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WorksheetsChronic Heart Failure Ch 31
Total questions: 97
Worksheet time: 49mins
What is the primary function of the left ventricle in the context of heart failure?
To filter blood
To pump oxygen-rich blood to the body
To produce red blood cells
To regulate blood pressure
Which of the following is NOT listed as a drug treatment for chronic heart failure in the table of contents?
Beta-Blockers
Loop Diuretics
Antibiotics
Digoxin
According to the contents, which section would you refer to for information on drugs that may worsen heart failure?
Pathophysiology
Drug-Induced Heart Failure
Lifestyle Management
Iron Replacement Therapy
If a patient needs information on compensatory mechanisms in heart failure, which section should they consult?
Diagnosis
Pathophysiology
Drug Treatment
Potassium Oral Supplementation
Which of the following is a key counseling point for chronic heart failure management, as indicated in the contents?
Key Counseling Points
Classification Systems
Ejection Fraction
Vericiguat
A student wants to learn about the role of ACE inhibitors in heart failure. Which section should they look at?
Beta-Blockers
Renin-Angiotensin-Aldosterone System Inhibitors
Loop Diuretics
Iron Replacement Therapy
Based on the table of contents, which of the following is a lifestyle management strategy for chronic heart failure?
Digoxin therapy
Potassium oral supplementation
Lifestyle Management
Sodium-Glucose Cotransporter 2 Inhibitors
Which of the following is a common cause of heart failure (HF)?
Ischemic conditions such as myocardial infarction (MI)
Excessive exercise
High protein diet
Frequent headaches
What is the primary problem in heart failure?
The heart is unable to supply sufficient oxygen-rich blood to the body
The heart beats too fast
The heart produces excess hormones
The heart pumps too much blood
Which lab/biomarker is used to distinguish between cardiac and non-cardiac causes of dyspnea?
BNP and proBNP
Hemoglobin
Troponin
Creatinine
Which of the following is a left-sided sign or symptom of heart failure?
Orthopnea (shortness of breath when lying flat)
Hepatomegaly (enlarged liver)
Jugular venous distention (JVD)
Ascites (abdominal fluid accumulation)
Which general sign or symptom is commonly seen in heart failure?
Dyspnea (shortness of breath at rest or during exertion)
Skin rash
Blurred vision
Hair loss
Which right-sided sign or symptom is associated with heart failure?
Peripheral edema
Paroxysmal nocturnal dyspnea
S3 gallop
Hypoperfusion
What does an ejection fraction (EF) less than 40% indicate?
Systolic dysfunction or heart failure with reduced ejection fraction (HFrEF)
Normal heart function
Diastolic dysfunction only
Increased cardiac output
Which diagnostic procedure is commonly used to estimate left ventricular ejection fraction (LVEF) in suspected heart failure?
Echocardiography (echo)
Chest X-ray
Electrocardiogram (ECG)
Blood pressure measurement
A patient presents with crackling sounds heard on lung exam and nocturnal cough. Which type of heart failure symptoms are these?
Left-sided symptoms
Right-sided symptoms
General symptoms
Non-cardiac symptoms
Which of the following is NOT a general sign or symptom of heart failure?
Fatigue and weakness
Reduced exercise capacity
Skin rash
Cough
Which term is used for heart failure when the left ventricular ejection fraction (LVEF) is 41-49%?
Heart Failure with Preserved EF (HFpEF)
Heart Failure with Mildly Reduced EF (HFmrEF)
Heart Failure with Reduced EF (HFrEF)
Heart Failure with Improved EF (HFimpEF)
What is the primary problem in Heart Failure with Preserved EF (HFpEF)?
Impaired ability to eject blood during systole
Impaired ventricular relaxation and filling during diastole
Likely mixed systolic and diastolic dysfunction
EF improved with treatment
According to the ACC/AHA staging system, what stage describes patients at risk for heart failure but without symptoms, structural heart disease, or elevated biomarkers?
Stage A
Stage B
Stage C
Stage D
Which NYHA functional class describes patients who are unable to perform physical activity without heart failure symptoms, or whose symptoms occur at rest?
Class I
Class II
Class III
Class IV
What is the main purpose of the staging system recommended by the American College of Cardiology and American Heart Association for heart failure?
To diagnose heart failure
To guide treatment and slow progression of structural heart disease
To measure blood pressure
To assess cholesterol levels
A patient with structural heart disease and prior or current symptoms of heart failure, such as shortness of breath and reduced exercise tolerance, would be classified as which ACC/AHA stage?
Stage A
Stage B
Stage C
Stage D
Which NYHA functional class is characterized by slight limitation of physical activity, where ordinary physical activity results in heart failure symptoms?
Class I
Class II
Class III
Class IV
A patient with advanced (refractory) heart failure and severe symptoms or recurrent hospitalizations despite maximal treatment is classified as which ACC/AHA stage?
Stage A
Stage B
Stage C
Stage D
Which of the following is NOT a primary problem associated with heart failure with reduced ejection fraction (HFrEF)?
Impaired ability to eject blood during systole
Impaired ventricular relaxation and filling during diastole
Systolic dysfunction
EF improved with treatment
In the NYHA functional classification, what does Class III indicate?
No limitations of physical activity
Slight limitation of physical activity
Marked limitation of physical activity; minimal exertion causes symptoms
Unable to perform physical activity without symptoms
Which of the following best defines cardiac output (CO)?
The volume of blood pumped by the heart in one minute
The pressure exerted by blood on vessel walls
The amount of oxygen carried by red blood cells
The rate of electrical impulses in the heart
Which neurohormonal pathway is activated to increase blood volume and force of contractions in heart failure with reduced ejection fraction (HFrEF)?
Renin-angiotensin-aldosterone system (RAAS)
Parasympathetic nervous system
Dopaminergic pathway
Cholinergic pathway
Which drug class is preferred in heart failure for antiarrhythmic therapy?
Amiodarone and dofetilide
Flecainide and dronedarone
Diltiazem and verapamil
Thiazolidinediones
What is the effect of angiotensin II in the RAAS pathway?
Causes systemic vasoconstriction and stimulates aldosterone release
Increases potassium excretion only
Decreases blood pressure by vasodilation
Inhibits sodium and water retention
Which of the following is a recommended lifestyle management strategy for patients with heart failure?
Monitor and document body weight daily
Increase sodium intake
Avoid all forms of exercise
Ignore weight changes
Which natural product may improve heart failure symptoms according to the document?
Hawthorn and coenzyme Q10
Vitamin C and zinc
Garlic and ginseng
Echinacea and melatonin
A patient with heart failure gains 3 pounds in one day. What should be done according to the action plan?
Notify the provider
Ignore the weight gain
Increase sodium intake
Stop documenting body weight
Which of the following drugs can cause or worsen heart failure?
Diltiazem and verapamil
Lisinopril and losartan
Metoprolol and carvedilol
Atorvastatin and simvastatin
How does norepinephrine (NE) and epinephrine (Epi) affect the heart in heart failure?
Increase heart rate, contractility (positive inotropy), and vasoconstriction
Decrease heart rate and cause vasodilation
Inhibit contractility and reduce blood pressure
Cause sodium and water retention
Why is omega-3 fatty acid supplementation considered in heart failure management?
It is reasonable to lower mortality and cardiovascular hospitalizations
It increases blood pressure
It causes fluid retention
It worsens heart failure symptoms
Which of the following drug classes provides a mortality benefit in the treatment of heart failure with reduced ejection fraction (HFrEF)?
Loop diuretics
Digoxin
Beta-blockers
Hydralazine
What is the preferred first-line treatment for all patients with HFrEF according to guideline-directed medical therapy (GDMT)?
Digoxin
Angiotensin receptor and neprilysin inhibitor (ARNI)
Loop diuretics
Ivabradine
Which medication is recommended for self-identified Black patients with HFrEF who remain symptomatic on optimized first-line medications?
Sacubitril
Hydralazine/isosorbide dinitrate
SGLT2 inhibitor
Beta-blocker
Loop diuretics in HFrEF treatment primarily provide which of the following benefits?
Decreased mortality
Increased cardiac output
Decreased symptoms by reducing blood volume, edema, and congestion
Increased contractility
Which of the following drugs is associated with a reduction in risk of hospitalization and cardiovascular death after recent heart failure hospitalization or need for IV diuretics?
Vericiguat
Digoxin
Beta-blocker
Loop diuretic
Explain why medications for HFrEF may be started simultaneously at low doses or sequentially. What is the clinical rationale for this approach?
To avoid drug interactions and maximize patient compliance
To achieve target doses without causing adverse effects and to ensure patient tolerance
To reduce the cost of therapy
To increase the speed of symptom relief
A patient with HFrEF is started on a beta-blocker, ACE inhibitor, and loop diuretic. After several weeks, the patient continues to have symptoms and meets criteria for additional therapy. Which medication could be added to reduce risk of hospitalization and CV death, provided heart rate and rhythm criteria are met?
Digoxin
Ivabradine
Hydralazine
Sacubitril
Which class of drugs is recommended first line in all heart failure (HF) patients regardless of symptom severity?
Renin-angiotensin-aldosterone system inhibitors (RAAS inhibitors)
Beta-blockers
Diuretics
Calcium channel blockers
What is the main benefit of SGLT2 inhibitors in patients with HFrEF or HFpEF?
Decreasing HF hospitalizations and cardiovascular mortality
Increasing blood pressure
Reducing cholesterol levels
Improving kidney function
Why should more than one RAAS inhibitor not be used together?
Increased risk of hyperkalemia and renal insufficiency
Increased risk of hypertension
Increased risk of bradycardia
Increased risk of diabetes
Which drug combination is preferred over ACE inhibitor or ARB alone due to improved outcomes in heart failure?
Sacubitril/valsartan (Entresto)
Lisinopril/spironolactone
Metoprolol/losartan
Furosemide/digoxin
What is the role of neprilysin in heart failure treatment?
Degrades vasodilatory peptides
Increases sodium retention
Stimulates aldosterone production
Blocks beta-adrenergic receptors
Which of the following is a contraindication for sacubitril/valsartan (Entresto)?
History of angioedema
History of hypertension
History of diabetes
History of asthma
A patient is switching from an ACE inhibitor to sacubitril/valsartan. What is required before starting sacubitril/valsartan?
36-hour washout period
Immediate switch without delay
12-hour washout period
No washout required
Which side effect is associated with sacubitril/valsartan due to increased bradykinin levels?
Cough
Rash
Constipation
Insomnia
Why are ARBs preferred over ACE inhibitors in patients with a history of angioedema?
ARBs do not increase bradykinin levels
ARBs are more effective in lowering blood pressure
ARBs have fewer drug interactions
ARBs are less expensive
What should be monitored in patients taking sacubitril/valsartan?
Blood pressure, renal function, signs/symptoms of heart failure, angioedema
Liver enzymes, cholesterol, blood glucose, vision
Heart rate, respiratory rate, temperature, weight
Potassium, calcium, magnesium, sodium
Which enzyme do ACE inhibitors block the conversion of?
Angiotensin I to angiotensin II
Aldosterone to renin
Bradykinin to angiotensin I
Renin to aldosterone
What is a common side effect associated with ACE inhibitors due to the degradation of bradykinin?
Cough and angioedema
Hypertension
Hyperglycemia
Constipation
Which ACE inhibitor has a boxed warning for causing injury and death to the developing fetus when used in the 2nd and 3rd trimesters?
Captopril
Losartan
Valsartan
Candesartan
What is the recommended washout period when switching between an ACE inhibitor and ARNI?
36 hours
12 hours
24 hours
48 hours
Which ARB does NOT require a washout period when switching with sacubitril/valsartan?
Valsartan
Candesartan
Losartan
Ramipril
Why should more than one RAAS inhibitor not be used together?
Increased risk of renal impairment, hypotension, and hyperkalemia
Increased risk of cough and headache
Increased risk of bradycardia and hypoglycemia
Increased risk of constipation and diarrhea
Which of the following is a contraindication for the use of ACE inhibitors?
History of angioedema
History of hypertension
History of diabetes
History of cough
What should be monitored when a patient is on ACE inhibitors?
Blood pressure, potassium, renal function, symptoms of heart failure, angioedema
Blood glucose, cholesterol, liver enzymes, weight
Heart rate, respiratory rate, temperature, vision
Calcium, magnesium, sodium, uric acid
A patient is switching from an ACE inhibitor to an ARNI. What is the most important step to prevent adverse effects?
Ensure a 36-hour washout period
Double the dose of ARNI
Stop all potassium supplements
Add a diuretic immediately
Which drug interaction can increase the risk of lithium toxicity when used with ACE inhibitors or ARBs?
Decreased lithium renal clearance
Increased potassium excretion
Increased sodium absorption
Decreased aldosterone secretion
Which of the following is a primary effect of beta-blockers on the cardiovascular system?
Improve cardiac function and lower morbidity and mortality
Increase catecholamine release
Stimulate alpha-1 adrenergic receptors
Cause severe hypertension in all patients
Which beta-blockers are recommended as first-line therapy for heart failure (HF) patients?
Bisoprolol, carvedilol, and metoprolol succinate ER
Atenolol, propranolol, and metoprolol tartrate
Labetalol, nadolol, and acebutolol
Only metoprolol tartrate and bisoprolol
What is the boxed warning associated with metoprolol succinate extended release?
Do not discontinue abruptly; gradually taper over 1-2 weeks
May cause severe hepatic impairment
Take with food to increase absorption
Can cause intraoperative floppy iris syndrome
Which of the following is a contraindication for the use of carvedilol?
Severe hepatic impairment
Diabetes mellitus
Mild hypertension
Hyperthyroidism
A patient with bronchospastic disease such as asthma or COPD should use which beta-blocker with caution?
Metoprolol succinate extended release
Atenolol
Bisoprolol
All of the above
Which side effect is common to both metoprolol and bisoprolol?
Bradycardia
Edema
Severe hepatic impairment
Cataract formation
A patient is being switched from carvedilol immediate release (IR) to controlled release (CR). What should be considered regarding dose conversion?
Dose conversions are not 1:1 between IR and CR
CR is always given at a lower dose than IR
IR and CR can be used interchangeably at the same dose
CR is not recommended for heart failure
Which of the following is a warning specific to carvedilol use in patients undergoing cataract surgery?
Intraoperative floppy iris syndrome
Severe bradycardia
Masking of hypoglycemia
Impotence
A patient with Raynaud’s disease is prescribed a beta-blocker. What should the healthcare provider consider?
Use caution, as beta-blockers can exacerbate Raynaud’s symptoms
Beta-blockers are contraindicated in Raynaud’s disease
Beta-blockers will improve Raynaud’s symptoms
No special considerations are needed
Which of the following is a potential effect of beta-blocker drug interactions with insulin and sulfonylureas?
Enhanced hyperglycemia
Enhanced hypoglycemia
Increased blood pressure
Decreased risk of anxiety
Which SGLT2 inhibitor is recommended first line for all patients with heart failure and has a fixed dose that does not require titration?
Metoprolol
Digoxin
Dapagliflozin (Farxiga)
Spironolactone
What is the main mechanism by which aldosterone receptor antagonists (ARAs) help in heart failure?
Increase sodium and water retention
Compete with aldosterone at receptor sites in the distal convoluted tubule
Inhibit CYP450 enzymes
Stimulate cardiac remodeling
Which of the following is a contraindication for the use of spironolactone?
Hyperkalemia
Hypokalemia
Hypertension
Diabetes mellitus
A patient with heart failure and an eGFR of 18 mL/min/1.73 m² is being considered for SGLT2 inhibitor therapy. What should be done?
Initiate SGLT2 inhibitor at standard dose
Initiate SGLT2 inhibitor at half dose
Do not initiate SGLT2 inhibitor
Increase the dose of SGLT2 inhibitor
Which side effect is associated with spironolactone but not with eplerenone?
Hyperkalemia
Gynecomastia
Dizziness
Hyperchloremic metabolic acidosis
Why should caution be used when combining beta-blockers with drugs that lower heart rate (HR)?
It may cause severe hypertension
It may lead to excessive bradycardia
It increases the risk of hyperglycemia
It causes increased anxiety
Explain why eplerenone is preferred over spironolactone in patients concerned about endocrine side effects.
Eplerenone is more potent
Eplerenone does not exhibit endocrine side effects
Eplerenone is less effective
Eplerenone increases sodium retention
Which of the following is a risk when combining an ACE inhibitor, ARB or ARNI, and an ARA?
Increased risk of hyperkalemia and renal insufficiency
Decreased risk of dehydration
Increased risk of hypokalemia
Decreased risk of hypertension
What is the primary action of loop diuretics in the nephron?
Inhibit the Na-K-2Cl cotransporter in the thick ascending limb of the loop of Henle
Stimulate sodium reabsorption in the distal tubule
Inhibit aldosterone in the collecting duct
Increase water reabsorption in the proximal tubule
Which of the following is NOT a common side effect of loop diuretics?
Hypercalcemia
Hypokalemia
Hypomagnesemia
Hyponatremia
A patient with a known sulfa allergy is prescribed a loop diuretic. Which loop diuretic is least likely to cross-react?
Ethacrynic acid
Furosemide
Bumetanide
Torsemide
Which of the following statements best explains why loop diuretics are often required for symptom control in heart failure, even though they do not improve survival?
They reduce congestive symptoms by increasing excretion of sodium, potassium, chloride, magnesium, calcium, and water, making it easier for the heart to pump.
They directly increase cardiac contractility.
They reduce blood pressure by vasodilation.
They increase preload to improve cardiac output.
Which of the following is the correct oral equivalent dosing for loop diuretics?
Furosemide 40 mg = Torsemide 20 mg = Bumetanide 1 mg = Ethacrynic acid 50 mg
Furosemide 20 mg = Torsemide 40 mg = Bumetanide 2 mg = Ethacrynic acid 25 mg
Furosemide 80 mg = Torsemide 40 mg = Bumetanide 2 mg = Ethacrynic acid 100 mg
Furosemide 10 mg = Torsemide 5 mg = Bumetanide 0.5 mg = Ethacrynic acid 12.5 mg
A patient is experiencing hearing loss and tinnitus after rapid IV administration of a loop diuretic. Which drug is most likely responsible?
Bumetanide
Spironolactone
Hydrochlorothiazide
Amiloride
Why should loop diuretics generally be taken early in the day?
To avoid nocturia
To prevent hyperglycemia
To reduce risk of photosensitivity
To increase absorption
Which laboratory value is most likely to increase with loop diuretic use?
Bicarbonate (HCO3)
Calcium
Potassium
Sodium
A patient is prescribed furosemide injection. What is an important storage instruction?
Store at room temperature; solution must be clear, do not use if yellow in color
Store in the freezer; use only if solution is cloudy
Store in direct sunlight; use if solution is yellow
Store in the refrigerator; use if solution is cloudy
Which of the following drugs should be avoided when using loop diuretics due to the risk of decreasing sodium and water retention and causing renal impairment?
NSAIDs
ACE inhibitors
Beta-blockers
Calcium channel blockers
What is the main risk when loop diuretics are used in combination with other ototoxic drugs?
Additive risk for ototoxicity
Increased risk of hypertension
Reduced diuretic effect
Increased risk of hyperkalemia
A patient is being treated with furosemide 40 mg IV BID for acute heart failure exacerbation. What is the equivalent daily oral dose of bumetanide?
4 mg PO bumetanide
8 mg PO bumetanide
2 mg PO bumetanide
10 mg PO bumetanide
Hydralazine is classified as which type of drug?
Direct arterial vasodilator
Beta-blocker
ACE inhibitor
Loop diuretic
Which combination is indicated in self-identified Black patients with heart failure who remain symptomatic despite optimal treatment?
Hydralazine/isosorbide dinitrate
ACE inhibitor/ARB
Beta-blocker/diuretic
Calcium channel blocker/nitrate
What is a major contraindication for hydralazine use?
Mitral valve rheumatic heart disease
Diabetes mellitus
Asthma
Chronic kidney disease
