Question 1

Which of the following normally causes renal sodium retention during compensated heart failure?&#10;A)Increased angiotensin II formation&#10;B)Increased atrial natriuretic factor release&#10;C)Sympathetic vasodilation of the afferent arterioles&#10;D)Increased glomerular filtration rate&#10;E)Increased antidiuretic hormone formation

Accepted Answer

Increased angiotensin II formation stimulates sodium retention in the renal tubules, leading to increased plasma volume and blood pressure. In compensated heart failure, the renin-angiotensin-aldosterone system is activated to maintain systemic blood pressure, and this results in increased angiotensin II formation, which causes renal sodium retention.

Question 2

Which of the following often occurs in decompensated heart failure?&#10;A)Edema of the heart muscle&#10;B)Increased norepinephrine in cardiac sympathetic nerves&#10;C)Increased calcium in the sarcoplasmic reticulum of cardiac muscle cells&#10;D)Decreased right atrial pressure&#10;E)Increased arterial pressure

Accepted Answer

A

Question 3

Which of the following is normally associated with the chronic stages of compensated heart failure? Assume the patient is resting.&#10;A)Decreased mean systemic filling pressure&#10;B)Increased right atrial pressure&#10;C)Increased heart rate&#10;D)Sweating&#10;E)Dyspnea

Accepted Answer

Increased right atrial pressure is typically seen in the chronic stages of compensated heart failure, as the heart has to work harder to pump blood and may struggle to maintain normal blood flow through the right side of the heart. Decreased mean systemic filling pressure, sweating, and dyspnea are more commonly associated with acute decompensated heart failure, while increased heart rate can occur in both acute and chronic stages.

Question 4

A 70-year-old man has been diagnosed with acute heart failure. Which of the following is normally associated with this condition? Assume the patient is resting.&#10;A)Dyspnea&#10;B)Decreased right atrial pressure&#10;C)Decreased heart rate&#10;D)Increased arterial pressure&#10;E)Decreased mean systemic filling pressure

Accepted Answer

E

Question 5

Which of the following conditions is often seen in patients with acute heart failure? Assume the patient is resting.&#10;A)Increased sympathetic output&#10;B)Decreased right atrial pressure&#10;C)Decreased heart rate&#10;D)Increased cardiac contractility&#10;E)Decreased blood volume

Accepted Answer

In patients with acute heart failure, there is often an increased sympathetic output as a compensatory mechanism to maintain cardiac output. This can lead to tachycardia, increased contractility, and increased peripheral vasoconstriction. Decreased right atrial pressure, decreased heart rate, decreased cardiac contractility, and decreased blood volume would all be contradictory to the compensatory mechanisms in acute heart failure.

Question 6

Which of the following normally occurs in unilateral left heart failure?&#10;A)Decreased pulmonary artery pressure&#10;B)Decreased left atrial pressure&#10;C)Decreased right atrial pressure&#10;D)Edema of feet&#10;E)Increased mean pulmonary filling pressure

Accepted Answer

Unilateral left heart failure causes an increased mean pulmonary filling pressure, which results in fluid accumulation in the lungs and pulmonary edema. The other choices are not typically associated with left heart failure.

Question 7

A 70-year-old woman has had difficulty breathing. She is diagnosed with acute pulmonary edema. Which of the following therapies is most beneficial?&#10;A)Place tourniquets on all four limbs&#10;B)Infuse red blood cells and fresh frozen plasma&#10;C)Infuse saline&#10;D)Infuse dobutamine&#10;E)Infuse norepinephrine

Accepted Answer

The answer of A 70-year-old woman has had difficulty breathing....

Question 8

A 60-year-old man had a heart attack 2 days ago, and his blood pressure has continued to decrease. He is now in cardiogenic shock. Which of the following therapies is most beneficial?&#10;A)Place tourniquets on all four limbs&#10;B)Give a sympathetic inhibitor&#10;C)Give furosemide&#10;D)Give a blood volume expander&#10;E)Increase dietary sodium

Accepted Answer

Giving a blood volume expander such as saline or albumin would help increase the circulating blood volume and subsequently increase blood pressure in the patient. This can help improve cardiac output and perfusion to vital organs. A sympathetic inhibitor (choice B) may also decrease blood pressure further and is not recommended in this scenario. Place tourniquets on all four limbs (choice A) is not appropriate as it may restrict blood flow to the limbs and worsen the patient's condition. Furosemide (choice C) is a diuretic and may worsen the hypotension in this patient. Increasing dietary sodium (choice E) may be helpful in preventing future episodes of hypotension, however, in this acute scenario immediate intervention is needed.

Question 9

Patients with pulmonary edema often have dyspnea because of accumulation of fluid in the lungs. Which of the following would normally be the most beneficial for a patient with acute pulmonary edema?&#10;A)Infuse furosemide&#10;B)Infuse dobutamine&#10;C)Infuse saline&#10;D)Infuse norepinephrine&#10;E)Infuse whole blood

Accepted Answer

Infusing furosemide, a loop diuretic, can help to decrease the accumulation of fluid in the lungs by increasing urine output and decreasing preload on the heart. This can help to alleviate symptoms of dyspnea and improve oxygenation. Dobutamine, a positive inotrope, may be used if the patient has low cardiac output, but it does not directly address the pulmonary edema. Saline infusion may actually exacerbate the edema by increasing fluid volume. Norepinephrine is a vasoconstrictor and may be used in septic shock, but it is not indicated for pulmonary edema. Whole blood transfusions may be used in cases of severe anemia, but they would not directly treat the underlying cause of pulmonary edema.

Question 10

A 50-year-old man with a resting cardiac output of 5 L/min exercises maximally, increasing cardiac output to 10 L/min. What is the cardiac reserve?&#10;A)10%&#10;B)20%&#10;C)50%&#10;D)100%&#10;E)200%

Accepted Answer

Cardiac reserve is the difference between the maximum cardiac output a person can achieve during peak exercise and their resting cardiac output. In this case, the increase from 5 L/min (resting) to 10 L/min (maximum) represents a 100% increase, or doubling, of the cardiac output.

Deck 22: Cardiac Failure