NURS 2003 EXAM (2025-2026)
QUESTIONS AND (elaborated) WITH
COMPLETE SOLUTIONS GRADED A+.
80% of heart failure cases are caused by what three things? - Answer -ischemic heart disease
-chronic hypertension
-myocardial infarction
Select all that apply:
Heart failure is most common in:
a) men
b) women
c) young adults
d) old adults - Answer a&d
What is ejection fraction? - Answer The percentage of total amount of end-diastolic blood
volume ejected during each systole.
What is a normal ejection fraction? - Answer more than 55% of ventricular volume
Heart failure with reduced ejection fraction can also be referred to as what? - Answer
Systolic heart failure
Heart failure with preserved ejection fraction can also be referred to as what? - Answer
Diastolic heart failure
Starling's Law - Answer The more the heart is filled during diastole the more forcefully it
contracts
Problems with the left ventricle indicate what? - Answer Issues relating to the lungs
(pulmonary)
Problems with the right ventricle indicate what? - Answer Peripheral and systemic issues (ie.,
enlarged liver)
,Cor pulmonare - Answer Right sided heart failure specifically from COPD
Symptoms of left-sided heart failure - Answer -paroxsymal nocturnal dyspnea
-elevated pulmonary capillary wedge pressure
-pulmonary congestion (cough, crackles, wheezes, blood-tinted sputum or hemoptysis,
tachypnea)
-restlessness
-confusion
-orthopnea
-tachycardia
-fatigue
-pallor or cyanosis
-exertional dyspnea
-elevated HR, BP
-excessory muscles in use for breathing
-clammy cool skin (vasoconstriction)
-decreased PaO2
-decreased cardiac output
-decreased tissue perfusion
-impaired gas exchange
-oliguria
Symptoms of right-sided heart failure - Answer -distended jugular veins
-anorexia
-GI distress/congestion
-weight gain
-edema
-fatigue
-elevated venous pressure
-ascites
-enlarged liver and spleen (splenomegaly and hepatomegaly)
-exercise intolerance
-chest pain
,What is the primary cause of right-sided heart failure? - Answer Left-sided heart failure
What are the 4 compensatory mechanisms for heart failure? - Answer 1.Dilation of ventricles
2.Hypertrophy of the ventricles
3.Activation of SNS
4.Neurohormonal responses
Explain dilation of ventricles as a compensatory mechanism - Answer Starling's Law explains
that ventricular muscle fibers will stretch to increase force of contraction and cardiac output,
although elasticity may decrease over time.
Explain hypertrophy as a compensatory mechanism - Answer Overworked and overstrained
myocardial muscles will respond by increasing muscle mass and thickness to restore cardiac
output.
Explain SNS activation as a compensatory mechanism - Answer Low cardiac output and
stroke volume triggers release of epi and norepi to increase HR, contractility, and
vasocontriction.
Explain neurohormonal response as a compensatory mechanism - Answer -RAAS: stimulates
release of ADH from posterior pituitary, ANG-II and aldosterone from adrenal glands
-Endothelin: potent vasoconstrictor
-HPA axis: cortisol
-ANP and BNP: natriuric peptides increase vasodilation and diuresis whilst preventing
hypertrophy
List the roles of ANP and BNP natriuric peptides - Answer -natriuresis
-diuresis
-high GFR
-inhibits renin release (lowers ANG enzyme production and vasoconstriction)
-vasodilation
-arterial hypotension
-reduce venous pressure
-reduce capillary pulmonary wedge pressure
Management for chronic heart failure - Answer 1.Identify type of heart failure
2.Sodium and fluid restrictions
, 3.Mild exercise for tolerance
4.Small meals
5.Medication adherence
6.Oxygen use
What are the 4 main treatments for heart failure? - Answer 1.ARB/ACE or ARNI (angiotensin
receptor neprilysin inhibitor) to inhibit vasoconstriction
2.Beta-blocker (-olol) to block effects of epinephrine and slow HR
3.MRA (mineralcorticoid receptor antagonist) to spake K+ and block effects of aldosterone
4.SGLT2 inhibitor to inhibit transport of sodium and glucose, reducing inflammation and SNS
activity
Asthma - Answer hyper-responsive inflammatory disorder of the airway
Triggers for asthma - Answer -environmental (cold air, smoke, emotional distress)
-allergies (dust mites, pollen, mold)
-respiratory (increased inflammation with hyper-responsive activity)
-drugs and food (beta blockers, NSAIDS, salicylates)
Phases of asthma - Answer Early phase:
-bronchospasm (peaks 30-90 min after exposure)
-vascular congestion
-increased mucus secretion
-edema
-tenacious sputum
-thickening of airway walls
Late phase:
-inflammation (peaks within 5-12 hours)
-immune activation (IL-4, IgE, neutrophils, lymphocytes, eosinophils)
-can last days
-reversal can be acheived with corticosteroids
Pathophysiology of asthma attack - Answer --> Asthma trigger (allergen, infection, irritant)
stimulates immune activation.
--> Mature B-cells, when activated by asthma trigger, become plasma cells.
QUESTIONS AND (elaborated) WITH
COMPLETE SOLUTIONS GRADED A+.
80% of heart failure cases are caused by what three things? - Answer -ischemic heart disease
-chronic hypertension
-myocardial infarction
Select all that apply:
Heart failure is most common in:
a) men
b) women
c) young adults
d) old adults - Answer a&d
What is ejection fraction? - Answer The percentage of total amount of end-diastolic blood
volume ejected during each systole.
What is a normal ejection fraction? - Answer more than 55% of ventricular volume
Heart failure with reduced ejection fraction can also be referred to as what? - Answer
Systolic heart failure
Heart failure with preserved ejection fraction can also be referred to as what? - Answer
Diastolic heart failure
Starling's Law - Answer The more the heart is filled during diastole the more forcefully it
contracts
Problems with the left ventricle indicate what? - Answer Issues relating to the lungs
(pulmonary)
Problems with the right ventricle indicate what? - Answer Peripheral and systemic issues (ie.,
enlarged liver)
,Cor pulmonare - Answer Right sided heart failure specifically from COPD
Symptoms of left-sided heart failure - Answer -paroxsymal nocturnal dyspnea
-elevated pulmonary capillary wedge pressure
-pulmonary congestion (cough, crackles, wheezes, blood-tinted sputum or hemoptysis,
tachypnea)
-restlessness
-confusion
-orthopnea
-tachycardia
-fatigue
-pallor or cyanosis
-exertional dyspnea
-elevated HR, BP
-excessory muscles in use for breathing
-clammy cool skin (vasoconstriction)
-decreased PaO2
-decreased cardiac output
-decreased tissue perfusion
-impaired gas exchange
-oliguria
Symptoms of right-sided heart failure - Answer -distended jugular veins
-anorexia
-GI distress/congestion
-weight gain
-edema
-fatigue
-elevated venous pressure
-ascites
-enlarged liver and spleen (splenomegaly and hepatomegaly)
-exercise intolerance
-chest pain
,What is the primary cause of right-sided heart failure? - Answer Left-sided heart failure
What are the 4 compensatory mechanisms for heart failure? - Answer 1.Dilation of ventricles
2.Hypertrophy of the ventricles
3.Activation of SNS
4.Neurohormonal responses
Explain dilation of ventricles as a compensatory mechanism - Answer Starling's Law explains
that ventricular muscle fibers will stretch to increase force of contraction and cardiac output,
although elasticity may decrease over time.
Explain hypertrophy as a compensatory mechanism - Answer Overworked and overstrained
myocardial muscles will respond by increasing muscle mass and thickness to restore cardiac
output.
Explain SNS activation as a compensatory mechanism - Answer Low cardiac output and
stroke volume triggers release of epi and norepi to increase HR, contractility, and
vasocontriction.
Explain neurohormonal response as a compensatory mechanism - Answer -RAAS: stimulates
release of ADH from posterior pituitary, ANG-II and aldosterone from adrenal glands
-Endothelin: potent vasoconstrictor
-HPA axis: cortisol
-ANP and BNP: natriuric peptides increase vasodilation and diuresis whilst preventing
hypertrophy
List the roles of ANP and BNP natriuric peptides - Answer -natriuresis
-diuresis
-high GFR
-inhibits renin release (lowers ANG enzyme production and vasoconstriction)
-vasodilation
-arterial hypotension
-reduce venous pressure
-reduce capillary pulmonary wedge pressure
Management for chronic heart failure - Answer 1.Identify type of heart failure
2.Sodium and fluid restrictions
, 3.Mild exercise for tolerance
4.Small meals
5.Medication adherence
6.Oxygen use
What are the 4 main treatments for heart failure? - Answer 1.ARB/ACE or ARNI (angiotensin
receptor neprilysin inhibitor) to inhibit vasoconstriction
2.Beta-blocker (-olol) to block effects of epinephrine and slow HR
3.MRA (mineralcorticoid receptor antagonist) to spake K+ and block effects of aldosterone
4.SGLT2 inhibitor to inhibit transport of sodium and glucose, reducing inflammation and SNS
activity
Asthma - Answer hyper-responsive inflammatory disorder of the airway
Triggers for asthma - Answer -environmental (cold air, smoke, emotional distress)
-allergies (dust mites, pollen, mold)
-respiratory (increased inflammation with hyper-responsive activity)
-drugs and food (beta blockers, NSAIDS, salicylates)
Phases of asthma - Answer Early phase:
-bronchospasm (peaks 30-90 min after exposure)
-vascular congestion
-increased mucus secretion
-edema
-tenacious sputum
-thickening of airway walls
Late phase:
-inflammation (peaks within 5-12 hours)
-immune activation (IL-4, IgE, neutrophils, lymphocytes, eosinophils)
-can last days
-reversal can be acheived with corticosteroids
Pathophysiology of asthma attack - Answer --> Asthma trigger (allergen, infection, irritant)
stimulates immune activation.
--> Mature B-cells, when activated by asthma trigger, become plasma cells.
