In heart failure with reduced ejection fraction, what is the core problem with the left ventricle?
Weak contraction during systole
✓
Stiff walls that fill poorly
Slow conduction through the AV node
Blood leaking across the septum
Correct Answer
Weak contraction during systole
Heart failure with reduced ejection fraction (HFrEF), traditionally called systolic heart failure, occurs when the left ventricle cannot contract forcefully enough to eject a normal share of its blood. Stiff walls that fill poorly describe heart failure with preserved ejection fraction. Slow conduction through the AV node is a conduction problem, not the defining feature of HFrEF. Blood leaking across the septum describes a septal defect, not HFrEF.
Category: Heart Failure Basics
Question 2
An echocardiogram shows structural damage to a patient's left ventricle, but the patient has never had symptoms of heart failure. Which ACC/AHA heart failure stage fits this patient?
Stage A
Stage B
✓
Stage C
Stage D
Correct Answer
Stage B
Stage B means structural heart disease is present but symptoms of heart failure have never occurred. Stage A describes a person at risk, such as someone with hypertension, who has no structural damage yet. Stage C adds current or past symptoms to structural disease. Stage D is advanced heart failure with symptoms that interfere with daily life despite treatment.
Category: Heart Failure Basics
Question 3
Brain natriuretic peptide (BNP) is released into the blood in response to which stimulus?
A fall in blood glucose
A drop in serum potassium
Stretching of ventricular muscle cells
✓
A rise in thyroid hormone
Correct Answer
Stretching of ventricular muscle cells
Cardiac muscle cells release BNP when the ventricles are overstretched by excess volume and pressure, so BNP levels rise as heart failure worsens and help gauge its severity. BNP promotes vasodilation and sodium excretion. A fall in blood glucose triggers glucagon and epinephrine release. A drop in serum potassium is not a trigger for BNP. A rise in thyroid hormone is not what releases BNP either.
Category: Heart Failure Basics
Question 4
Which adverse effect of ACE inhibitors is largely avoided when a patient is switched to an angiotensin II receptor blocker (ARB)?
Hyperkalemia
Fetal toxicity
Hypotension
Dry cough
✓
Correct Answer
Dry cough
ACE inhibitors allow bradykinin to build up, which causes a persistent dry cough; ARBs do not affect bradykinin, so the cough is largely avoided. Hyperkalemia can occur with both classes because both reduce aldosterone. Fetal toxicity is a boxed warning for both classes. Hypotension is possible with both because both lower blood pressure.
Category: RAAS Drugs
Question 5
Dapagliflozin is added for a patient with heart failure and type 2 diabetes who also uses insulin. The nurse should closely monitor for which problem related to this combination?
Low blood glucose
✓
High serum calcium
Hearing loss
Breast enlargement
Correct Answer
Low blood glucose
SGLT2 inhibitors lower blood glucose by sending glucose out in the urine, so adding one to insulin increases the risk of hypoglycemia, and the provider may lower the dose of one or both drugs. High serum calcium is not an expected effect of this combination. Hearing loss is linked to loop diuretics, not SGLT2 inhibitors. Breast enlargement is associated with spironolactone.
Category: SGLT2 Inhibitors
Question 6
A patient taking losartan for heart failure tells the nurse she has just learned she is pregnant. Why is this a concern?
The drug loses its effect in pregnancy
The drug can cause fetal injury or death
✓
Pregnancy greatly raises the risk of cough
The drug causes gestational diabetes
Correct Answer
The drug can cause fetal injury or death
Drugs that act on the renin-angiotensin system, including ARBs such as losartan, carry a boxed warning for fetal toxicity, so the drug is stopped as soon as pregnancy is detected and the provider is notified. The concern is not that the drug loses its effect in pregnancy. Pregnancy greatly raising the risk of cough is not the issue, and ARBs rarely cause cough. The drug does not cause gestational diabetes.
Category: RAAS Drugs
Question 7
Taking sacubitril/valsartan at the same time as an ACE inhibitor sharply raises the risk of which adverse effect?
Hypokalemia
Bradycardia
Angioedema
✓
Hyperglycemia
Correct Answer
Angioedema
Neprilysin and ACE both break down bradykinin, so blocking both enzymes at once sharply raises the risk of angioedema, and an ACE inhibitor must be stopped well before sacubitril/valsartan is started. Hypokalemia is not the concern, since both drugs tend to raise potassium. Bradycardia is not a typical effect of either drug. Hyperglycemia is not the reason the combination is forbidden.
Category: RAAS Drugs
Question 8
Digoxin is contraindicated in a patient with which condition?
Atrial fibrillation
Heart failure (HFrEF)
Atrial flutter
Wolff-Parkinson-White syndrome
✓
Correct Answer
Wolff-Parkinson-White syndrome
In Wolff-Parkinson-White syndrome an accessory pathway bypasses the AV node, and digoxin can speed conduction down that pathway and trigger dangerous ventricular rates. Atrial fibrillation is an indication, since digoxin slows the ventricular rate. Heart failure (HFrEF) is the main heart failure indication, because digoxin strengthens contraction. Atrial flutter is also treated with digoxin for rate control.
Category: Adjunct Drugs
Question 9
Which beta blocker is one of the agents proven to reduce mortality in HFrEF?
Metoprolol succinate
✓
Propranolol
Atenolol
Sotalol
Correct Answer
Metoprolol succinate
The beta blockers recommended for HFrEF because they lowered mortality in trials are metoprolol succinate, bisoprolol and carvedilol. Propranolol is a nonselective agent used for hypertension, angina and other conditions, not heart failure. Atenolol has not shown that mortality benefit in heart failure. Sotalol is used as an antidysrhythmic, not as heart failure therapy.
Category: Beta Blockers
Question 10
A beta blocker should not be started for a patient in which situation?
Stable chronic heart failure
Acute decompensated heart failure
✓
Controlled hypertension
History of a past MI
Correct Answer
Acute decompensated heart failure
During acute decompensated heart failure the heart depends on sympathetic stimulation to maintain output, so starting a beta blocker can worsen the crisis; therapy is begun once the patient is stable. Stable chronic heart failure is exactly when a beta blocker is started and slowly increased. Controlled hypertension is a common indication. A history of a past MI is a reason to use a beta blocker, not to avoid it.
Category: Beta Blockers
Question 11
A patient with diabetes is starting bisoprolol. The nurse teaches that beta blockers can hide which warning sign of hypoglycemia?
Sweating
Hunger
Rapid heart rate
✓
Confusion
Correct Answer
Rapid heart rate
Beta blockade blunts the adrenergic signs of hypoglycemia, especially a rapid heart rate, tremor and palpitations, so the patient should check blood glucose rather than rely on those cues. Sweating is driven by cholinergic sympathetic fibers and usually still occurs. Hunger is not blocked by beta blockade. Confusion comes from low glucose in the brain and is not masked.
Category: Beta Blockers
Question 12
A patient with type 2 diabetes who takes empagliflozin reports nausea, vomiting, abdominal pain and unusual fatigue. Blood glucose is only mildly elevated. Which complication should the nurse suspect?
Hypoglycemia
Hyperkalemia
Hypercalcemia
Ketoacidosis
✓
Correct Answer
Ketoacidosis
SGLT2 inhibitors can cause ketoacidosis in patients with diabetes, and it may occur even when blood glucose is normal or only mildly raised, so these symptoms need prompt evaluation for ketones and acidosis. Hypoglycemia would not fit a raised glucose level. Hyperkalemia is not a typical effect of SGLT2 inhibitors and does not explain this picture. Hypercalcemia is not an expected effect of this drug.
Category: SGLT2 Inhibitors
Question 13
A patient started on empagliflozin should be taught to report which common adverse effect?
Genital yeast infection
✓
Persistent dry cough
Ringing in the ears
Bright halos around lights
Correct Answer
Genital yeast infection
SGLT2 inhibitors leave glucose in the urine, which favors fungal growth, so genital yeast infections and urinary tract infections are common adverse effects; good hygiene and prompt reporting are taught. Persistent dry cough is typical of ACE inhibitors. Ringing in the ears points to loop diuretic ototoxicity. Bright halos around lights are associated with ivabradine and digoxin toxicity.
Category: SGLT2 Inhibitors
Question 14
Before starting dapagliflozin for heart failure, the nurse assesses which factor because the drug causes osmotic diuresis?
Hearing acuity
Volume status
✓
Visual acuity
Bone density
Correct Answer
Volume status
Sodium and glucose pulled into the urine carry water with them, so a patient who is already dehydrated can develop significant hypotension; dry mucous membranes, poor skin turgor and a rapid heart rate are reported before the first dose. Hearing acuity matters with loop diuretics, not SGLT2 inhibitors. Visual acuity is not affected by this drug. Bone density is not a baseline assessment for this class.
Category: SGLT2 Inhibitors
Question 15
Giving furosemide together with which drug increases the risk of hearing loss?
Metformin
Acetaminophen
Gentamicin
✓
Levothyroxine
Correct Answer
Gentamicin
Loop diuretics and aminoglycoside antibiotics such as gentamicin are both ototoxic, so together they raise the risk of tinnitus and permanent hearing loss. Metformin does not add ototoxicity. Acetaminophen is not ototoxic at usual doses. Levothyroxine does not damage hearing.
Category: Diuretics
Question 16
A patient will take furosemide once daily at home. When should the nurse teach the patient to take it?
At bedtime
With the evening meal
In the late evening
In the morning
✓
Correct Answer
In the morning
Taking a diuretic in the morning lets the diuresis happen during waking hours, so sleep is not interrupted by trips to the bathroom and nighttime falls are less likely. At bedtime would cause urination through the night. With the evening meal would still lead to diuresis overnight. In the late evening has the same problem.
Category: Diuretics
Question 17
A patient with heart failure exacerbation receives IV furosemide. Which finding shows that the drug is having its intended effect?
Fewer crackles and less edema
✓
A steady gain in body weight
A drop in serum potassium
New ringing in the ears
Correct Answer
Fewer crackles and less edema
Furosemide removes excess fluid, so clearing lung crackles, reduced edema, increased urine output and weight loss show it is working. A steady gain in body weight suggests fluid is still being retained. A drop in serum potassium is an adverse effect to monitor, not the goal. New ringing in the ears signals ototoxicity.
Category: Diuretics
Question 18
Digoxin strengthens myocardial contraction by inhibiting which target?
Beta-1 adrenergic receptor
Sodium-potassium ATPase pump
✓
Pacemaker funny current channel
Neprilysin enzyme
Correct Answer
Sodium-potassium ATPase pump
Blocking the sodium-potassium ATPase pump raises intracellular sodium, which leads to more calcium inside cardiac cells and a stronger contraction. The beta-1 adrenergic receptor is blocked by beta blockers, which weaken contraction. The pacemaker funny current channel is blocked by ivabradine to slow the heart rate. The neprilysin enzyme is blocked by sacubitril.
Category: Adjunct Drugs
Question 19
A patient taking hydralazine/isosorbide dinitrate asks whether it is safe to take sildenafil. The nurse explains that the combination can cause which effect?
Severe hyperkalemia
Rebound hypertension
Profound hypotension
✓
Digoxin toxicity
Correct Answer
Profound hypotension
Nitrates and PDE5 inhibitors such as sildenafil both raise cyclic GMP and dilate blood vessels, so together they can drop blood pressure to dangerous levels; the combination is contraindicated. Severe hyperkalemia is not caused by this pairing. Rebound hypertension is the opposite of what happens. Digoxin toxicity is unrelated to these drugs.
Category: Adjunct Drugs
Question 20
Temporary brightness or halos in part of the visual field, called luminous phenomena, are a characteristic adverse effect of which heart failure drug?
Furosemide
Lisinopril
Spironolactone
Ivabradine
✓
Correct Answer
Ivabradine
Ivabradine blocks HCN channels in the sinus node, and a related channel in the retina explains the visual brightness that often appears in the first months and usually fades. Furosemide is linked to ototoxicity, not visual changes. Lisinopril is linked to cough and angioedema. Spironolactone is linked to hyperkalemia and breast changes.
Category: Adjunct Drugs