Heart Failure Module Post Test

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| By Joe Powers
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Heart Failure Module Post Test - Quiz

Quiz accompanying Heart Failure module November, 2012.


Questions and Answers
  • 1. 

    A patient tells you that he needs 4 pillows to sleep at night but prefers to sleep in his recliner with the head elevated. This is an example of:

    • A.

      A. Dyspnea on Exertion

    • B.

      B. Orthopnea

    • C.

      C. Paroxysymal Nocturnal Dyspnea

    • D.

      D. Bronchitis

    Correct Answer
    B. B. Orthopnea
    Explanation
    Orthopnea refers to the difficulty in breathing when lying flat, which is relieved by sitting up or sleeping in a recliner with the head elevated. In this case, the patient requires 4 pillows to sleep at night, indicating that lying flat causes discomfort and difficulty in breathing. Therefore, the patient's preference to sleep in a recliner with the head elevated is an example of orthopnea.

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  • 2. 

    Mr. M arrives on your floor from the ER. He is on bedrest and denies chest pain; however, you notice that his O2 sats are 87% on 2L and he is unable to complete his sentences as he rests between each few words. He tells you that he knew something was wrong this morning because he was more short of breath than usual. He explains that he had to rest in between putting his clothes on. According to the NYHA classification he would be :

    • A.

      A. NYHA I

    • B.

      B. NYHA II

    • C.

      C. NYHA III

    • D.

      B. NYHA IV

    Correct Answer
    D. B. NYHA IV
    Explanation
    According to the given information, Mr. M is experiencing severe symptoms of shortness of breath and has significantly impaired exercise tolerance. He is unable to complete his sentences without resting between each few words and his oxygen saturation is low. These symptoms indicate that he is in NYHA class IV, which is characterized by symptoms of heart failure even at rest and inability to carry out any physical activity without discomfort.

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  • 3. 

    A compensatory mechanism involved in HF that leads to inappropriate fluid retention and additional workload of the heart is:

    • A.

      A. Ventricular dilation

    • B.

      B. Ventricular hypertrophy

    • C.

      C. Neurohormonal response

    • D.

      D. Sympathetic nervous system activation

    Correct Answer
    C. C. Neurohormonal response
    Explanation
    In heart failure, the body's compensatory mechanism involves a neurohormonal response. This response is characterized by the activation of various hormones and neurotransmitters such as angiotensin II, aldosterone, and norepinephrine. These substances cause vasoconstriction, sodium and water retention, and increased sympathetic activity. While this response initially aims to maintain cardiac output, it ultimately leads to fluid retention, increased workload on the heart, and worsening of heart failure symptoms. Therefore, the neurohormonal response is an inappropriate compensatory mechanism in heart failure.

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  • 4. 

    Signs and symptoms of heart failure may include all of the following except:

    • A.

      A. Confusion

    • B.

      B. Frequent belching

    • C.

      C. Anxiety and fatigue

    • D.

      D. Early satiety

    Correct Answer
    B. B. Frequent belching
    Explanation
    Heart failure is a condition where the heart is unable to pump enough blood to meet the body's needs. Common signs and symptoms of heart failure include confusion, anxiety, fatigue, and early satiety. However, frequent belching is not typically associated with heart failure. Belching is more commonly related to gastrointestinal issues such as indigestion or acid reflux. Therefore, the correct answer is b. Frequent belching.

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  • 5. 

    Findings from the Randomized Aldactone Survival Study (RALES) indicate that the addition of spironolactone , an aldosterone antagonist, lowers mortality by inhibiting the release of Aldosterone.  The following are true regarding Aldosterone except

    • A.

      A. It promotes sodium and water retention

    • B.

      B. Potassium levels should be monitored carefully because of the diuretic effects of aldosterone can lead to hypokalemia

    • C.

      C. It is considered a mild diuretic that may reverse remodeling

    • D.

      D. Recommended for patients with New York Heart Association (NYHA) class III or IV with a reduced LVEF

    Correct Answer
    A. A. It promotes sodium and water retention
    Explanation
    Aldosterone is a hormone produced by the adrenal glands that promotes sodium and water reabsorption in the kidneys, leading to increased blood volume and blood pressure. Therefore, the statement that it promotes sodium and water retention is incorrect. The other options are true: b) Potassium levels should be monitored carefully because aldosterone can cause potassium excretion, leading to hypokalemia. c) Aldosterone is not considered a diuretic, but rather a hormone that regulates fluid and electrolyte balance. d) Spironolactone, an aldosterone antagonist, is recommended for patients with NYHA class III or IV heart failure and reduced left ventricular ejection fraction.

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  • 6. 

    1. Which of the following is true regarding ACE-I and ARB and their mechanism of action?

    • A.

      A. ARB cause increased kinin and prostaglandin production

    • B.

      B. ACE-I inhibit the conversion of angiotensin I to angiotensin II

    • C.

      C. ACE-I work directly at the site of the angiotensin receptor

    • D.

      D. All of the above

    Correct Answer
    B. B. ACE-I inhibit the conversion of angiotensin I to angiotensin II
    Explanation
    ACE-I (angiotensin-converting enzyme inhibitors) work by inhibiting the conversion of angiotensin I to angiotensin II. This leads to vasodilation and a decrease in blood pressure. ARBs (angiotensin receptor blockers) on the other hand, block the action of angiotensin II at the receptor sites. They do not cause increased kinin and prostaglandin production. Therefore, the correct answer is b. ACE-I inhibit the conversion of angiotensin I to angiotensin II.

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  • 7. 

    Mr. Bigheart is admitted with  HF NYHA  class III. His echocardiogram shows an ejection fraction of 39%.  According to the ACC/AHA guidelines, he should be placed on an evidence-based beta blocker. Which of the following is NOT an evidence–based beta blocker?

    • A.

      A. Sotolol

    • B.

      B. Bisoprolol

    • C.

      C. Carvedilol

    • D.

      D. Metoprolol Tartrate

    • E.

      E. A & D

    Correct Answer
    E. E. A & D
    Explanation
    The correct answer is e. A & D. This means that both Sotolol and Metoprolol Tartrate are not evidence-based beta blockers according to the ACC/AHA guidelines.

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  • 8. 

    Mr. Bigheart is readmitted 3 times over the next year. At his most recent admission, his echocardiogram shows his ejection fraction to be 20%.  Which one of his findings would not make Mr. Bigheart a candidate for CRT?

    • A.

      A. Ejection fraction = 34%

    • B.

      B. EKG with QRS duration = 118ms

    • C.

      C. He has non-ischemic cardiomyopathy

    • D.

      D. He is > 85 years old

    Correct Answer
    B. B. EKG with QRS duration = 118ms
    Explanation
    A CRT (Cardiac Resynchronization Therapy) is a treatment option for patients with heart failure and a prolonged QRS duration, typically greater than 120ms. In this case, Mr. Bigheart's EKG shows a QRS duration of 118ms, which is not prolonged enough to make him a candidate for CRT. Therefore, option b is the correct answer.

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  • 9. 

    Quality Measures for Heart Failure have been instituted for Mr. Bigheart.  The nurse notices that the patient is not on an ACE-I/ARB. The physician informs the nurse that the patient is allergic to an ACE-Inhibitor. Identify the correct statement below.

    • A.

      A. It is not a problem because the patient does not need to be on an ACE/ARB for this QM.

    • B.

      B. There should be documentation of an allergic reaction to both an ACE & ARB for this patient.

    • C.

      C. He does not need an ACE-I/ARB because he is going home on Bisoprolol

    • D.

      D. Both B & C

    Correct Answer
    B. B. There should be documentation of an allergic reaction to both an ACE & ARB for this patient.
    Explanation
    The correct statement is b. There should be documentation of an allergic reaction to both an ACE & ARB for this patient. This is because the nurse noticed that the patient is not on an ACE-I/ARB and the physician informed the nurse that the patient is allergic to an ACE-Inhibitor. In order to ensure patient safety and avoid any potential adverse reactions, there should be proper documentation of the patient's allergic reaction to both an ACE and ARB before considering alternative medications.

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  • 10. 

    Which of the following symptoms is associated mainly with right – sided HF?

    • A.

      A. Neck vein distention

    • B.

      B. Tachypnea and dyspnea

    • C.

      C. Adventitious breath sounds

    • D.

      D. Orthopnea

    Correct Answer
    A. A. Neck vein distention
    Explanation
    Right-sided heart failure (HF) occurs when the right side of the heart is unable to effectively pump blood to the lungs for oxygenation. This can lead to increased pressure in the veins, causing neck vein distention. Tachypnea and dyspnea (rapid breathing and difficulty breathing) are more commonly associated with left-sided HF, as the left side of the heart is responsible for pumping oxygenated blood to the rest of the body. Adventitious breath sounds (abnormal lung sounds) can be present in both left and right-sided HF. Orthopnea (difficulty breathing while lying flat) is also more commonly associated with left-sided HF.

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  • 11. 

    An ACE Inhibitor causes which of the following to occur?

    • A.

      A. Increased vascular resistance

    • B.

      B. Vasoconstriction

    • C.

      C. Increase in sodium excretion

    • D.

      D. Decrease in heart rate

    Correct Answer
    C. C. Increase in sodium excretion
    Explanation
    An ACE inhibitor causes an increase in sodium excretion. ACE inhibitors block the action of the enzyme ACE (angiotensin-converting enzyme), which is responsible for converting angiotensin I to angiotensin II. Angiotensin II is a potent vasoconstrictor and also stimulates the release of aldosterone, which leads to sodium and water retention. By inhibiting ACE, ACE inhibitors decrease the production of angiotensin II, resulting in vasodilation and increased sodium excretion. This helps to reduce blood pressure and fluid volume in the body.

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  • 12. 

    Ejection fraction can be assessed by :

    • A.

      A. Left ventriculogram during cardiac catheterization

    • B.

      B. Nuclear Imaging Study

    • C.

      C. Echocardiogram

    • D.

      D. All of the above

    Correct Answer
    D. D. All of the above
    Explanation
    The ejection fraction, which measures the percentage of blood pumped out of the left ventricle with each heartbeat, can be assessed using different methods. A left ventriculogram during cardiac catheterization involves injecting contrast dye into the heart's left ventricle and taking X-ray images to visualize the pumping function. Nuclear imaging studies, such as a radionuclide ventriculography or a gated single-photon emission computed tomography (SPECT) scan, use radioactive tracers to assess the ejection fraction. Echocardiography, a non-invasive imaging technique that uses sound waves, can also measure the ejection fraction. Therefore, all of the mentioned methods can be used to assess the ejection fraction.

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  • 13. 

      Only an MD can make an education referral to the Heart Failure Program.

    • A.

      A. True

    • B.

      B. False

    Correct Answer
    B. B. False
    Explanation
    The statement is false because it states that only an MD can make an education referral to the Heart Failure Program. This implies that no other healthcare professional or individual can make a referral, which is not true. Other healthcare professionals, such as nurse practitioners or physician assistants, may also be able to make referrals to the program.

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  • 14. 

    A patient has been admitted 5 times over the last year with acute decompensated heart failure.  An echocardiogram shows an EF of 38%.  His QRS is 130ms.  He would be a good candidate for CRT therapy.

    • A.

      A. True

    • B.

      B. False

    Correct Answer
    B. B. False
    Explanation
    The patient's echocardiogram shows an EF of 38%, which indicates reduced heart function. However, the QRS of 130ms suggests that the patient has a wide QRS complex, which is a contraindication for CRT therapy. Therefore, the patient would not be a good candidate for CRT therapy.

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  • 15. 

    While auscultating your patient’s heart sounds, you hear a harsh , systolic murmur in the aortic area. The patient was admitted with HF which may likely be related to his history of aortic stenosis.

    • A.

      A. True

    • B.

      B. False

    Correct Answer
    A. A. True
    Explanation
    The presence of a harsh, systolic murmur in the aortic area suggests aortic stenosis, which is a narrowing of the aortic valve. Aortic stenosis can lead to heart failure (HF) because the narrowed valve obstructs blood flow from the left ventricle to the aorta, causing increased pressure and workload on the heart. Therefore, it is likely that the patient's history of aortic stenosis is related to their current HF.

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  • 16. 

    Side effects of Beta-blockers include all of the following except:

    • A.

      A. Erectile dysfunction

    • B.

      B. Gynecomastia

    • C.

      C. Hypotenstion

    • D.

      D. Bradycardia

    Correct Answer
    B. B. Gynecomastia
    Explanation
    Beta-blockers are a class of medications commonly used to treat conditions such as hypertension and heart disease. They work by blocking the effects of adrenaline on the body, which helps to lower blood pressure and heart rate. Some common side effects of beta-blockers include erectile dysfunction, hypotension (low blood pressure), and bradycardia (slow heart rate). However, gynecomastia, which is the development of breast tissue in males, is not a known side effect of beta-blockers.

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  • 17. 

    A patient tells you that he needs 4 pillows to sleep at night but prefers to sleep in his recliner with the head elevated. This is an example of:

    • A.

      A. Dyspnea on Exertion

    • B.

      B. Orthopnea

    • C.

      C. Paroxysymal Nocturnal Dyspnea

    • D.

      D. Bronchitis

    Correct Answer
    B. B. Orthopnea
    Explanation
    Orthopnea refers to the difficulty of breathing while lying flat. In this scenario, the patient prefers to sleep in a recliner with the head elevated, indicating that lying flat worsens their breathing. This aligns with the definition of orthopnea, making it the correct answer choice. Dyspnea on exertion refers to difficulty breathing during physical activity, paroxysmal nocturnal dyspnea refers to sudden episodes of difficulty breathing at night, and bronchitis is an inflammation of the bronchial tubes. None of these options accurately describe the patient's situation.

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  • Current Version
  • Mar 22, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Nov 02, 2012
    Quiz Created by
    Joe Powers
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