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IT1 Exam 4

Total questions: 100

Worksheet time: 1hrs 6mins

Name
Class
Date
1.

What is ejection fraction?

a)

Amount of blood pumped out of ventricle/total amount of blood in ventricle

b)

Total amount of blood in ventricle/Amount of blood pumped out of ventricle

2.

What is a normal residual volume that is always present in a healthy heart?

a)

55-70%

b)

40-77%

c)

43-65%

d)

35-70%

3.

What is considered reduced ejection fraction?

a)

<40%

b)

<30%

c)

<50%

d)

<55%

4.

What is reduced ejection fraction?

a)

Can fill

b)

Can’t contract fully

c)

Can’t fill

d)

Can contract fully

5.

What is preserved ejection fraction categorized as?

a)

>55%

b)

>60%

c)

>70%

d)

>44%

6.

Which describes preserved ejection fraction?

a)

Can’t fill

b)

Can contract

c)

Can fill

d)

Can’t contract

7.

Select the true statements: 

a)

HFrEF: Can’t contract

b)

HFpEF: Can’t Fill

c)

HFrEF: Can contract

d)

HFpEF: Can fill

e)

R

8.

What are some factors that can cause HF?

a)

Direct damage to the heart

b)

Increase resistance/afterload

c)

Adolescents

d)

Pregnancy

e)

I

9.

What are some examples of DIRECT damage to the heart?

a)

Coronary artery disease (CAD)

b)

MI

c)

Smoking

d)

Obesity

10.

Select all that apply: Things that cause DIRECT damage to the heart

a)

Valvular heart disease

b)

Congenital heart disease

c)

Atrial fibrillation

d)

Physical inactivity

e)

HTN

11.

Select all that apply: Things that cause increased resistance to the heart

a)

Diabetes

b)

Obesity

c)

Smoking

d)

Elderly

e)

Atrial fibrillation

12.

What are the clinical presentations of HF?

a)

Fluid overload

b)

Pulmonary congestion

c)

Peripheral edema

d)

JVD

e)

Dyspnea

13.

What are the signs of pulmonary congestion?

a)

Difficulty breathing

b)

Extra fluid on lungs

c)

Pitting

d)

Pneumonia

14.

How do you differentiate between HF, pneumonia, pulmonary embolism and COPD/asthma?

a)

BNP elevated

b)

Fluid build up

c)

Sleep sitting up

d)

Speech impairment

e)

T

15.

What does NYHA classification test for?

a)

Severity of symptoms

b)

Structural abnormalities

16.

True or false: NYHA does not allow patients to move up and down the scale.

a)

False

b)

True

17.

Select NYHA class 1:

a)

No limitation of physical activity

b)

Slight limitation of physical activity

c)

Marked limitation

d)

Unable to carry on physical activity

18.

Select NYHA functional class 2:

a)

Slight limitation of physical activity but ordinary physical activity results in symptoms of HF

b)

No limitation

c)

Marked limitation, comfortable at rest but less ordinary activity causes symptoms of HF

d)

Unable to carry on physical activity w/ out symptoms of HF or symptoms of HF at rest

19.

What is ACC/AHA staging based on:

a)

Severity of symptoms

b)

Structural abnormalities

20.

True or false: Patients can go up and down on the ACC/AHA scale.

a)

False

b)

True

21.

Which describes stage C of ACCF/AHA stage of HF?

a)

High risk for HF but without structural heart disease or symptoms of HF

b)

Structural heart disease but without signs or symptoms of HF

c)

Structural heart disease with prior or current symptoms of HF

d)

Refractory HF requiring specialized interventions

22.

Which describes stage B of ACCF/AHA stage of HF?

a)

High risk for HF but without structural heart disease or symptoms of HF

b)

Structural heart disease but without signs or symptoms of HF

c)

Structural heart disease with prior or current symptoms of HF

d)

Refractory HF requiring specialized interventions

23.

Which describes stage D of ACCF/AHA stage of HF?

a)

High risk for HF but without structural heart disease or symptoms of HF

b)

Structural heart disease but without signs or symptoms of HF

c)

Structural heart disease with prior or current symptoms of HF

d)

Refractory HF requiring specialized interventions

24.

Which describes stage A of ACCF/AHA stage of HF?

a)

High risk for HF but without structural heart disease or symptoms of HF

b)

Structural heart disease but without signs or symptoms of HF

c)

Structural heart disease with prior or current symptoms of HF

d)

Refractory HF requiring specialized interventions

25.

Which describes stage B?

a)

No symptoms

b)

Structural abnormalities present

c)

Symptoms of HF

d)

No structural abnormalities

26.

What should be initiated for those with stage B?

a)

ACEi/ARB

b)

Beta-blocker

c)

Diuretic

d)

Verapamil

27.

What are the specific beta blockers that are recommended for HFrEF

a)

Carvedilol

b)

Metoprolol Succinate

c)

Metoprolol Tartrate

d)

Bisoprolol

28.

Which medications should NOT be used for those with HFrEF?

a)

Diltiazem

b)

Verapamil

c)

Cardizem

d)

Sildenafil

29.

What are some signs and symptoms of HF?

a)

Low BP

b)

Changes in weight

c)

Rapid respiratory rate

d)

Increased BP

30.

What are some labs that should be ran for HF?

a)

Elevated BNP

b)

Kidney function

c)

BUN

d)

S

31.

Which of these at an elevated level indicates severe infection, renal failure and MI?

a)

BUN

b)

BNP

c)

TG

d)

LDL

32.

What does a chest x-ray show?

a)

Enlarged heart

b)

Pulmonary effusion

c)

Ejection fraction 

d)

Structural abnormalities

33.

What does a ECHO show?

a)

Structural abnormalities

b)

Ejection fraction

c)

Arrythmias

d)

E

34.

True or false: EKG will help to see if HF is due to an arrhythmia.

a)

False

b)

True

35.

What are some symptoms of hypoperfusion?

a)

Fatigue (upon exertion)

b)

Exercise intolerance

c)

Pale skin

d)

SOB

36.

What is a sign of fluid overload?

a)

SOB (relief upon sitting upright)

b)

Edema

c)

Weight gain

d)

Weight loss

e)

Infection

37.

Which medications cause a NEGATIVE inotropic effect?

a)

Antiarrhythics

b)

Beta blockers

c)

Calcium channel blockers

d)

Itraconazole

e)

NSAID

38.

Which are sodium and water retention medications?

a)

NSAIDs

b)

COX2 inhibitors

c)

Glucocorticoids

d)

Salicylates

e)

Beta Blockers

39.

Select the LOOP diuretics that are used for HF:

a)

Furosemide

b)

Ethacrynic Acid

c)

Bumetanide

d)

Torsemide

e)

Dorzolamide

f)

Spironolactone

40.

What do Loop Diuretics excrete?

a)

Na

b)

Cl

c)

K

d)

Ca2+

e)

Mg

41.

Which class inhibits Na+2Cl/K+?

a)

Loop diuretics

b)

ACE

c)

ARB

d)

Beta Blocker

42.

Which are the aldosterone receptor antagonists that are used in the treatment of HF?

a)

Spironolactone

b)

Eplerenone

c)

Finerenone

43.

Which ACEi are used for treatment of HF

a)

Captopril

b)

Enalapril

c)

Fosinopril

d)

Lisinopril

e)

Quinapril

44.

Which ARBs are used for treatment of HF?

a)

Candesartan

b)

Losartan

c)

Valsartan

d)

Irbesartan

e)

Telmisartan

45.

Which are Beta 1 Antagonists?

a)

Bisoprolol

b)

Metoprolol Succinate

c)

Carvedilol

46.

Which are Alpha 1/Beta 1 and 2 Antagonist?

a)

Bisoprolol

b)

Metoprolol Succinate

c)

Carvedilol

47.

Which drug is Sacubitril combined with in Entresto?

a)

Valsartan

b)

Isosorbide

c)

Spironolactone

d)

HCTZ

48.

How does Sacubitril increase ANP and BNP levels?

a)

Inhibits Neprilysin

b)

Agonist to Neprilysin

49.

Which drug in Entreso is a pro drug?

a)

Sacubitril

b)

Levetiricem

c)

Diltiazem

d)

Verapamil

50.

Which drug is metabolized by esterases to form LBQ657?

a)

Sacubitril

b)

Metoprolol Succinate

c)

Ezetimibe

d)

Isosorbide

51.

Which medication is used for off label treatment of HF?

a)

Hydralazine

b)

Isosorbide Mononitrate

c)

Isosorbide Dinitrate

d)

Lisinopril

52.

Which is a arterial vasodilator?

a)

Hydralazine

b)

Isosorbide Dinitrate

c)

Isosorbide Mononitrate

d)

D

53.

Which two vasodilators are combined in the FDA approved drug BiDil?

a)

Isosorbide Mononitrate

b)

Isosorbide Dinitrate

c)

Hydralazine

54.

What is the mechanism of how Hydralazine treats HF?

a)

Direct action on arteriole smooth muscle

b)

Increase potassium permeability

c)

Block calcium signaling

d)

Stimulates NO formation

e)

Decreases NO formation

55.

What are released when nitrates are bio activated?

a)

Nitric Oxide

b)

Catecholamines

c)

Ions

d)

Troponin

56.

Which CYP enzyme metabolizes Ivabradine?

a)

CYP3A4

b)

CYP2A3

c)

CYP3A6

d)

CYP2D5

57.

Why does Digoxin have variable oral bioavailability?

a)

Changes in GI motility

b)

Malabsorption syndromes

c)

Foods

d)

Drugs

e)

Weight

58.

What is it about Digoxin that makes it a risk for toxicity?

a)

Narrow TI

b)

Wide TI

59.

What is the level of overdose for Digoxin?

a)

10-15 mg

b)

2 mg

c)

6-8 mg

d)

12-15 mg

60.

What are some indicators of Digoxin toxicity?

a)

Nausea, vomiting

b)

Arrhythmia

c)

Confusion

d)

Hyperkalemia

61.

What is the treatment for Digoxin toxicity?

a)

Digifab

b)

Digibind

c)

Digimon

d)

Digitek

62.

How does Digoxin Immune Fab work?

a)

Given IV

b)

Binds to and neutralizes circulating digoxin

c)

Inactive complexes are eliminated renally

d)

Inactive complexes are eliminated in feces

63.

How might diuretics interact with Digoxin?

a)

Loops cause hyperkalemia -> less K+ will compete with Digoxin = greater distribution of Digoxin

b)

Potassium sparing -> HYPERkalemia due to increased levels of potassium = More K+ will compete with Digoxin = reduced distribution of Digoxin

c)

Loops cause hyperkalemia -> less K+ will compete with Digoxin = reduced distribution of Digoxin

d)

Potassium sparing -> HYPERkalemia due to increased levels of potassium = More K+ will compete with Digoxin = Increased distribution of Digoxin

64.

Select the catecholamines used to treat acute decompensated HF

a)

Dopamine

b)

Dobutamine

c)

Fentanyl

d)

Digoxin

65.

How are dopamine and Dobutamine administered?

a)

IV

b)

Oral

c)

Subcutaneous

d)

Nasal

66.

Which is a inotropic drug - PDE3 inhibitor?

a)

Milrinone

b)

Digoxin

c)

Hydrocodone

d)

APAP

e)

Aspirin

67.

Which medications are only used for symptom control?

a)

Digoxin

b)

Diuretics

c)

Ivabradine

d)

Hydralazine/Isosorbide dinitrate

e)

Entreso

68.

Which is used for morbidity and mortality benefit?

a)

ACEi, ARBs, ARNI

b)

Digoxin

c)

Beta blockers

d)

Hydralazine/Isosorbide Dinitrate

e)

Aldosterone antagonists

69.

What is the MOA of ACEi?

a)

Decreases Angiotensin I

b)

Decreases Angiotensin II

c)

Inhibits Na/Ca/K pump

70.

What are the clinical benefits of ACEi?

a)

Vasodilation

b)

Decreases cardiac remodeling

c)

Preservation of renal function

d)

Decreased mortality and morbidity

e)

Increases cardiac remodeling

71.

Which are exclusions for ACEi/ARB treatment?

a)

Hypotensive

b)

Hyperkalemia

c)

Acute renal insufficiency

d)

High BMI

e)

W

72.

What are some adverse effects of ACEi?

a)

Dry cough

b)

Transient increase in SCr

c)

Angioedema

d)

Hypotension

e)

Hyperkalemia

73.

Which are precautions that should be acknowledged before putting a patient on ACEi?

a)

Bilateral Renal Artery Stenosis 

b)

Acute Renal Injury

c)

Pregnancy 

d)

Organ transplant

74.

Which are monitoring parameters that should be considered to ensure safety and efficacy before prescribing ACEi?

a)

BP

b)

Renal function

c)

Potassium

d)

Calcium

75.

How does Sacubitril help HF?

a)

Enhances natriuretic peptide activity

b)

Vasodilation

c)

Natriurersis/diuretics

d)

Inhibition aldosterone secretion

e)

Decrease cardiac remodeling

76.

Why aren’t ARNIs a 1st line choice?

a)

Expensive

b)

Insurance may not cover

c)

Not much info and studies done yet

d)

Does not act on correct target

e)

Only applies to STAGE C

77.

Which shouldn’t you administer 36 hours of an ACEi?

a)

ARNI

b)

ARB

c)

Beta Blocker

d)

CCB

78.

Which medication should be used in ALL patients with reduced EF to prevent HF?

a)

ACE

b)

ARB

c)

CCB

d)

BB

e)

ARNI

79.

How do BBs works?

a)

Activates beta receptors

b)

Inhibits activation of beta receptors

c)

B1 receptors are responsible in heart for contracting and HR

d)

B2 receptors are responsible for contracting and HR

80.

What are the clinical benefits of BB?

a)

Antihypertensive

b)

Control HR

c)

Decreases cardiac remodeling/disease progression

d)

Decreased morbidity and mortality

e)

Hypotension

81.

What are some side effects of beta blockers?

a)

Hypotension

b)

Bradycardia

c)

Fatigue

d)

Depression

e)

Syncope

82.

What are some precautions before prescribing BBs?

a)

Bronchospastic diseases

b)

Diabetes

c)

Decompensated HF

d)

Severe bradycardia

e)

Edema

83.

What should you monitor for BB therapy?

a)

HR

b)

Fatigue

c)

BP

d)

Fluid overload

e)

Cold extremities

84.

You shouldn’t start an ACEi if:

a)

Hypotensive

b)

High K

c)

High SCr

d)

High Calcium

85.

Don’t start BB if:

a)

Acute decompensated HF

b)

Severely symptomatic

c)

Fluid overload

d)

Low HF

e)

Low BP

86.

What are some adverse effects of aldosterone antagonists?

a)

Worsening of renal function

b)

Hypotension

c)

Hyperkalemia

d)

Gynecomastia

e)

Cyan lips

f)

C

87.

What are some contraindications for Aldosterone Antagonists?

a)

Addison’s disease

b)

Anuria

c)

Pele renounce

d)

Hyperkalemia

e)

Hypokalemia

88.

What are some monitoring parameters for Aldosterone Antagonists?

a)

Potassium

b)

BP

c)

SCr

d)

BUN

89.

If a patient can’t take Aldosterone Antagonists because renal function or potassium levels.. what should be prescribed?

a)

Loop

b)

ACE

c)

Vasodilator

90.

What are some reasons to use Hydralazine/Isosorbide Dinitrate (Vasodilator)?

a)

African American

b)

Can’t take ACEi/ARB/Aldosterone Antagonists

c)

Isn’t subject to potassium levels

d)

Isn’t subject to renal function

e)

Good alternative because it does not cause dry cough

91.

What is a adverse effect of hydralazine/Isosorbide dinitrate?

a)

Headache

b)

Vomiting

c)

Weak in legs

d)

Confusion

92.

Which SHOULDN’T you give with Viagra/Sildenafil?

a)

BB

b)

CCB

c)

Aldosterone

d)

Vasodilator

93.

How do diuretics work?

a)

Blocks sodium reabsorption thereby promoting fluid excretion

b)

Alters progression

c)

Improves survival

d)

Decreases fluid overload

e)

Decreased systemic vascular resistance

94.

How do you measure efficacy with Diuretics in patients with HFrEF?

a)

Weight

b)

BP

c)

Monitor kidney function

d)

BUN

e)

EKG

f)

B

95.

_______ used in combination with other diuretics to prevent hypokalemia.

a)

Aldosterone Antagonsists

b)

ACEi

c)

ARB

d)

Potassium sparing diuretics

e)

Loop diuretics

96.

Which is the most POTENT diuretic?

a)

Lisinopril

b)

Losartan

c)

Loop diuretics

d)

Calcium channel blocker

97.

Which are indications of HFrEF?

a)

Edema

b)

Lung fields are all white

c)

JVD

d)

Fluid overload

e)

Thirsty

98.

Where can you find ejection fraction?

a)

EKG

b)

ECHO

c)

ECG

99.

What is the target dose of Digoxin?

a)

0.5-1 ng/mL

b)

0.5-2 ng/mL

c)

1-3 ng/mL

d)

3-5 ng/mL

100.

What are complications from HTN:

a)

Increased risk of stroke

b)

Damage to kidneys

c)

Causes your heart to work harder than it already is

d)

Causes internal bleeding

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