NURS 621 MedChallenger Cardiovascular
Exam Questions and Answers | 2026
Update | 100% Correct.
Heart Failure (Questions 1-15)
Question 1
A patient presents with acute pulmonary edema, BP 210/120, acute
dyspnea and hypoxia. CXR shows pulmonary edema. TTE shows LVEF
down to 30% from 40% with pseudonormalization and grade 3 diastolic
dysfunction. How should this type of heart failure be documented?
A. Acute systolic heart failure
B. Acute on Chronic Biventricular Systolic HFrEF with Diastolic
Dysfunction
C. Chronic diastolic heart failure
D. De novo heart failure with preserved ejection fraction
,,,answer,,,: B
*Rationale: The patient has acute decompensation on chronic heart
failure (LVEF dropped from 40% to 30%), biventricular involvement
(pulmonary edema + likely systemic congestion), systolic dysfunction
(HFrEF), and diastolic dysfunction (grade 3 pseudonormalization). This
combination requires a complete, specific diagnosis to guide treatment .*
,Question 2
All of the following are usually signs/symptoms of left heart failure
EXCEPT:
A. Dyspnea
B. Cyanosis
C. Pulmonary edema
D. Hepatic congestion
,,,answer,,,: D
Rationale: Hepatic congestion (hepatomegaly, RUQ pain) is a sign of
right heart failure, not left heart failure. Left heart failure causes
pulmonary symptoms: dyspnea, crackles, cyanosis, and pulmonary
edema due to backup of blood into the pulmonary circulation. Right
heart failure causes systemic congestion including hepatic congestion,
peripheral edema, and JVD .
Question 3
A 55-year-old female presents with increased dyspnea over several days.
She has had HTN since her 20s that has been difficult to control. Exam
reveals S3 and S4 with 2/6 systolic murmur. SR 91 with LVH and old
stable LBBB. This patient likely has:
A. An acute MI
B. Cardiac tamponade
C. ASD needing repair
D. Biventricular CHF with acute decompensation
,,,,answer,,,: D
Rationale: The S3 gallop indicates systolic dysfunction; S4 indicates
diastolic dysfunction from chronic HTN. LVH and LBBB suggest
structural heart disease. The combination of dyspnea, HTN history, and
exam findings points to biventricular CHF with acute decompensation .
Question 4
A 48-year-old male on treatment for HF with enalapril, digoxin, and
lasix for three months. Over the past two weeks, he developed a cough.
Lungs are clear and euvolemic. What is the best intervention?
A. Continue current regimen and add metolazone
B. Stop enalapril and start norvasc
C. Continue enalapril and lasix, stop digoxin
D. No medication changes needed
,,,answer,,,: B
Rationale: Cough is a known side effect of ACE inhibitors (enalapril)
due to bradykinin accumulation. Norvasc (amlodipine, a CCB) is an
alternative antihypertensive. The patient is euvolemic, so diuretics don't
need adjustment. ACE inhibitor-induced cough resolves after stopping
the drug .
Question 5
Decreased vascular compliance and hardening of the arteries predisposes
older adults to what type of HF?
, A. Systolic/HFrEF
B. Diastolic/HFpEF
C. Biventricular HFrEF
D. Chronic HF
,,,answer,,,: A
Rationale: Decreased vascular compliance increases afterload, making
the ventricle work harder to eject blood. Over time, this leads to systolic
dysfunction (HFrEF). While diastolic dysfunction (HFpEF) also occurs
in older adults, the question specifically links decreased compliance to
increased afterload and eventual systolic failure .
Question 6
What has emerged as the marker of choice for differentiating a cardiac
or respiratory cause of dyspnea?
A. Troponin I
B. B-type natriuretic peptide (BNP)
C. Creatine kinase-MB
D. C-reactive protein
,,,answer,,,: B
*Rationale: BNP is released from ventricular myocytes in response to
increased wall tension (volume overload). Elevated BNP (>100 pg/mL)
suggests heart failure as the cause of dyspnea. Normal BNP makes heart
failure unlikely. This has become the standard biomarker for
differentiating cardiac vs. respiratory dyspnea in the emergency
setting .*
Exam Questions and Answers | 2026
Update | 100% Correct.
Heart Failure (Questions 1-15)
Question 1
A patient presents with acute pulmonary edema, BP 210/120, acute
dyspnea and hypoxia. CXR shows pulmonary edema. TTE shows LVEF
down to 30% from 40% with pseudonormalization and grade 3 diastolic
dysfunction. How should this type of heart failure be documented?
A. Acute systolic heart failure
B. Acute on Chronic Biventricular Systolic HFrEF with Diastolic
Dysfunction
C. Chronic diastolic heart failure
D. De novo heart failure with preserved ejection fraction
,,,answer,,,: B
*Rationale: The patient has acute decompensation on chronic heart
failure (LVEF dropped from 40% to 30%), biventricular involvement
(pulmonary edema + likely systemic congestion), systolic dysfunction
(HFrEF), and diastolic dysfunction (grade 3 pseudonormalization). This
combination requires a complete, specific diagnosis to guide treatment .*
,Question 2
All of the following are usually signs/symptoms of left heart failure
EXCEPT:
A. Dyspnea
B. Cyanosis
C. Pulmonary edema
D. Hepatic congestion
,,,answer,,,: D
Rationale: Hepatic congestion (hepatomegaly, RUQ pain) is a sign of
right heart failure, not left heart failure. Left heart failure causes
pulmonary symptoms: dyspnea, crackles, cyanosis, and pulmonary
edema due to backup of blood into the pulmonary circulation. Right
heart failure causes systemic congestion including hepatic congestion,
peripheral edema, and JVD .
Question 3
A 55-year-old female presents with increased dyspnea over several days.
She has had HTN since her 20s that has been difficult to control. Exam
reveals S3 and S4 with 2/6 systolic murmur. SR 91 with LVH and old
stable LBBB. This patient likely has:
A. An acute MI
B. Cardiac tamponade
C. ASD needing repair
D. Biventricular CHF with acute decompensation
,,,,answer,,,: D
Rationale: The S3 gallop indicates systolic dysfunction; S4 indicates
diastolic dysfunction from chronic HTN. LVH and LBBB suggest
structural heart disease. The combination of dyspnea, HTN history, and
exam findings points to biventricular CHF with acute decompensation .
Question 4
A 48-year-old male on treatment for HF with enalapril, digoxin, and
lasix for three months. Over the past two weeks, he developed a cough.
Lungs are clear and euvolemic. What is the best intervention?
A. Continue current regimen and add metolazone
B. Stop enalapril and start norvasc
C. Continue enalapril and lasix, stop digoxin
D. No medication changes needed
,,,answer,,,: B
Rationale: Cough is a known side effect of ACE inhibitors (enalapril)
due to bradykinin accumulation. Norvasc (amlodipine, a CCB) is an
alternative antihypertensive. The patient is euvolemic, so diuretics don't
need adjustment. ACE inhibitor-induced cough resolves after stopping
the drug .
Question 5
Decreased vascular compliance and hardening of the arteries predisposes
older adults to what type of HF?
, A. Systolic/HFrEF
B. Diastolic/HFpEF
C. Biventricular HFrEF
D. Chronic HF
,,,answer,,,: A
Rationale: Decreased vascular compliance increases afterload, making
the ventricle work harder to eject blood. Over time, this leads to systolic
dysfunction (HFrEF). While diastolic dysfunction (HFpEF) also occurs
in older adults, the question specifically links decreased compliance to
increased afterload and eventual systolic failure .
Question 6
What has emerged as the marker of choice for differentiating a cardiac
or respiratory cause of dyspnea?
A. Troponin I
B. B-type natriuretic peptide (BNP)
C. Creatine kinase-MB
D. C-reactive protein
,,,answer,,,: B
*Rationale: BNP is released from ventricular myocytes in response to
increased wall tension (volume overload). Elevated BNP (>100 pg/mL)
suggests heart failure as the cause of dyspnea. Normal BNP makes heart
failure unlikely. This has become the standard biomarker for
differentiating cardiac vs. respiratory dyspnea in the emergency
setting .*
