W6 Cardiac B Flashcards
1
Q
What is heart failure?
A
A debilitating heart condition that affects the heart’s ability to pump effectively, resulting in reduced cardiac output.
2
Q
What are the primary manifestations of heart failure?
A
- Dyspnoea
- Fatigue
- Fluid retention
- Pulmonary congestion
- Peripheral oedema
3
Q
How does the National Heart Foundation define heart failure?
A
“A complex clinical syndrome with typical symptoms and signs that generally occur on exertion, but can also occur at rest, secondary to an abnormality of cardiac structure or function.”
4
Q
What are the learning outcomes after completing the eBook on heart failure?
A
- Understand the underlying pathophysiology of heart failure
- Discuss the clinical manifestations of heart failure
- Discuss the pharmacology treatment and management for heart failure
- Demonstrate and perform a patient-centred assessment of a patient with heart failure
- Discuss the diagnostic tests required for heart conditions
- Discuss cardiac rehabilitation and interprofessional collaboration
5
Q
What is cardiac output?
A
The volume of blood pumped out of the heart each minute.
6
Q
How is cardiac output calculated?
A
Cardiac Output [CO] = Heart Rate [HR] x Stroke Volume [SV]
7
Q
What factors influence stroke volume?
A
- Preload
- Afterload
- Contractility
8
Q
What is preload?
A
The end-diastolic volume just prior to ventricular contraction, impacted by venous return and ventricular compliance.
9
Q
What is afterload?
A
The resistance the ventricle must overcome to eject blood into the arteries.
10
Q
What is contractility?
A
The force of myocardial contraction, influenced by factors like ventricular myocardial stretch and sympathetic nervous system activation.
11
Q
What is ejection fraction (EF)?
A
A measure of how effectively the heart is pumping, often determining the type of heart failure.
12
Q
What is the normal range for ejection fraction?
A
50-70%
13
Q
What can reduced ejection fraction indicate?
A
Compromised cardiac function, as seen in heart failure.
14
Q
True or False: Heart failure can only be diagnosed at rest.
A
False
15
Q
Fill in the blank: Cardiac output is measured as the volume of blood pumped out of the heart each minute and can be measured by _______ and _______.
A
[heart rate], [stroke volume]
16
Q
What are the resources recommended for understanding heart failure?
A
- Brown et al. (2023) - Lewis’s Medical-Surgical Nursing
- Craft & Gordon (2023) - Understanding pathophysiology
- Burchum & Rosenthal (2022) - Lehne’s Pharmacology for Nursing Care
17
Q
What is heart failure?
A
A condition characterised by abnormal ventricular function resulting in inefficient myocardial performance and compromised ability to meet the metabolic demands of the body.
18
Q
What are the consequences of heart failure?
A
Inadequate tissue perfusion and volume overload.
19
Q
How many people in Australia live with heart failure?
A
About 144,000 people (0.6% of the Australian population).
20
Q
Which gender experiences heart failure more frequently?
A
Men experience heart failure almost twice as often as women.
21
Q
What is the mortality statistic related to heart failure?
A
Heart failure accounts for almost 1 in 50 deaths, equating to one person dying from heart failure every 2.5 hours.
22
Q
How many people are hospitalised every day with heart failure?
A
About 170 people (approximately 1 person every 9 minutes).
23
Q
What has contributed to the decrease in deaths from heart failure over time?
A
Advances in therapy to treat the condition.
24
Q
What classification system did the New York Heart Association (NYHA) develop?
A
Guidelines for classifying people with heart failure based on their tolerance to physical activity.
25
What does Stage A of the ACC/AHA classification indicate?
High risk for developing CHF with no structural disorder of the heart.
26
What is the defining feature of NYHA Class I?
No limitation of physical activity.
27
What does Stage B of the ACC/AHA classification signify?
Structural disorder of the heart with no symptoms of CHF developed.
28
What is NYHA Class II?
Slight limitation of physical activity, comfortable at rest.
29
What characterizes Stage C of the ACC/AHA classification?
Past or current symptoms of CHF associated with underlying heart disease.
30
Describe NYHA Class III.
Marked limitation of physical activity, comfortable at rest.
31
What does Stage D of the ACC/AHA classification refer to?
End-stage disease requiring specialized treatment strategies.
32
What is the defining feature of NYHA Class IV?
Inability to carry on any physical activity without discomfort, with symptoms present even at rest.
33
What is the difference between NYHA Class IIIa and Class IIIb?
Class IIIa has no dyspnea at rest; Class IIIb has recent dyspnea at rest.
34
What is the significance of understanding heart failure classification?
It helps in understanding the patient's diagnosis and the impact on their activities of daily living.
35
What are the two main types of heart failure?
Left-sided heart failure and right-sided heart failure
36
What is the difference between acute and chronic heart failure?
Heart failure can present as both chronic and acute exacerbations
37
What is right-sided heart failure commonly caused by?
* Respiratory conditions (e.g., pulmonary hypertension, chronic lung disease)
* Left-sided heart failure
38
How does the right ventricle differ from the left ventricle in terms of afterload sensitivity?
The right ventricle has a greater sensitivity to afterload changes
39
What happens to the right ventricle to preserve stroke volume?
It leads to dilatation
40
What is the pressure comparison between pulmonary and systemic circulation?
Pressure in the pulmonary circulation is significantly lower than in systemic circulation
41
Why does the right ventricle require less muscle power than the left ventricle?
Because it operates under lower pressure conditions
42
What is congestive cardiac failure (CCF) commonly associated with?
Left-sided heart failure leading to pulmonary congestion
43
What defines heart failure with reduced ejection fraction (HFrEF)?
Reduced left ventricular systolic function leading to poor contraction and emptying
44
What are common symptoms of heart failure with reduced ejection fraction (HFrEF)?
* Oedema
* Orthopnoea
* Shortness of breath
45
What characterizes heart failure with preserved ejection fraction (HFpEF)?
Heart failure symptoms with a preserved ejection fraction of 50% or higher
46
What causes decreased compliance of the left ventricle in HFpEF?
Poor filling of the left ventricle
47
What leads to right-sided heart failure?
Impaired contractility of the right ventricle due to various factors
48
Fill in the blank: Heart failure with reduced ejection fraction was formerly referred to as _______.
systolic heart failure
49
Fill in the blank: Heart failure with preserved ejection fraction was formerly referred to as _______.
diastolic heart failure
50
True or False: Left-sided heart failure can lead to right-sided heart failure.
True
51
What are some factors that can impair contractility of the right ventricle?
* Increased pressure
* Volume overload
* Intrinsic myocardial contractility dysfunction
* Cardiac arrhythmias
52
What is the initial problem that leads to left ventricular failure?
Decreased Left Ventricular Function
## Footnote
This includes a decrease in the force of LV contraction, resulting in increased LV end-diastolic pressure and preload.
53
What happens to the left ventricular end-diastolic volume (LVEDP) during LV failure?
↑ LV end-diastolic volume (LVEDP)
## Footnote
This increase is due to decreased force of LV contraction.
54
What is a consequence of increased left atrial preload?
Pulmonary oedema
## Footnote
This occurs due to the backup of fluid into the lungs.
55
What is one of the pulmonary consequences of left ventricular failure?
↑ Pulmonary vascular resistance
## Footnote
This can lead to right ventricular failure.
56
What compensatory mechanism involves the activation of the sympathetic nervous system?
Sympathetic Nervous System Activation
## Footnote
This leads to the release of noradrenaline/adrenaline.
57
List the effects of sympathetic nervous system activation during LV failure.
* Peripheral artery constriction
* ↑ Force of LV contraction
* ↑ Systemic vascular resistance
* ↑ LV oxygen demand
58
What triggers the Renin-Angiotensin-Aldosterone System (RAAS)?
↓ Renal blood flow
## Footnote
This initiates a cascade resulting in sodium and water retention.
59
What are the components of the RAAS in response to decreased renal blood flow?
* Renin
* Angiotensin
* Aldosterone
60
What is the effect of Antidiuretic Hormone (ADH) during heart failure?
Promotes water retention
## Footnote
This leads to increased systemic blood pressure.
61
True or False: The compensatory mechanisms in LV failure improve perfusion long-term.
False
## Footnote
These mechanisms temporarily improve perfusion but ultimately worsen the condition.
62
What is the vicious cycle in left ventricular failure?
↑ LV oxygen demand + ↓ oxygen supply = LV hypoxia
## Footnote
This hypoxia further reduces LV function, worsening heart failure.
63
What are the negative outcomes of compensatory mechanisms in LV failure?
* ↑ LV oxygen demand
* ↓ oxygen supply
* LV hypoxia
* Fluid overload
* Increased pressures
64
Fill in the blank: The body’s attempt to compensate for failing heart leads to a _______.
vicious cycle
65
How do neurohormonal and hemodynamic responses contribute to heart failure?
They contribute to progressive heart failure, pulmonary oedema, and right ventricular failure.
66
What is preload in the context of cardiac function?
The volume of blood in the ventricle at the end of diastole.
67
What happens to stroke volume with some increase in preload?
It can enhance stroke volume due to the Frank-Starling mechanism.
68
What is the main issue associated with excessive preload?
It becomes harmful over time.
69
What occurs when preload increases and compresses the lumen of coronary arteries?
It decreases blood flow to the myocardium, leading to myocardial ischaemia.
70
What is the consequence of myocardial ischaemia on cardiac function?
It results in decreased contractility.
71
How does chronic increased preload affect the myocardium?
It causes stretching of the myocardium.
72
What dysfunction arises from chronic stretching of the myocardium?
Sarcomere dysfunction.
73
What is the effect of sarcomere dysfunction on contractility?
It leads to decreased contractility.
74
What is the vicious cycle created by decreased contractility?
It leads to incomplete emptying of the ventricle, further increasing preload.
75
Why is managing preload critical in treating heart failure?
To prevent myocardial stretch and ischaemia.
76
Name one intervention to reduce preload in heart failure management.
Diuretics.
77
What is the role of nitrates in the management of heart failure?
To improve coronary perfusion.
78
How do beta-blockers help in heart failure treatment?
They reduce myocardial oxygen demand.
79
What does HFrEF stand for?
Heart Failure with Reduced Ejection Fraction
## Footnote
HFrEF is characterized by weak contractions of the heart's left ventricle.
80
What is the ejection fraction percentage in HFrEF?
Less than 40%
## Footnote
This indicates that the heart is not pumping enough blood during systole.
81
What does HFpEF stand for?
Heart Failure with preserved Ejection Fraction
## Footnote
HFpEF is characterized by a stiff and thickened left ventricle.
82
What happens to the left ventricle during HFpEF?
It becomes stiff and thickened
## Footnote
This condition makes it harder for the ventricle to fill with blood during diastole.
83
How does the ejection fraction in HFpEF compare to HFrEF?
Ejection fraction remains normal in HFpEF
## Footnote
This means that despite less blood filling the ventricle, most of it is still pumped out.
84
What is the primary issue during systole in HFrEF?
Weak contractions of the left ventricle
## Footnote
This leads to poor blood pumping.
85
What phase of the heart cycle is affected in HFrEF?
Systole
## Footnote
This is the phase when the heart contracts and pumps blood.
86
What phase of the heart cycle is affected in HFpEF?
Diastole
## Footnote
This is the phase when the heart relaxes and fills with blood.
87
True or False: Both HFrEF and HFpEF result in less blood circulating through the body.
True
## Footnote
Both conditions lead to reduced blood circulation despite their different mechanisms.
88
Fill in the blank: In HFrEF, the heart's left ventricle has ______ contractions.
weak
## Footnote
This results in ineffective blood pumping.
89
Fill in the blank: In HFpEF, the left ventricle is ______ and thickened.
stiff
## Footnote
This complicates the filling process during diastole.
90
What is right heart failure often caused by?
Left heart failure
## Footnote
Left ventricular pressures reflect back into the pulmonary circulation, increasing workload and resistance to the right ventricle.
91
Name two common pulmonary diseases that can cause right heart failure.
* COPD
* Cystic fibrosis
## Footnote
These diseases can lead to increased workload on the right ventricle.
92
What is the medical term for right-sided heart failure due to lung disease?
Cor pulmonale
## Footnote
This term describes the pathophysiological progression from chronic lung disease to right-sided heart failure.
93
What are the two major effects of chronic lung diseases on the heart?
* ↑ Pulmonary vascular resistance
* ↓ Oxygen supply to the heart
## Footnote
These effects make it harder for the right ventricle to pump blood and reduce oxygen availability to the myocardium.
94
What compensatory mechanism does the heart use to overcome increased pulmonary vascular resistance?
↑ RV contraction force
## Footnote
This increases the right ventricle's oxygen demand, which may lead to hypoxia.
95
What effect does right ventricular hypoxia have on contraction force?
↓ force of RV contraction
## Footnote
This weakness leads to increased RV end-diastolic pressure.
96
What is the result of increased RV end-diastolic pressure?
↑ RV preload and ↑ right atrial (RA) preload
## Footnote
This combination increases venous pressure and causes fluid to back up into systemic circulation.
97
What is the end result of fluid backing up into systemic circulation?
Peripheral oedema
## Footnote
This results in fluid leakage into tissues, especially in the lower limbs.
98
What creates a self-perpetuating cycle of RV failure?
Hypoxia and increased RV workload
## Footnote
These factors worsen each other, leading to fluid overload.
99
List three common clinical signs of right-sided heart failure.
* Peripheral oedema
* Hepatomegaly
* Jugular venous distension
## Footnote
These signs help indicate the presence of right-sided heart failure.
100
What is a key focus in the management of right-sided heart failure due to lung disease?
* Treating the underlying lung disease
* Reducing pulmonary vascular resistance
* Supporting heart function
## Footnote
Management strategies may include oxygen therapy, vasodilators, and diuretics for edema.
101
What is the primary purpose of compensatory mechanisms in a failing heart?
To maintain cardiac output and perfusion
## Footnote
Compensatory mechanisms attempt to support heart function despite dysfunction.
102
Name the main compensatory mechanisms utilized by the failing heart.
* Sympathetic nervous system activation
* Neurohormonal responses
* Ventricular dilation
* Ventricular hypertrophy
* Ventricular remodeling
* Counter-regulatory mechanisms
## Footnote
Each mechanism plays a role in the body's attempt to maintain heart function.
103
What effect does sympathetic nervous system activation have on heart rate and blood pressure?
Increases heart rate and blood pressure
## Footnote
This activation is triggered by baroreceptors sensing decreased blood pressure.
104
What is the role of the renin-angiotensin-aldosterone system (RAAS) in heart failure?
Increases blood volume, blood pressure, and preload
## Footnote
RAAS is activated due to reduced renal perfusion and contributes to heart failure progression.
105
Fill in the blank: The heart adapts structurally through _______ and dilation of the ventricles.
Hypertrophy
## Footnote
This adaptation can lead to decreased contractility and worsening heart failure.
106
What are the initial effects of sympathetic nervous system activation on cardiac workload?
Temporarily improves perfusion but increases cardiac workload and oxygen demand
## Footnote
This can lead to adverse effects over time.
107
What are the clinical implications of RAAS inhibitors in heart failure treatment?
They interrupt maladaptive compensatory mechanisms and slow down or prevent remodeling
## Footnote
Examples include ACE inhibitors, beta-blockers, and aldosterone antagonists.
108
True or False: Left-sided heart failure typically presents with body-wide swelling.
False
## Footnote
Left-sided failure often causes lung symptoms, while right-sided failure causes swelling.
109
What are the causes of myocardial dysfunction leading to heart failure?
* Myocardial infarction
* Ischaemic heart disease
* Hypertension
* Other cardiac disorders
## Footnote
These conditions can decrease cardiac output and systemic blood pressure.
110
What happens to renal perfusion as a result of heart failure?
Decreases
## Footnote
This reduction activates compensatory mechanisms like RAAS.
111
Fill in the blank: Compensatory mechanisms can ultimately _______ heart damage over time.
Worsen
## Footnote
The body's attempts to compensate may lead to further deterioration of heart function.
112
What is ventricular remodeling in the context of heart failure?
Changes in heart size and shape that can worsen heart failure
## Footnote
This process includes hypertrophy and dilation of the heart ventricles.
113
What triggers the activation of the sympathetic nervous system in heart failure?
Baroreceptors sensing decreased blood pressure
## Footnote
These receptors are located in the left ventricle, aortic arch, and carotid sinus.
114
What is a common symptom of heart failure characterized by breathlessness on activity?
Dyspnoea (usually with exertion)
## Footnote
This symptom is often one of the first noticeable signs in patients with heart failure.
115
What symptom of heart failure involves difficulty breathing when lying flat?
Orthopnoea
## Footnote
Patients may need to sit up to breathe comfortably.
116
What is paroxysmal nocturnal dyspnoea?
Sudden nighttime breathlessness
## Footnote
This occurs when patients wake up at night feeling unable to breathe.
117
What symptom is associated with poor perfusion and low cardiac output in heart failure?
Fatigue
## Footnote
This fatigue can be debilitating and impacts daily activities.
118
What clinical sign suggests right-sided congestion in heart failure?
Elevated jugular venous pressure (JVP)
## Footnote
This can be assessed by observing the neck veins.
119
What does hepatojugular reflux indicate in heart failure patients?
Sustained rise in JVP with abdominal pressure
## Footnote
This is a sign of fluid overload.
120
What heart sound indicates fluid overload in heart failure?
Third heart sound (S3)
## Footnote
The presence of S3 is significant in diagnosing heart failure.
121
What is a common less typical symptom of heart failure?
Nocturnal cough
## Footnote
This may be mistaken for other respiratory conditions.
122
What neuropsychological signs can be associated with heart failure?
Confusion and depression
## Footnote
These signs are particularly noted in elderly patients.
123
What are some less specific signs of heart failure?
Weight gain (>2 kg/week) or weight loss, peripheral oedema
## Footnote
These signs can also occur in other conditions.
124
What is the primary issue in left-sided heart failure?
Ineffective pumping of blood to the body, leading to pulmonary congestion
## Footnote
This results in symptoms related to lung congestion.
125
What are some signs of left-sided heart failure?
Increased heart rate, respiratory crackles, pleural effusion
## Footnote
These signs reflect fluid accumulation in the lungs.
126
What symptoms are commonly seen in left-sided heart failure?
Weakness, anxiety, orthopnoea, nocturia
## Footnote
These symptoms can significantly affect the quality of life.
127
What is the main consequence of right-sided heart failure?
Systemic venous congestion
## Footnote
This leads to symptoms affecting the rest of the body, especially the extremities.
128
What are some signs of right-sided heart failure?
Jugular vein distension, peripheral oedema, ascites
## Footnote
These signs indicate fluid overload in the systemic circulation.
129
What is a common symptom of right-sided heart failure?
Fatigue and dependent, bilateral oedema
## Footnote
Patients may notice swelling in their legs and feet.
130
True or False: Left-sided heart failure often progresses to right-sided heart failure if untreated.
True
## Footnote
Understanding this progression is crucial for patient management.
131
What is a key clinical relevance of recognizing symptoms of heart failure?
Early recognition of heart failure
## Footnote
This is important for timely intervention and management.
132
Fill in the blank: Patients with HFrEF often present with signs of ______ and inadequate perfusion of the systemic circulation.
pulmonary oedema
133
Fill in the blank: Patients with HFpEF often present with ______ on exertion.
dyspnoea
134
What is chronic heart failure?
A progressive decline in ventricular function coupled with chronic neurohormonal activation resulting in ventricular remodeling.
## Footnote
This multifaceted process encompasses changes in the size, shape, and mechanical efficacy of the ventricles.
135
What are the signs and symptoms of chronic heart failure?
Signs and symptoms of both left and right heart failure.
## Footnote
Includes fatigue, dyspnoea, tachycardia, oedema, nocturia, skin changes, behavioral changes, chest pain, and weight changes.
136
What is fatigue in the context of chronic heart failure?
One of the earliest symptoms that limits activities, caused by reduced cardiac output, impaired perfusion, anaemia, and decreased oxygenation.
## Footnote
It often signifies the progression of heart failure.
137
What causes dyspnoea in chronic heart failure?
Increased pulmonary pressures and pulmonary oedema.
## Footnote
Patients may also have a dry, non-productive cough that can be alleviated by position changes or over-the-counter cough medicine.
138
What is tachycardia and why does it occur in chronic heart failure?
An increased heart rate that compensates for a failing heart and reduced cardiac output.
## Footnote
It is a physiological response to maintain adequate circulation.
139
What is oedema in the context of chronic heart failure?
Swelling that can occur peripherally, in the liver, abdomen, and/or lungs, generally resulting in weight gain.
## Footnote
A sudden weight gain of 1.5kg in 2 days can indicate worsening heart failure.
140
What is nocturia?
Frequent nighttime urination caused by improved renal perfusion while resting.
## Footnote
Patients typically have decreased urine output during the day due to impaired renal perfusion.
141
What are the skin changes associated with chronic heart failure?
Skin can appear dusky, shiny, and/or swollen with diminished or absent hair growth due to poor oxygenation.
## Footnote
These changes result from reduced blood flow and oxygen to the skin.
142
What behavioral changes can occur in chronic heart failure?
Patients can become restless, confused, and/or experience decreased cognitive functioning due to reduced cerebral circulation.
## Footnote
This is a consequence of decreased cardiac output.
143
What causes chest pain in chronic heart failure?
Decreased coronary artery perfusion may lead to angina (chest pain).
## Footnote
This symptom reflects inadequate oxygen supply to the heart muscle.
144
What weight changes can occur in chronic heart failure?
Weight changes can be caused by fluid retention and weight loss from cardiac cachexia, which involves muscle wasting and fat loss.
## Footnote
Fluid retention often leads to weight gain, while cachexia results in weight loss.
145
What are the associated complications of heart failure?
Complications can affect the heart, liver, lungs, and kidneys.
146
What is a Left Ventricular (LV) thrombus?
A thrombus formation in the LV due to decreased ventricular contractility and pooling of blood.
147
What causes pleural effusion in heart failure?
Fluid accumulates in the pleural space due to increased capillary pressure.
148
How does heart failure lead to renal failure?
Decreased cardiac output leads to decreased renal perfusion.
149
What is hepatomegaly and how is it related to heart failure?
Hepatomegaly is liver enlargement due to impaired venous return in right-sided heart failure.
150
What are arrhythmias and how do they relate to heart failure?
Arrhythmias occur due to stretching of cardiac walls, altering electrical pathways.
151
What is a common arrhythmia seen in people with heart failure?
Atrial fibrillation (AF) is a common arrhythmia in heart failure patients.
152
Fill in the blank: Increased capillary pressure leads to _______ in heart failure.
pleural effusion
153
True or False: Hepatomegaly is common in left-sided heart failure.
False
154
Fill in the blank: A decrease in ventricular contractility can increase the chance of _______ formation.
thrombus
155
What type of assessment is completed for patients with heart failure?
Primary and secondary assessment along with vital signs
156
What are the two approaches that can be used for nursing assessment?
Head-to-toe assessment approach or systems approach
157
List some important subjective data to gather in heart failure assessment.
* Current symptoms
* Past health history (e.g., CHD, hypertension)
* Medications
158
What objective data might be found in a focused cardiovascular assessment?
* Cool, diaphoretic skin
* Tachycardia
* Abdominal distention
159
What are some possible diagnostic findings in heart failure?
* Abnormal serum electrolytes
* Increased BNP or ANP markers
* Chest x-ray showing cardiomegaly
160
What are the main goals in the treatment of chronic heart failure?
* Maximise cardiac output
* Reduce symptoms
* Improve quality of life
161
What is a multidisciplinary heart failure program?
Referral to a program for patients with heart failure and high risk factors
162
What is the purpose of nurse-led titration clinics?
To decrease hospitalisations in patients who have not reached maximum doses of heart failure medication
163
Fill in the blank: Educating patients and their carers about self-management of heart failure is recommended to decrease _______.
hospitalisation and mortality
164
What dietary recommendations should be made for patients with heart failure?
* Examine labels for sodium content
* Avoid salt when cooking
* Daily weigh
165
What ongoing monitoring should patients with heart failure perform?
* Know signs of worsening heart failure
* Report weight gain
* Attend regular check-ups
166
True or False: Patients with heart failure should avoid emotional upsets.
True
167
What is the role of medication therapy in managing heart failure?
* Take medication as prescribed
* Know signs of orthostatic hypotension
* Monitor BP and heart rate
168
What guidelines have been selected for the management of patients with heart failure?
Guidelines reflecting evidenced-based standards of care
169
What should be prioritized in palliative and end-of-life care for patients with advanced heart failure?
Providing comfort and relieving symptoms
170
What is an important aspect of planning nursing care for patients experiencing exacerbations of heart failure?
Planning a regular daily rest and activity program
171
Fill in the blank: The Heart Foundation has created a document intended to guide patients on the important aspects of managing their own _______.
condition
172
What should patients report to the healthcare team regarding their heart failure symptoms?
* Weight gain of 1.5kg in 2 days
* Difficulty breathing
* Swelling of ankles or abdomen
173
What type of professionals should be involved in the ongoing management of a person with chronic heart failure?
* Healthcare team
* Specialty nurses
* Nurse practitioners
174
What is a recommended activity program for patients with heart failure?
* Increase walking
* Consider cardiac rehabilitation
* Avoid extreme temperatures
175
What is the focus of the chapter on Heart Failure Pharmacology?
The pharmacological management of heart failure
## Footnote
It includes both prevention and treatment strategies.
176
What are the key non-pharmacological and pharmacological measures for heart failure management according to NHFACSANZ guidelines?
Management of blood pressure and serum cholesterol levels
## Footnote
Both non-pharmacological and pharmacological measures are included.
177
Name three medications used to prevent heart failure in patients with left ventricular systolic dysfunction.
* ACE inhibitors
* Beta blockers
* Sodium-glucose cotransporter 2 (SGLT2) inhibitors for patients with T2 diabetes
178
What is the primary role of SGLT2 inhibitors in heart failure management?
To improve heart function
## Footnote
They are primarily used for diabetes management.
179
List two examples of SGLT2 inhibitors.
* Dagagliflozin
* Empagliflozin
180
What combination of medications is recommended to decrease mortality in heart failure management?
* ACE inhibitors
* Beta-blockers
* Potassium sparing diuretic (MRA)
181
What is an alternative treatment if the initial combination of heart failure medications is ineffective?
Angiotensin receptor neprilysin inhibitor (ARNI) combination
182
What medication may be considered for patients who do not respond to first-line treatment of heart failure?
Digoxin
## Footnote
It can be used even in the absence of an arrhythmia.
183
Name two loop diuretics used in heart failure management.
* Furosemide
* Bumetanide
184
What is an example of a potassium-sparing diuretic?
Spironolactone
185
What is the combination of medications in the Angiotensin Receptor Neprilysin Inhibitor (ARNI)?
Sacubitril with Valsartan
186
True or False: The NHFACSANZ guidelines suggest that diuretics are not important in heart failure management.
False
187
Fill in the blank: The guidelines from NHFACSANZ indicate that a combination of ACE inhibitors, beta-blockers, and a _______ can decrease mortality.
potassium sparing diuretic (MRA)
188
What is the purpose of the video mentioned in the chapter?
To cover many of the heart failure medications used in clinical practice
189
What is the focus of Chapter 51 in Lehne's Pharmacology for Nursing Care?
Drugs for Heart Failure
190
What is the primary risk factor related to hypercholesterolaemia?
A number of cardiovascular conditions
191
True or False: Beta-blockers have not been covered in previous chapters of the eBook.
False
192
What is the role of pharmacists in managing cardiac disorders?
Key members of the healthcare team from admission to discharge and in the community
## Footnote
Pharmacists verify current medications, educate patients, provide medication summaries, and assist with medication adherence.
193
What kind of support do pharmacists provide regarding medications?
They provide information on:
* Prescription and over-the-counter (OTC) medications
* Medication and food interactions
* Non-prescription product use
## Footnote
Pharmacists also assist patients in understanding medication labels and instructions.
194
How do dieticians support patients with cardiac conditions?
They offer dietary guidance, provide heart-healthy eating guidelines, and create personalized meal plans
## Footnote
Dieticians play a vital role in recovery and ongoing nutritional support.
195
What is the role of physiotherapists in cardiac recovery?
They support recovery by improving muscle strength, reducing fatigue, and developing safe exercise plans
## Footnote
This includes cardiac rehabilitation and helping patients regain confidence in physical activity.
196
What assistance do occupational therapists provide to cardiac patients?
They assist with returning to daily activities, recommend home modifications, and offer energy conservation strategies
## Footnote
Occupational therapists help improve safety and manage fatigue.
197
What services do social workers offer to patients with heart failure?
They provide emotional support, assist with accessing community services, and help navigate financial, legal, and insurance concerns
## Footnote
Social workers facilitate advance care planning and long-term support networks.
198
What is the primary role of general practitioners in cardiac care?
They provide ongoing care, manage risk factors, and coordinate referrals
## Footnote
General practitioners monitor heart function, blood pressure, cholesterol, and kidney function regularly.
199
What expertise do cardiologists bring to the management of heart conditions?
They provide expert assessment, diagnosis, and management of complex heart conditions
## Footnote
Cardiologists lead specialized treatments, procedures, or surgeries when needed.
200
What responsibilities do clinical nurse specialists/nurse practitioners have in cardiac care?
They monitor patient progress, provide education, perform key assessments, and coordinate care plans
## Footnote
They especially focus on hospital discharge planning.
201
What is the focus of palliative care consultants/teams in heart failure management?
They focus on symptom management and improving quality of life in advanced heart failure
## Footnote
Palliative care teams support decision-making and provide comfort care when treatments are no longer effective.
202
How do mental health professionals assist patients with cardiac conditions?
They help cope with anxiety, depression, or stress related to their diagnosis and provide therapy or counseling
## Footnote
Mental health professionals assist with emotional adjustments to lifestyle changes and chronic illness management.
203
Fill in the blank: The Australian Heart Foundation provides information on how to manage heart disease, including links to _______.
resources that are available to them
## Footnote
This includes information on living well with heart failure.
204
True or False: Pharmacists do not play a role in educating patients about new medications.
False
## Footnote
Pharmacists are key in educating patients on new medications.
205
What does the chapter on Diagnostics and Treatment cover?
An overview of medical diagnosis and management for atherosclerosis, hypertension, coronary heart disease, angina, and heart failure
## Footnote
These conditions have overlapping factors in assessment and management.
206
What are the components of a thorough medical assessment?
• Health history and physical examination
• Determining the underlying cause
## Footnote
This may include pulmonary function studies.
207
Which blood studies are commonly included in the diagnostic process?
• Cardiac markers (troponin, CK)
• Electrolytes (sodium, potassium, calcium, magnesium)
• Renal function (eGFR, urea, creatinine)
• Blood glucose
• C-reactive protein, homocysteine
• Full blood count, white cell count, haemoglobin
• aPTT, INR, natriuretic peptides (BNP, ANP)
• Liver function tests
• Serum lipids (cholesterol, triglycerides, HDL, LDL)
• ABG
## Footnote
CK stands for creatinine kinase.
208
True or False: Nurses and midwives are expected to perform venepuncture and access blood test results.
True
## Footnote
They will learn which tubes are used for each test.
209
What imaging techniques are mentioned for cardiovascular diagnostics?
• Chest x-ray
• Echocardiogram (ECHO)
• Transoesophageal echocardiogram
• Nuclear imaging
• 12-lead ECG
• Holter monitoring
• Telemetry
• Exercise (stress) testing
## Footnote
ECHO assesses heart movement and blood flow.
210
Fill in the blank: Cardiac catheterisation and coronary angiography are examples of _______.
[invasive studies]
## Footnote
These studies examine coronary arteries and other aspects of heart health.
211
What does a cardiovascular MRI assess?
Heart structure and function
## Footnote
It includes magnetic resonance angiography and cardiac CT.
212
What is the role of the fractional flow reserve in diagnostics?
To assess the blood flow in coronary arteries
## Footnote
It is part of invasive studies.
213
What does telemetry monitor?
Heart rhythm and rate
## Footnote
It is used in conjunction with other diagnostic tools.
214
What are the purposes of exercise (stress) testing?
To evaluate heart function under stress
## Footnote
Helps in diagnosing coronary artery disease.
215
Q1: What is the primary cause of pulmonary oedema in left-sided heart failure?
A. Decreased renal perfusion
B. Increased systemic vascular resistance
C. Backflow of blood into the pulmonary circulation
D. Right ventricular hypertrophy
Q1: What is the primary cause of pulmonary oedema in left-sided heart failure?
A. Decreased renal perfusion
B. Increased systemic vascular resistance
C. Backflow of blood into the pulmonary circulation ✅
D. Right ventricular hypertrophy
216
Q2: Which ejection fraction (EF) value is typically seen in HFrEF?
A. >70%
B. 50–70%
C. 40–49%
D. <40%
Q2: Which ejection fraction (EF) value is typically seen in HFrEF?
A. >70%
B. 50–70%
C. 40–49%
D. <40% ✅
217
Q3: Which of the following symptoms is most commonly associated with right-sided heart failure?
A. Orthopnoea
B. Pulmonary crackles
C. Peripheral oedema
D. Frothy sputum
Q3: Which of the following symptoms is most commonly associated with right-sided heart failure?
A. Orthopnoea
B. Pulmonary crackles
C. Peripheral oedema ✅
D. Frothy sputum
218
Q4: Which hormone is released in response to low cardiac output to retain fluid and constrict vessels?
A. Insulin
B. Antidiuretic hormone (ADH)
C. Prolactin
D. Thyroxine
Q4: Which hormone is released in response to low cardiac output to retain fluid and constrict vessels?
A. Insulin
B. Antidiuretic hormone (ADH) ✅
C. Prolactin
D. Thyroxine
219
Q5: What compensatory mechanism involves increased ventricular muscle thickness?
A. Ventricular dilation
B. Neurohormonal response
C. Ventricular hypertrophy
D. Baroreceptor reflex
Q5: What compensatory mechanism involves increased ventricular muscle thickness?
A. Ventricular dilation
B. Neurohormonal response
C. Ventricular hypertrophy ✅
D. Baroreceptor reflex
220
Q6: What diagnostic result would support a diagnosis of HFpEF?
A. EF of 30%
B. Stiff, non-compliant left ventricle with EF ≥ 50%
C. Right atrial enlargement
D. Reduced preload
Q6: What diagnostic result would support a diagnosis of HFpEF?
A. EF of 30%
B. Stiff, non-compliant left ventricle with EF ≥ 50% ✅
C. Right atrial enlargement
D. Reduced preload
221
Q7: A patient with HFrEF may exhibit which of the following signs?
A. High urine output
B. Bradycardia
C. Pulmonary congestion and reduced perfusion
D. Clubbing
Q7: A patient with HFrEF may exhibit which of the following signs?
A. High urine output
B. Bradycardia
C. Pulmonary congestion and reduced perfusion ✅
D. Clubbing
222
Q8: What is a key difference between the right and left ventricles?
A. Right ventricle has thicker myocardium
B. Right ventricle has greater afterload sensitivity
C. Left ventricle handles venous return
D. Left ventricle requires less contraction force
Q8: What is a key difference between the right and left ventricles?
A. Right ventricle has thicker myocardium
B. Right ventricle has greater afterload sensitivity ✅
C. Left ventricle handles venous return
D. Left ventricle requires less contraction force
223
Q9: What causes nocturia in heart failure patients?
A. Increased activity during the day
B. Hormonal imbalances
C. Improved renal perfusion when supine
D. Excessive daytime hydration
Q9: What causes nocturia in heart failure patients?
A. Increased activity during the day
B. Hormonal imbalances
C. Improved renal perfusion when supine ✅
D. Excessive daytime hydration
224
Q10: Which medication is classified as an ARNI?
A. Lisinopril
B. Spironolactone
C. Sacubitril/valsartan
D. Metoprolol
Q10: Which medication is classified as an ARNI?
A. Lisinopril
B. Spironolactone
C. Sacubitril/valsartan ✅
D. Metoprolol
225
Q11: Which symptom is an early indicator of chronic heart failure?
A. Chest pain
B. Edema
C. Fatigue
D. Weight loss
Q11: Which symptom is an early indicator of chronic heart failure?
A. Chest pain
B. Edema
C. Fatigue ✅
D. Weight loss
226
Q12: What finding is most likely in a patient with right-sided heart failure?
A. Paroxysmal nocturnal dyspnoea
B. Hepatomegaly
C. Pulmonary crepitations
D. Orthopnoea
Q12: What finding is most likely in a patient with right-sided heart failure?
A. Paroxysmal nocturnal dyspnoea
B. Hepatomegaly ✅
C. Pulmonary crepitations
D. Orthopnoea
227
Q13: What is the formula for cardiac output?
A. HR + SV
B. SV / HR
C. HR x SV
D. EF x SV
Q13: What is the formula for cardiac output?
A. HR + SV
B. SV / HR
C. HR x SV ✅
D. EF x SV
228
Q14: A weight gain of 1.5kg over 2 days may indicate:
A. Normal fluid fluctuation
B. Pulmonary embolism
C. Fluid retention due to worsening heart failure
D. Excess caloric intake
Q14: A weight gain of 1.5kg over 2 days may indicate:
A. Normal fluid fluctuation
B. Pulmonary embolism
C. Fluid retention due to worsening heart failure ✅
D. Excess caloric intake
229
Q15: Which of the following is a potassium-sparing diuretic?
A. Furosemide
B. Bumetanide
C. Spironolactone
D. Digoxin
Q15: Which of the following is a potassium-sparing diuretic?
A. Furosemide
B. Bumetanide
C. Spironolactone ✅
D. Digoxin
230
Q16: Which compensatory mechanism can worsen heart failure over time?
A. Sympathetic nervous system activation
B. Pulmonary vasodilation
C. Baroreceptor inhibition
D. Increased sodium excretion
Q16: Which compensatory mechanism can worsen heart failure over time?
A. Sympathetic nervous system activation ✅
B. Pulmonary vasodilation
C. Baroreceptor inhibition
D. Increased sodium excretion
231
Q17: What clinical feature is most indicative of HFpEF?
A. Weak systolic contraction
B. Stiffened ventricle with preserved EF
C. Excess preload
D. Jugular venous distension
Q17: What clinical feature is most indicative of HFpEF?
A. Weak systolic contraction
B. Stiffened ventricle with preserved EF ✅
C. Excess preload
D. Jugular venous distension
232
Q18: What would likely be elevated in a blood test of a heart failure patient?
A. BNP
B. Hemoglobin
C. Glucose
D. Platelet count
Q18: What would likely be elevated in a blood test of a heart failure patient?
A. BNP ✅
B. Hemoglobin
C. Glucose
D. Platelet count
233
Q19: Which interprofessional team member helps with safe return to ADLs?
A. Social worker
B. Pharmacist
C. Occupational therapist
D. Mental health nurse
Q19: Which interprofessional team member helps with safe return to ADLs?
A. Social worker
B. Pharmacist
C. Occupational therapist ✅
D. Mental health nurse
234
Q20: What is the purpose of nurse-led titration clinics?
A. Manage emergencies
B. Optimize medication dosing
C. Provide psychological support
D. Offer cardiac imaging
Q20: What is the purpose of nurse-led titration clinics?
A. Manage emergencies
B. Optimize medication dosing ✅
C. Provide psychological support
D. Offer cardiac imaging
235
Q21: What is the primary pathophysiological problem in heart failure?
A. Coronary artery vasospasm
B. Ineffective myocardial contraction leading to poor perfusion
C. Valve regurgitation
D. Increased oxygen extraction by tissues
Q21: What is the primary pathophysiological problem in heart failure?
A. Coronary artery vasospasm
B. Ineffective myocardial contraction leading to poor perfusion ✅
C. Valve regurgitation
D. Increased oxygen extraction by tissues
236
Q22: Which heart failure complication involves fluid in the pleural space?
A. Pericarditis
B. Pulmonary embolism
C. Pleural effusion
D. Cardiogenic shock
Q22: Which heart failure complication involves fluid in the pleural space?
A. Pericarditis
B. Pulmonary embolism
C. Pleural effusion ✅
D. Cardiogenic shock
237
Q23: Which of the following symptoms is more common in left-sided heart failure than right-sided?
A. Peripheral oedema
B. Ascites
C. Orthopnoea
D. Hepatomegaly
Q23: Which of the following symptoms is more common in left-sided heart failure than right-sided?
A. Peripheral oedema
B. Ascites
C. Orthopnoea ✅
D. Hepatomegaly
238
Q24: Which test provides direct visualisation of coronary arteries?
A. Echocardiogram
B. Chest X-ray
C. Coronary angiography
D. ECG
Q24: Which test provides direct visualisation of coronary arteries?
A. Echocardiogram
B. Chest X-ray
C. Coronary angiography ✅
D. ECG
239
Q25: Which clinical sign might suggest worsening right-sided heart failure?
A. Productive cough
B. Jugular venous distension
C. Inspiratory crackles
D. S3 gallop
Q25: Which clinical sign might suggest worsening right-sided heart failure?
A. Productive cough
B. Jugular venous distension ✅
C. Inspiratory crackles
D. S3 gallop
240
Q26: What is a common cause of isolated right-sided heart failure?
A. Systemic hypertension
B. Coronary artery disease
C. Chronic lung disease (e.g., COPD)
D. Left ventricular infarction
Q26: What is a common cause of isolated right-sided heart failure?
A. Systemic hypertension
B. Coronary artery disease
C. Chronic lung disease (e.g., COPD) ✅
D. Left ventricular infarction
241
Q27: What lifestyle education is most appropriate for a patient with fluid overload from HF?
A. Increase daily fluid intake
B. Weigh self once a week
C. Monitor daily weight and report gains over 1.5kg in 2 days
D. Take diuretics only when oedema is visible
Q27: What lifestyle education is most appropriate for a patient with fluid overload from HF?
A. Increase daily fluid intake
B. Weigh self once a week
C. Monitor daily weight and report gains over 1.5kg in 2 days ✅
D. Take diuretics only when oedema is visible
242
Q28: Which best describes the purpose of cardiac rehabilitation?
A. Prepare for cardiac surgery
B. Prevent sudden cardiac arrest
C. Improve physical function and reduce hospitalisation
D. Titrate medications
Q28: Which best describes the purpose of cardiac rehabilitation?
A. Prepare for cardiac surgery
B. Prevent sudden cardiac arrest
C. Improve physical function and reduce hospitalisation ✅
D. Titrate medications
243
Q29: Which symptom would you expect in a patient with pulmonary congestion?
A. Wheezing
B. Frothy, pink sputum
C. Bradycardia
D. RUQ pain
Q29: Which symptom would you expect in a patient with pulmonary congestion?
A. Wheezing
B. Frothy, pink sputum ✅
C. Bradycardia
D. RUQ pain
244
Q30: What does the New York Heart Association (NYHA) classification assess?
A. ECG changes
B. Risk of sudden death
C. Physical activity tolerance
D. BNP levels
Q30: What does the New York Heart Association (NYHA) classification assess?
A. ECG changes
B. Risk of sudden death
C. Physical activity tolerance ✅
D. BNP levels
245
Q31: What role does the sympathetic nervous system play in early heart failure?
A. Increases urine output
B. Decreases heart rate
C. Enhances contractility and heart rate
D. Lowers blood pressure
Q31: What role does the sympathetic nervous system play in early heart failure?
A. Increases urine output
B. Decreases heart rate
C. Enhances contractility and heart rate ✅
D. Lowers blood pressure
246
Q32: What are the main treatment goals in chronic heart failure?
A. Cure the disease
B. Reduce symptoms, maximise cardiac output, and improve quality of life
C. Reduce afterload only
D. Increase stroke volume permanently
Q32: What are the main treatment goals in chronic heart failure?
A. Cure the disease
B. Reduce symptoms, maximise cardiac output, and improve quality of life ✅
C. Reduce afterload only
D. Increase stroke volume permanently
247
Q33: What non-cardiac complication is associated with right-sided HF?
A. Splenomegaly
B. Hepatomegaly
C. Pulmonary oedema
D. Bradycardia
Q33: What non-cardiac complication is associated with right-sided HF?
A. Splenomegaly
B. Hepatomegaly ✅
C. Pulmonary oedema
D. Bradycardia
248
Q34: What nursing assessment finding might indicate worsening HF?
A. Reduced BNP
B. Increased urine output
C. Cyanosis and bilateral leg oedema
D. Hypoactive bowel sounds
Q34: What nursing assessment finding might indicate worsening HF?
A. Reduced BNP
B. Increased urine output
C. Cyanosis and bilateral leg oedema ✅
D. Hypoactive bowel sounds
249
Q35: What medication reduces preload by promoting diuresis?
A. Metoprolol
B. Spironolactone
C. Digoxin
D. Atorvastatin
Q35: What medication reduces preload by promoting diuresis?
A. Metoprolol
B. Spironolactone ✅
C. Digoxin
D. Atorvastatin
250
Q36: What symptom may indicate reduced cerebral perfusion in HF?
A. Dry mouth
B. Behavioural changes and confusion
C. Sinus tachycardia
D. Nocturia
Q36: What symptom may indicate reduced cerebral perfusion in HF?
A. Dry mouth
B. Behavioural changes and confusion ✅
C. Sinus tachycardia
D. Nocturia
251
Q37: What best describes HFpEF?
A. Decreased ejection fraction <40%
B. Increased preload with weak ventricular contraction
C. Impaired diastolic filling with preserved EF ≥50%
D. Right ventricular hypertrophy
Q37: What best describes HFpEF?
A. Decreased ejection fraction <40%
B. Increased preload with weak ventricular contraction
C. Impaired diastolic filling with preserved EF ≥50% ✅
D. Right ventricular hypertrophy
252
Q38: What is the expected effect of SGLT2 inhibitors in HF management?
A. Raise serum potassium
B. Improve glucose metabolism only
C. Enhance myocardial contractility
D. Improve heart function and reduce hospitalisation
Q38: What is the expected effect of SGLT2 inhibitors in HF management?
A. Raise serum potassium
B. Improve glucose metabolism only
C. Enhance myocardial contractility
D. Improve heart function and reduce hospitalisation ✅
253
Q39: What intervention would a physiotherapist most likely provide to a HF patient?
A. Home modification planning
B. Medication reconciliation
C. Cardiac-safe exercise prescription
D. Palliative support
Q39: What intervention would a physiotherapist most likely provide to a HF patient?
A. Home modification planning
B. Medication reconciliation
C. Cardiac-safe exercise prescription ✅
D. Palliative support
254
Q40: Which of the following findings would most likely support a diagnosis of acute HF exacerbation?
A. Clear lung sounds
B. EF >60%
C. Sudden weight gain and increased dyspnoea
D. Flat neck veins
Q40: Which of the following findings would most likely support a diagnosis of acute HF exacerbation?
A. Clear lung sounds
B. EF >60%
C. Sudden weight gain and increased dyspnoea ✅
D. Flat neck veins
255
Q10: Which medication combination is considered first-line therapy for reducing mortality in HFrEF?
A. Beta-blockers and calcium channel blockers
B. ACE inhibitors, beta-blockers, and potassium-sparing diuretics
C. Diuretics and antiplatelets
D. ARBs and nitrates
Q10: Which medication combination is considered first-line therapy for reducing mortality in HFrEF?
A. Beta-blockers and calcium channel blockers
B. ACE inhibitors, beta-blockers, and potassium-sparing diuretics ✅
C. Diuretics and antiplatelets
D. ARBs and nitrates
255
Q35: What is the mechanism of action of loop diuretics in heart failure?
A. Decrease heart rate
B. Reduce afterload by vasodilation
C. Promote sodium and water excretion to reduce fluid overload
D. Improve myocardial contractility
Q35: What is the mechanism of action of loop diuretics in heart failure?
A. Decrease heart rate
B. Reduce afterload by vasodilation
C. Promote sodium and water excretion to reduce fluid overload ✅
D. Improve myocardial contractility
256
Q41: Which of the following medications is a loop diuretic used to reduce preload in heart failure?
A. Empagliflozin
B. Spironolactone
C. Furosemide
D. Lisinopril
Q41: Which of the following medications is a loop diuretic used to reduce preload in heart failure?
A. Empagliflozin
B. Spironolactone
C. Furosemide ✅
D. Lisinopril
257
Q42: In which situation is digoxin most appropriately used in heart failure management?
A. As first-line therapy in HFpEF
B. When ACE inhibitors are contraindicated
C. In patients not responding to first-line medications, even without arrhythmia
D. For rapid diuresis in fluid overload
Q42: In which situation is digoxin most appropriately used in heart failure management?
A. As first-line therapy in HFpEF
B. When ACE inhibitors are contraindicated
C. In patients not responding to first-line medications, even without arrhythmia ✅
D. For rapid diuresis in fluid overload
258
Q43: Which medication class combines neprilysin inhibition with angiotensin receptor blockade?
A. ACE inhibitors
B. ARBs
C. ARNIs
D. Beta blockers
Q43: Which medication class combines neprilysin inhibition with angiotensin receptor blockade?
A. ACE inhibitors
B. ARBs
C. ARNIs ✅
D. Beta blockers
259
Q44: What is a common side effect patients should monitor for when taking ACE inhibitors?
A. Hypoglycaemia
B. Bradycardia
C. Dry cough
D. Hyperreflexia
Q44: What is a common side effect patients should monitor for when taking ACE inhibitors?
A. Hypoglycaemia
B. Bradycardia
C. Dry cough ✅
D. Hyperreflexia
260
Q45: What is the main benefit of using ARNI therapy (sacubitril/valsartan) in heart failure?
A. Improves cholesterol levels
B. Reduces ejection fraction
C. Decreases hospitalisation and mortality
D. Eliminates need for beta-blockers
Q45: What is the main benefit of using ARNI therapy (sacubitril/valsartan) in heart failure?
A. Improves cholesterol levels
B. Reduces ejection fraction
C. Decreases hospitalisation and mortality ✅
D. Eliminates need for beta-blockers
261
Q46: Which of the following heart failure medications directly blocks sympathetic stimulation to reduce heart rate and myocardial oxygen demand?
A. ACE inhibitors
B. Beta blockers
C. Diuretics
D. Digoxin
Q46: Which of the following heart failure medications directly blocks sympathetic stimulation to reduce heart rate and myocardial oxygen demand?
A. ACE inhibitors
B. Beta blockers ✅
C. Diuretics
D. Digoxin
262
Q47: Why are beta blockers introduced gradually in heart failure management?
A. They cause immediate vasodilation
B. They can worsen symptoms if initiated too quickly
C. They raise blood pressure dramatically
D. They reduce ejection fraction
Q47: Why are beta blockers introduced gradually in heart failure management?
A. They cause immediate vasodilation
B. They can worsen symptoms if initiated too quickly ✅
C. They raise blood pressure dramatically
D. They reduce ejection fraction
263
Q48: Which of the following is a contraindication for starting ACE inhibitor therapy?
A. Hypertension
B. Dry cough
C. Hypokalaemia
D. History of angioedema
Q48: Which of the following is a contraindication for starting ACE inhibitor therapy?
A. Hypertension
B. Dry cough
C. Hypokalaemia
D. History of angioedema ✅
264
Q49: What is the mechanism of action of ACE inhibitors in heart failure?
A. Promote sodium retention
B. Inhibit aldosterone secretion
C. Block conversion of angiotensin I to II, reducing afterload and preload
D. Reduce myocardial contractility
Q49: What is the mechanism of action of ACE inhibitors in heart failure?
A. Promote sodium retention
B. Inhibit aldosterone secretion
C. Block conversion of angiotensin I to II, reducing afterload and preload ✅
D. Reduce myocardial contractility
265
Q50: What is a common electrolyte imbalance associated with loop diuretics like furosemide?
A. Hypercalcaemia
B. Hyponatraemia
C. Hyperkalaemia
D. Hypokalaemia
Q50: What is a common electrolyte imbalance associated with loop diuretics like furosemide?
A. Hypercalcaemia
B. Hyponatraemia
C. Hyperkalaemia
D. Hypokalaemia ✅
266
Q51: What does the addition of spironolactone offer in heart failure management?
A. Blood glucose regulation
B. Enhanced cardiac contractility
C. Mortality benefit through aldosterone antagonism
D. Increased preload
Q51: What does the addition of spironolactone offer in heart failure management?
A. Blood glucose regulation
B. Enhanced cardiac contractility
C. Mortality benefit through aldosterone antagonism ✅
D. Increased preload
267
Q52: Which of the following requires INR monitoring?
A. ACE inhibitors
B. Beta blockers
C. Warfarin
D. Sacubitril
Q52: Which of the following requires INR monitoring?
A. ACE inhibitors
B. Beta blockers
C. Warfarin ✅
D. Sacubitril
268
Q53: A patient taking an ARNI should be monitored for which adverse effect?
A. Bradycardia
B. Persistent cough
C. Hyperkalaemia
D. Hypoglycaemia
Q53: A patient taking an ARNI should be monitored for which adverse effect?
A. Bradycardia
B. Persistent cough
C. Hyperkalaemia ✅
D. Hypoglycaemia
269
Q54: Which heart failure medication class increases urine output without significantly affecting potassium levels?
A. Loop diuretics
B. SGLT2 inhibitors
C. MRAs
D. ACE inhibitors
Q54: Which heart failure medication class increases urine output without significantly affecting potassium levels?
A. Loop diuretics
B. SGLT2 inhibitors ✅
C. MRAs
D. ACE inhibitors
270
Q55: Empagliflozin and dapagliflozin are most accurately classified as:
A. Loop diuretics
B. Beta blockers
C. SGLT2 inhibitors
D. Calcium channel blockers
Q55: Empagliflozin and dapagliflozin are most accurately classified as:
A. Loop diuretics
B. Beta blockers
C. SGLT2 inhibitors ✅
D. Calcium channel blockers
271
Q56: Which medication can cause digitalis toxicity, especially in hypokalaemic patients?
A. Metoprolol
B. Digoxin
C. Sacubitril
D. Furosemide
Q56: Which medication can cause digitalis toxicity, especially in hypokalaemic patients?
A. Metoprolol
B. Digoxin ✅
C. Sacubitril
D. Furosemide
272
Q57: What is an important patient education point for those starting an ACE inhibitor?
A. Take with potassium supplements
B. Discontinue if dry cough occurs
C. Expect immediate symptom relief
D. Double the dose if symptoms worsen
Q57: What is an important patient education point for those starting an ACE inhibitor?
A. Take with potassium supplements
B. Discontinue if dry cough occurs ✅
C. Expect immediate symptom relief
D. Double the dose if symptoms worsen
273
Q58: In what scenario is an ARNI (e.g., sacubitril/valsartan) considered over ACE inhibitors?
A. When the patient is diabetic
B. When EF is preserved
C. If the patient remains symptomatic on ACE inhibitors and beta blockers
D. When potassium is low
Q58: In what scenario is an ARNI (e.g., sacubitril/valsartan) considered over ACE inhibitors?
A. When the patient is diabetic
B. When EF is preserved
C. If the patient remains symptomatic on ACE inhibitors and beta blockers ✅
D. When potassium is low
274
Q59: Which medication class may increase diuresis and improve cardiac outcomes without a direct impact on blood pressure?
A. ARBs
B. MRAs
C. SGLT2 inhibitors
D. Beta blockers
Q59: Which medication class may increase diuresis and improve cardiac outcomes without a direct impact on blood pressure?
A. ARBs
B. MRAs
C. SGLT2 inhibitors ✅
D. Beta blockers
275
Q60: What is a key nursing consideration before administering digoxin?
A. Check blood pressure
B. Assess for cough
C. Assess apical heart rate for 1 minute
D. Encourage fluid intake
Q60: What is a key nursing consideration before administering digoxin?
A. Check blood pressure
B. Assess for cough
C. Assess apical heart rate for 1 minute ✅
D. Encourage fluid intake
