Chapter 38: Heart Failure pt. ii Flashcards by Cheetah Girl

wWhat is the primary cause of heart failure (HF)?

a) High cholesterol
b) Myocardial insult
c) Diabetes
d) Obesity

b) Myocardial insult

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Which term describes the percentage of total blood volume in the left ventricle (LV) at the end of diastole that is pumped out of the LV with the next systole?

a) Cardiac output (CO)
b) Stroke volume (SV)
c) Left ventricular ejection fraction (LVEF)
d) End-diastolic volume (EDV)

c) Left ventricular ejection fraction (LVEF)

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Which condition is NOT commonly associated with heart failure (HF)

a) Hypertension (HTN)
b) Coronary artery disease (CAD)
c) Myocardial infarction (MI)
d) Chronic obstructive pulmonary disease (COPD)

d) Chronic obstructive pulmonary disease (COPD)

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Why is heart failure (HF) considered a major health problem in the United States?

a) It primarily affects young adults.
b) Its incidence is decreasing over time.
c) It is the most common reason for hospital admission in adults over the age of 65.
d) It is exclusively caused by genetic factors.

c) It is the most common reason for hospital admission in adults over the age of 65.

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Heart failure with reduced ejection fraction (HFrEF) is due to a defect in which function?

a) Ventricular diastolic function/filling
b) Ventricular systolic function/contraction
c) Atrial contraction
d) Venous return

b) Ventricular systolic function/contraction

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What are the primary risk factors for heart failure (HF)?

a) Diabetes and obesity
b) Hypertension (HTN) and coronary artery disease (CAD)
c) Advanced age and smoking
d) Vascular disease and metabolic syndrome

b) Hypertension (HTN) and coronary artery disease (CAD)

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Which factor is considered a modifiable risk factor for HF and should be aggressively treated?

a) Coronary artery disease (CAD)
b) Hypertension (HTN)
c) Diabetes
d) Advanced age

b) Hypertension (HTN)

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Which of the following conditions does NOT contribute to the development of heart failure (HF)?

a) Septal defects
b) Sarcoidosis
c) Viral myocarditis
d) Chronic kidney disease

d) Chronic kidney disease

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What does the cardiac output (CO) depend on?

a) Afterload, myocardial contractility, heart rate (HR), and stroke volume (SV)

b) Myocardial contractility, ejection fraction, stroke volume (SV), and preload

c) Preload, stroke volume (SV), ejection fraction, and heart rate (HR)

d) Preload, afterload, myocardial contractility, and heart rate (HR)

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What is the genetic basis of certain cardiomyopathies that lead to heart failure (HF)?

a) Autosomal recessive traits
b) X-linked recessive traits
c) Autosomal dominant traits with variable genetic expression
d) Mitochondrial DNA mutations

c) Autosomal dominant traits with variable genetic expression

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Which of the following best describes the hallmark of heart failure with reduced ejection fraction (HFrEF)?

A. Increased blood pressure and volume retention

B. Decreased left ventricular ejection fraction (LVEF)

C. Increased preload and ventricular contractility

D. Normal LVEF and preserved diastolic function

B. Decreased left ventricular ejection fraction (LVEF)

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What is the primary cause of right-sided heart failure (HF)?

A. Left-sided HF
B. Pulmonary embolism
C. Myocardial infarction of the right ventricle
D. Cor pulmonale

A. Left-sided HF

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A patient with heart failure experiences peripheral edema, hepatomegaly, and jugular venous distention (JVD). These findings are consistent with which of the following?

A. Left-sided HF
B. HFrEF only
C. Right-sided HF
D. HFpEF only

C. Right-sided HF

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A patient with HF presents with pulmonary congestion and edema. Which type of HF is most likely present?

A. Right-sided HF
B. Biventricular HF
C. Left-sided HF
D. Diastolic dysfunction only

C. Left-sided HF

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HF and __________ involves fluid and sodium retention.

A. Baroreceptor stimulation of the sympathetic nervous system (SNS)

B. Release of catecholamines

C. Activation of the renin-angiotensin-aldosterone system (RAAS)

D. Ventricular hypertrophy

C. Activation of the renin-angiotensin-aldosterone system (RAAS)

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Patients with HFpEF typically have which characteristic?

A. Low left ventricular ejection fraction (LVEF)
B. Stiff and noncompliant left ventricle
C. Increased afterload due to valvular disease
D. High blood pressure without fluid overload

B. Stiff and noncompliant left ventricle

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Which of the following is a common cause of HFpEF?

A. Diabetes mellitus
B. Cardiomyopathy
C. Chronic hypertension
D. Pulmonary embolism

C. Chronic hypertension

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What is a potential consequence of chronic activation of the sympathetic nervous system (SNS) in HF?

A. Reduced heart rate (chronotropy)
B. Decreased myocardial oxygen demand
C. Increased ventricular dilation
D. Increased myocardial oxygen demand

D. Increased myocardial oxygen demand

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Which finding is typically observed in biventricular HF?

A. Only left ventricular dysfunction
B. Decreased systemic venous pressure
C. Dysfunction of both ventricles and systemic venous engorgement
D. Reduced perfusion to only the lungs

C. Dysfunction of both ventricles and systemic venous engorgement

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What clinical manifestation would most likely occur due to increased pulmonary hydrostatic pressure in left-sided HF?

A. Pulmonary congestion

B. Peripheral edema

C. Hepatomegaly

D. Jugular venous distention (JVD)

A. Pulmonary congestion

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Continuous activation of the RAAS in HF can lead to which of the following?

A. Improved myocardial function
B. Sodium excretion and reduced fluid volume
C. Myocardial fibrosis and hypertrophy
D. Decreased aldosterone production

C. Myocardial fibrosis and hypertrophy

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The primary goal of RAAS activation in HF is to:

A. Reduce preload and maintain CO
B. Increase preload and ventricular contractility to maintain CO
C. Decrease peripheral vascular resistance
D. Decrease blood pressure and heart rate

B. Increase preload and ventricular contractility to maintain CO

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A patient with HF develops hyponatremia. What is the primary cause of this electrolyte imbalance in HF?

A. Reduced aldosterone levels
B. Decreased renin release
C. Ventricular hypertrophy
D. Increased fluid retention due to ADH secretion

D. Increased fluid retention due to ADH secretion

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Which of the following best describes ventricular remodeling in HF?

A. Rapid improvement in heart function due to neurohormonal responses

B. Changes in myocardial structure due to compensatory mechanisms

C. Reduced sympathetic nervous system activation

D. Decreased end-diastolic volume

B. Changes in myocardial structure due to compensatory mechanisms

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Which clinical manifestation is most commonly associated with right-sided heart failure? a. Jugular venous distention (JVD) b. Pulmonary congestion c. Dyspnea on exertion d. Orthopnea

a. Jugular venous distention (JVD) Rationale: Right-sided heart failure leads to fluid backing up into the venous system, causing signs such as peripheral edema, hepatomegaly, and jugular venous distention.

Which compensatory mechanism is aimed at increasing preload and ventricular contractility in heart failure? a. Sympathetic nervous system (SNS) activation b. Release of atrial natriuretic peptide (ANP) c. Renin-angiotensin-aldosterone system (RAAS) activation d. Ventricular hypertrophy

c. Renin-angiotensin-aldosterone system (RAAS) activation

Which peptide is released in response to increased cardiac wall stretching in heart failure? a. Endothelin b. Aldosterone c. Catecholamines d. Brain natriuretic peptide (BNP)

d. Brain natriuretic peptide (BNP)

What is the primary hormonal effect of natriuretic peptides in heart failure? a. Increased aldosterone secretion b. Stimulation of renin secretion c. Inhibition of aldosterone and renin secretion d. Stimulation of antidiuretic hormone (ADH) release

c. Inhibition of aldosterone and renin secretion

Which condition is characterized by an enlarged left ventricle due to chronic pressure overload? a. Hypertrophy b. Remodeling c. Dilation d. Endothelin release

a. Hypertrophy

Which substance, released during heart failure, has a vasoconstrictive effect but depresses ventricular contractility? a. Prostaglandin b. Nitric oxide c. Endothelin d. BNP

c. Endothelin

Continuous activation of the SNS in heart failure can lead to which adverse effect? a. Increased myocardial oxygen demand b. Vasodilation c. Decreased afterload d. Increased serum sodium

a. Increased myocardial oxygen demand

What is the main compensatory response of baroreceptors to low arterial pressure? a. Increase in catecholamine release b. Vasodilation c. Inhibition of RAAS d. Promotion of myocardial fibrosis

a. Increase in catecholamine release

Which substance acts as a counterregulatory mechanism by promoting vasodilation and decreasing afterload? a. Aldosterone b. Nitric oxide c. Renin d. Angiotensin II

b. Nitric oxide

Which complication is a common result of biventricular heart failure? a. Peripheral vasodilation b. Increased cardiac output c. Systemic venous engorgement d. Decreased BNP levels

c. Systemic venous engorgement

In the context of heart failure, what is the effect of aldosterone release on the kidneys? a. Sodium excretion b. Potassium retention c. Sodium retention d. Increased glomerular filtration rate

c. Sodium retention

What is the primary goal of RAAS activation in heart failure? a. Increase afterload b. Decrease blood pressure c. Reduce ventricular hypertrophy d. Increase preload and contractility

d. Increase preload and contractility

Which finding is characteristic of ventricular remodeling in heart failure? a. Decreased ventricular mass b. Enlargement and increased sphericity of the ventricles c. Reduced myocardial fibrosis d. Increased LVEF

b. Enlargement and increased sphericity of the ventricles

Which therapy is used to prevent or reverse ventricular remodeling in HF? a. Cardiac resynchronization therapy (CRT) b. Calcium channel blockers c. Loop diuretics d. Antiarrhythmic drugs

a. Cardiac resynchronization therapy (CRT) Rationale: CRT and other therapies like ACE inhibitors and beta-blockers have been shown to improve outcomes by reducing or reversing ventricular remodeling.

What physiological change initially results from dilation of the heart chambers? a. Decreased cardiac output b. Increased afterload c. Increased cardiac output d. Myocyte apoptosis

c. Increased cardiac output

Which neurohormonal response in HF increases myocardial oxygen demand? a. Release of aldosterone b. Activation of natriuretic peptides c. Prostaglandin release d. Sympathetic nervous system stimulation

d. Sympathetic nervous system stimulation

What role do proinflammatory cytokines play in heart failure? a. Enhance cardiac contractility b. Decrease systemic inflammation c. Increase LVEF d. Promote myocyte apoptosis and hypertrophy

d. Promote myocyte apoptosis and hypertrophy

Which of the following substances stimulates renal tubular water reabsorption in HF? a. Endothelin b. BNP c. Antidiuretic hormone (ADH) d. Nitric oxide

c. Antidiuretic hormone (ADH)

Which effect of chronic RAAS activation contributes to HF progression? a. Decreased preload b. Myocardial fibrosis c. Improved ventricular compliance d. Reduced afterload

b. Myocardial fibrosis

What is the role of the renin-angiotensin-aldosterone system (RAAS) in the context of heart failure? a. To decrease fluid retention b. To increase sodium and water excretion c. To increase preload and ventricular contractility d. To reduce blood pressure through vasodilation

c. To increase preload and ventricular contractility

What effect does chronic activation of the sympathetic nervous system (SNS) have on the failing heart? a. Reduces myocardial oxygen demand b. Promotes vasodilation and decreases blood pressure c. Increases myocardial oxygen demand and intensifies ventricular dysfunction d. Stimulates the release of atrial natriuretic peptide

c. Increases myocardial oxygen demand and intensifies ventricular dysfunction

What triggers the release of endothelin in heart failure? a. Hypoxia, ischemia, and inflammatory cytokines b. Increased oxygen levels c. Elevated atrial pressure d. Low levels of aldosterone

a. Hypoxia, ischemia, and inflammatory cytokines Rationale: Endothelin is a vasoconstrictive peptide released in response to factors like hypoxia, ischemia, and neurohormonal and inflammatory signals, which can negatively affect heart contractility.

What is the initial adaptive function of ventricular dilation in heart failure? a. Reduces preload b. Improves coronary artery circulation c. Increases the force of contraction and cardiac output d. Reduces the need for oxygen in cardiac tissue

c. Increases the force of contraction and cardiac output Rationale: Ventricular dilation initially increases the heart’s contraction force by stretching myocardial fibers, which helps maintain cardiac output.

Which of the following is a counterregulatory mechanism that helps counteract the effects of the RAAS and SNS? a. Natriuretic peptides (ANP and BNP) b. Activation of proinflammatory cytokines c. Continuous release of aldosterone d. Release of endothelin

a. Natriuretic peptides (ANP and BNP) Rationale: ANP and BNP work to reduce the effects of the RAAS and SNS by promoting natriuresis, diuresis, vasodilation, and reducing blood pressure.

What is acute decompensated heart failure (ADHF) characterized by? a. A sudden increase in HF symptoms and decreased functional status b. Gradual worsening of heart failure symptoms over months c. Exclusively pulmonary symptoms without systemic effects d. Improved sodium excretion through the kidneys

a. A sudden increase in HF symptoms and decreased functional status

Which population is most frequently hospitalized for ADHF in the United States? a. Children b. Middle-aged adults c. Older Americans d. Pregnant women

c. Older Americans

What is the primary cause of pulmonary edema in ADHF? a. Right-sided heart failure b. Dehydration c. Left-sided heart failure d. Peripheral edema

c. Left-sided heart failure

4. What clinical sign is most sensitive and specific for elevated left ventricular (LV) filling pressures? a. Crackles on lung auscultation b. Jugular venous distention (JVD) c. Pink, frothy sputum d. Rapid heart rate

b. Jugular venous distention (JVD)

Which symptom may indicate the early stages of pulmonary congestion in ADHF? a. Cyanosis b. Coughing c. Bradycardia d. Warm extremities

b. Coughing

What typically happens when pulmonary venous pressure continues to rise beyond the lymphatic system’s capacity? a. Fluid is effectively cleared by the lymphatics b. The patient develops hypotension c. Heart rate slows down significantly d. Fluid moves into the interstitial space, causing interstitial edema

d. Fluid moves into the interstitial space, causing interstitial edema

Which of the following symptoms may be observed in patients with severe pulmonary edema? a. Bright red sputum b. Pink, frothy sputum c. Yellow, thick sputum d. Clear, watery sputum

b. Pink, frothy sputum

Which hemodynamic classification is the most common presentation in patients with ADHF? a. Dry-cold b. Wet-cold c. Dry-warm d. Wet-warm

d. Wet-warm

What does a “wet” patient in the context of ADHF indicate? a. Volume overload with symptoms like congestion and dyspnea b. The patient is experiencing excessive perspiration c. The patient has a fever d. Presence of hypotension and cool extremities

a. Volume overload with symptoms like congestion and dyspnea

Which respiratory sign is often seen in ADHF patients during auscultation of the lungs? a. Absence of breath sounds b. Wheezing and crackles c. Clear lung fields d. Dull percussion notes

b. Wheezing and crackles

Why might the absence of crackles not rule out ADHF in some patients? a. It indicates a different underlying disease b. Crackles are never a common sign in ADHF c. Patients with chronic HF may develop increased lymphatic drainage of alveolar edema d. It means the patient is fully compensated

c. Patients with chronic HF may develop increased lymphatic drainage of alveolar edema

What causes hoarseness (Ortner sign) in patients with ADHF? a. Compression of the recurrent laryngeal nerve from an enlarged left atrium b. Fluid accumulation in the alveoli c. Severe respiratory alkalosis d. Sudden drop in blood pressure

a. Compression of the recurrent laryngeal nerve from an enlarged left atrium

What happens to blood gases when fluid moves into the alveoli in ADHF? a. PaO2 levels increase b. PaCO2 levels decrease c. Arterial blood gas values worsen, showing lower PaO2 and increased PaCO2 d. Respiratory alkalosis is maintained

c. Arterial blood gas values worsen, showing lower PaO2 and increased PaCO2

What is chronic heart failure primarily associated with? a) Increased cardiac output (CO) and decreased venous pressure b) Reduced cardiac output (CO) and increased venous pressure c) Increased pulmonary function and muscle hypertrophy d) Decreased inflammation and vasodilation

b) Reduced cardiac output (CO) and increased venous pressure Rationale: Chronic HF is characterized by a progressive decline in CO and increased venous pressure, leading to neurohormonal and hemodynamic changes that drive disease progression.

Which compensatory mechanism occurs early in chronic HF to maintain cardiac output? a) Decreased heart rate b) Increased blood volume c) Tachycardia d) Vasodilation

c) Tachycardia

What is the primary cause of dyspnea in chronic HF patients? a) Bronchial constriction b) Increased pulmonary pressures from interstitial and alveolar edema c) Hyperventilation d) Reduced renal function

b) Increased pulmonary pressures from interstitial and alveolar edema

What does orthopnea, a type of dyspnea, indicate in chronic HF? a) Increased renal perfusion b) A decrease in cardiac output while standing c) High sodium intake d) Fluid redistribution from the legs to the lungs when lying down

d) Fluid redistribution from the legs to the lungs when lying down

What is paroxysmal nocturnal dyspnea (PND) caused by? a) Increased fluid intake during the day b) Fluid accumulation in the alveoli during a supine position c) Stress-related respiratory distress d) Airway inflammation

b) Fluid accumulation in the alveoli during a supine position

Why might chronic HF patients experience a chronic, nonproductive cough? a) Pulmonary congestion b) Increased mucus production c) Allergic reactions d) Bronchospasms

a) Pulmonary congestion

Which symptom may be seen as an early response to a reduced cardiac output? a) Fatigue b) Nausea c) Increased appetite d) Peripheral neuropathy

a) Fatigue Rationale: Reduced CO and decreased blood flow to tissues cause fatigue and limited daily activity performance.

What are palpitations in chronic HF typically related to? a) Chronic stress b) Overhydration c) High blood pressure d) Dysrhythmias, such as atrial fibrillation (AF)

d) Dysrhythmias, such as atrial fibrillation (AF)

What is a possible indicator of volume overload in chronic HF? a) Weight loss b) Increased urine output during the day c) Edema d) Hypotension

c) Edema Rationale: Fluid retention due to impaired renal and vascular function leads to peripheral and systemic edema.

Which of the following is a neurologic manifestation of chronic HF? a) Night sweats b) Dizziness and lightheadedness c) Increased concentration d) Decreased appetite

b) Dizziness and lightheadedness

Why might chronic HF patients experience mental status changes? a) Cerebral hypoperfusion b) Increased sympathetic stimulation c) Chronic dehydration d) Cerebral hypoperfusion and possible hypoxia

d) Cerebral hypoperfusion and possible hypoxia

What skin change is commonly observed in chronic HF patients? a) Reddened, inflamed skin b) Dusky or mottled skin c) Yellowish tint to the eyes d) Flushed cheeks

b) Dusky or mottled skin

What may cause chest pain in patients with chronic HF? a) Reduced CO and myocardial stretch from volume overload b) Excessive oxygen intake c) High-sodium diet d) Increased hemoglobin levels

a) Reduced CO and myocardial stretch from volume overload

What is a potential cause of nocturia in chronic HF? a) Increased renal perfusion in the supine position b) Increased daytime activity c) Hormonal imbalance d) High-sugar diet

a) Increased renal perfusion in the supine position

15. How can chronic HF affect weight changes in patients? a) Decreased sodium intake b) Enhanced muscle mass c) Increased caloric intake d) Fluid retention and cardiac cachexia

d) Fluid retention and cardiac cachexia

Why should HF patients be screened for depression? a) Depression has no impact on HF outcomes b) Depression is common in HF and can worsen adherence to treatment plans c) HF patients typically have no mental health issues d) Depression improves cardiac function

b) Depression is common in HF and can worsen adherence to treatment plans

What does the presence of hepatomegaly in HF patients suggest? a) Lung congestion only b) Hypercalcemia c) Fluid overload affecting the liver d) Decreased renal function

c) Fluid overload affecting the liver

What causes sleep problems in chronic HF patients? a) Increased daytime exercise b) Sleep apnea, nocturia, or psychologic issues c) High-salt intake before bedtime d) decreased oxygen levels at night

b) Sleep apnea, nocturia, or psychologic issues

What role do inflammatory cytokines play in chronic HF? a) They reduce cardiac remodeling b) They have no effect on HF c) They contribute to disease progression and symptoms d) They prevent neurohormonal activation

c) They contribute to disease progression and symptoms

What should be assessed when HF patients experience a dry, chronic cough? a) Use of ACE inhibitors and pulmonary conditions b) History of food allergies c) Previous dehydration episodes d) Increased appetite during illness

a) Use of ACE inhibitors and pulmonary conditions Rationale: ACE inhibitors can cause a chronic cough due to elevated bradykinin levels; other potential causes should be evaluated.

A patient presents with edema in the pedal and scrotal areas, hepatomegaly, and jugular vein distension (JVD). Which type of heart failure does this most likely indicate? a) Left-sided heart failure b) Right-sided heart failure c) Congestive heart failure without specificity d) Pulmonary edema

b) Right-sided heart failure

A patient with left-sided heart failure is most likely to present with which of the following respiratory findings? a) Ascites and edema b) Anorexia and RUQ pain c) Crackles and a dry, hacking cough d) Murmurs and JVD

c) Crackles and a dry, hacking cough

3. Which clinical finding is more commonly associated with left-sided heart failure rather than right-sided heart failure? a) Hepatomegaly b) Right ventricular heaves c) Frothy, pink-tinged sputum d) Weight gain

c) Frothy, pink-tinged sputum

A patient reports dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. These symptoms are indicative of which condition? a) Left-sided heart failure b) Right-sided heart failure c) Pulmonary embolism d) Anemia

a) Left-sided heart failure Rationale: Dyspnea, orthopnea, and paroxysmal nocturnal dyspnea are classic symptoms of left-sided heart failure due to fluid accumulation in the lungs and pulmonary congestion.

A patient with right-sided heart failure reports anorexia and gastrointestinal (GI) bloating. What is the likely cause of these symptoms? a) Increased appetite due to elevated sympathetic tone b) Pressure on the diaphragm from abdominal fluid accumulation c) Pulmonary congestion d) Reduced perfusion to skeletal muscles

b) Pressure on the diaphragm from abdominal fluid accumulation

Which symptom would you expect to find in a patient with left-sided heart failure but not right-sided heart failure? a) Weight gain b) Hepatomegaly c) Pulmonary crackles d) Anasarca

c) Pulmonary crackles Rationale: Pulmonary crackles result from fluid accumulation in the lungs and are a distinguishing feature of left-sided heart failure, whereas right-sided heart failure primarily leads to systemic congestion.

A patient with right-sided heart failure is experiencing RUQ (right upper quadrant) pain. This is most likely due to which underlying condition? a) Pleural effusion b) Pulmonary edema c) Muscle cramping d) Hepatomegaly from venous congestion

d) Hepatomegaly from venous congestion

Which of the following signs is associated with left ventricular hypertrophy and may be observed in left-sided heart failure? a) Pulsus alternans b) Anasarca c) JVD d) Right ventricular heaves

a) Pulsus alternans

Which of the following diagnostic tests provides the most comprehensive information regarding left ventricular ejection fraction (LVEF) in a patient with heart failure (HF)? A. Chest X-ray B. Echocardiogram C. 6-minute walk test D. Polysomnography

B. Echocardiogram Rationale: An echocardiogram is a valuable, noninvasive diagnostic tool that offers detailed information about LVEF, chamber size, valve function, and other aspects of heart function in HF. A chest x-ray provides less specific information, while a 6-minute walk test assesses functional capacity, and polysomnography is used to evaluate sleep apnea.

When evaluating a patient with chronic HF, the healthcare provider may order BNP and NT-proBNP tests. The primary role of these laboratory studies is to: A. Assess kidney function B. Identify the presence of a pulmonary embolism C. Correlate with the degree of left ventricular failure D. Differentiate between acute coronary syndrome and HF

C. Correlate with the degree of left ventricular failure Rationale: BNP and NT-proBNP levels correlate with the degree of left ventricular (LV) failure. Elevated levels are commonly seen in HF but can also increase due to other conditions, such as pulmonary embolism, renal failure, and acute coronary syndrome.

Which of the following diagnostic tests is often performed during a heart catheterization to evaluate for unexplained, new-onset HF due to possible infiltrative disease? A. Cardiac MRI B. Endomyocardial biopsy C. MUGA scan D. 12-lead ECG Correct

B. Endomyocardial biopsy Rationale: An endomyocardial biopsy performed during heart catheterization is useful for identifying infiltrative or infective diseases that may cause unexplained, new-onset HF.

A patient undergoing evaluation for HF presents with elevated BNP levels. What should the nurse understand about the significance of this finding? A. BNP levels are elevated exclusively due to heart failure. B. Elevated BNP levels can only occur in acute HF exacerbations. C. High BNP levels correlate with LV failure but can also be elevated by other conditions. D. Baseline BNP levels are not necessary for interpreting lab results.

C. High BNP levels correlate with LV failure but can also be elevated by other conditions. Rationale: While BNP and NT-proBNP levels generally correlate with LV failure, they can be elevated by conditions like pulmonary embolism, renal failure, and acute coronary syndrome. Establishing baseline BNP levels is helpful for accurate assessment.

In distinguishing between heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF), which of the following diagnostic tools is most beneficial? A. Multigated acquisition (MUGA) scan B. Chest X-ray C. Echocardiogram D. 12-lead ECG Correct

C. Echocardiogram Rationale: An echocardiogram is instrumental in distinguishing between HFrEF and HFpEF by evaluating LVEF, chamber sizes, and overall heart function.

For a patient suspected of having sleep-related complications contributing to HF, which diagnostic study is most appropriate? A. Polysomnography B. 6-minute walk test C. Cardiac catheterization D. Cardiac MRI

A. Polysomnography

In addition to assessing chamber size and LVEF, an echocardiogram also provides valuable information about: A. Kidney function and electrolyte balance B. Cardiac valve function, wall thickness, and motion C. Presence of pulmonary embolism D. Baseline BNP and NT-proBNP levels

B. Cardiac valve function, wall thickness, and motion Rationale: An echocardiogram offers detailed data about heart valve function, wall thickness, and motion, among other aspects. It does not assess kidney function or BNP levels directly.

A 6-minute walk test in a patient with HF is primarily used to assess: A. Intracardiac pressures B. Pulmonary artery pressures C. Cardiac valve abnormalities D. Functional exercise capacity and endurance

D. Functional exercise capacity and endurance Rationale: The 6-minute walk test measures functional capacity and endurance in patients with HF, providing an idea of their overall functional status. It does not measure intracardiac pressures directly.

What is the primary goal of therapy for patients hospitalized with acute decompensated heart failure (ADHF)? A. Providing nutritional education B. Increasing blood glucose levels C. Relieving symptoms and optimizing volume status D. Reducing patient mobility

C. Relieving symptoms and optimizing volume status Rationale: Therapy for ADHF focuses on relieving symptoms, optimizing volume status, supporting oxygenation, and end-organ perfusion, among other goals.

Which assessment finding would indicate fluid volume overload in a patient with ADHF? A. Weight loss B. Positive hepatojugular reflux test C. Clear breath sounds D. Absence of edema

B. Positive hepatojugular reflux test Rationale: Fluid volume overload may be indicated by findings such as a positive hepatojugular reflux test, edema, JVD, crackles, hypoxia, and others.

For a stable patient with ADHF in the emergency department or telemetry unit, which of the following is an important part of ongoing monitoring? A. Frequent intake, output, and daily weight measurements B. Urine output assessment every 8 hours C. Immediate placement of a pulmonary artery catheter D. Weekly evaluation of serum electrolytes

A. Frequent intake, output, and daily weight measurements

In managing a patient with ADHF and dyspnea, what positioning technique should the nurse use to decrease venous return and improve thoracic capacity? A. Trendelenburg position B. Supine position C. High-Fowler’s position with feet dangling D. Prone position

C. High-Fowler’s position with feet dangling

What is a sign of decreased perfusion in a patient with ADHF? A. Hypertension B. Warm extremities C. Increased urine output D. Cool extremities

D. Cool extremities Rationale: Signs of decreased perfusion include hypotension, decreased urine output, cool extremities, altered mentation, and worsening renal and liver function tests.

A patient with ADHF has a PAWP of 28 mm Hg. What does this indicate? A. Normal left atrial filling pressure B. Elevated left atrial filling pressure C. Low cardiac output D. Optimal volume status

B. Elevated left atrial filling pressure Rationale: A PAWP higher than the normal range (6-15 mm Hg) indicates elevated left atrial filling pressure, which is common in ADHF.

Which intervention may be used to rapidly remove excess intravascular fluid and sodium in patients with volume overload who are unresponsive to diuretics? A. Extracorporeal membrane oxygenation (ECMO) B. Ventricular assist device (VAD) C. Ultrafiltration or aquapheresis D. Implantation of of CRT

C. Ultrafiltration or aquapheresis Rationale: Ultrafiltration, or aquapheresis, is an option for volume overload unresponsive to diuretics, allowing for rapid fluid removal while maintaining hemodynamic stability.

Which statement about noninvasive positive pressure ventilation (e.g., BiPAP) in ADHF patients is accurate? A. BiPAP increases preload and cardiac workload. B. BiPAP is contraindicated in pulmonary edema. C. BiPAP decreases preload and improves oxygenation. D. BiPAP provides no benefit for respiratory distress.

C. BiPAP decreases preload and improves oxygenation.

Mechanical cardiac assist devices are typically used in patients with ADHF in which condition? A. Mild fluid overload B. Hemodynamically stable state C. Only as a preventative measure D. Worsening HF with hemodynamic instability

D. Worsening HF with hemodynamic instability

What is the purpose of an intraaortic balloon pump (IABP) in the management of ADHF? A. Increase pulmonary artery pressures B. Decrease cardiac workload through counterpulsation C. Reduce urine output D. Provide long-term support for ADHF

B. Decrease cardiac workload through counterpulsation Rationale: IABP increases coronary blood flow and decreases cardiac workload through counterpulsation, making it useful for hemodynamically unstable patients.

ECMO therapy for ADHF is primarily used for: A. Temporary support in refractory HF or as a bridge to heart transplant B. Long-term mechanical support C. Reducing intravascular volume D. Treatment of mild heart failure symptoms

A. Temporary support in refractory HF or as a bridge to heart transplant Rationale: ECMO provides short-term mechanical circulatory support in cases of refractory HF or cardiogenic shock and requires an ICU setting.

Which of the following is a nonpharmacologic therapy option for a patient with ADHF who is not responding to traditional interventions and meets specific criteria? A. Hemodialysis B. Implantation of cardiac resynchronization therapy (CRT) C. ECMO therapy D. Administration of intravenous diuretics

B. Implantation of cardiac resynchronization therapy (CRT) Rationale: CRT, a biventricular pacemaker, may be considered in patients with ADHF who meet specific criteria and do not respond to traditional therapies, helping to improve heart function.

In patients with ADHF, frequent monitoring of vital signs and O2 saturation is essential. What additional indicator is commonly assessed to evaluate decreased organ perfusion? A. Hyperthermia B. Increased appetite C. Altered mentation D. Increased urine output

C. Altered mentation

High levels of monitoring, including hourly assessments of vital signs and urine output, are necessary for patients with ADHF who are: A. Being managed in a general medical ward B. Unresponsive to diuretics C. Hemodynamically unstable and in the ICU D. Discharged home on oral diuretics

C. Hemodynamically unstable and in the ICU

Which noninvasive strategy is often employed to improve oxygenation in severe cases of pulmonary edema associated with ADHF? A. Noninvasive positive pressure ventilation (e.g., BiPAP) B. Intubation and mechanical ventilation only C. High-flow nasal cannula oxygen therapy D. Simple nasal cannula oxygen

A. Noninvasive positive pressure ventilation (e.g., BiPAP)

Which drug is considered the first line of treatment for patients with volume overload in Acute Decompensated Heart Failure (ADHF)? A. Morphine B. Vasodilators C. Diuretics D. Positive inotropes

C. Diuretics Rationale: Diuretics are the first line of treatment for patients with volume overload as they help reduce sodium and water reabsorption, thereby decreasing intravascular volume.

What is the primary effect of IV loop diuretics in the treatment of ADHF? A. Increase preload B. Decrease intravascular volume C. Increase afterload D. Decrease myocardial contractility

B. Decrease intravascular volume

Which of the following is a preferred method of administering IV loop diuretics in ADHF? A. IV infusion B. Oral bolus C. Subcutaneous injection D. Intramuscular injection

A. IV infusion Rationale: IV loop diuretics, such as furosemide, are preferred to be given by bolus or infusion to manage volume overload in ADHF effectively.

Which electrolyte levels should be continually monitored when a patient is on diuretic therapy for ADHF? A. Sodium and chloride B. Potassium and calcium C. Magnesium and chloride D. Potassium and magnesium

D. Potassium and magnesium

Which of the following drugs is a primary venodilator used in the treatment of ADHF? A. Nitroprusside B. Nesiritide C. Nitroglycerin D. Morphine

C. Nitroglycerin Rationale: IV nitroglycerin is a primary venodilator that reduces blood return to the right side of the heart, decreasing preload.

What should be monitored frequently when titrating IV nitroglycerin in a patient with ADHF? A. Heart rate B. Respiratory rate C. Blood pressure D. Oxygen saturation

C. Blood pressure Rationale: Blood pressure should be monitored often (every 5 to 10 minutes) when titrating IV nitroglycerin to avoid hypotension.

Which drug is a potent IV arterial vasodilator that reduces both preload and afterload in ADHF? A. Nitroglycerin B. Sodium nitroprusside C. Nesiritide D. Dopamine

B. Sodium nitroprusside

What is a potential complication of sodium nitroprusside therapy at high doses? A. Hyperkalemia B. Hypocalcemia C. Cyanide toxicity D. Metabolic alkalosis

C. Cyanide toxicity

Which drug is used for the short-term treatment of ADHF after a failed response to IV diuretics? A. Nitroglycerin B. Sodium nitroprusside C. Morphine D. Nesiritide

D. Nesiritide

How does morphine help in the management of ADHF? A. Dilates pulmonary and systemic blood vessels B. Decreases myocardial oxygen demand C. Increases myocardial contractility D. Reduces electrolyte imbalances

A. Dilates pulmonary and systemic blood vessels

What is the role of inotropic drugs in the management of ADHF? A. Decrease afterload B. Increase myocardial contractility C. Reduce blood pressure D. Decrease fluid volume

B. Increase myocardial contractility

Which of the following is a selective β-agonist that works mainly on the β1-receptors in the heart? A. Dopamine B. Dobutamine C. Norepinephrine D. Milrinone

B. Dobutamine

What is the primary difference between dopamine and dobutamine in the treatment of ADHF? A. Dopamine increases SVR, while dobutamine does not B. Dobutamine increases urine output, while dopamine does not C. Dopamine causes dysrhythmias, while dobutamine does not D. Dobutamine is a phosphodiesterase inhibitor, while dopamine is not

A. Dopamine increases SVR, while dobutamine does not

Which of the following is a primary indication for milrinone use in ADHF? A. Decrease fluid volume B. Increase myocardial contractility C. Reduce myocardial oxygen consumption D. Improve electrolyte balance

B. Increase myocardial contractility

Which adverse effect is associated with milrinone therapy? A. Hyperglycemia B. Hyperkalemia C. Dysrhythmias D. Hypocalcemia

C. Dysrhythmias

When might Digoxin be added to the treatment regimen for ADHF? A. When patients have low blood pressure B. When fluid volume is excessive C. When symptoms persist after other medications D. When electrolyte imbalances are corrected

C. When symptoms persist after other medications

Which electrolyte levels must be maintained when administering digoxin for ADHF? A. Sodium and chloride B. Potassium and magnesium C. Calcium and phosphate D. Sodium and potassium

B. Potassium and magnesium

What is the primary goal of chronic heart failure (HF) therapies? A. Decrease mortality and morbidity B. Increase fluid retention C. Reduce myocardial oxygen consumption D. Eliminate exercise from the patient’s routine

A. Decrease mortality and morbidity

Which therapy helps improve oxygen saturation and relieve dyspnea in patients with HF? A. Diuretics B. ACE inhibitors C. Supplemental oxygen D. Beta-blockers

C. Supplemental oxygen

What is a key recommendation for patients with chronic HF to conserve energy? A. Avoid all physical activity B. Engage in intense exercise routines C. Increase fluid intake D. Physical and emotional rest

D. Physical and emotional rest

What type of exercise program is recommended for all patients with chronic HF? A. High-intensity interval training B. Endurance training C. Weightlifting D. Cardiac rehabilitation

D. Cardiac rehabilitation

Which of the following is the cornerstone of drug therapy in chronic HF? A. Neurohormonal blockade B. Calcium channel blockers C. Anticoagulants D. Antiplatelet agents

A. Neurohormonal blockade

Which drug is considered first-line for patients with HFrEF to decrease mortality and hospitalizations? A. ACE inhibitors B. Beta-blockers C. ARBs D. Diuretics

A. ACE inhibitors

What is the mechanism of action for ACE inhibitors in the treatment of HFrEF? A. Inhibits aldosterone synthesis B. Blocks conversion of angiotensin I to angiotensin II C. Increases myocardial contractility D. Reduces calcium influx into myocardial cells

B. Blocks conversion of angiotensin I to angiotensin II

Which side effect is commonly associated with ACE inhibitors? A. Persistent dry cough B. Tachycardia C. Hypokalemia D. Hypercalcemia

A. Persistent dry cough

For patients unable to tolerate ACE inhibitors, which alternative medication is recommended? A. Diuretics B. Beta-blockers C. ARBs D. Calcium channel blockers

C. ARBs

Which combination drug provides dual blockade of the RAAS and natriuretic peptide system? A. Spironolactone B. Metoprolol C. Digoxin D. Sacubitril/valsartan

D. Sacubitril/valsartan

Which potassium-sparing diuretic inhibits aldosterone activation? A. Furosemide B. Spironolactone C. Hydrochlorothiazide D. Metolazone

B. Spironolactone

What is the primary monitoring focus for patients on aldosterone antagonists? A. Serum sodium levels B. Renal function and serum potassium levels C. Blood pressure and heart rate D. Blood glucose levels

B. Renal function and serum potassium levels

Which class of drugs directly blocks the negative effects of the SNS on the failing heart? A. Diuretics B. ACE inhibitors C. Beta-blockers D. ARBs

C. Beta-blockers

Which beta-blocker is known to decrease mortality in patients with HFrEF? A. Atenolol B. Propranolol C. Bisoprolol D. Labetalol

C. Bisoprolol

What is the primary benefit of beta-blocker therapy in patients with HFrEF? A. Reduction of fluid retention B. Increase in left ventricular ejection fraction (LVEF) C. Decrease in electrolyte imbalances D. Reduction in myocardial ischemia

B. Increase in left ventricular ejection fraction (LVEF)

Which side effect of beta-blockers requires careful titration in patients with volume overload? A. Reduced myocardial contractility B. Increased heart rate C. Hypertension D. Hyperkalemia

A. Reduced myocardial contractility

What is a major side effect of neurohormonal blockade in chronic HF? A. Hypercalcemia B. Hypotension C. Hypernatremia D. Hypoglycemia

B. Hypotension

What is the primary benefit of diuretics in the management of HF? A. Reduce symptoms of fluid overload B. Increase myocardial contractility C. Reduce blood pressure D. Improve heart rate

A. Reduce symptoms of fluid overload

Which type of diuretic acts on the ascending loop of Henle? A. Thiazide diuretics B. Potassium-sparing diuretics C. Loop diuretics D. Osmotic diuretics

C. Loop diuretics

What is a potential side effect of loop diuretics? A. Hyperkalemia B. Hypercalcemia C. Low serum potassium levels D. Hypernatremia

C. Low serum potassium levels

Which diuretic inhibits sodium reabsorption in the distal tubule? A. Loop diuretics B. Thiazide diuretics C. Potassium-sparing diuretics D. Osmotic diuretics

B. Thiazide diuretics

What is a common side effect of thiazide diuretics? A. Hypotension B. Hypoglycemia C. Hypercalcemia D. Hyperkalemia

A. Hypotension

In chronic HF, what is the primary goal when administering diuretics? A. To achieve rapid weight loss B. To increase myocardial contractility C. To completely eliminate fluid retention D. To maintain the lowest effective dose

D. To maintain the lowest effective dose

What might be required in HF patients experiencing diuretic resistance? A. Decreasing doses of diuretics B. Switching to oral diuretics only C. Increasing doses and adding different types of diuretics D. Discontinuing diuretic therapy

C. Increasing doses and adding different types of diuretics

Which cardiac device is recommended for patients with an LVEF less than 35% to coordinate ventricular contractions? A. Pacemaker B. Implantable Cardioverter-Defibrillator (ICD) C. Cardiac Resynchronization Therapy (CRT) D. Ventricular Assist Device (VAD)

C. Cardiac Resynchronization Therapy (CRT)

Which cardiac device is used for primary prevention of sudden cardiac death (SCD) in patients with HFrEF? A. Pacemaker B. Implantable Cardioverter-Defibrillator (ICD) C. Cardiac Resynchronization Therapy (CRT) D. Ventricular Assist Device (VAD)

B. Implantable Cardioverter-Defibrillator (ICD)

What is one of the key benefits of remote monitoring in patients with heart failure? A. Reducing medication doses B. Increasing fluid intake C. Avoiding regular check-ups D. Predicting HF decompensation

D. Predicting HF decompensation

Which parameter monitored remotely can indicate worsening heart failure? A. Weight gain B. BP C. Increased HR trends D. Decreased patient activity level

C. Increased HR trends

What is HR variability (HRV) associated with in heart failure patients? A. Higher risk for exacerbation and hospitalization B. Increased exercise capacity C. Reduced risk for exacerbation D. Improved quality of life

A. Higher risk for exacerbation and hospitalization

What can a PA sensor implanted during a right heart catheterization monitor? A. Blood glucose levels B. Pulmonary artery pressures (PAP) C. Renal function D. Serum sodium levels

B. Pulmonary artery pressures (PAP)

How can early detection of increases in intracardiac pressures benefit heart failure patients? A. Increase medication doses B. Delay treatment C. Allow for proactive management and decreased hospitalizations D. Avoid regular monitoring

C. Allow for proactive management and decreased hospitalizations

What are common reasons HF patients are readmitted to the hospital? A. High-sodium diet and not taking prescribed medications B. Regular physical exercise C. Consistent weight management D. Frequent medical check-ups

A. High-sodium diet and not taking prescribed medications

What dietary information should be reviewed with HF patients to help them make better diet choices? A. Their favorite foods B. When, where, and how often they dine out C. Their fluid intake D. Their caloric intake

B. When, where, and how often they dine out

What is the general sodium intake restriction for heart failure patients? A. 1 gram per day B. 2 grams per day C. 3 grams per day D. 4 grams per day

B. 2 grams per day

When might fluid restrictions be necessary for heart failure patients? A. For all HF patients B. For patients with mild HF C. For patients with no fluid retention D. For stage D HF patients with persistent fluid retention

D. For stage D HF patients with persistent fluid retention

When should heart failure patients contact their healthcare provider regarding weight gain? A. A weight gain of 1 lb over 2 days B. A weight gain of 3 lb over 2 days C. A weight gain of 1 lb over a week D. A weight gain of 2 lb over a week

B. A weight gain of 3 lb over 2 days

Which over-the-counter (OTC) medications pose a significant risk to people with heart failure? (Select all that apply.) A. Nonsteroidal antiinflammatory drugs (NSAIDs) B. High-dose aspirin C. Ephedrine D. Acetaminophen E. Pseudoephedrine

A. Nonsteroidal antiinflammatory drugs (NSAIDs) B. High-dose aspirin C. Ephedrine E. Pseudoephedrine

What should be included in the assessment of a patient with heart failure? (Select all that apply.) A. Current prescription medications B. Over-the-counter (OTC) drugs C. Diet history D. Fluid intake E. Chronic health problems

A. Current prescription medications B. Over-the-counter (OTC) drugs C. Diet history E. Chronic health problems

Which clinical problems are associated with heart failure? (Select all that apply.) A. Activity intolerance B. Fatigue C. Fluid imbalance D. Enhanced tissue perfusion E. Impaired cardiac function

A. Activity intolerance B. Fatigue C. Fluid imbalance E. Impaired cardiac function

What are the priority problems for nursing care in a patient with heart failure? (SATA) A. Decreased CO B. Impaired oxygenation C. Increased respiratory rate D. Fluid overload

A. Decreased CO B. Impaired oxygenation D. Fluid overload

What are the overall goals for the patient with heart failure? (SATA) A. Increase in symptoms B. Decrease in peripheral edema C. Decrease in exercise tolerance D. No complications related to HF

B. Decrease in peripheral edema D. No complications related to HF

What factors should be aggressively identified and treated to prevent the progression to symptomatic heart failure? (Select all that apply.) A. Obesity B. Metabolic syndrome C. Diabetes D. HTN

all of the choices are correct

What should be evaluated in patients with valve disease contributing to heart failure? A. Diuretic therapy B. Valve repair or replacement C. Fluid intake D. Dietary modifications

B. Valve repair or replacement

What are common precipitating factors for acute decompensated heart failure (ADHF)? (Select all that apply.) A. Respiratory infections B. Dysrhythmias C. Acute coronary syndrome D. Uncontrolled HTN

all of the choices are correct

What is essential to the success of the treatment plan for heart failure? (Select all that apply.) A. Regular physical exercise B. Support systems C. Complex care across settings D. Fragmented care

B. Support systems C. Complex care across settings

What are the goals of ambulatory heart failure care? (Select all that apply.) A. Symptom management B. Improved quality of life (QOL) C. Reduced exercise tolerance D. Identifying factors precipitating ADHF and hospitalization

A. Symptom management B. Improved quality of life (QOL) D. Identifying factors precipitating ADHF and hospitalization

What is a key component of transitional care programs for heart failure patients? A. Limiting patient education on self-management B. Intensive disease management programs C. Reducing the use of telehealth D. Avoiding home surveillance follow-up

B. Intensive disease management programs

What should be included in the overall care plan for heart failure patients and caregivers? (Select all that apply.) A. Clear action plan for response to signs and symptoms of exacerbation B. Medication and device therapies C. Regular physical assessments D. Complex medication regimen

A. Clear action plan for response to signs and symptoms of exacerbation B. Medication and device therapies

What is the impact of heart failure on patients' quality of life (QOL)? (Select all that apply.) A. Improved exercise tolerance B. Reduced ability to perform daily activities C. Increased fatigue D. Improved mental health

B. Reduced ability to perform daily activities C. Increased fatigue

Why are support systems essential for heart failure patients? A. They reduce the need for medication B. They provide emotional and practical support C. They replace the need for healthcare providers D. They increase the risk of fragmented care

B. They provide emotional and practical support

What factors must be addressed in the treatment of heart failure? (SATA) A. Precipitating factors B. Etiologies C. Contributing conditions D. Avoiding exercise

A. Precipitating factors B. Etiologies C. Contributing conditions

Which therapeutic options are available for stage D heart failure (HF) patients? (Select all that apply.) A. Chronic inotropic therapy B. Mechanical circulatory support (MCS) devices C. Anticoagulant therapy D. Palliative care and hospice E. Heart transplant

A. Chronic inotropic therapy B. Mechanical circulatory support (MCS) devices D. Palliative care and hospice E. Heart transplant

What benefits do mechanical circulatory support (MCS) devices offer for patients with end-stage HF? (Select all that apply.) A. Improved outcomes B. Reduced medication doses C. Increased quality of life (QOL) D. Reduced need for follow-up care

A. Improved outcomes C. Increased quality of life (QOL)

What is the significance of starting mechanical circulatory support (MCS) before the onset of severe right heart failure (HF) and systemic organ failure? A. It reduces mortality B. It increases medication doses C. It delays treatment D. It improves diagnostic accuracy

A. It reduces mortality

What are common indicators for end-stage HF? (Select all that apply.) A. Repeated hospitalizations for ADHF B. Increased exercise tolerance C. Frequent emergency department visits D. Improved quality of life

A. Repeated hospitalizations for ADHF C. Frequent emergency department visits

What are the expected outcomes for a patient with heart failure? (SATA) A. Maintain adequate O2/CO2 exchange B. Reduction or absence of edema C. Increased blood glucose levels D. Stable baseline weight

A. Maintain adequate O2/CO2 exchange B. Reduction or absence of edema D. Stable baseline weight