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Nurse Competence and Knowledge Survey

The validation of this survey is published in Patient Education and Counseling; Volume 67, Issues 1-2, July 2007, Pages 3-10 (Goodlin SJ, Trupp R, Bernhardt P, Grady KL, Dracup K. Development and evaluation of the “Advanced Heart Failure Clinical Competence Survey”: A tool to assess knowledge of heart failure care and self-assessed competence).

The validation of this survey is published in Patient Education and Counseling; Volume 67, Issues 1-2, July 2007, Pages 3-10 (Goodlin SJ, Trupp R, Bernhardt P, Grady KL, Dracup K. Development and evaluation of the “Advanced Heart Failure Clinical Competence Survey”: A tool to assess knowledge of heart failure care and self-assessed competence).

Please rate the following statements as they pertain to <u>you in your care</u> for patients with <u>advanced heart failure</u>.
 1 = not at all true 5 = completely true

1 I know the specific aspects of the history and physical to assess 1 2 3 4 5
2 I know the manifestations of dysfunction in specific organ systems associated with worsening heart failure 1 2 3 4 5
3 I know which diagnostic tests to review to assess the patient’s status 1 2 3 4 5
4 I know what changes in vital signs mean regarding effectiveness of medical therapy or worsening heart failure 1 2 3 4 5
5 I know the possible courses of illness for patients with advanced heart failure. 1 2 3 4 5
6 I know the signs and symptoms associated with increased volume status. 1 2 3 4 5
7 I know the signs and symptoms associated with low cardiac output. 1 2 3 4 5
8 I am able to evaluate signs and symptom severity in a heart failure patient relevant to their medical status and care goals. 1 2 3 4 5
9 I understand what clinical data correlate with poor prognosis. 1 2 3 4 5
10 I understand why specific medications are prescribed for patients with heart failure. 1 2 3 4 5
11 I understand the doses, drug interactions, and side effects of heart failure medications. 1 2 3 4 5
12 I am able to instruct patients in dietary sodium intake, fluid restriction and titration of diuretics according to their weight and symptoms. 1 2 3 4 5
13 I am able to review goals with patients in the context of new or persistent problems. 1 2 3 4 5
14 I am able to assess patient or family distress and integrate interdisciplinary team recommendations for management of distress. 1 2 3 4 5
15 I know what heart failure medications and other treatments might relieve dyspnea. 1 2 3 4 5
16 I know how to help patients and families cope with fears, guilt and grief. 1 2 3 4 5
17 I know how to provide bereavement support for a family after the patient’s death. 1 2 3 4 5
18 I am comfortable talking with patients and families about prognosis and dying from heart failure 1 2 3 4 5

Please answer the following questions “true” or “false” for patients with advanced heart failure

19 Diuretic doses should be adjusted to keep BUN and creatinine levels within normal range. True False
20 Non-steroidal anti-inflammatory drugs (NSAIDs) are a good first line treatment for joint pain. True False
21 Liver function worsens with worsening heart failure. True False
22 Clear lung fields on exam rule out fluid over-load True False
23 Over one-half of patients have pain. True False
24 Fatigue may be the most prominent symptom. True False
25 When the goal becomes palliative care, continuous intravenous inotrope therapy should be discontinued. True False
26 Patients with hypoperfusion and low cardiac output generally have high blood pressure, rales and edema. True False
27 A patient with a serum creatinine of 1.8 mg/dl has equivalent prognosis to a patient with creatinine of 2.2 mg/dl. True False
28 Serum sodium of 134 mg/dl is associated with better prognosis than sodium of 137 mg/dl. True False
29 A patient whose extremities are cool and blood pressure is less than 90 mm Hg systolic has a better prognosis than a patient whose hands are warm but has rales half-way up the lung fields. True False
30 In a patient who wishes palliation of symptoms, parenteral diuretics may be needed to promote diuresis. True False
31 A patient with advanced heart failure can decrease volume status by eliminating salt from the diet. True False
32 Spironolactone is given primarily because it is a potassium-sparing diuretic. True False
33 Approximately one-third of patients with advanced heart failure have memory impairment True False
34 Reducing the spouse’ distress will improve the patient’s status. True False
35 Opioids and nitrates may relieve dyspnea from fluid overload in decompensated heart failure. True False
36 ACE Inhibitors and diuretics are not likely to reduce dyspnea. True False
37 A persistent cough in patients taking ACE inhibitors suggests the drug should be stopped. True False
38 Patients who tolerate Beta blocker therapy should be encouraged to take their ACE inhibitors and Beta blockers at the same time each morning. True False
39 A left ventricular ejection fraction of >30% is an indicator of severe left ventricular dysfunction. True False
40 It is not necessary to weigh end-stage heart failure patients every day. True False
41 A blood pressure of 88/56 mm Hg is not worrisome if the patient’s previous value was 92 /60 mm Hg and symptoms have not worsened. True False
42 Once placed in a patient, an Implantable Cardioverter Defibrillator (ICD) can not be deactivated True False
43 Sleep-disordered breathing worsens heart failure. True False

Please answer the following multiple choice questions regarding care for patients with advanced heart failure:

44. Mr. Smith is a 77 year old man with heart failure (ejection fraction 25% one year ago) who comes in with symptoms of fatigue and anxiety. His wife died 6 months ago and he lives alone. What is the most appropriate first step?

  1. Examine heart and lungs for decompensated heart failure
  2. Social work evaluation for social support needs
  3. Depression screen and begin a Selective Serontonin Reuptake Inhibitor
  4. Begin lorazepam 0.5 mg PO three times daily as needed for anxiety.

45. You evaluate Mrs. Jones, an 80 year old woman with heart failure. Her husband complains they are exhausted. Which of the following are NOT appropriate evaluations of Mrs. Jones?

  1. Sleep study
  2. Weight, cardiac and pulmonary exam
  3. Social work with attention to husband’s anxiety and function
  4. Electrolytes BUN and creatinine

46. Which aspects of the history for a heart failure patient <u>DO NOT</u> suggest worsening of their clinical status?

  1. Weight gain of 5 pounds in the past week
  2. Using more pillows at night to sleep
  3. Worsening fatigue with daily activities
  4. Weight loss of 5 pounds in the past week

47. You assess Joe Smith, a 72 year old man with coronary disease and heart failure. Which of the following <u>SHOULD NOT</u> make you worry that he is fluid-overloaded?

  1. His weight is increased 3 pounds since last week and he awakens in the middle of the night.
  2. He tells you he ate ham last Saturday night.
  3. He reports less frequent angina.
  4. On exam his jugular venous pressure is 16 and he has an S3 gallop.

48. Which of the following statements <u>IS NOT</u> true regarding the trajectory of illness with advanced heart failure?

  1. A patient may have multiple episodes of decompensated heart failure that respond to intravenous medications over 2 years.
  2. A patient admitted for NYHA Class IV heart failure who achieves a normal volume status with medication titration has a prognosis of 2 years or longer.
  3. A patient may deny shortness of breath.
  4. Patients have normal functional status until just before death.

49. Which of the following explain an irregularly irregular pulse?

  1. Aortic stenosis
  2. Low cardiac output
  3. Ventricular ectopy
  4. Atrial fibrillation

50. Which of the following medications directly improve disorders in the renin-angiotensin system in heart failure?

  1. ACE Inhibitors
  2. Loop diuretics
  3. Digitalis
  4. Nitrates

51. Which of the following is <u>NOT</u> true regarding a heart failure exacerbation resulting in severe dyspnea?

  1. May cause the patient to fear suffocation
  2. Might result in the patient or family calling 911
  3. Should be anticipated with a plan for medications to relieve symptoms and a number to telephone for help.
  4. Requires hospitalization or emergency department intervention.

52. The following directly alter pathological retention of sodium and fluid in advanced heart failure:

  1. Loop diuretics
  2. Beta-blockers
  3. ACE Inhibitors
  4. Nitrates

53. In diastolic heart failure :

  1. the majority of patients are young (<60 years of age)
  2. antihypertensive agents are contraindicated
  3. treatment includes ACE Inhibitors and Beta-blockers
  4. no restriction of dietary sodium is needed

54. Anxiety in the patient and family are <u>UNLIKELY</u> to respond to which of the following interventions?

  1. counseling by a social worker or religious leader about the meaning of life and death
  2. education about heart failure and modification of diet
  3. treatment of sleep disturbance
  4. up-titration of lisinopril

Created: June 21, 2007 16:18
Last updated: September 21, 2008 08:24


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