In heart failure with preserved ejection fraction, a stiff left ventricle fills poorly, which is why this type was traditionally called diastolic heart failure.
Correct Answer
True
True. In HFpEF the ventricle can still contract, but it is stiff and does not relax and fill well during diastole, so less blood is available to pump. Aging and long-standing hypertension are common causes.
Category: Heart Failure Basics
Question 2
Patients taking a diuretic for heart failure should add extra salt to their meals to replace the sodium lost in the urine.
Correct Answer
False
False. Patients with heart failure are taught to limit sodium, because extra salt makes the body hold more water and works against the diuretic. They are also taught to read food labels and to report rapid weight gain or new swelling.
Category: Diuretics
Question 3
NSAIDs taken with sacubitril/valsartan increase the risk of kidney impairment.
Correct Answer
True
True. NSAIDs reduce prostaglandin-driven blood flow to the kidneys, and combining them with a drug that blocks angiotensin II can impair renal function. Patients should check with the provider before using over-the-counter pain relievers.
Category: RAAS Drugs
Question 4
Combining an ACE inhibitor, an ARB and an ARNI gives added benefit, so all three classes are commonly prescribed together.
Correct Answer
False
False. Only one of these renin-angiotensin drug classes should be prescribed at a time. Combining them raises the risk of hyperkalemia, hypotension, kidney injury and, with an ACE inhibitor plus an ARNI, angioedema.
Category: RAAS Drugs
Question 5
Spironolactone and eplerenone should not be prescribed together.
Correct Answer
True
True. Both drugs block the mineralocorticoid receptor, so using them together adds no benefit and greatly increases the risk of dangerous hyperkalemia. Concurrent use is a listed contraindication.
Category: RAAS Drugs
Question 6
Mineralocorticoid receptor antagonists such as spironolactone are contraindicated in a patient who already has hyperkalemia.
Correct Answer
True
True. Spironolactone and eplerenone block aldosterone, so the kidneys keep potassium, and starting one when potassium is already high can cause dangerous hyperkalemia. Serum potassium and kidney function are checked before and during therapy.
Category: RAAS Drugs
Question 7
Beta blockers reduce myocardial oxygen demand by lowering heart rate and contractility.
Correct Answer
True
True. By blocking the effects of epinephrine and norepinephrine on the heart, beta blockers slow the rate and soften contraction, so the heart needs less oxygen. The slower rate also lengthens filling time.
Category: Beta Blockers
Question 8
In heart failure with reduced ejection fraction, beta blockers relieve symptoms but have no effect on mortality.
Correct Answer
False
False. The evidence-based beta blockers, metoprolol succinate, bisoprolol and carvedilol, lower mortality in HFrEF. They are started at a low dose once the patient is stable and increased slowly.
Category: Beta Blockers
Question 9
Bisoprolol and metoprolol succinate are nonselective beta blockers that block beta-1 and beta-2 receptors equally.
Correct Answer
False
False. Bisoprolol and metoprolol succinate are cardioselective, meaning they act mainly on beta-1 receptors in the heart. Carvedilol is the nonselective heart failure beta blocker.
Category: Beta Blockers
Question 10
Carvedilol is a good choice for a patient with severe asthma because it does not affect beta-2 receptors.
Correct Answer
False
False. Carvedilol is nonselective and blocks beta-2 receptors in the airways, which can trigger bronchospasm. Nonselective beta blockers are avoided in moderate to severe asthma.
Category: Beta Blockers
Question 11
SGLT2 inhibitors such as dapagliflozin are used to treat heart failure even in patients who do not have diabetes.
Correct Answer
True
True. Dapagliflozin and empagliflozin were first used for type 2 diabetes but are now approved for heart failure regardless of diabetes status. Their diuretic and direct cardiac effects reduce hospitalization.
Category: SGLT2 Inhibitors
Question 12
SGLT2 inhibitors reduce the risk of urinary tract infections.
Correct Answer
False
False. SGLT2 inhibitors increase the risk of urinary tract infections, including pyelonephritis, because glucose left in the urine supports bacterial growth. Patients are taught to report burning, urgency or fever.
Category: SGLT2 Inhibitors
Question 13
Furosemide carries a boxed warning that it can cause profound loss of water and electrolytes.
Correct Answer
True
True. Furosemide is a potent loop diuretic, and excessive amounts can cause severe dehydration and electrolyte depletion. Blood pressure, urine output and electrolytes are monitored during therapy.
Category: Diuretics
Question 14
Thiazide diuretics are more potent than loop diuretics for removing fluid in heart failure.
Correct Answer
False
False. Loop diuretics such as furosemide, bumetanide and torsemide are more potent than thiazides, which is why a loop diuretic is the usual choice to relieve congestion in heart failure. Thiazides act in the distal tubule and have a milder effect.
Category: Diuretics
Question 15
Torsemide is a potassium-sparing diuretic.
Correct Answer
False
False. Torsemide is a loop diuretic, like furosemide and bumetanide, and it increases potassium loss. Spironolactone and eplerenone are the potassium-sparing drugs used in heart failure.
Category: Diuretics
Question 16
Ivabradine should be taken with food.
Correct Answer
True
True. Ivabradine is taken with meals, which is part of the standard administration teaching for the drug. Patients also avoid grapefruit juice and report dizziness or an irregular heartbeat.
Category: Adjunct Drugs
Question 17
Ivabradine is considered safe to use during pregnancy.
Correct Answer
False
False. Ivabradine can cause fetal harm, so patients should not be pregnant or become pregnant while taking it. Patients who could become pregnant are counseled on effective contraception and to report a pregnancy right away.
Category: Adjunct Drugs
Question 18
Low serum magnesium lowers the risk of digoxin toxicity.
Correct Answer
False
False. Hypomagnesemia increases the risk of digoxin toxicity and dysrhythmias, and it is listed as a contraindication. Magnesium and potassium levels are both monitored in patients taking digoxin.
Category: Adjunct Drugs
Question 19
Digoxin is contraindicated in ventricular fibrillation.
Correct Answer
True
True. In ventricular fibrillation the ventricles quiver without pumping, and digoxin, which can itself provoke ventricular dysrhythmias, offers no benefit and may worsen the rhythm. Ventricular fibrillation is treated as a cardiac arrest with defibrillation instead.
Category: Adjunct Drugs
Question 20
Hydralazine can cause a drug-induced lupus-like syndrome.
Correct Answer
True
True. Hydralazine can trigger a lupus-like reaction with joint pain, fever and rash. Patients report these symptoms, and the reaction usually resolves after the drug is stopped.
Category: Adjunct Drugs