NR 508 Week 3 Quiz - treatment of heart failure because they have mo...

NR 508 Week 3 Quiz Angiotensin-converting-enzyme (ACE) inhibitors are a central part of the treatment of heart failure because they have more than one action to address the pathological changes in this disorder. Which of the following pathological changes in heart failure is NOT addressed by ACE inhibitors?

• Changes in the structure of the left ventricle so that it dilates, hypertrophies, and

uses energy less efficiently.

• Reduced formation of cross-bridges so that contractile force decreases.
• Activation of the sympathetic nervous system that increases heart rate and

preload.

• Decreased renal blood flow that decreases oxygen supply to the kidneys.

(ANS-

• Activation of the sympathetic nervous system that increases heart rate and

preload.

One of the three types of heart failure involves systolic dysfunction. Potential

causes of this most common form of heart failure include:

• Myocardial ischemia and injury secondary to myocardial infarction
• Inadequate relaxation and loss of muscle fiber secondary to valvular dysfunction
• Increased demands of the heart beyond its ability to adapt secondary to anemia
• Slower filling rate and elevated systolic pressures secondary to uncontrolled

hypertension (ANS- 1. Myocardial ischemia and injury secondary to myocardial infarction

The American Heart Association and the American College of Cardiology have devised a classification system for heart failure that can be used to direct treatment.

Patients with symptoms and underlying disease are classified as stage:

• A
• B
• C
• D

(ANS- 3. C

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Diagnosis of heart failure cannot be made by symptoms alone because many disorders share the same symptoms. The most specific and sensitive diagnostic test

for heart failure is:

• Chest x-rays that show cephalization and measure heart size
• Two-dimensional echocardiograms that identify structural anomalies and cardiac

dysfunction

• Complete blood count, blood urea nitrogen, and serum electrolytes that facilitate

staging for end-organ damage

• Measurement of brain natriuretic peptide to distinguish between systolic and

diastolic dysfunction (ANS- 2. Two-dimensional echocardiograms that identify structural anomalies and cardiac dysfunction

Treatments for heart failure, including drug therapy, are based on the stages

developed by the ACC/AHA. Stage A patients are treated with:

• Drugs for hypertension and hyperlipidemia, if they exist
• Lifestyle management including diet, exercise, and smoking cessation only
• Angiotensin-converting enzyme (ACE) inhibitors to directly affect the heart

failure only

• No drugs are used in this early stage

(ANS- 1. Drugs for hypertension and hyperlipidemia, if they exist

Class I recommendations for stage A heart failure include:

• Aerobic exercise within tolerance levels to prevent the development of heart

failure

• Reduction of sodium intake to less than 2,000 mg/day to prevent fluid retention
• Beta blockers for all patients regardless of cardiac history
• Treatment of thyroid disorders, especially if they are associated with

tachyarrhythmias (ANS- 4. Treatment of thyroid disorders, especially if they are associated with tachyarrhythmias

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Stage B patients should have beta blockers added to their heart failure treatment

regimen when:

• They have an ejection fraction less than 40%
• They have had a recent MI
• Both 1 and 2
• Neither 1 nor 2

(ANS- 3. Both 1 and 2

Increased life expectancy for patients with heart failure has been associated with

the use of:

• ACE inhibitors, especially when started early in the disease process
• All beta blockers regardless of selectivity
• Thiazide and loop diuretics
• Cardiac glycosides

(ANS- 1. ACE inhibitors, especially when started early in the disease process

Stage C patients usually require a combination of three to four drugs to manage their heart failure. In addition to ACE inhibitors and beta blockers, diuretics may be added. Which of the following statements about diuretics is NOT true?

• Diuretics reduce preload associated with fluid retention.
• Diuretics can be used earlier than stage C when the goal is control of

hypertension.

• Diuretics may produce problems with electrolyte imbalances and abnormal

glucose and lipid metabolism.

• Diuretics from the potassium-sparing class should be used when using an

angiotensin receptor blocker (ARB).(ANS- 4. Diuretics from the potassium-sparing class should be used when using an angiotensin receptor blocker (ARB).

Digoxin has a very limited role in treatment of heart failure. It is used mainly for

patients with:

• Ejection fractions above 40%
• An audible S3
• Mitral stenosis as a primary cause for heart failure 3 / 4

• Renal insufficiency

(ANS- 2. An audible S3

Which of the following classes of drugs is contraindicated in heart failure?

• Nitrates
• Long-acting dihydropyridines
• Calcium channel blockers
• Alpha-beta blockers

(ANS- 3. Calcium channel blockers

Heart failure is a leading cause of death and hospitalization in older adults (greater

than 65 years old). The drug of choice for this population is:

• Aldosterone antagonists
• Eplerenone
• ACE inhibitors
• ARBs

(ANS- 3. ACE inhibitors

ACE inhibitors are contraindicated in pregnancy. While treatment of heart failure during pregnancy is best done by a specialist, which of the following drug classes is considered to be safe, at least in the later parts of pregnancy?

• Diuretics
• ARBs
• Beta blockers
• Nitrates

(ANS- 3. Beta blockers

Heart failure is a chronic condition that can be adequately managed in primary care. However, consultation with or referral to a cardiologist is appropriate when:

• Symptoms markedly worsen or the patient becomes hypotensive and has

syncope

• There is evidence of progressive renal insufficiency or failure
• The patient remains symptomatic on optimal doses of an ACE inhibitor, a beta

blocker, and a diuretic

• Any of the above (ANS- 4. Any of the above
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