NR508 / NR 508 Midterm Exam (Latest ):
Advanced Physical Assessment - Chamberlain
Angiotensin-converting-enzyme (ACE) inhibitors are a central part of the
treatment of heart failure because they have more than one action to
address the pathological changes in this disorder. Which of the following
pathological changes in heart failure is NOT addressed by ACE inhibitors?
1. Changes in the structure of the left ventricle so that it dilates,
hypertrophies, and uses energy less efficiently.
2. Reduced formation of cross-bridges so that contractile force decreases.
3. Activation of the sympathetic nervous system that increases heart rate
and preload.
4. Decreased renal blood flow that decreases oxygen supply to the kidneys. -
3. Activation of the sympathetic nervous system that increases heart rate
and preload.
One of the three types of heart failure involves systolic dysfunction. Potential
causes of this most common form of heart failure include:
1. Myocardial ischemia and injury secondary to myocardial infarction
2. Inadequate relaxation and loss of muscle fiber secondary to valvular
dysfunction
3. Increased demands of the heart beyond its ability to adapt secondary to
anemia
4. Slower filling rate and elevated systolic pressures secondary to
uncontrolled hypertension - 1. Myocardial ischemia and injury secondary to
myocardial infarction
The American Heart Association and the American College of Cardiology
have devised a classification system for heart failure that can be used to
direct treatment. Patients with symptoms and underlying disease are
classified as stage:
1. A
2. B
3. C
,NR508 / NR 508 Midterm Exam (Latest ):
Advanced Physical Assessment - Chamberlain
4. D - 3. C
Diagnosis of heart failure cannot be made by symptoms alone because many
disorders share the same symptoms. The most specific and sensitive
diagnostic test for heart failure is:
1. Chest x-rays that show cephalization and measure heart size
2. Two-dimensional echocardiograms that identify structural anomalies and
cardiac dysfunction
3. Complete blood count, blood urea nitrogen, and serum electrolytes that
facilitate staging for end-organ damage
4. Measurement of brain natriuretic peptide to distinguish between systolic
and diastolic dysfunction - 2. Two-dimensional echocardiograms that identify
structural anomalies and cardiac dysfunction
Treatments for heart failure, including drug therapy, are based on the stages
developed by the ACC/AHA. Stage A patients are treated with:
1. Drugs for hypertension and hyperlipidemia, if they exist
2. Lifestyle management including diet, exercise, and smoking cessation
only
3. Angiotensin-converting enzyme (ACE) inhibitors to directly affect the heart
failure only
4. No drugs are used in this early stage - 1. Drugs for hypertension and
hyperlipidemia, if they exist
Class I recommendations for stage A heart failure include:
1. Aerobic exercise within tolerance levels to prevent the development of
heart failure
2. Reduction of sodium intake to less than 2,000 mg/day to prevent fluid
retention
3. Beta blockers for all patients regardless of cardiac history
,NR508 / NR 508 Midterm Exam (Latest ):
Advanced Physical Assessment - Chamberlain
4. Treatment of thyroid disorders, especially if they are associated with
tachyarrhythmias - 4. Treatment of thyroid disorders, especially if they are
associated with tachyarrhythmias
Stage B patients should have beta blockers added to their heart failure
treatment regimen when:
1. They have an ejection fraction less than 40%
2. They have had a recent MI
3. Both 1 and 2
4. Neither 1 nor 2 - 3. Both 1 and 2
Increased life expectancy for patients with heart failure has been associated
with the use of:
1. ACE inhibitors, especially when started early in the disease process
2. All beta blockers regardless of selectivity
3. Thiazide and loop diuretics
4. Cardiac glycosides - 1. ACE inhibitors, especially when started early in the
disease process
Stage C patients usually require a combination of three to four drugs to
manage their heart failure. In addition to ACE inhibitors and beta blockers,
diuretics may be added. Which of the following statements about diuretics is
NOT true?
1. Diuretics reduce preload associated with fluid retention.
2. Diuretics can be used earlier than stage C when the goal is control of
hypertension.
3. Diuretics may produce problems with electrolyte imbalances and abnormal
glucose and lipid metabolism.
, NR508 / NR 508 Midterm Exam (Latest ):
Advanced Physical Assessment - Chamberlain
4. Diuretics from the potassium-sparing class should be used when using an
angiotensin receptor blocker (ARB). - 4. Diuretics from the potassium-sparing
class should be used when using an angiotensin receptor blocker (ARB).
Digoxin has a very limited role in treatment of heart failure. It is used mainly
for patients with:
1. Ejection fractions above 40%
2. An audible S3
3. Mitral stenosis as a primary cause for heart failure
4. Renal insufficiency - 2. An audible S3
Which of the following classes of drugs is contraindicated in heart failure?
1. Nitrates
2. Long-acting dihydropyridines
3. Calcium channel blockers
4. Alpha-beta blockers - 3. Calcium channel blockers
Heart failure is a leading cause of death and hospitalization in older adults
(greater than 65 years old). The drug of choice for this population is:
1. Aldosterone antagonists
2. Eplerenone
3. ACE inhibitors
4. ARBs - 3. ACE inhibitors
ACE inhibitors are contraindicated in pregnancy. While treatment of heart
failure during pregnancy is best done by a specialist, which of the following
drug classes is considered to be safe, at least in the later parts of
pregnancy?
Advanced Physical Assessment - Chamberlain
Angiotensin-converting-enzyme (ACE) inhibitors are a central part of the
treatment of heart failure because they have more than one action to
address the pathological changes in this disorder. Which of the following
pathological changes in heart failure is NOT addressed by ACE inhibitors?
1. Changes in the structure of the left ventricle so that it dilates,
hypertrophies, and uses energy less efficiently.
2. Reduced formation of cross-bridges so that contractile force decreases.
3. Activation of the sympathetic nervous system that increases heart rate
and preload.
4. Decreased renal blood flow that decreases oxygen supply to the kidneys. -
3. Activation of the sympathetic nervous system that increases heart rate
and preload.
One of the three types of heart failure involves systolic dysfunction. Potential
causes of this most common form of heart failure include:
1. Myocardial ischemia and injury secondary to myocardial infarction
2. Inadequate relaxation and loss of muscle fiber secondary to valvular
dysfunction
3. Increased demands of the heart beyond its ability to adapt secondary to
anemia
4. Slower filling rate and elevated systolic pressures secondary to
uncontrolled hypertension - 1. Myocardial ischemia and injury secondary to
myocardial infarction
The American Heart Association and the American College of Cardiology
have devised a classification system for heart failure that can be used to
direct treatment. Patients with symptoms and underlying disease are
classified as stage:
1. A
2. B
3. C
,NR508 / NR 508 Midterm Exam (Latest ):
Advanced Physical Assessment - Chamberlain
4. D - 3. C
Diagnosis of heart failure cannot be made by symptoms alone because many
disorders share the same symptoms. The most specific and sensitive
diagnostic test for heart failure is:
1. Chest x-rays that show cephalization and measure heart size
2. Two-dimensional echocardiograms that identify structural anomalies and
cardiac dysfunction
3. Complete blood count, blood urea nitrogen, and serum electrolytes that
facilitate staging for end-organ damage
4. Measurement of brain natriuretic peptide to distinguish between systolic
and diastolic dysfunction - 2. Two-dimensional echocardiograms that identify
structural anomalies and cardiac dysfunction
Treatments for heart failure, including drug therapy, are based on the stages
developed by the ACC/AHA. Stage A patients are treated with:
1. Drugs for hypertension and hyperlipidemia, if they exist
2. Lifestyle management including diet, exercise, and smoking cessation
only
3. Angiotensin-converting enzyme (ACE) inhibitors to directly affect the heart
failure only
4. No drugs are used in this early stage - 1. Drugs for hypertension and
hyperlipidemia, if they exist
Class I recommendations for stage A heart failure include:
1. Aerobic exercise within tolerance levels to prevent the development of
heart failure
2. Reduction of sodium intake to less than 2,000 mg/day to prevent fluid
retention
3. Beta blockers for all patients regardless of cardiac history
,NR508 / NR 508 Midterm Exam (Latest ):
Advanced Physical Assessment - Chamberlain
4. Treatment of thyroid disorders, especially if they are associated with
tachyarrhythmias - 4. Treatment of thyroid disorders, especially if they are
associated with tachyarrhythmias
Stage B patients should have beta blockers added to their heart failure
treatment regimen when:
1. They have an ejection fraction less than 40%
2. They have had a recent MI
3. Both 1 and 2
4. Neither 1 nor 2 - 3. Both 1 and 2
Increased life expectancy for patients with heart failure has been associated
with the use of:
1. ACE inhibitors, especially when started early in the disease process
2. All beta blockers regardless of selectivity
3. Thiazide and loop diuretics
4. Cardiac glycosides - 1. ACE inhibitors, especially when started early in the
disease process
Stage C patients usually require a combination of three to four drugs to
manage their heart failure. In addition to ACE inhibitors and beta blockers,
diuretics may be added. Which of the following statements about diuretics is
NOT true?
1. Diuretics reduce preload associated with fluid retention.
2. Diuretics can be used earlier than stage C when the goal is control of
hypertension.
3. Diuretics may produce problems with electrolyte imbalances and abnormal
glucose and lipid metabolism.
, NR508 / NR 508 Midterm Exam (Latest ):
Advanced Physical Assessment - Chamberlain
4. Diuretics from the potassium-sparing class should be used when using an
angiotensin receptor blocker (ARB). - 4. Diuretics from the potassium-sparing
class should be used when using an angiotensin receptor blocker (ARB).
Digoxin has a very limited role in treatment of heart failure. It is used mainly
for patients with:
1. Ejection fractions above 40%
2. An audible S3
3. Mitral stenosis as a primary cause for heart failure
4. Renal insufficiency - 2. An audible S3
Which of the following classes of drugs is contraindicated in heart failure?
1. Nitrates
2. Long-acting dihydropyridines
3. Calcium channel blockers
4. Alpha-beta blockers - 3. Calcium channel blockers
Heart failure is a leading cause of death and hospitalization in older adults
(greater than 65 years old). The drug of choice for this population is:
1. Aldosterone antagonists
2. Eplerenone
3. ACE inhibitors
4. ARBs - 3. ACE inhibitors
ACE inhibitors are contraindicated in pregnancy. While treatment of heart
failure during pregnancy is best done by a specialist, which of the following
drug classes is considered to be safe, at least in the later parts of
pregnancy?
