Heart Failure Exam Questions and
Answers with Rationales
Based on NCLEX-style and nursing exam preparation materials, here is a
comprehensive practice exam covering Heart Failure. Each question includes
the correct answer in bold and a detailed rationale in italics.
Section 1: Pathophysiology & Assessment
(Questions 1-15)
Question 1:
A patient is diagnosed with left ventricular systolic dysfunction heart failure.
Which of the following are expected findings with this condition?
A) Echocardiogram shows an ejection fraction of 38%.
B) Heart catheterization shows an ejection fraction of 65%.
C) Patient has frequent episodes of nocturnal paroxysmal dyspnea.
D) Options A and C are both expected findings with left-sided systolic
dysfunction heart failure.
*Rationale: Systolic heart failure is defined by reduced ejection fraction ≤40% on
echocardiogram. Paroxysmal nocturnal dyspnea is a classic symptom of left-sided
heart failure due to fluid accumulation in the lungs when recumbent. An EF of
65% is normal and not consistent with systolic failure .*
Question 2:
What type of heart failure does this statement describe? "The ventricle is unable
to properly fill with blood because it is too stiff. Therefore, blood backs up into the
lungs causing the patient to experience shortness of breath."
,A) Left ventricular diastolic dysfunction
B) Left ventricular systolic dysfunction
C) Right ventricular diastolic dysfunction
D) Right ventricular systolic dysfunction
Rationale: Diastolic dysfunction occurs when the ventricle becomes stiff and
cannot relax properly during diastole, impairing filling. This leads to backup of
blood into the pulmonary circulation, causing shortness of breath. Systolic
dysfunction involves impaired contraction/ejection .
Question 3:
A nurse is assessing a client with right-sided heart failure. Which of the following
findings should the nurse expect? (Select all that apply)
A) Jugular vein distention
B) Pulmonary crackles
C) Ascites
D) Hepatomegaly
E) Orthopnea
Answer: A, C, D
Rationale: Right-sided heart failure causes systemic fluid backup (backward
failure) due to the right ventricle's inability to pump blood into the pulmonary
circulation. This results in jugular vein distention (JVD), hepatomegaly (enlarged
liver), ascites (abdominal fluid), and peripheral edema. Pulmonary crackles and
orthopnea are characteristic of left-sided heart failure due to pulmonary
congestion .
Question 4:
Which of the following is a late sign of heart failure?
A) Shortness of breath
B) Frothy blood-tinged sputum
C) Edema
D) Orthopnea
,Rationale: Frothy, blood-tinged sputum indicates acute pulmonary edema, a
severe, life-threatening manifestation of advanced heart failure. While dyspnea,
orthopnea, and edema are important signs, they typically appear earlier in the
disease progression. Pink frothy sputum represents alveolar hemorrhage and fluid
accumulation requiring emergent intervention .
Question 5:
A 74-year-old female presents to the ER with complaints of dyspnea, persistent
cough, and inability to sleep at night due to difficulty breathing. On assessment,
you note crackles throughout the lung fields, respiratory rate of 25, and oxygen
saturation of 90% on room air. Which of the following lab results confirms your
suspicions of heart failure?
A) BNP 820
B) K+ 5.6
C) BUN 9
D) Troponin <0.02
*Rationale: B-type natriuretic peptide (BNP) is released from ventricular myocytes
in response to increased wall stress from volume overload. A BNP level greater
than 100 pg/mL suggests heart failure, and levels >400 pg/mL are strongly
indicative. This patient's BNP of 820 confirms heart failure as the cause of her
symptoms. Troponin assesses myocardial injury; potassium and BUN are not
diagnostic for HF .*
Question 6:
You listen to the heart of your 50-year-old patient. You hear an S3 gallop. What is
the likely diagnosis?
A) Patent ductus arteriosus
B) Aortic stenosis
C) Mitral stenosis
D) Heart failure
*Rationale: An S3 gallop is produced by blood striking a non-compliant, volume-
overloaded ventricle during rapid filling in early diastole. In adults over age 40, an
, S3 is almost always pathologic and suggests heart failure with reduced ejection
fraction or volume overload states such as mitral regurgitation. In children and
young adults, an S3 may be physiologic .*
Question 7:
At night, a 63-year-old woman suddenly developed an asphyxia attack. She has a
15-year history of essential hypertension and had a myocardial infarction 2 years
ago. Objectively: orthopneic position, pale skin, cold sweat, acrocyanosis. Pulse
104/min, BP 210/130 mm Hg, RR 38/min. What is the most likely complication?
A) Acute left ventricular failure
B) Paroxysmal tachycardia
C) Bronchial asthma attack
D) Pulmonary embolism
Rationale: This presentation—acute onset of dyspnea, orthopnea, crackles,
hypertension, and cold extremities—is classic for acute left ventricular
failure/pulmonary edema. The patient's history of hypertension and prior MI
places her at high risk. The rapid onset and absence of wheezing makes asthma
less likely .
Question 8:
Which of the following would NOT be an expected sign of right-sided congestive
heart failure?
A) Prominent jugular vein
B) Hepatomegaly
C) Pulmonary edema
D) Pleural effusion
Rationale: Pulmonary edema is a manifestation of LEFT-sided heart failure due to
backup of blood into the pulmonary circulation. Right-sided heart failure causes
systemic congestion (JVD, hepatomegaly, ascites, peripheral edema). Pleural
effusions can occur in right-sided failure but are not the hallmark sign .
Question 9:
What is the name for shortness of breath when lying down?
Answers with Rationales
Based on NCLEX-style and nursing exam preparation materials, here is a
comprehensive practice exam covering Heart Failure. Each question includes
the correct answer in bold and a detailed rationale in italics.
Section 1: Pathophysiology & Assessment
(Questions 1-15)
Question 1:
A patient is diagnosed with left ventricular systolic dysfunction heart failure.
Which of the following are expected findings with this condition?
A) Echocardiogram shows an ejection fraction of 38%.
B) Heart catheterization shows an ejection fraction of 65%.
C) Patient has frequent episodes of nocturnal paroxysmal dyspnea.
D) Options A and C are both expected findings with left-sided systolic
dysfunction heart failure.
*Rationale: Systolic heart failure is defined by reduced ejection fraction ≤40% on
echocardiogram. Paroxysmal nocturnal dyspnea is a classic symptom of left-sided
heart failure due to fluid accumulation in the lungs when recumbent. An EF of
65% is normal and not consistent with systolic failure .*
Question 2:
What type of heart failure does this statement describe? "The ventricle is unable
to properly fill with blood because it is too stiff. Therefore, blood backs up into the
lungs causing the patient to experience shortness of breath."
,A) Left ventricular diastolic dysfunction
B) Left ventricular systolic dysfunction
C) Right ventricular diastolic dysfunction
D) Right ventricular systolic dysfunction
Rationale: Diastolic dysfunction occurs when the ventricle becomes stiff and
cannot relax properly during diastole, impairing filling. This leads to backup of
blood into the pulmonary circulation, causing shortness of breath. Systolic
dysfunction involves impaired contraction/ejection .
Question 3:
A nurse is assessing a client with right-sided heart failure. Which of the following
findings should the nurse expect? (Select all that apply)
A) Jugular vein distention
B) Pulmonary crackles
C) Ascites
D) Hepatomegaly
E) Orthopnea
Answer: A, C, D
Rationale: Right-sided heart failure causes systemic fluid backup (backward
failure) due to the right ventricle's inability to pump blood into the pulmonary
circulation. This results in jugular vein distention (JVD), hepatomegaly (enlarged
liver), ascites (abdominal fluid), and peripheral edema. Pulmonary crackles and
orthopnea are characteristic of left-sided heart failure due to pulmonary
congestion .
Question 4:
Which of the following is a late sign of heart failure?
A) Shortness of breath
B) Frothy blood-tinged sputum
C) Edema
D) Orthopnea
,Rationale: Frothy, blood-tinged sputum indicates acute pulmonary edema, a
severe, life-threatening manifestation of advanced heart failure. While dyspnea,
orthopnea, and edema are important signs, they typically appear earlier in the
disease progression. Pink frothy sputum represents alveolar hemorrhage and fluid
accumulation requiring emergent intervention .
Question 5:
A 74-year-old female presents to the ER with complaints of dyspnea, persistent
cough, and inability to sleep at night due to difficulty breathing. On assessment,
you note crackles throughout the lung fields, respiratory rate of 25, and oxygen
saturation of 90% on room air. Which of the following lab results confirms your
suspicions of heart failure?
A) BNP 820
B) K+ 5.6
C) BUN 9
D) Troponin <0.02
*Rationale: B-type natriuretic peptide (BNP) is released from ventricular myocytes
in response to increased wall stress from volume overload. A BNP level greater
than 100 pg/mL suggests heart failure, and levels >400 pg/mL are strongly
indicative. This patient's BNP of 820 confirms heart failure as the cause of her
symptoms. Troponin assesses myocardial injury; potassium and BUN are not
diagnostic for HF .*
Question 6:
You listen to the heart of your 50-year-old patient. You hear an S3 gallop. What is
the likely diagnosis?
A) Patent ductus arteriosus
B) Aortic stenosis
C) Mitral stenosis
D) Heart failure
*Rationale: An S3 gallop is produced by blood striking a non-compliant, volume-
overloaded ventricle during rapid filling in early diastole. In adults over age 40, an
, S3 is almost always pathologic and suggests heart failure with reduced ejection
fraction or volume overload states such as mitral regurgitation. In children and
young adults, an S3 may be physiologic .*
Question 7:
At night, a 63-year-old woman suddenly developed an asphyxia attack. She has a
15-year history of essential hypertension and had a myocardial infarction 2 years
ago. Objectively: orthopneic position, pale skin, cold sweat, acrocyanosis. Pulse
104/min, BP 210/130 mm Hg, RR 38/min. What is the most likely complication?
A) Acute left ventricular failure
B) Paroxysmal tachycardia
C) Bronchial asthma attack
D) Pulmonary embolism
Rationale: This presentation—acute onset of dyspnea, orthopnea, crackles,
hypertension, and cold extremities—is classic for acute left ventricular
failure/pulmonary edema. The patient's history of hypertension and prior MI
places her at high risk. The rapid onset and absence of wheezing makes asthma
less likely .
Question 8:
Which of the following would NOT be an expected sign of right-sided congestive
heart failure?
A) Prominent jugular vein
B) Hepatomegaly
C) Pulmonary edema
D) Pleural effusion
Rationale: Pulmonary edema is a manifestation of LEFT-sided heart failure due to
backup of blood into the pulmonary circulation. Right-sided heart failure causes
systemic congestion (JVD, hepatomegaly, ascites, peripheral edema). Pleural
effusions can occur in right-sided failure but are not the hallmark sign .
Question 9:
What is the name for shortness of breath when lying down?
