Heart Failure: NCLEX Priorities
HF for NCLEX: left vs right, pulmonary vs systemic congestion, BNP, ACE/ARB + beta-blocker + diuretic, daily weights.
Heart failure is one of the most-tested cardiac topics. The NCLEX expects you to distinguish left vs right, pick the right meds, and teach daily weights and salt restriction.
Left vs right
Left HF → pulmonary congestion (crackles, dyspnea, pink frothy sputum, orthopnea, PND). Right HF → systemic congestion (JVD, peripheral edema, hepatomegaly, ascites, weight gain).
Diagnostics
BNP elevated (>100 suggests HF; higher = more severe). Echo for EF. CXR for pulmonary congestion.
Drugs (GDMT)
ACE/ARB or ARNI, beta-blocker (carvedilol, metoprolol succinate), aldosterone antagonist (spironolactone), SGLT2 inhibitor. Diuretics for symptom control (furosemide).
Teaching
Daily weights at same time, same scale, same clothes. Report gain >2 lb/day or 5 lb/week. Low-sodium diet (<2 g/day). Activity as tolerated. Vaccinations.
Acute exacerbation
Sit upright, O2, diuretic, morphine (controversial), reduce preload. 'LMNOP': Lasix, morphine, nitrates, O2, position upright.
Frequently asked
EF normal but symptoms, HF still?
HFpEF (preserved EF). Manage HTN, diuretic, SGLT2 inhibitor.
Spironolactone, when?
NYHA II-IV with reduced EF. Mortality benefit. Watch K+.
Quick check
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