Of the following responses, what would you expect to see in left sided heart failure? (Select all that apply)

Elevated PCWP, tachycardia/tachypnea

Cough, edema

Dyspnea, weight gain. Cheyne-Stokes respiration

Fatigue, crackles, cough

JVD. increased abdominal girth

Edema, S3 and S4

Answer and Explanation

Correct Answer : A,C,D,F

A. Left-sided heart failure leads to pulmonary congestion because the left ventricle cannot pump blood effectively, causing increased pulmonary venous pressure. This manifests as an elevated pulmonary capillary wedge pressure (PCWP), tachycardia, and tachypnea as compensatory mechanisms to maintain oxygenation and cardiac output.

B. While cough can occur in left-sided heart failure due to pulmonary congestion, peripheral edema is more characteristic of right-sided heart failure, not left-sided. Cough alone without other pulmonary signs is nonspecific.

C. Dyspnea on exertion or at rest is a hallmark of left-sided failure due to pulmonary fluid accumulation. Weight gain may occur from fluid retention, and Cheyne-Stokes respiration, a pattern of periodic breathing, can occur in advanced left-sided heart failure, particularly at night.

D. Fatigue results from decreased cardiac output, and crackles (rales) on auscultation indicate fluid in the alveoli from pulmonary congestion. A persistent cough is also associated with left-sided heart failure due to fluid buildup in the lungs.

E. Jugular venous distention (JVD) and hepatomegaly/ascites (increased abdominal girth) are classic signs of right-sided heart failure, not left-sided. Left-sided failure primarily affects the lungs, not systemic venous circulation.

F. Pulmonary edema may occur secondary to left ventricular dysfunction. An S3 gallop reflects increased volume in the ventricle during diastole, while an S4 gallop indicates stiff or noncompliant ventricles, both of which are associated with left-sided heart failure. Peripheral edema is less prominent but may appear if failure progresses to biventricular involvement.

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Correct Answer is C

Explanation

A. Beta-blockers, such as metoprolol or esmolol, are commonly used to slow the ventricular rate in certain tachyarrhythmias like atrial fibrillation or atrial flutter, especially when the patient is hemodynamically stable. However, in this scenario, the patient is symptomatic with a very high heart rate (165 bpm), which may indicate compromised cardiac output. Symptoms may include hypotension, chest pain, shortness of breath, or altered mental status. In unstable patients, beta-blockers are too slow to reverse the hemodynamic instability, making emergent cardioversion the appropriate first-line treatment.

B. Pacemakers are indicated for bradycardia or high-grade heart block, not tachyarrhythmias. Using a pacemaker in a patient with supraventricular tachycardia (SVT) or other narrow complex tachycardias would not correct the rapid heart rate and may worsen patient condition.

C. This patient demonstrates narrow complex tachycardia (likely SVT) that is regular and rapid, with symptoms indicating hemodynamic instability. According to ACLS (Advanced Cardiac Life Support) guidelines, synchronized electrical cardioversion is indicated for unstable tachyarrhythmias to restore sinus rhythm promptly. Synchronized cardioversion ensures the electrical shock is delivered during the R wave to avoid inducing ventricular fibrillation. Emergent cardioversion is prioritized over medications when a patient is unstable because it immediately restores cardiac output and perfusion.

D. Atropine is an anticholinergic drug used primarily for bradycardia to increase heart rate by blocking vagal stimulation. Administering atropine to a patient with tachycardia would be inappropriate and could further increase heart rate, worsening myocardial oxygen demand and precipitating ischemia or hemodynamic collapse.

A. Metabolic acidosis B. Respiratory alkalosis C. Metabolic alkalosis D. Respiratory acidosis

Correct Answer is D

Explanation

A. Metabolic acidosis results from increased acid production, decreased acid excretion, or bicarbonate loss (e.g., diabetic ketoacidosis, renal failure, diarrhea). The scenario describes hypoventilation due to opioid-induced respiratory depression, which is a respiratory problem, not a metabolic one.

B. Respiratory alkalosis occurs when there is hyperventilation, leading to excessive carbon dioxide elimination (PaCO₂ < 35 mm Hg). In this patient, morphine depresses spontaneous respirations, causing hypoventilation, not hyperventilation.

C. Metabolic alkalosis results from bicarbonate excess or hydrogen ion loss (e.g., vomiting, diuretics), which is unrelated to this patient’s ventilatory changes.

D. Respiratory acidosis occurs when alveolar ventilation decreases, causing carbon dioxide retention (PaCO₂ > 45 mm Hg) and lowering pH. Morphine sulfate depresses the patient’s spontaneous respirations from 12 to 4 breaths per minute, significantly reducing CO₂ elimination. Since the SIMV rate is low (4 breaths/min), total ventilation is inadequate, leading to CO₂ accumulation and respiratory acidosis.

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Of the following responses, what would you expect to see in left sided heart failure? (Select all that apply)

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Naxlex Comprehensive Predictor Exams

The patient's heart rate is 165 beats per minute and his cardiac monitor shows a rapid rate with narrow QRS complexes; the waves cannot be seen, but the rhythm is regular. The patient is symptomatic, so the nurse prepares the patient for:

Correct Answer is C

Explanation

Correct Answer is D

Explanation

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