Chapter 17, Heart Failure
Multiple Choice
Identify the choice that best completes the statement or answers the question.
1. Which statement best differentiates cardiac afterload from cardiac preload?
1. Cardiac afterload is the volume of blood in the heart at the end of diastole.
2. Cardiac afterload is the amount of resistance that the ventricle must overcome.
3. Cardiac afterload is the factor that affects cardiac output.
4. Cardiac afterload is the amount of blood that enters the right atrium.
2. How is stage C heart failure different from other stages of heart failure, according to the American
College of Cardiology/American Heart Association classification?
1. Clients will have unidentifiable structural or functional heart abnormalities.
2. Clients may develop structural heart disease associated with heart failure.
3. Clients may have current or prior symptoms of heart failure.
4. Clients may have advanced structural heart disease.
3. Heart failure is classified into four different stages by the American College of Cardiology/American
Heart Association. In which way is the condition of a client in stage B different from the condition
of clients in other stages?
1. The client in stage B is supported by a mechanical circulatory assist device.
2. The client in stage B is undergoing treatment for prior symptoms of heart failure.
3. The client in stage B hasNaUhRisSto
IrNy GofTaBp.reCvOioMus myocardial infarction.
4. The client in stage B has diabetes mellitus and a family history of cardiomyopathy.
4. A middle-aged adult is diagnosed with Class III (moderate) heart failure. In which way is Class III
heart failure different from other classes of heart failure in the client, according to the New York
Association of Classification of Heart Failure?
1. The client with Class III (moderate) heart failure will feel comfortable with
ordinary physical activity.
2. The client with Class III (moderate) heart failure will feel fatigue and palpitations
but only with ordinary activity.
3. The client with Class III (moderate) heart failure will have fatigue, palpitations, or
dyspnea while doing less-than-normal physical activities.
4. The client with Class III (moderate) heart failure will be unable to carry out
physical activities comfortably.
5. In which manner does the heart function when a client is diagnosed with heart failure?
1. The decrease in preload causes high blood volume, filling the ventricle.
2. The ventricular muscle pumps out the excess blood.
3. The stroke volume decreases when the ventricle ejects its blood.
4. The contractility and stroke volume decrease.
6. The registered nurse is teaching nursing staff about ischemic cardiomyopathy. Which statement
made by one of the attending nurses indicates effective learning?
1. “There is scarring of the heart muscle caused by coronary artery insufficiency.”
2. “There is enlargement and hypertrophy of the left or right ventricles.”
, 3. “It is a disorder that restricts the ventricle’s ability to fully expand.”
4. “It is a genetic predisposition for the muscular enlargement of the interventricular
septal wall.”
7. In which way does the nurse define oncotic pressure?
1. A pressure reading within the inferior vena cava
2. A force that attempts to pull fluid from the interstitial and intracellular spaces
3. A force that attempts to push fluid out of the capillary pores into interstitial and
intracellular spaces
4. A pressure reading upon inflation of the balloon on the tip of the Swan-Ganz
catheter
8. The nurse is assessing a client after cardiac testing. One test result indicates a cardiac output of 4,500
mL per minute. Using the calculation to determine normal cardiac output, which conclusion does the
nurse draw?
1. The client’s cardiac output is normal.
2. The client’s cardiac output is slightly higher than normal.
3. The client’s cardiac output is lower than normal.
4. The client’s cardiac output is grossly higher than normal.
9. In which way is chronic heart failure different from acute heart failure?
1. Chronic heart failure is the rapid, sudden development of heart failure.
2. Chronic heart failure gradually develops over a long period.
3. Chronic heart failure is caused by substantial ventricular muscle injury.
4. Chronic heart failure is N
reU
feR
rrS
edItN
oGasTcBa.
rdCioOgM
enic shock.
10. Which condition is the initial cause of an afterload increase in the right ventricle?
1. Cirrhosis of the liver
2. Pulmonary hypertension
3. Elevated systolic pressure
4. Blocked coronary arteries
11. How is high-output failure different from low-output failure?
1. In high-output failure, the heart can weaken and the ventricle can fail.
2. In high-output failure, the heart is unable to fill with adequate amounts of blood.
3. In high-output failure, there is a lack of delivery of adequate oxygen to the tissues.
4. In high-output failure, there is a lack of sufficient blood to recirculate through the
heart.
12. The registered nurse is teaching nursing staff about the normal level for central venous pressure.
Which statement made by one of the attending nurses indicates effective learning?
1. “The normal range for central venous pressure is 4 to 13 mm Hg.”
2. “The normal range for central venous pressure is 60 to 80 mm Hg.”
3. “The normal range for central venous pressure is 12 to 15 mm Hg.”
4. “The normal range for central venous pressure is 1 to 5 mm Hg.”
13. Which is a potent vasodilator produced by vascular endothelial cells?
1. Nitric oxide
2. Endothelin
, 3. Tumor necrosis factor-alpha
4. Digitalis
14. The registered nurse is reviewing information with coronary staff nurses about the renin–
angiotensin–aldosterone system (RAAS). Which statement made by an attending nurse
indicates understanding?
1. “RAAS is a mechanism that regulates arterial blood pressure.”
2. “RAAS is a mechanism that decreases blood pressure.”
3. “RAAS is a mechanism that increases blood volume in response to increased renal
perfusion.”
4. “RAAS is a mechanism with detrimental effects that decrease workload for the left
ventricle.”
15. Which pathology is a cause specifically for right ventricle failure (RVF)?
1. Pulmonary emboli
2. Endocarditis
3. Myocarditis
4. Rheumatic fever
16. The nurse is reviewing instructions with a client being discharged home after experiencing heart
failure. When reviewing medications, the client asks about the addition of captopril to the previous
medication regimen. Which action of captopril will the nurse explain to the client?
1. Captopril lowers resistance against the left ventricle.
2. Captopril is considered a potassium-sparing diuretic.
3. Captopril decreases blooNdUvRoS
luI
mNe G
anTdBs.
odCiO
umM retention.
4. Captopril inhibits peripheral vasoconstriction.
17. An older adult client presents with swollen ankles and fingers, and reports that low-level activity
causes fatigue and heart palpitations. The client is diagnosed with heart failure. Which symptom
indicates the client’s condition is considered to be a Class III, moderate heart failure?
1. Dyspnea
2. Confusion
3. Cold, pale extremities
4. Inability sleep
18. Which condition according to the Framingham Criteria for Diagnosis of Congestive Heart Failure is
caused by nighttime cough?
1. Paroxysmal nocturnal dyspnea
2. Jugular vein distension
3. Pulmonary crackles
4. Cardiomegaly
19. The registered nurse is reviewing cardiac output with nursing staff. Which statement by an attending
nurse indicates understanding?
1. “Cardiac output is the amount of blood that the heart pumps out of the left
ventricle.”
2. “Cardiac output is increased in heart failure.”
3. “Cardiac output is unvaried by body size.”
Multiple Choice
Identify the choice that best completes the statement or answers the question.
1. Which statement best differentiates cardiac afterload from cardiac preload?
1. Cardiac afterload is the volume of blood in the heart at the end of diastole.
2. Cardiac afterload is the amount of resistance that the ventricle must overcome.
3. Cardiac afterload is the factor that affects cardiac output.
4. Cardiac afterload is the amount of blood that enters the right atrium.
2. How is stage C heart failure different from other stages of heart failure, according to the American
College of Cardiology/American Heart Association classification?
1. Clients will have unidentifiable structural or functional heart abnormalities.
2. Clients may develop structural heart disease associated with heart failure.
3. Clients may have current or prior symptoms of heart failure.
4. Clients may have advanced structural heart disease.
3. Heart failure is classified into four different stages by the American College of Cardiology/American
Heart Association. In which way is the condition of a client in stage B different from the condition
of clients in other stages?
1. The client in stage B is supported by a mechanical circulatory assist device.
2. The client in stage B is undergoing treatment for prior symptoms of heart failure.
3. The client in stage B hasNaUhRisSto
IrNy GofTaBp.reCvOioMus myocardial infarction.
4. The client in stage B has diabetes mellitus and a family history of cardiomyopathy.
4. A middle-aged adult is diagnosed with Class III (moderate) heart failure. In which way is Class III
heart failure different from other classes of heart failure in the client, according to the New York
Association of Classification of Heart Failure?
1. The client with Class III (moderate) heart failure will feel comfortable with
ordinary physical activity.
2. The client with Class III (moderate) heart failure will feel fatigue and palpitations
but only with ordinary activity.
3. The client with Class III (moderate) heart failure will have fatigue, palpitations, or
dyspnea while doing less-than-normal physical activities.
4. The client with Class III (moderate) heart failure will be unable to carry out
physical activities comfortably.
5. In which manner does the heart function when a client is diagnosed with heart failure?
1. The decrease in preload causes high blood volume, filling the ventricle.
2. The ventricular muscle pumps out the excess blood.
3. The stroke volume decreases when the ventricle ejects its blood.
4. The contractility and stroke volume decrease.
6. The registered nurse is teaching nursing staff about ischemic cardiomyopathy. Which statement
made by one of the attending nurses indicates effective learning?
1. “There is scarring of the heart muscle caused by coronary artery insufficiency.”
2. “There is enlargement and hypertrophy of the left or right ventricles.”
, 3. “It is a disorder that restricts the ventricle’s ability to fully expand.”
4. “It is a genetic predisposition for the muscular enlargement of the interventricular
septal wall.”
7. In which way does the nurse define oncotic pressure?
1. A pressure reading within the inferior vena cava
2. A force that attempts to pull fluid from the interstitial and intracellular spaces
3. A force that attempts to push fluid out of the capillary pores into interstitial and
intracellular spaces
4. A pressure reading upon inflation of the balloon on the tip of the Swan-Ganz
catheter
8. The nurse is assessing a client after cardiac testing. One test result indicates a cardiac output of 4,500
mL per minute. Using the calculation to determine normal cardiac output, which conclusion does the
nurse draw?
1. The client’s cardiac output is normal.
2. The client’s cardiac output is slightly higher than normal.
3. The client’s cardiac output is lower than normal.
4. The client’s cardiac output is grossly higher than normal.
9. In which way is chronic heart failure different from acute heart failure?
1. Chronic heart failure is the rapid, sudden development of heart failure.
2. Chronic heart failure gradually develops over a long period.
3. Chronic heart failure is caused by substantial ventricular muscle injury.
4. Chronic heart failure is N
reU
feR
rrS
edItN
oGasTcBa.
rdCioOgM
enic shock.
10. Which condition is the initial cause of an afterload increase in the right ventricle?
1. Cirrhosis of the liver
2. Pulmonary hypertension
3. Elevated systolic pressure
4. Blocked coronary arteries
11. How is high-output failure different from low-output failure?
1. In high-output failure, the heart can weaken and the ventricle can fail.
2. In high-output failure, the heart is unable to fill with adequate amounts of blood.
3. In high-output failure, there is a lack of delivery of adequate oxygen to the tissues.
4. In high-output failure, there is a lack of sufficient blood to recirculate through the
heart.
12. The registered nurse is teaching nursing staff about the normal level for central venous pressure.
Which statement made by one of the attending nurses indicates effective learning?
1. “The normal range for central venous pressure is 4 to 13 mm Hg.”
2. “The normal range for central venous pressure is 60 to 80 mm Hg.”
3. “The normal range for central venous pressure is 12 to 15 mm Hg.”
4. “The normal range for central venous pressure is 1 to 5 mm Hg.”
13. Which is a potent vasodilator produced by vascular endothelial cells?
1. Nitric oxide
2. Endothelin
, 3. Tumor necrosis factor-alpha
4. Digitalis
14. The registered nurse is reviewing information with coronary staff nurses about the renin–
angiotensin–aldosterone system (RAAS). Which statement made by an attending nurse
indicates understanding?
1. “RAAS is a mechanism that regulates arterial blood pressure.”
2. “RAAS is a mechanism that decreases blood pressure.”
3. “RAAS is a mechanism that increases blood volume in response to increased renal
perfusion.”
4. “RAAS is a mechanism with detrimental effects that decrease workload for the left
ventricle.”
15. Which pathology is a cause specifically for right ventricle failure (RVF)?
1. Pulmonary emboli
2. Endocarditis
3. Myocarditis
4. Rheumatic fever
16. The nurse is reviewing instructions with a client being discharged home after experiencing heart
failure. When reviewing medications, the client asks about the addition of captopril to the previous
medication regimen. Which action of captopril will the nurse explain to the client?
1. Captopril lowers resistance against the left ventricle.
2. Captopril is considered a potassium-sparing diuretic.
3. Captopril decreases blooNdUvRoS
luI
mNe G
anTdBs.
odCiO
umM retention.
4. Captopril inhibits peripheral vasoconstriction.
17. An older adult client presents with swollen ankles and fingers, and reports that low-level activity
causes fatigue and heart palpitations. The client is diagnosed with heart failure. Which symptom
indicates the client’s condition is considered to be a Class III, moderate heart failure?
1. Dyspnea
2. Confusion
3. Cold, pale extremities
4. Inability sleep
18. Which condition according to the Framingham Criteria for Diagnosis of Congestive Heart Failure is
caused by nighttime cough?
1. Paroxysmal nocturnal dyspnea
2. Jugular vein distension
3. Pulmonary crackles
4. Cardiomegaly
19. The registered nurse is reviewing cardiac output with nursing staff. Which statement by an attending
nurse indicates understanding?
1. “Cardiac output is the amount of blood that the heart pumps out of the left
ventricle.”
2. “Cardiac output is increased in heart failure.”
3. “Cardiac output is unvaried by body size.”
