1. A patient with end-stage heart failure receives a continuous-flow LVAD.
The primary physiologic mechanism by which the LVAD increases cardiac
output is:
A. Increasing myocardial contractility
B. Unloading the left ventricle and delivering continuous flow to the
aorta
C. Increasing heart rate
D. Decreasing systemic vascular resistance
Answer: B. Explanation: Continuous-flow LVADs unload the LV and
pump blood directly into the aorta, increasing systemic output.
2. Which of the following is a common indication for LVAD implantation as
destination therapy?
A. Acute myocardial infarction with ST elevation only
B. Refractory end-stage heart failure not eligible for transplant
C. Stable NYHA class II heart failure
D. Asymptomatic severe mitral regurgitation
Answer: B. Explanation: Destination therapy is for patients with end-
stage HF who are not transplant candidates.
3. A pulsatility index (PI) trending down on LVAD telemetry typically
suggests:
A. Increased native LV contribution
B. Worsening RV failure
C. Reduced LV filling or hypovolemia
D. Pump thrombosis
Answer: C. Explanation: Lower PI often reflects less native LV pulsatility
due to low preload (e.g., hypovolemia) or high pump speed.
4. Which anticoagulation strategy is commonly used with continuous-flow
LVADs?
, A. No anticoagulation required
B. Warfarin (INR target individualized) plus aspirin
C. Heparin only indefinitely
D. Dual antiplatelet therapy with clopidogrel and ticagrelor
Answer: B. Explanation: Most LVAD patients are on warfarin targeting
device-specific INR plus aspirin to reduce thrombotic risk.
5. A sudden increase in LVAD pump power with decreased flows and
hematuria suggests:
A. Dehydration
B. Pump thrombosis
C. Infection
D. Battery depletion
Answer: B. Explanation: Increased power demand with low flow is
classic for pump thrombosis.
6. Best initial step for driveline exit site with purulent drainage:
A. Increase pump speed
B. Start broad-spectrum oral antibiotics and culture site
C. Remove the LVAD
D. Apply topical heparin
Answer: B. Explanation: Driveline infections require culture and
antibiotics; management depends on severity.
7. The driveline is routed through which anatomical location on typical
LVAD implantation?
A. Through the left atrium
B. Through the abdominal wall to exit the skin
C. Through the right ventricle wall
D. Through the internal jugular vein
Answer: B. Explanation: The driveline exits through the
abdominal/subcutaneous tissue to the skin for external
controller/power.
8. Which sign is most consistent with right ventricular (RV) failure after
LVAD implantation?
A. Rising systemic blood pressure
B. Elevated central venous pressure, peripheral edema, hepatic
congestion
C. Hypokalemia
, D. Increased LV pulsatility index
Answer: B. Explanation: RV failure causes systemic venous congestion,
high CVP, edema, and hepatic dysfunction.
9. A patient with LVAD presents with acute hypotension and a low pump
flow alarm. First immediate step:
A. Give IV broad-spectrum antibiotics
B. Check and secure external controller and power source, assess blood
pressure and volume status
C. Increase warfarin dose
D. Remove the driveline
Answer: B. Explanation: Quickly confirm power/controller function and
assess for hypovolemia, tamponade, or obstruction.
10.What is the most common neurologic complication in LVAD patients?
A. Seizures due to hypoglycemia
B. Ischemic or hemorrhagic stroke
C. Multiple sclerosis flare
D. Peripheral neuropathy
Answer: B. Explanation: Stroke (ischemic or hemorrhagic) is a common
and serious LVAD complication due to anticoagulation and device
thromboembolism.
11.How does continuous-flow LVAD affect arterial pulse pressure?
A. Increases pulse pressure dramatically
B. Often narrows pulse pressure and can reduce palpable pulse
C. No change
D. Causes wide fluctuation every minute
Answer: B. Explanation: Continuous flow often reduces pulse pressure
making pulses weak or nonpalpable.
12.Which lab finding is most concerning for hemolysis in an LVAD patient?
A. Low lactate dehydrogenase (LDH)
B. Elevated LDH, low haptoglobin, increased plasma free hemoglobin
C. Hypernatremia
D. Decreased AST
Answer: B. Explanation: Hemolysis shows high LDH, low haptoglobin,
and increased plasma free hemoglobin.
, 13.Which imaging is preferred to evaluate suspected pump thrombosis?
A. Chest X-ray only
B. Echocardiography (transthoracic or transesophageal) and CT or device
ramp test as adjuncts
C. Abdominal ultrasound
D. Bone scan
Answer: B. Explanation: Echo assesses ventricular size/function and
inflow/outflow; CT or ramp tests can help identify thrombosis.
14.What is the rationale for the “ramp test” in LVAD evaluation?
A. To measure pulmonary artery pressures only
B. To assess changes in LV size and device flows across pump speeds to
detect thrombosis or suction
C. To test battery duration
D. To evaluate for infection
Answer: B. Explanation: Ramp tests change pump speed to see expected
changes in LV dimension and flow; abnormal responses suggest
thrombosis or suction.
15.A driveline exit site dressing should be changed:
A. Daily using sterile technique per program protocol
B. Never changed after discharge
C. Only when heavily soiled
D. With alcohol swabs at home without gloves
Answer: A. Explanation: Regular sterile dressing changes reduce
infection risk; frequency per program (commonly daily or every other
day).
16.The recommended mechanism to reduce gastrointestinal (GI) bleeding
risk in LVAD patients includes:
A. Stop all anticoagulation permanently
B. Adjust anticoagulation, consider octreotide for angiodysplasia, and
manage blood pressure
C. Give high-dose NSAIDs
D. Increase pump speed to maximum
Answer: B. Explanation: GI bleeding often relates to angiodysplasia and
anticoagulation; therapy includes adjusting anticoagulation and medical
measures.
The primary physiologic mechanism by which the LVAD increases cardiac
output is:
A. Increasing myocardial contractility
B. Unloading the left ventricle and delivering continuous flow to the
aorta
C. Increasing heart rate
D. Decreasing systemic vascular resistance
Answer: B. Explanation: Continuous-flow LVADs unload the LV and
pump blood directly into the aorta, increasing systemic output.
2. Which of the following is a common indication for LVAD implantation as
destination therapy?
A. Acute myocardial infarction with ST elevation only
B. Refractory end-stage heart failure not eligible for transplant
C. Stable NYHA class II heart failure
D. Asymptomatic severe mitral regurgitation
Answer: B. Explanation: Destination therapy is for patients with end-
stage HF who are not transplant candidates.
3. A pulsatility index (PI) trending down on LVAD telemetry typically
suggests:
A. Increased native LV contribution
B. Worsening RV failure
C. Reduced LV filling or hypovolemia
D. Pump thrombosis
Answer: C. Explanation: Lower PI often reflects less native LV pulsatility
due to low preload (e.g., hypovolemia) or high pump speed.
4. Which anticoagulation strategy is commonly used with continuous-flow
LVADs?
, A. No anticoagulation required
B. Warfarin (INR target individualized) plus aspirin
C. Heparin only indefinitely
D. Dual antiplatelet therapy with clopidogrel and ticagrelor
Answer: B. Explanation: Most LVAD patients are on warfarin targeting
device-specific INR plus aspirin to reduce thrombotic risk.
5. A sudden increase in LVAD pump power with decreased flows and
hematuria suggests:
A. Dehydration
B. Pump thrombosis
C. Infection
D. Battery depletion
Answer: B. Explanation: Increased power demand with low flow is
classic for pump thrombosis.
6. Best initial step for driveline exit site with purulent drainage:
A. Increase pump speed
B. Start broad-spectrum oral antibiotics and culture site
C. Remove the LVAD
D. Apply topical heparin
Answer: B. Explanation: Driveline infections require culture and
antibiotics; management depends on severity.
7. The driveline is routed through which anatomical location on typical
LVAD implantation?
A. Through the left atrium
B. Through the abdominal wall to exit the skin
C. Through the right ventricle wall
D. Through the internal jugular vein
Answer: B. Explanation: The driveline exits through the
abdominal/subcutaneous tissue to the skin for external
controller/power.
8. Which sign is most consistent with right ventricular (RV) failure after
LVAD implantation?
A. Rising systemic blood pressure
B. Elevated central venous pressure, peripheral edema, hepatic
congestion
C. Hypokalemia
, D. Increased LV pulsatility index
Answer: B. Explanation: RV failure causes systemic venous congestion,
high CVP, edema, and hepatic dysfunction.
9. A patient with LVAD presents with acute hypotension and a low pump
flow alarm. First immediate step:
A. Give IV broad-spectrum antibiotics
B. Check and secure external controller and power source, assess blood
pressure and volume status
C. Increase warfarin dose
D. Remove the driveline
Answer: B. Explanation: Quickly confirm power/controller function and
assess for hypovolemia, tamponade, or obstruction.
10.What is the most common neurologic complication in LVAD patients?
A. Seizures due to hypoglycemia
B. Ischemic or hemorrhagic stroke
C. Multiple sclerosis flare
D. Peripheral neuropathy
Answer: B. Explanation: Stroke (ischemic or hemorrhagic) is a common
and serious LVAD complication due to anticoagulation and device
thromboembolism.
11.How does continuous-flow LVAD affect arterial pulse pressure?
A. Increases pulse pressure dramatically
B. Often narrows pulse pressure and can reduce palpable pulse
C. No change
D. Causes wide fluctuation every minute
Answer: B. Explanation: Continuous flow often reduces pulse pressure
making pulses weak or nonpalpable.
12.Which lab finding is most concerning for hemolysis in an LVAD patient?
A. Low lactate dehydrogenase (LDH)
B. Elevated LDH, low haptoglobin, increased plasma free hemoglobin
C. Hypernatremia
D. Decreased AST
Answer: B. Explanation: Hemolysis shows high LDH, low haptoglobin,
and increased plasma free hemoglobin.
, 13.Which imaging is preferred to evaluate suspected pump thrombosis?
A. Chest X-ray only
B. Echocardiography (transthoracic or transesophageal) and CT or device
ramp test as adjuncts
C. Abdominal ultrasound
D. Bone scan
Answer: B. Explanation: Echo assesses ventricular size/function and
inflow/outflow; CT or ramp tests can help identify thrombosis.
14.What is the rationale for the “ramp test” in LVAD evaluation?
A. To measure pulmonary artery pressures only
B. To assess changes in LV size and device flows across pump speeds to
detect thrombosis or suction
C. To test battery duration
D. To evaluate for infection
Answer: B. Explanation: Ramp tests change pump speed to see expected
changes in LV dimension and flow; abnormal responses suggest
thrombosis or suction.
15.A driveline exit site dressing should be changed:
A. Daily using sterile technique per program protocol
B. Never changed after discharge
C. Only when heavily soiled
D. With alcohol swabs at home without gloves
Answer: A. Explanation: Regular sterile dressing changes reduce
infection risk; frequency per program (commonly daily or every other
day).
16.The recommended mechanism to reduce gastrointestinal (GI) bleeding
risk in LVAD patients includes:
A. Stop all anticoagulation permanently
B. Adjust anticoagulation, consider octreotide for angiodysplasia, and
manage blood pressure
C. Give high-dose NSAIDs
D. Increase pump speed to maximum
Answer: B. Explanation: GI bleeding often relates to angiodysplasia and
anticoagulation; therapy includes adjusting anticoagulation and medical
measures.
