A patient with left-sided heart failure would most likely present with which findings?

Dyspnea, orthopnea, and crackles in the lungs. Left-sided heart failure causes blood to back up into the pulmonary system, leading to pulmonary symptoms: dyspnea, orthopnea (difficulty breathing when lying flat), crackles, and possibly pink frothy sputum. Right-sided failure causes systemic symptoms (JVD, peripheral edema, hepatomegaly).

A patient with atrial fibrillation is at increased risk for which complication?

Stroke. Atrial fibrillation causes the atria to quiver rather than contract effectively, allowing blood to pool and form clots. These clots can travel to the brain, causing stroke. Anticoagulation is a key treatment to prevent this complication.

Which finding differentiates arterial insufficiency from venous insufficiency?

Arterial: diminished pulses; Venous: present pulses. In arterial insufficiency, pulses are diminished or absent because blood flow to the extremity is compromised. In venous insufficiency, arterial flow is normal so pulses are present. Arterial disease has pain with elevation; venous has pain with dependency.

9.2 Cardiovascular Alterations | NCLEX-PN (Practical Nurse) | Free Exam Prep

Cardiovascular Alterations

Cardiovascular conditions are among the leading causes of death and disability. LPN/VNs must recognize signs and symptoms of cardiovascular alterations and understand appropriate nursing interventions.

Heart Failure

Heart failure occurs when the heart cannot pump enough blood to meet the body's needs.

Types of Heart Failure:

Type	Description	Key Findings
Left-Sided (Most Common)	Left ventricle fails, blood backs up into lungs	Pulmonary congestion: dyspnea, orthopnea, crackles, pink frothy sputum
Right-Sided	Right ventricle fails, blood backs up into systemic circulation	Systemic congestion: JVD, peripheral edema, hepatomegaly, ascites
Systolic	Reduced ejection fraction (< 40%)	Weak contractions, low cardiac output
Diastolic	Preserved ejection fraction, stiff ventricle	Normal EF, impaired filling

Heart Failure Management:

Intervention	Purpose
Daily weights	Detect fluid retention early (report gain > 2-3 lb/day)
I&O monitoring	Track fluid balance
Low sodium diet	Reduce fluid retention (< 2,000 mg/day)
Fluid restriction	May be ordered in severe cases
Elevate HOB	Reduce preload, ease breathing
Medications	Diuretics, ACE inhibitors, beta blockers, digoxin
Oxygen therapy	Improve oxygenation

Coronary Artery Disease and Myocardial Infarction

Angina vs. Myocardial Infarction:

Feature	Stable Angina	Unstable Angina	Myocardial Infarction
Trigger	Predictable (exertion, stress)	Unpredictable, at rest	Often at rest
Duration	< 5 minutes	> 15 minutes	> 30 minutes
Relief	Rest, nitroglycerin	May not respond to NTG	Does not respond to NTG
Troponin	Negative	Usually negative	Elevated

MI Signs and Symptoms:

Chest pain/pressure (substernal, may radiate to arm, jaw, back)
Diaphoresis
Nausea/vomiting
Dyspnea
Anxiety, sense of impending doom
Atypical presentation (especially women, elderly, diabetics): Fatigue, indigestion, back pain

MI Management (MONA):

Morphine (pain relief, reduces oxygen demand)
Oxygen (if SpO2 < 94%)
Nitroglycerin (vasodilation, but not if hypotensive)
Aspirin (antiplatelet)

Arrhythmias

Common Arrhythmias:

Arrhythmia	Characteristics	Clinical Significance
Sinus Bradycardia	HR < 60, regular rhythm	May be normal in athletes; concerning if symptomatic
Sinus Tachycardia	HR > 100, regular rhythm	Response to fever, pain, anxiety, hypovolemia
Atrial Fibrillation	Irregular irregular rhythm, no P waves	Increased stroke risk; anticoagulation needed
Atrial Flutter	Sawtooth pattern, regular rhythm	May progress to A-fib
Ventricular Tachycardia	Wide QRS, rate > 100	Medical emergency if sustained
Ventricular Fibrillation	Chaotic, no organized rhythm	Cardiac arrest—immediate defibrillation
Asystole	Flat line	Cardiac arrest—CPR, epinephrine

Atrial Fibrillation Management:

Rate control (beta blockers, calcium channel blockers, digoxin)
Anticoagulation (warfarin, DOACs) to prevent stroke
Rhythm control (cardioversion, antiarrhythmics) in some cases

Peripheral Vascular Disease

Arterial vs. Venous Disease:

Feature	Arterial Insufficiency	Venous Insufficiency
Pain	Intermittent claudication, rest pain	Aching, heaviness
Skin	Pale, shiny, hairless, cool	Brownish discoloration, warm
Pulses	Diminished or absent	Present
Edema	Minimal	Significant
Ulcers	Painful, on toes/heel/lateral ankle	Less painful, medial ankle
Position	Worse when elevated, better when dependent	Worse when dependent, better when elevated

Nursing Interventions:

Arterial disease: Keep extremities warm (not hot), position with legs slightly dependent, avoid crossing legs, smoking cessation
Venous disease: Elevate legs, compression stockings, avoid prolonged standing, exercise

Shock

Type	Cause	Key Findings	Treatment Focus
Hypovolemic	Blood/fluid loss	Tachycardia, hypotension, oliguria	Volume replacement
Cardiogenic	Pump failure (MI, HF)	Elevated JVP, crackles, hypotension	Inotropes, reduce workload
Distributive/Septic	Vasodilation from infection	Warm initially, then cold; fever; altered LOC	Antibiotics, fluids, vasopressors
Anaphylactic	Allergic reaction	Urticaria, angioedema, stridor, hypotension	Epinephrine, antihistamines
Neurogenic	Spinal cord injury	Bradycardia with hypotension, warm dry skin	Fluids, vasopressors

Early Signs of Shock:

Tachycardia (compensatory)
Restlessness, anxiety
Tachypnea
Decreased urine output
Cool, pale, clammy skin (except distributive/neurogenic)

Late Signs of Shock:

Hypotension
Confusion, decreased LOC
Weak, thready pulse
Anuria
Mottled skin

NCLEX-PN

1Introduction to the NCLEX-PN

2Chapter 2: Coordinated Care

3Chapter 3: Safety and Infection Prevention and Control

4Chapter 4: Health Promotion and Maintenance

5Chapter 5: Psychosocial Integrity

6Basic Care and Comfort

7Pharmacological and Parenteral Therapies

8Reduction of Risk Potential

9Physiological Adaptation

Key Takeaways