) Drink more fluids to avoid dehydration.
D) Avoid all physical activity.
RATIONALE :Patients on diuretics should be aware of signs of electrolyte imbalance,
as these can lead to serious complications.
QUESTION G: The patient’s heart failure is classified as NYHA Class II. What does
this classification indicate?
A) No symptoms with normal activity
B) Symptoms with moderate exertion (CORRECT)
C) Symptoms at rest
D) Severe limitations in activity
RATIONALE :NYHA Class II indicates that patients experience symptoms with
moderate exertion but are comfortable at rest.
QUESTION 10: A nurse is caring for a heart failure patient who is experiencing
anxiety. What is the most appropriate nursing intervention?
A) Administering sedatives as ordered
B) Ignoring the patient’s concerns
C) Providing reassurance and information (CORRECT)
D) Encouraging the patient to stay alone
RATIONALE :Providing reassurance and clear information helps alleviate anxiety by
addressing the patient’s concerns and improving their understanding of their condition.
QUESTION 11: A patient with heart failure is being monitored for fluid overload.
What is the most reliable indicator of fluid retention?
A) Daily weight
B) Blood pressure
C) Peripheral edema (CORRECT)
D) Heart rate
RATIONALE :Daily weight is the most reliable indicator of fluid retention, as even
small increases can signify fluid overload in heart failure patients.
, QUESTION 12: The nurse notes that the patient’s heart failure is exacerbated by
noncompliance with medications. What is the best approach to address this issue?
A) Increase medication dosage
B) Schedule more frequent follow-up appointments
C) Educate the patient on the importance of adherence (CORRECT)
D) Refer the patient to a specialist
RATIONALE :Educating the patient on the importance of medication adherence can
improve compliance and help manage heart failure more effectively.
QUESTION 13: A patient with heart failure is experiencing nocturnal dyspnea. What
is the best nursing intervention?
A) Encourage daytime napping
B) Administer bronchodilators
C) Elevate the head of the bed at night (CORRECT)
D) Limit fluid intake before bedtime
RATIONALE :Elevating the head of the bed can help alleviate nocturnal dyspnea by
reducing venous return and pulmonary congestion during sleep.
QUESTION 14: A nurse is teaching a patient about the signs of worsening
heart failure. Which symptom should the nurse emphasize?
A) Increased appetite
B) Mild fatigue
C) Sudden weight gain (CORRECT)
D) Occasional cough
RATIONALE :Sudden weight gain can indicate fluid retention and worsening heart
failure, making it a critical symptom for patients to monitor.
QUESTION 15: A patient with heart failure asks about the role of beta-blockers in
their treatment. What is the best response from the nurse?
A) "They will help you sleep better."
B) "They decrease heart rate and help the heart pump more efficiently."
(CORRECT)
C) "They will increase your blood pressure."
D) "They are used to relieve shortness of breath."
RATIONALE :Beta-blockers decrease heart rate and improve cardiac output, which is
beneficial in managing heart failure.
