CHF NCLEX Questions with Rationales: Complete Practice Guide for Nursing Students
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Preparing for the NCLEX exam requires mastering cardiovascular disorders, and congestive heart failure (CHF) is one of the most frequently tested topics. Understanding CHF pathophysiology, clinical manifestations, and nursing interventions is essential for passing your exam and providing quality patient care.
This comprehensive guide provides practice questions with detailed rationales to help you master CHF concepts for the NCLEX exam.
Understanding Congestive Heart Failure (CHF)
Congestive heart failure occurs when the heart cannot pump blood efficiently enough to meet the body’s metabolic needs. This inefficiency results from various conditions that damage or overwork the heart muscle, including coronary artery disease, hypertension, and myocardial infarction.
Types of Heart Failure
Left-Sided Heart Failure: When the left ventricle fails to pump effectively, blood backs up into the pulmonary circulation, causing fluid accumulation in the lungs. This leads to pulmonary congestion and respiratory symptoms.
Right-Sided Heart Failure: When the right ventricle fails, blood backs up into the systemic circulation, causing peripheral edema, jugular venous distention, and hepatomegaly.
Systolic vs. Diastolic Dysfunction: Systolic heart failure involves reduced ejection fraction (inability to pump), while diastolic heart failure involves impaired filling (stiff ventricles).
The New York Heart Association classifies heart failure severity:
Class I: No limitation of physical activity
Class II: Slight limitation; comfortable at rest
Class III: Marked limitation; less than ordinary activity causes symptoms
Class IV: Unable to carry out any activity without symptoms; symptoms at rest
Memory Tip: “I Need My Rest” (I-no Restriction, II-slight, III-marked, IV-rest)
CHF NCLEX Questions with Rationales
Question 1: Assessment Findings
A nurse is assessing a patient admitted with acute exacerbation of congestive heart failure. Which assessment findings would the nurse expect?
A. Bradycardia and decreased urine output B. Hypertension and clear lung sounds C. Tachycardia, crackles in lungs, and peripheral edema D. Hypotension and increased appetite
Correct Answer: C
Rationale: Patients with acute CHF exacerbation typically present with tachycardia (compensatory mechanism), pulmonary crackles (left-sided failure causing pulmonary congestion), and peripheral edema (right-sided failure or fluid overload). The heart attempts to compensate for decreased cardiac output by increasing heart rate. Options A, B, and D do not reflect typical CHF presentation.
Question 2: Medication Management
The healthcare provider prescribes furosemide (Lasix) 40 mg IV for a patient with CHF. Which assessment is the priority before administering this medication?
A. Blood glucose level B. Potassium level C. White blood cell count D. Liver enzymes
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium loss through increased urinary excretion. Hypokalemia can lead to dangerous cardiac arrhythmias, especially in patients with heart disease. The nurse must check the potassium level before administration and monitor for signs of hypokalemia throughout treatment. Normal potassium range is 3.5-5.0 mEq/L.
Question 3: Discharge Teaching
A nurse is providing discharge teaching to a patient with chronic heart failure. Which statement by the patient indicates understanding of fluid management?
A. “I should drink at least 3 liters of water daily.” B. “I will weigh myself weekly and report any changes.” C. “I will weigh myself every morning and call my doctor if I gain 3 pounds in 2 days.” D. “I can eat whatever I want as long as I take my medications.”
Correct Answer: C
Rationale: Daily weight monitoring is crucial for CHF patients to detect fluid retention early. A weight gain of 2-3 pounds in one day or 5 pounds in one week indicates fluid retention and requires prompt medical attention. Patients should limit fluid intake (not increase it), monitor weight daily (not weekly), and follow a low-sodium diet to prevent fluid retention.
Question 4: Pharmacology
A patient with CHF is prescribed digoxin 0.125 mg PO daily. Before administering the medication, the nurse notes the patient’s apical pulse is 58 beats per minute. What is the appropriate nursing action?
A. Administer the medication as ordered B. Withhold the medication and notify the physician C. Give half the dose and reassess in one hour D. Administer the medication with food
Correct Answer: B
Rationale: Digoxin slows the heart rate and increases contractility. The standard protocol is to withhold digoxin if the apical pulse is below 60 beats per minute in adults and notify the physician. Administering digoxin when the heart rate is already low can cause dangerous bradycardia and heart blocks. The nurse should never adjust medication doses independently.
Question 5: Priority Assessment
The nurse is caring for a patient receiving nesiritide (Natrecor) for acute decompensated heart failure. What is the priority assessment?
A. Urine output B. Blood pressure C. Respiratory rate D. Temperature
Correct Answer: B
Rationale: Nesiritide is a vasodilator that can cause significant hypotension, which is the most serious side effect. The nurse must monitor blood pressure closely, especially during the first few hours of infusion. While monitoring other vital signs is important, preventing hypotensive episodes is the priority to maintain adequate tissue perfusion.
Question 6: Diagnostic Tests
A patient presents to the emergency department with suspected heart failure. Which laboratory value most specifically indicates heart failure?
A. Elevated troponin level B. Elevated BNP (B-type natriuretic peptide) C. Decreased hemoglobin D. Elevated white blood cell count
Correct Answer: B
Rationale: BNP is released by the ventricles in response to stretching caused by increased volume and pressure. Elevated BNP levels (>100 pg/mL) are highly specific for heart failure. The higher the BNP level, the more severe the heart failure. Troponin indicates myocardial damage, hemoglobin relates to oxygen-carrying capacity, and WBC suggests infection or inflammation.
Question 7: ACE Inhibitors
The nurse is teaching a patient with CHF about the newly prescribed ACE inhibitor lisinopril. Which instruction is most important?
A. “Take the medication with a potassium supplement.” B. “Change positions slowly to prevent dizziness.” C. “Take the medication on an empty stomach.” D. “Expect a productive cough, which is normal.”
Correct Answer: B
Rationale: ACE inhibitors cause vasodilation, which can lead to orthostatic hypotension, especially when initiating therapy. Patients should be instructed to rise slowly from sitting or lying positions and sit on the edge of the bed before standing. ACE inhibitors are potassium-sparing, so supplements are not needed. A persistent dry cough is a side effect that should be reported, not expected as normal.
Question 8: Activity Tolerance
A patient with Class III heart failure asks about exercise. What is the best nursing response?
A. “You should avoid all physical activity to rest your heart.” B. “Gradually increase activity as tolerated with rest periods.” C. “Exercise vigorously for 30 minutes daily.” D. “Only exercise when you feel well.”
Correct Answer: B
Rationale: Patients with Class III heart failure have marked limitation but benefit from gradual activity increase with adequate rest periods. Complete bed rest leads to deconditioning and increases thromboembolic risk. Activity should be balanced with rest, and patients should stop if experiencing dyspnea, chest pain, or excessive fatigue. Vigorous exercise is inappropriate for Class III patients.
Question 9: Dietary Management
Which meal choice by a CHF patient indicates understanding of dietary restrictions?
A. Grilled chicken, canned vegetables, and whole wheat bread B. Ham sandwich with pickles and potato chips C. Baked salmon, fresh steamed broccoli, and brown rice D. Frozen dinner, crackers, and canned soup
Correct Answer: C
Rationale: CHF patients require a low-sodium diet (typically <2 grams/day) to prevent fluid retention. Fresh foods like baked salmon, steamed vegetables, and brown rice are naturally low in sodium. Canned, processed, and frozen foods (options A, B, and D) are typically high in sodium and should be avoided.
Question 10: Complications
A patient with CHF develops confusion, muscle weakness, and nausea. The patient is taking furosemide and digoxin. The nurse suspects which complication?
A. Hyperkalemia B. Hypokalemia C. Fluid overload D. Hypercalcemia
Correct Answer: B
Rationale: Furosemide causes potassium loss, and hypokalemia increases the risk of digoxin toxicity. Symptoms of hypokalemia include confusion, muscle weakness, fatigue, and arrhythmias. These symptoms also overlap with digoxin toxicity. The nurse should check potassium levels immediately and anticipate holding digoxin until levels are corrected.
Monitor vital signs: Especially blood pressure, heart rate, and oxygen saturation
Daily weights: Same time, same scale, same clothing
Fluid balance: Monitor intake and output carefully
Position patient: Semi-Fowler’s or high Fowler’s to reduce dyspnea
Oxygen therapy: As ordered to maintain SpO2 >90%
Medication administration: Follow protocols for cardiac medications
Patient education: Diet, medications, activity, symptoms to report
Patient Education Priorities
Symptoms to Report Immediately:
Sudden weight gain (2-3 lbs in 1 day or 5 lbs in 1 week)
Increased shortness of breath
Swelling in legs, feet, or abdomen
Persistent cough or pink frothy sputum
Dizziness or fainting
Rapid or irregular heartbeat
Lifestyle Modifications:
Limit sodium intake to less than 2 grams daily
Restrict fluid intake as prescribed
Balance activity with rest periods
Avoid alcohol and smoking
Take medications as prescribed
Monitor weight daily
NCLEX Test-Taking Strategies for CHF Questions
Prioritize ABCs: Airway, Breathing, Circulation always come first
Recognize left vs right-sided failure: Know which symptoms belong to each
Medication safety: Know what to check before giving cardiac drugs
Patient education: Focus on prevention and early detection
Complications: Understand electrolyte imbalances and drug toxicities
Common NCLEX Pitfalls to Avoid
Forgetting to check apical pulse before giving digoxin or beta blockers
Not recognizing orthostatic hypotension risk with vasodilators
Confusing signs of left-sided vs right-sided failure
Missing drug interactions between diuretics and cardiac glycosides
Not understanding NYHA classification implications for care
Conclusion
Mastering CHF concepts is essential for NCLEX success. Focus on understanding pathophysiology, recognizing clinical manifestations, medication management, and patient education. Practice questions with rationales help reinforce these concepts and improve your critical thinking skills.
Remember to prioritize patient safety, monitor for complications, and always use the nursing process: Assessment, Diagnosis, Planning, Implementation, and Evaluation. Regular practice with NCLEX-style questions will build your confidence and prepare you for exam day success.
Disclaimer: This content is for educational purposes only. Always follow current NCLEX guidelines and your nursing program’s protocols. Consult with your instructors and use official NCLEX review materials for comprehensive preparation.
