Deck 22: Treatment of Heart Failure

Question 1

Describe the physiological effect of restricting sodium intake along with diuretic therapy for a patient with mild CHF.

A) Restriction of sodium intake along with diuretic therapy may decrease the edema and congestion that occurs with CHF, but it has no effect on cardiac output.
B) Restriction of sodium intake along with diuretic therapy may decrease the edema, congestion, and reduced cardiac output that occurs with CHF.
C) Restriction of sodium intake along with diuretic therapy may improve the reduced cardiac output, but it has no effect on the edema and congestion that occurs with CHF.
D) None of these are correct.

Answer 1

Restriction of sodium intake along with diuretic therapy may decrease the edema, congestion, and reduced cardiac output that occurs with CHF.

Question 2

Identify the main therapeutic effect of the diuretic agents.

A) The main therapeutic effect produced by diuretics is the elimination of excess potassium and water by the kidneys.
B) The main therapeutic effect produced by diuretics is the elimination of excess sodium and water by the kidneys.
C) The main therapeutic effect produced by diuretics is the elimination of excess renin and water by the kidneys.
D) The main therapeutic effect produced by diuretics is the elimination of excess aldosterone and water by the kidneys.

Answer 2

The main therapeutic effect produced by diuretics is the elimination of excess sodium and water by the kidneys.

Question 3

Implementing a treatment plan with digoxin for a patient who already takes quinidine for arrhthymias requires:

A) An increase in the dosage of the digoxin due to antagonism with the quinidine
B) A decrease in the dosage of the digoxin due to the potentiation of the digoxin levels in the plasma
C) An increase in the dosage of the quinidine due to antagonism with the digoxin
D) None of these are correct.

Answer 3

A decrease in the dosage of the digoxin due to the potentiation of the digoxin levels in the plasma

Question 4

Identify the main causes of heart failure.

A) Untreated hypertension, myocardial infarction, and valvular defects
B) Untreated hyperglycemia, myocardial infarction, and valvular defects
C) Untreated hyperthyroidism, myocardial infarction and valvular defects
D) None of these are correct.

Question 5

Implementing a treatment plan that includes a vasodilator such as hydralazine requires monitoring the patient for:

A) Postural hypotension
B) Reflex tachycardia
C) Nausea and headache
D) All of these are correct.

Question 6

Differentiate between angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs),and select the correct statement related to the mechanism of action of the ARBs.

A) The effect of using ARBs is similar to the effect of using the ACE inhibitors, except that ARBs do not increase bradykinin.
B) The effect of using ARBs is similar to the effect of using the ACE inhibitors, except that ARBs do not decrease pre- and afterload.
C) The effect of using ARBs is similar to the effect of using the ACE inhibitors, except that ARBs do not increase cardiac output.
D) The effect of using ARBs is similar to the effect of using the ACE inhibitors, except that ARBs only decrease preload.

Question 7

Differentiate between digitalization and maintenance in the administration of digoxin,and select the correct statement related to the digitalization/maintenance process.

A) Digitalization is similar to the process of administering a loading dose because both rapidly produce a therapeutic blood level of drug.
B) Subsequent daily maintenance doses of digoxin are lower and adjusted to maintain a therapeutic level of the glycoside in the blood.
C) During digitalization, digoxin is administered by either the PO or IV route of administration.
D) All of these are correct.

Question 8

Explain the physiological changes that occur in the heart when there is a diagnosis of chronic heart failure.

A) Chronic heart failure leads to cardiac muscle undergoing hypertrophy, where the walls of the heart chambers increase in size and undergo structural remodeling in an attempt to generate more forceful contractions.
B) Chronic heart failure leads to weakness of the bicuspid and mitral valves, which slows the movement of blood from the atria to the ventricles.
C) Chronic heart failure leads to weakness of the aorta, which slows the movement of blood from the left ventricle to the body.
D) Chronic heart failure leads to weakness of the pulmonary semilunar valve, which slows the movement of blood from the right ventricle to the lungs.

Question 9

Differentiate between the thiazides,loop diuretics,and aldosterone antagonists,and select the diuretic agent that has the longest duration of action.

A) Spironolactone (Aldactone)
B) Furosemide (Lasix)
C) Hydrochlorothiazide (Hydrodiuril)
D) Amiloride (Midamor)

Question 10

Differentiate between preload and afterload,and select the correct statement.

A) Preload is the force (force of ventricular contraction) that the heart must generate in order to overcome vascular resistance (open the aortic valve) and eject blood out of the left ventricle. Afterload is the amount of blood returning to the heart (venous return).
B) Preload is the force (force of atrial contraction) that the heart must generate in order to overcome vascular resistance (open the mitral valve) and eject blood out of the left ventricle.
C) Preload is the amount of blood returning to the heart (venous return). Afterload is the force (force of ventricular contraction) that the heart must generate in order to overcome vascular resistance (open the aortic valve) and eject blood out of the left ventricle.
D) None of these are correct.

Question 11

Using your knowledge of the mechanism of action of digoxin,determine what facts should be given to a patient who is being started on digoxin for the first time.

A) Maintain adequate potassium intake.
B) Avoid taking antacids and laxatives when taking digoxin.
C) Pulse rate should be between 60 and 100 beats per minute.
D) All of these are correct.

Question 12

Use the mechanism of action of the venodilators nitroglycerin and isosorbide dinitrate to determine the physiologic action that results from their administration.

A) Venodilators reduce venous return to the heart.
B) Venodilators increase cardiac output.
C) Venodilators decrease the rate of contractions of the heart.
D) All of these are correct.

Question 13

Use the mode of action of the beta-blockers to determine the therapeutic action of the beta-blockers in the treatment of CHF.

A) Beta-blockers inhibit the release of renin, which in turn prevents the formation of angiotensin II, which causes vasoconstriction.
B) Beta-blockers decrease the rate at which the heart beats and reduce the force of the contractions of the heart.
C) Beta-blockers reduce the conduction rate of the electrical currents of the heart.
D) None of these are correct.

Question 14

Select the preferred beta-blockers used for the treatment of CHF.

A) Ramipril (Altace) and Lisinopril (Zestril)
B) Metoprolol (Lopressor) and carvedilol (Coreg)
C) Atenolol (Tenormin) and metoprolol (Lopressor)
D) None of these are correct.

Question 15

Differentiate between the loop diuretics,bumetanide (Bumex),torsemide (Demadex),and furosemide (Lasix),and select the agent that has the shortest duration of action.

A) Torsemide (Demadex)
B) Furosemide (Lasix)
C) Bumetanide (Bumex)
D) None of these are correct

Question 16

Use the mechanism of action of the ACE inhibitors to determine the physiologic action that results from their use in the treatment of CHF.

A) ACE inhibitors reduce the formation of angiotensin II.
B) ACE inhibitors promote excretion of sodium and water from the kidneys.
C) ACE inhibitors decrease the inactivation of bradykinin.
D) All of these are correct.

Question 17

Translate the presence of excessive ST segments and T wave depressions on an ECG.

A) The presence of excessive ST segments and T wave depressions on an ECG indicate an excess of aldosterone in the body.
B) The presence of excessive ST segments and T wave depressions on an ECG indicate an excess of antidiuretic hormone in the body.
C) The presence of excessive ST segments and T wave depressions on an ECG indicate digoxin toxicity.
D) None of these are correct

Question 18

Explain the difference between hyperkalemia and hypercalcemia.

A) Hyperkalemia is low serum potassium, and hypercalcemia is high serum calcium.
B) Hypercalcemia is high serum potassium, and hyperkalemia is high serum calcium.
C) Hyperkalemia is high serum potassium, and hypercalcemia is high serum calcium.
D) Hyperkalemia is high serum potassium, and hypercalcemia is low serum calcium.

Question 19

Select the correct statement related to the renin-angiotensin-aldosterone (RAA) mechanism.

A) A drop in systemic blood pressure or a decrease in renal blood flow stimulates the release of renin from the kidneys. Renin initiates reactions that lead to the formation of angiotensin II. Angiotensin II causes vasoconstriction and the release of aldosterone (sodium retention) and ADH (water retention). These actions normally function to maintain normal blood pressure and blood volume.
B) An increase in systemic blood pressure or an increase in renal blood flow stimulates the release of renin from the kidneys. Renin initiates reactions that lead to the formation of angiotensin II. Angiotensin II causes vasoconstriction and the release of aldosterone (sodium retention) and ADH (water retention). These actions normally function to maintain normal blood pressure and blood volume.
C) A drop in systemic blood pressure or a decrease in renal blood flow stimulates the release of renin from the kidneys. Renin initiates reactions that lead to the formation of angiotensin II. Angiotensin II causes vasodilation and the release of aldosteone (sodium retention) and ADH (water retention). These actions normally function to maintain normal blood pressure and blood volume.
D) None of these are correct.

Question 20

Outline the steps in the mechanism of action of digoxin.

A) Digoxin stimulates Na/K ATPase. Stimulation of Na/K ATPase increases intracellular concentration of Na⁺ ions. Increased intracellular Na⁺ decreases the Na⁺/Ca⁺⁺ exchanger and allows intracellular Ca⁺⁺ concentrations to increase. Increased intracellular Ca⁺⁺ increases the formation of actinomyosin and increases the force of myocardial contractions.
B) Digoxin binds to and inhibits Na/K ATPase. Inhibition of Na/K ATPase decreases intracellular concentration of Na⁺ ions. Decreased intracellular Na⁺ increases the Na⁺/ Ca⁺⁺ exchanger and allows intracellular Ca⁺⁺ concentrations to decrease. Decreased intracellular Ca⁺⁺ increases the formation of actinomyosin and increases the force of myocardial contractions.
C) Digoxin binds to and inhibits Na/K ATPase. Inhibition of Na/K ATPase increases intracellular concentration of Na⁺ ions. Increased intracellular Na⁺ decreases the Na⁺/ Ca⁺⁺ exchanger and allows intracellular Ca⁺⁺ concentrations to increase. Increased intracellular Ca⁺⁺ increases the formation of actinomyosin and increases the force of myocardial contractions.
D) None of these are correct