NCLEX Practice Questions for Heart Failure

1. Which of the following patients are MOST at risk for developing heart failure? Select-all-that-apply:

A. A 69 year old male with a history of alcohol abuse and is recovering from a myocardial infarction.

B. A 55 year old female with a health history of asthma and hypoparathyroidism.

C. A 30 year old male with a history of endocarditis and has severe mitral stenosis.

D. A 45 year old female with lung cancer stage 2.

E. A 58 year old female with uncontrolled hypertension and is being treated for influenza.

2. A patient is being discharged home after hospitalization of left ventricular systolic dysfunction. As the
nurse providing discharge teaching to the patient, which statement is NOT a correct statement about this
condition?

A. “Signs and symptoms of this type of heart failure can include: dyspnea, persistent cough, difficulty
breathing while lying down, and weight gain.”

B. “It is important to monitor your daily weights, fluid and salt intake.”

C. “Left-sided heart failure can lead to right-sided heart failure, if left untreated.”

D. “This type of heart failure can build up pressure in the hepatic veins and cause them to become
congested with fluid which leads to peripheral edema.”

3. Which of the following are NOT typical signs and symptoms of right-sided heart failure? Select-all-that-
apply:

A. Jugular venous distention

B. Persistent cough

C. Weight gain

D. Crackles

E. Nocturia

F. Orthopnea

4. A patient is diagnosed with left-sided systolic dysfunction heart failure. Which of the following are
expected findings with this condition?

A. Echocardiogram shows an ejection fraction of 38%.

B. Heart catheterization shows an ejection fraction of 65%.

C. Patient has frequent episodes of nocturnal paroxysmal dyspnea.

D. Options A and C are both expected findings with left sided systolic dysfunction heart failure.
5. True or False: Patients with left-sided diastolic dysfunction heart failure usually have a normal ejection
fraction.

6. A patient has a history of heart failure. Which of the following statements by the patient indicates the
patient may be experiencing heart failure exacerbation?

A. “I’ve noticed that I’ve gain 6 lbs in one week.”

B. “While I sleep I have to prop myself up with a pillow so I can breathe.”

C. “I haven’t noticed any swelling in my feet or hands lately.”

D. Options B and C are correct.

E. Options A and B are correct.

F. Options A, B, and C are all correct.

7. Patients with heart failure can experience episodes of exacerbation. All of the patients below have a
history of heart failure. Which of the following patients are at MOST risk for heart failure exacerbation?

A. A 55 year old female who limits sodium and fluid intake regularly.

B. A 73 year old male who reports not taking Amiodarone for one month and is experiencing atrial
fibrillation.

C. A 67 year old female who is being discharged home from heart valve replacement surgery.

D. A 78 year old male who has a health history of eczema and cystic fibrosis.

8. A 74 year old female presents to the ER with complaints of dyspnea, persistent cough, and unable to
sleep at night due to difficulty breathing. On assessment, you note crackles throughout the lung fields,
respiratory rate of 25, and an oxygen saturation of 90% on room air. Which of the following lab results
confirm your suspicions of heart failure?

A. K+ 5.6

B. BNP 820

C. BUN 9

D. Troponin <0.02

9. Which of the following tests/procedures are NOT used to diagnose heart failure?

A. Echocardiogram

B. Brain natriuretic peptide blood test

C. Nuclear stress test

D. Holter monitoring
10. What type of heart failure does this statement describe? The ventricle is unable to properly fill with
blood because it is too stiff. Therefore, blood backs up into the lungs causing the patient to experience
shortness of breath.

A. Left ventricular systolic dysfunction

B. Left ventricular ride-sided dysfunction

C. Right ventricular diastolic dysfunction

D. Left ventricular diastolic dysfunction

11. A patient with left-sided heart failure is having difficulty breathing. Which of the following is the most
appropriate nursing intervention?

A. Encourage the patient to cough and deep breathe.

B. Place the patient in Semi-Fowler’s position.

C. Assist the patient into High Fowler’s position.

D. Perform chest percussion therapy.

12. You’re providing diet discharge teaching to a patient with a history of heart failure. Which of the
following statements made by the patient represents they understood the diet teaching?

A. “I will limit my sodium intake to 5-6 grams a day.”

B. “I will be sure to incorporate canned vegetables and fish into my diet.”

C. “I’m glad I can still eat sandwiches because I love bologna and cheese sandwiches.”

D. “I will limit my consumption of frozen meals.”

13. Select all the correct statements about educating the patient with heart failure:

A. It is important patients with heart failure notify their physician if they gain more than 6 pounds in a
day or 10 pounds in a week.

B. Patients with heart failure should receive an annual influenza vaccine and be up-to-date with the
pneumonia vaccine.”

C. Heart failure patients should limit sodium intake to 2-3 grams per day.

D. Heart failure is exacerbated by illness, too much fluid or sodium intake, and arrhythmias.

E. Patients with heart failure should limit exercise because of the risks.

14. A patient taking Digoxin is experiencing severe bradycardia, nausea, and vomiting. A lab draw shows
that their Digoxin level is 4 ng/mL. What medication do you anticipate the physician to order for this
patient?

A. Narcan

B. Aminophylline
C. Digibind

D. No medication because this is a normal Digoxin level.

15. Which of the following is a late sign of heart failure?

A. Shortness of breath

B. Orthopnea

C. Edema

D. Frothy-blood tinged sputum

16. These drugs are used as first-line treatment of heart failure. They work by allowing more blood to
flow to the heart which decreases the work load of the heart and allows the kidneys to secrete sodium.
However, some patients can develop a nagging cough with these types of drugs. This description
describes?

A. Beta-blockers

B. Vasodilators

C. Angiotensin II receptor blockers

D. Angiotensin-converting-enzyme inhibitors

17. A patient with heart failure is taking Losartan and Spironolactone. The patient is having EKG changes
that presents with tall peaked T-waves and flat p-waves. Which of the following lab results confirms
these findings?

A. Na+ 135

B. BNP 560

C. K+ 8.0

D. K+ 1.5

18. During your morning assessment of a patient with heart failure, the patient complains of sudden
vision changes that include seeing yellowish-green halos around the lights. Which of the following
medications do you suspect is causing this issue?

A. Lisinopril

B. Losartan

C. Lasix

D. Digoxin

19. Select all the correct statements about the pharmacodynamics of Beta-blockers for the treatment of
heart failure:

A. These drugs produce a negative inotropic effect on the heart by increasing myocardial contraction.
B. A side effect of these drugs include bradycardia.

C. These drugs are most commonly prescribed for patients with heart failure who have COPD.

D. Beta-blockers are prescribed with ACE or ARBs to treat heart failure.

20. You are assisting a patient up from the bed to the bathroom. The patient has swelling in the feet and
legs. The patient is receiving treatment for heart failure and is taking Hydralazine and Isordil. Which of
the following is a nursing priority for this patient while assisting them to the bathroom?

A. Measure and record the urine voided.

B. Assist the patient up slowing and gradually.

C. Place the call light in the patient’s reach while in the bathroom.

D. Provide privacy for the patient.

21. A patient is taking Digoxin. Prior to administration you check the patient’s apical pulse and find it to
be 61 bpm. Morning lab values are the following: K+ 3.3 and Digoxin level of 5 ng/mL. Which of the
following is the correct nursing action?

A. Hold this dose and administer the second dose at 1800.

B. Administer the dose as ordered.

C. Hold the dose and notify the physician of the Digoxin level.

D. Hold this dose until the patient’s potassium level is normal.

22. Which of the following is a common side effect of Spironolactone?

A. Renal failure

B. Hyperkalemia

C. Hypokalemia

D. Dry cough

23. The physician’s order says to administered Lasix 40 mg IV twice a day. The patient has the following
morning labs: Na+ 148, BNP 900, K+ 2.0, and BUN 10. Which of the following is a nursing priority?

A. Administer the Lasix as ordered

B. Notify the physician of the BNP level

C. Assess the patient for edema

D. Hold the dose and notify the physician about the potassium level

24. You’re developing a nursing care plan for a patient who has a diagnosis of congestive heart
failure exacerbation. The patient has bilateral 2+ pitting edema in the lower extremities, extreme
dyspnea on exertion, and crackles in the right and left lower bases of the lungs. The patient is prescribed
Furosemide (Lasix) 40 mg IV twice a day. Which of the following options below will you include as
nursing interventions for this patient? SELECT-ALL-THAT-APPLY:

A. Keep patient’s legs below heart level daily.

B. Weigh patient every morning on standing scale.

C. Patient will verbalize 3 health benefits to following a low sodium diet prior to discharge.

D. Maintain a daily fluid restriction of no more than 4 L of fluid per day.

E. Educate the patient daily about the importance of asking for help before ambulating.

F. Strictly monitor intake and output daily.

G. Monitor potassium levels daily.

Myocardial Infarction NCLEX Questions

1. You're educating a patient about the causes of a myocardial infarction. Which statement by the
patient indicates they misunderstood your teaching and requires you to re-educate them?*

A. Coronary artery dissection can happen spontaneously and occurs more in women.

B. The most common cause of a myocardial infarction is a coronary spasm from illicit drug use or
hypertension.

C. Patients who have coronary artery disease are at high risk for developing a myocardial infarction.

D. Both A and B are incorrect.

2. You note in the patient's chart that the patient recently had a myocardial infarction due to a blockage
in the left coronary artery. You know that which of the following is true about this type of blockage?*

A. A blockage in the left coronary artery causes the least amount of damage to the heart muscle.

B. Left coronary artery blockages can cause anterior wall death which affects the left ventricle.

C. Left coronary artery blockage can cause posterior wall death which affects the right ventricle.

D. The left anterior descending artery is least likely to be affected by coronary artery disease.

3. A patient is 36 hours status post a myocardial infarction. The patient is starting to complain of chest
pain when they lay flat or cough. You note on auscultation of the heart a grating, harsh sound. What
complication is this patient mostly likely suffering from?*

A. Cardiac dissection

B. Ventricular septum rupture

C. Mitral valve prolapse

D. Pericarditis
4. After a myocardial infraction, at what time (approximately) do the macrophages present at the site of
injury to perform granulation of the tissue?*

A. 24 hours

B. 2 days

C. 10 days

D. 6 hours

5. 24-36 hours after a myocardial infarction _____________ congregate at the site during the
inflammation phase.*

A. Neutrophils

B. Eosinophils

C. Platelets

D. Macrophages

6. A patient is complaining of chest pain. You obtain a 12-lead EKG and see ST elevation in leads II, III,
AVF. What area of the heart does this represent?*

A. Lateral

B. Septal

C. Anterior

D. Inferior

7. On an EKG, the lateral view of the heart is represented with leads?*

A. V1, V2, V3

B. II, II, AVF

C. I, AVL, V5, V6

D. V1, V2, V6

8. A patient is admitted with chest pain to the ER. The patient has been in the ER for 5 hours and is being
admitted to your unit for overnight observation. From the options below, what is the most IMPORTANT
information to know about this patient at this time?*

A. Troponin result and when the next troponin level is due to be collected

B. Diet status

C. Last consumption of caffeine

D. CK result and when the next CK level is due to be collected

9. A doctor has ordered cardiac enzymes on a patient being admitted with chest pain. You know that
_____________ levels elevate 2-4 hours after injury to the heart and is the most regarded marker by
providers.*

A. Myoglobin

B. CK-MB

C. CK

D. Troponin

10. A patient is complaining of chest pain. On the bedside cardiac monitor you observe pronounce T-
wave inversion. You obtain the patient's vital signs and find the following: Blood pressure 190/98, HR
110, oxygen saturation 96% on room air, and respiratory rate 20. Select-all-that-apply in regards to the
MOST IMPORTANT nursing interventions you will provide based on the patient’s current status:*

A. Obtain a 12-lead EKG

B. Place the patient in supine position

C. Assess urinary output

D. Administer Nitroglycerin sublingual as ordered per protocol

E. Collect cardiac enzymes as ordered per protocol

F. Encourage patient to cough and deep breath

G. Administer Morphine IV as ordered per protocol

H. Place patient on oxygen via nasal cannula

I. No interventions are needed at this time

11. In regards to the patient in the previous question, after administering the first dose of Nitroglycerin
sublingual the patient's blood pressure is now 68/48. The patient is still having chest pain and T-wave
inversion on the cardiac monitor. What is your next nursing intervention?*

A. Hold further doses of Nitroglycerin and notify the doctor immediately for further orders.

B. Administer Morphine IV and place the patient in reverse Trendelenburg position.

C. Administer Nitroglycerin and monitor the patient’s blood pressure.

D. All the options are incorrect.

12. A patient recovering from a myocardial infarction is complaining of the taste of blood in their mouth.
On assessment, you note there is bleeding on the anterior gums. Which medication can cause this?*

A. Coreg

B. Cardizem

C. Lovenox
D. Lipitor

13. A patient is on a Heparin drip post myocardial infarction. The patient has been on the drip for 4 days.
You are assessing the patient's morning lab work. Which of the following findings in the patient's lab
work is a potential life-threatening complication of Heparin therapy and requires intervention?*

A. K+ 3.7

B. PTT 65 seconds

C. Hgb 14.5

D. Platelets 135,000

14. A patient is experiencing Heparin-Induced Thrombocytopenia from Heparin therapy. The doctor
orders Heparin to be discontinued. The patient will most likely be placed on what other medication?*

A. Argatroban

B. Lovenox

C. Levophed

D. Tridil

15. A patient taking Lovenox is having a severe reaction. What is the antidote for this medication?*

A. Activated Charcoal

B. Acetylcysteine

C. Narcan

D. Protamine sulfate

16. A patient is being discharged home after receiving treatment for a myocardial infarction. The patient
will be taking Coreg. What statement by the patient demonstrates they understood your education
material about this drug?*

A. "I will take this medication at night."

B. "I will take this medication as needed."

C. "I will monitor my heart rate and blood pressure while taking this medication."

D. "I will take this medication in the morning with grapefruit juice."

17. A patient is complaining of a nagging cough that is continuous. Which medication below can cause
this side effect?*

A. Losartan

B. Lisinopril

C. Cardizem
D. Lipitor

18. A patient's morning lab work shows a potassium level of 6.3. The patient’s potassium level yesterday
was 4.0 The patient was recently started on new medications for treatment of myocardial infarction.
What medication below can cause an increased potassium level?*

A. Losartan

B. Norvasc

C. Aspirin

D. Cardizem

19. Which of the following EKG changes are abnormal findings that may indicate ischemia or injury to the
cardiac muscle found on a 12-lead EKG? SELECT-ALL-THAT-APPLY:*

A. Lengthening p-waves

B. ST-segment elevation

C. T-wave inversion

D. Tall t-waves

E. QT interval narrowing

F. ST-segment depression

Angina NCLEX Questions

1. The myocardium receives its blood supply from what structure within the body?

A. pulmonary arteries

B. superior vena cava

C. coronary arteries

D. pulmonary veins

The answer is C. The coronary arteries supply the myocardium (heart muscle) with oxygen-rich blood.
There are two main coronary arteries: right coronary and left coronary artery.

2. What vessel supplies parts of the electrical conduction system, SA and AV node, in the heart with
blood?

A. left anterior descending artery

B. right coronary artery

C. left pulmonary artery

D. left coronary artery

The answer is B. The right coronary artery supplies the SA and AV node with blood.

3. Select all the structures in the heart the left coronary artery supplies:

A. left ventricle

B. interventricular septum

C. SA node

D. right atrium

E. left atrium

F. AV node

The answers are A, B, and E. The left coronary artery supplies the left side of the heart, such as the left
ventricle, left atrium, and interventricular septum.

4. A patient presents to the emergency room reporting chest pain. They state their chest pain occurs
with activity and that it subsided after taking nitroglycerin. In addition, the patient states the pain lasted
for 8 minutes. Based on the patient’s signs and symptoms, what type of angina may the patient be
experiencing?

A. unstable angina

B. variant angina

C. stable angina

D. microvascular angina

The answer is C. Stable angina happens with exertion, is short-lived, and is relieved with rest or
nitroglycerin, which is what the patient is reporting. Therefore, this may be a case of stable angina.

5. The nurse educated the patient about nitroglycerin and how to take it. Which statements by the
patient require re-education? Select all that apply:

A. “This medication can lower my blood pressure. So, I will monitor my blood pressure while I take it.”

B. “I will take this medication every 15 minutes as needed for chest pain.”

C. “I will seek medical treatment if my chest pain isn’t relieved after 3 doses.”

D. “I will either swallow or place a tablet under my tongue when I take this medication.”

The answers are B and D. The patient should take it every 5 minutes (NOT 15 minutes) under the tongue
ONLY (not swallowed) for ONLY 3 doses. If the chest pain is not relieved, the patient needs to seek
medical attention.

6. A patient reports having angina. What signs and symptoms reported by the patient indicates they may
be experiencing variant (prinzmetal) angina? Select all that apply:
A. Chest pain occurs at night or early morning when at rest

B. The pain is not relieved by nitroglycerin.

C. The chest pain lasts for more than 15 minutes and has a crescendo pattern.

D. It occurs more frequently when the patient uses marijuana and drinks alcohol.

The answers are A and D. This is a type of angina that occurs due to a vasospasm. It is relieved by
nitroglycerin and can happen at rest (typically during the night or early morning). Risk factors for this
type of angina include using substances that cause vasoconstriction like cocaine, marijuana, or high
alcohol ingestion.

7. A patient is experiencing crushing chest pain, nausea, vomiting, and diaphoresis. The ECG show ST
segment depression. Troponin levels are positive. Based on these findings, what type of condition may
be presenting?

A. NSTEMI

B. STEMI

C. Unstable angina

D. Variant angina

The answer is A. NSTEMI (Non-ST-segment Elevation) is a type of heart attack. It occurs when a partial
blockage of a coronary artery presents. The ST segment is NOT elevated, but it can be depressed. In
addition, troponin levels will be elevated.

8. What signs and symptoms are associated with unstable angina? Select all that apply:

A. Predictable chest pain

B. Not relieved with nitroglycerin or rest

C. Chest pain happens with little to no activity

D. Troponin levels are normal

E. ECG changes with ST-segment elevation

F. Unpredictable chest pain that lasts longer than 15 minutes

The answer are B, C, D, and F. Unstable angina is unexpected chest pain, unaltered with rest or
nitroglycerin, unrelenting (lasts longer than 15 minutes).

9. True or False: Troponin levels are elevated during stable angina.

True

False

The answer is FALSE. Stable angina does NOT cause elevated levels. This happens in NSTEMI and STEMI.

10. What is the most common cause of stable angina?

A. rupture of a fatty plaque within a coronary artery

B. formation of a fatty plaque within the coronary artery that has caused the artery to stiffen

C. thrombus formation within a coronary artery

D. vasospasm of a coronary artery

The answer is B. Option A happens in many cases of unstable angina. Option C happens in most cases of
a myocardial infarction, and option D happens in cases of variant angina.

ARDS
1.) You’re providing care to a patient who is being treated for aspiration pneumonia. The patient is on a
100% non-rebreather mask. Which finding below is a HALLMARK sign and symptom that the patient is
developing acute respiratory distress syndrome (ARDS)?

A. The patient is experiencing bradypnea.

B. The patient is tired and confused.

C. The patient’s PaO2 remains at 45 mmHg.

D. The patient’s blood pressure is 180/96.

The answer is C. A hallmark sign and symptom found in ARDS is refractory hypoxemia. This is where that
although the patient is receiving a high amount of oxygen (here a 100% non-rebreather mask) the
patient is STILL hypoxic. Option C is the answer because it states the patient’s arterial oxygen level is
remaining at 45 mmHg (a normal is 80 mmHg but when treating patients with ARDS a goal is at least 60
mmHg). Yes, the patient can be tired and confused from a low oxygen level BUT this question wants to
know the HALLMARK sign and symptom.

2. You’re teaching a class on critical care concepts to a group of new nurses. You’re discussing the topic
of acute respiratory distress syndrome (ARDS). At the beginning of the lecture, you assess the new
nurses understanding about this condition. Which statement by a new nurse demonstrates he
understands the condition?

A. “This condition develops because the exocrine glands start to work incorrectly leading to thick,
copious mucous to collect in the alveoli sacs.”

B. “ARDS is a pulmonary disease that gradually causes chronic obstruction of airflow from the lungs.”

C. “Acute respiratory distress syndrome occurs due to the collapsing of a lung because air has
accumulated in the pleural space.”

D. “This condition develops because alveolar capillary membrane permeability has changed leading to
fluid collecting in the alveoli sacs.”
The answer is D. ARDS is a type of respiratory failure that occurs when the capillary membrane that
surrounds the alveoli sac becomes damaged, which causes fluid to leak into the alveoli sac. Option A
describes cystic fibrosis, option B describes COPD, and option C describes a pneumothorax.

3. During the exudative phase of acute respiratory distress syndrome (ARDS), the patient’s lung cells that
produce surfactant have become damaged. As the nurse you know this will lead to?

A. bronchoconstriction

B. atelectasis

C. upper airway blockage

D. pulmonary edema

The answer is B. Surfactant decreases surface tension in the lungs. Therefore, the alveoli sacs will stay
stable when a person exhales (hence the sac won’t collapse). If there is a decrease in surfactant
production this creates an unpredictable alveoli sac that can easily collapse, hence a condition called
ATELETASIS will occur (collapse of the lung tissue) when there is a decrease production in surfactant.

4. A patient has been hospitalized in the ICU for a near drowning event. The patient’s respiratory
function has been deteriorating over the last 24 hours. The physician suspects acute respiratory distress
syndrome. A STAT chest x-ray is ordered. What finding on the chest x-ray is indicative of ARDS?

A. infiltrates only on the upper lobes

B. enlargement of the heart with bilateral lower lobe infiltrates

C. white-out infiltrates bilaterally

D. normal chest x-ray

The answer is C. This is a finding found in ARDS….pronounce white-out infiltrates bilaterally.

5. You’re providing care to a patient who was just transferred to your unit for the treatment of ARDS. The
patient is in the exudative phase. The patient is ordered arterial blood gases. The results are back. Which
results are expected during this early phase of acute respiratory distress syndrome that correlates with
this diagnosis?

A. PaO2 40, pH 7.59, PaCO2 30, HCO3 23

B. PaO2 85, pH 7.42, PaCO2 37, HCO3 26

C. PaO2 50, pH 7.20, PaCO2 48, HCO3 29

D. PaO2 55, pH 7.26, PaCO2 58, HCO3 19

The answer is A. This option demonstrates respiratory alkalosis. In the early stages of ARDS (exudative)
the patient will start to enter in respiratory alkalosis. The patient starts to have tachypnea (the body’s
way of trying to increase the oxygen level but it can’t). They will have a very low PaO2 level (normal
PaO2 is 80 mmHg), the blood pH will become high (normal is 7.35-7.45) (alkalotic). In the late stage, the
patient can enter into respiratory acidosis.
6. Which patient below is at MOST risk for developing ARDS and has the worst prognosis?

A. A 52-year-old male patient with a pneumothorax.

B. A 48-year-old male being treated for diabetic ketoacidosis.

C. A 69-year-old female with sepsis caused by a gram-negative bacterial infection.

D. A 30-year-old female with cystic fibrosis.

The answer is C. Sepsis is the MOST common cause of ARDS because of systemic inflammation
experienced. This is also true if the cause of the sepsis is a gram-negative bacterium (this also makes the
infection harder to treat…hence poor prognosis). With sepsis, the immune cells that are present with the
inflammation travel to the lungs and damage the alveolar capillary membrane leading to fluid to leak in
the alveolar sacs.

7. As the nurse you know that acute respiratory distress syndrome (ARDS) can be caused by direct or
indirect lung injury. Select below all the INDIRECT causes of ARDS:

A. Drowning

B. Aspiration

C. Sepsis

D. Blood transfusion

E. Pneumonia

F. Pancreatitis

The answers are: C, D, F Indirect causes are processes that can cause inflammation OUTSIDE of the
lungs….so the issue arises somewhere outside the lungs. Therefore, sepsis (infection…as long as it is
outside the lungs), blood transfusion, and pancreatitis are INDIRECT causes. Drowning, aspiration, and
pneumonia are issues that arise in the lungs (therefore, they are DIRECT causes of lung injury).

8. A patient is on mechanical ventilation with PEEP (positive end-expiratory pressure). Which finding
below indicates the patient is developing a complication related to their therapy and requires immediate
treatment?

A. HCO3 26 mEq/L

B. Blood pressure 70/45

C. PaO2 80 mmHg

D. PaCO2 38 mmHg

The answer is B. Mechanical ventilation with PEEP can cause issues with intrathoracic pressure and
decrease the cardiac output (watch out for a low blood pressure) along with hyperinflation of the lungs
(possible pneumothorax or subq emphysema which is air that escapes into the skin because the lungs
are leaking air).
9. You are caring for a patient with acute respiratory distress syndrome. As the nurse you know that
prone positioning can be beneficial for some patients with this condition. Which findings below indicate
this type of positioning was beneficial for your patient with ARDS?

A. Improvement in lung sounds

B. Development of a V/Q mismatch

C. PaO2 increased from 59 mmHg to 82 mmHg

D. PEEP needs to be titrated to 15 mmHg of water

The answers are A and C. Prone positioning helps improve PaO2 (82 mmHg is a good finding) without
actually giving the patient high concentrations of oxygen. It helps improves perfusion and ventilation
(hence correcting the V/Q mismatch). In this position, the heart is no longer laying against the posterior
part of the lungs (improves air flow…hence improvement of lung sounds) and it helps move secretions
from other areas that were fluid filled and couldn’t move in the supine position, hence helping improve
atelectasis.

10. A patient is experiencing respiratory failure due to pulmonary edema. The physician suspects ARDS
but wants to rule out a cardiac cause. A pulmonary artery wedge pressure is obtained. As the nurse you
know that what measurement reading obtained indicates that this type of respiratory failure is NOT
cardiac related?

A. >25 mmHg

B. <10 mmHg

C. >50 mmHg

D. <18 mmHg

The answer is D. A pulmonary artery wedge pressure measures the left atrial pressure. A pulmonary
catheter is “wedged” with a balloon in the pulmonary arterial branch to measure the pressure. If the
reading is less than 18 mmHg it indicates this is NOT a cardiac issue but most likely ARDS. Therefore, the
pulmonary edema is due to damage to the alveolar capillary membrane leaking fluid into the alveolar
sac….NOT a heart problem ex: heart failure.

11. You’re precepting a nursing student who is assisting you care for a patient on mechanical ventilation
with PEEP for treatment of ARDS. The student asks you why the PEEP setting is at 10 mmHg. Your
response is:

A. “This pressure setting assists the patient with breathing in and out and helps improve air flow.”

B. “This pressure setting will help prevent a decrease in cardiac output and hyperinflation of the lungs.”

C. “This pressure setting helps prevent fluid from filling the alveoli sacs.”

D. “This pressure setting helps open the alveoli sacs that are collapsed during exhalation.”

The answer is D. This setting of PEEP (it can range between 10 to 20 mmHg of water) and it helps to open
the alveoli sacs that are collapsed, especially during exhalation.
AKI
1. ______________ is solely filtered from the bloodstream via the glomerulus and is NOT reabsorbed
back into the bloodstream but is excreted through the urine.

A. Urea

B. Creatinine

C. Potassium

D. Magnesium

The answer is B. Creatinine is a waste product from muscle breakdown and is removed from the
bloodstream via the glomerulus of the nephron. It is the only substance that is solely filtered out of the
blood but NOT reabsorbed back into the system. It is excreted out through the urine. This is why a
creatinine clearance test is used as an indicator for determining renal function and for calculating the
glomerular filtration rate.

2. A patient with acute renal injury has a GFR (glomerular filtration rate) of 40 mL/min. Which signs and
symptoms below may this patient present with? Select all that apply:

A. Hypervolemia

B. Hypokalemia

C. Increased BUN level

D. Decreased Creatinine level

The answers are A and C. The glomerular filtration rate indicates how well the glomerulus is filtering the
blood. A normal GFR tends to be 90 mL/min or higher. A GFR of 40 mL/min indicates that the kidney’s
ability to filter the blood is decreased. Therefore, the kidneys will be unable to remove waste and
excessive water from the blood…hence hypervolemia and an increased BUN level will present in this
patient. The patient will experience HYPERkalemia (not hypo) because the kidneys are unable to remove
potassium from the blood. In addition, an INCREASED creatinine level (not decreased) will present
because the kidneys cannot remove excessive waste products, such as creatinine.

3. You’re assessing morning lab values on a female patient who is recovering from a myocardial
infraction. Which lab value below requires you to notify the physician?

A. Potassium level 4.2 mEq/L

B. Creatinine clearance 35 mL/min

C. BUN 20 mg/dL

D. Blood pH 7.40
The answer is B. A normal creatinine clearance level in a female should be 85-125 mL/min (95-140
mL/min males). A creatinine clearance level indicates the amount of blood the kidneys can make per
minute that contain no amounts of creatinine in it. Remember creatinine is a waste product of muscle
breakdown. Therefore, the kidneys should be able to remove excessive amounts of it from the
bloodstream. A patient who has experienced a myocardial infraction is at risk for pre-renal acute injury
due to decreased cardiac output to the kidneys from a damaged heart muscle (the heart isn’t able to
pump as efficiently because of ischemia). All the other labs values are normal.

4. A 55 year old male patient is admitted with a massive GI bleed. The patient is at risk for what type of
acute kidney injury?

A. Post-renal

B. Intra-renal

C. Pre-renal

D. Intrinsic renal

The answer is C. Pre-renal injury is due to decreased perfusion to the kidneys secondary to a cause
(massive GI bleeding…patient is losing blood volume). This leads to a major decrease in kidney function
because the kidneys are deprived of nutrients to function and the amount of blood it can filter. Pre-renal
injury can eventually lead to intrarenal damage where the nephrons become damaged.

5. Select all the patients below that are at risk for acute intra-renal injury?

A. A 45 year old male with a renal calculus.

B. A 65 year old male with benign prostatic hyperplasia.

C. A 25 year old female receiving chemotherapy.

D. A 36 year old female with renal artery stenosis.

E. A 6 year old male with acute glomerulonephritis.

F. An 87 year old male who is taking an aminoglycoside medication for an infection.

The answers are: C, E, and F. These patients are at risk for an intra-renal injury, which is where there is
damage to the nephrons of kidney. The patients in options A and B are at risk for POST-RENAL injury
because there is an obstruction that can cause back flow of urine into the kidney, which can lead to
decreased function of the kidney. The patient in option D is at risk for PRE-RENAL injury because there is
an issue with perfusion to the kidney.

6. A patient with acute kidney injury has the following labs: GFR 92 mL/min, BUN 17 mg/dL, potassium
4.9 mEq/L, and creatinine 1 mg/dL. The patient’s 24 hour urinary output is 1.75 Liters. Based on these
findings, what stage of AKI is this patient in?

A. Initiation

B. Diuresis
C. Oliguric

D. Recovery

The answer is D. This patient is in the recovery stage of AKI. The patient’s labs and urinary output
indicate the renal function has returned to normal. Remember the recovery stages starts when the GFR
(glomerular filtration rate) has returned to normal (normal GFR 90 mL/min or higher), which will allow
waste levels and electrolyte levels to be maintained.

7. A 36 year old male patient is diagnosed with acute kidney injury. The patient is voiding 4 L/day of
urine. What complication can arise based on the stage of AKI this patient is in? Select all that apply:

A. Water intoxication

B. Hypotension

C. Low urine specific gravity

D. Hypokalemia

E. Normal GFR

The answers are: B, C, and D. This patient is in the DIURESIS stage of AKI. The nephrons are now starting
to filter out waste but cannot concentrate the urine. There is now a high amount of urea in the filtrate
(because the nephrons can filter the urea out of the blood) and this causes osmotic diuresis. Urinary
output will be excessive (3 to 6 L/day). Therefore, the patient is at risk for hypotension, diluted urine (low
urine specific gravity), and hypokalemia (waste potassium in the urine). The patient is not at risk for
water intoxication and will not have a normal GFR until the recovery stage.

8. True or False: All patients with acute renal injury will progress through the oliguric stage of AKI but not
all patients will progress through the diuresis stage.

The answer is FALSE. Some patients will skip the oliguric stage of AKI and progress to the diuresis stage.

9. Which patient below with acute kidney injury is in the oliguric stage of AKI:

A. A 56 year old male who has metabolic acidosis, decreased GFR, increased BUN/Creatinine,
hyperkalemia, edema, and urinary output 350 mL/day.

B. A 45 year old female with metabolic alkalosis, hypokalemia, normal GFR, increased BUN/creatinine,
edema, and urinary output 600 mL/day.

C. A 39 year old male with metabolic acidosis, hyperkalemia, improving GFR, resolving edema, and
urinary output 4 L/day.

D. A 78 year old female with respiratory acidosis, increased GFR, decreased BUN/creatinine,
hypokalemia, and urinary output 550 mL/day.

The answer is A. During the oliguric stage of AKI the patient will have a urinary output of 400 mL/day or
LESS. This is due to a decreased GRF (glomerular filtration rate), which will lead to increased amounts of
waste in the blood (increased BUN/Creatinine), metabolic acidosis (decreased excretion of hydrogen
ions), hyperkalemia, hypervolemia (edema/hypertension), and urinary output of <400 mL/day.
10. You’re developing a nursing care plan for a patient in the diuresis stage of AKI. What nursing
diagnosis would you include in the care plan?

A. Excess fluid volume

B. Risk for electrolyte imbalance

C. Urinary retention

D. Acute pain

The answer is B. During the diuresis stage of AKI, the patient will be losing an excessive amount of urine
(3-6 Liters/day) and is at risk for fluid volume deficient and electrolyte imbalance. The nurse must
monitor the patient’s electrolyte levels, especially potassium (hypokalemia).

11. While educating a group of nursing students about the stages of acute kidney injury, a student asks
how long the oliguric stage lasts. You explain to the student this stage can last?

A. 1-2 weeks

B. 1-3 days

C. Few hours to 2 weeks

D. 12 months

The answer is A. The oliguric stage can last 1-2 weeks. Regarding the other stages of AKI: Initiation: few
hours to several days, diuresis: 1-3 weeks, and recovery: 12 months or more.

12. A patient with AKI has a urinary output of 350 mL/day. In addition, morning labs showed an
increased BUN and creatinine level along with potassium level of 6 mEq/L. What type of diet ordered by
the physician is most appropriate for this patient?

A. Low-sodium, high-protein, and low-potassium

B. High-protein, low-potassium, and low-sodium

C. Low-protein, low-potassium, and low-sodium

D. High-protein and high-potassium

The answer is C. The patient with AKI, especially in the oliguric stage of AKI, should eat a low-protein,
low-potassium, and low-sodium diet. This is because the kidneys are unable to filter out waste products,
excessive water, and maintain electrolyte balance. The patient will have a buildup of waste (BUN and
creatinine). Remember these waste products are the byproduct of protein (urea) and muscle breakdown
(creatinine). So the patient should avoid high-protein foods. In addition, the patient is at risk for
hyperkalemia and fluid overload (needs low-potassium and sodium foods).

Nephron Function Quiz

1. ____________ and _____________ are known as the renal corpuscle.
A. Bowman’s Capsule and Renal Cortex

B. Glomerulus and Bowman’s Capsule

C. Loop of Henle and Renal Medulla

D. Proximal Convoluted Duct and Distal Convoluted Duct

2. Blood flows out of the glomerulus via the:

A. Afferent arteriole

B. Peritubular capillaries

C. Vasa Recta

D. Efferent arteriole

3. The glomerulus filters all the following substances EXCEPT: (SELECT-ALL-THAT-APPLY)

A. Blood cells

B. Water

C. Urea

D. Proteins

E. Amino acids

F. Creatinine

G. Sodium and Chloride

H. Calcium

I. Bicarbonate

4. Which parts of the nephron are found in the renal medulla of the kidney?

A. Proximal Convoluted Tubule and Distal Convoluted Tubule

B. Loop of Henle and Distal Convoluted Tubule

C. Loop of Henle and Collecting Tubule

D. Loop of Henle (except the descending limb) and Distal Convoluted Tubule

5. Which part of the Loop of Henle is ONLY permeable to water?

A. Descending Limb

B. Transverse Limb

C. Ascending Limb

D. Proximal Limb
6. The _______________________ is responsible for reabsorbing MOST of the substances found in the
filtrate which includes nearly 100% of glucose and amino acids along with approximately 90%
bicarbonate and 60-70% of water, sodium and chloride.

A. Distal Convoluted Tubule

B. Collecting Tubule

C. Loop of Henle

D. Proximal Convoluted Tubule

7. The main role of the Loop of Henle is to?

A. Maintain an isotonic environment in the renal medulla

B. Concentrate the urine by allowing reabsorption of water and sodium chloride from the filtrate

C. Dilute the urine by secreting water and sodium chloride into the filtrate

D. Assist the Proximal Convoluted Tubule with hydrogen ion secretion to maintain normal blood pH

8. Which part of the kidney is very vital in helping the Loop of Henle with performing its role with filtrate
reabsorption?

A. Renal Medulla

B. Renal Cortex

C. Renal Papilla

D. Minor and Major Calyx

9. Which substance found in the filtrate is only filtered from the bloodstream by the glomerulus and is
not reabsorbed or secreted into the renal tubule? (Hint: this substance’s rate of excretion from the
bloodstream allows us to determine the efficiency of the kidneys)

A. Urea

B. Creatinine

C. Hydrogen ions

D. Nitrogen

10. In the Distal Convoluted Tubule, which hormone plays a role in sodium reabsorption which causes
water to be reabsorbed as well?

A. Anti-diuretic hormone (ADH)

B. Parathyroid Hormone (PTH)

C. Aldosterone

D. Cortisol
11. True or False: Calcium is reabsorbed in the loop of Henle under the influence of the parathyroid
hormone.

12. Which part of the renal tubule performs the “final touches” on the filtrate before it leaves the kidney
as urine?

A. Collecting Tubule/Duct

B. Renal Papilla

C. Loop of Henle

D. Distal Convoluted Tubule

13. Which hormone plays a role in water reabsorption in the collecting duct/tubule?

A. Aldosterone

B. Thyroxine

C. Anti-diuretic hormone

D. Corticotropin-releasing hormone

14. The final components of urine do NOT include? Select-ALL-that apply:

A. Glucose

B. Urea

C. Creatinine

D. Lipids

E. Proteins

NEPHROTIC SYNDROME
1. A 6 year old male is diagnosed with nephrotic syndrome. In your nursing care plan you will include
which of the following as a nursing diagnosis for this patient?

A. Risk for infection

B. Deficient fluid volume

C. Constipation

D. Overflow urinary incontinence

The answer is A. A patient with nephrotic syndrome is at risk for infection due to the potential loss of
proteins (immunoglobulins) in the urine that help fight infection. In addition, medication treatment for
nephrotic syndrome may include corticosteroids or immune suppressors, which will further suppress the
immune system. Option B is wrong because the patient will be experiencing fluid volume overload (not
deficient). Option C and D are wrong because constipation and overflow urinary incontinence are not
common findings with nephrotic syndrome.

2. Which patient below is NOT at risk for developing nephrotic syndrome?

A. An 8 year old male with diabetes mellitus.

B. A 5 year old female diagnosed with minimal change disease.

C. A 10 year old male with Lupus.

D. A 7 year old male recently diagnosed with Goodpasture’s Syndrome.

The answer is D. The patients in options A-C are all at risk for nephrotic syndrome. The patient in option
D is at risk for acute glomerulonephritis.

3. You’re collecting a urine sample on a patient who is experiencing proteinuria due to nephrotic
syndrome. As the nurse, you know the urine will appear:

A. Tea-colored

B. Orange and frothy

C. Dark and foamy

D. Straw-colored

The answer is C. The urine will appear dark and foamy due to the high amount of proteins present in the
urine. Remember in nephrotic syndrome the patient is losing a massive amount of protein per day (3
grams per day) and this will cause the urine to foam.

4. The mother of a child, who was recently diagnosed with nephrotic syndrome, asks how she can
identify early signs that her child is experiencing a relapse with the condition. You would tell her to
monitor the child for the following: Select-all-that-apply:

A. Weight loss

B. Protein in the urine using an over-the-counter kit

C. Tea-colored urine

D. Swelling in the legs, hands, face, or abdomen

The answers are B and D. The patient will NOT experience weight loss but weight GAIN as a sign of
relapse with this condition. In addition, the urine will appear dark and foamy. Tea-colored urine indicates
there is blood in the urine, which is NOT common with nephrotic syndrome.

5. You’re providing education to a group of nursing students about nephrotic syndrome. A student
describes the signs and symptoms of this condition. Which signs and symptoms verbalized by the
student require you to re-educate the student about this topic? Select-all-that-apply:

A. Slight proteinuria

B. Hypoalbuminemia
C. Edema

D. Hyperlipidemia

E. Tea-colored urine

F. Hypertension

The answers are A, E, and F. The patient with nephrotic syndrome will experience massive proteinuria
(not slight) along with low albumin in the blood (hypoalbuminemia), edema, and high cholesterol and
triglyceride levels. It is not common for the patient to experience tea-colored urine or hypertension
(rare) this is very common with acute glomerulonephritis.

6. You’re providing care to a 6 year old male patient who is receiving treatment for nephrotic syndrome.
Which assessment finding below requires you to notify the physician immediately?

A. Frothy, dark urine

B. Redden area on the patient’s left leg that is swollen and warm

C. Elevated lipid level on morning labs

D. Urine test results that shows proteinuria

The answer is B. Patients with nephrotic syndrome are at risk for hypercoagulability (blood clot
formation) due to the loss of proteins in the urine that prevent blood clot formation. Option B represents
a possible deep vein thrombosis, which will appear as a redden, warm, and swollen area on the
extremity. Options A, C, and D are common findings with nephrotic syndrome, which are expected.

7. As the nurse, you know that it is important to implement a low sodium and potassium diet for a
patient with nephrotic syndrome. However, it is important to implement what other type of diet due to
another complication associated with this syndrome?

A. Low-phosphate

B. Low-fat

C. High-carbohydrate

D. High-magnesium

The answer is B. Patients with nephrotic syndrome can experience hyperlipidemia. Why? Remember that
in this condition there will be low amounts of albumin in the blood. This decrease of albumin in the
blood causes the liver to make more albumin, BUT while it does this it also makes more cholesterol and
triglycerides…hence increasing lipid levels. Therefore, the patient should follow a low-sodium and
potassium diet along with a low-fat diet as well.

8. A patient is diagnosed nephrotic syndrome. What signs and symptoms below are common in this
condition? Select-all-that-apply:

A. Hypertension

B. Decreased Glomerular Filtration Rate

C. Foamy, frothy urine

D. Massive Proteinuria

E. Hyperlipidemia

F. Edema

G. Hematuria

H. Hypoalbuminemia

The answers are: C, D, E, F, and H. Hypertension, decreased glomerular filtration rate, and hematuria are
common findings in ACUTE GLOMERULONEPHRITIS.

CARDIOGENIC SHOCK
1. A patient is being treated for cardiogenic shock. Which statement below best describes this condition?
Select all that apply:

A. “The patient will experience an increase in cardiac output due to an increase in preload and
afterload.”

B. “A patient with this condition will experience decreased cardiac output and decreased tissue
perfusion.”

C. “This condition occurs because the heart has an inadequate blood volume to pump.”

D. “Cardiogenic shock leads to pulmonary edema.”

The answers are: B and D. Cardiogenic shock occurs when the heart can NOT pump enough blood to
meet the perfusion needs of the body. The cardiac output will be DECREASED, which will DECREASE
tissue perfusion and cause cell injury to organs/tissues. In this condition, the heart is WEAK and can’t
pump blood out of the heart. In cardiogenic shock, there is NOT an issue with blood volume, but there is
a problem with the heart itself.

2. Cardiac output is very important for determining if a patient is in cardiogenic shock. What is a normal
cardiac output in an adult?

A. 2-5 liters/minute

B. 1-3 liters/minute

C. 4-8 liters/minute

D. 8-10 liters/minute

The answer is C. Cardiac output is the amount of blood the heart pumps per minute. The heart’s cardiac
output should be anywhere from 4-8 liters of blood per minute.
3. ________________ is the amount the ventricle stretches at the end of diastole.

A. Preload

B. Afterload

C. Stroke Volume

D. Contractility

The answer is A. Preload is the amount the ventricle stretches at the end of diastole (hence it’s the
amount the ventricles stretches once it’s filled with blood and right before the contraction of the
ventricle ….so it’s the end-diastolic volume).

4. Cardiac output is equal to the heart rate multiplied by the stroke volume. Treatment for cardiogenic
shock includes medications that increase cardiac output. One of the factors that help determine cardiac
output is stroke volume. Select all the factors that determine stroke volume?

A. Cardiac Index

B. Preload

C. Pulmonary capillary wedge pressure

D. Afterload

E. Heart rate

F. Contractility

The answers are B, D, and F. Cardiac output is determined by the person’s heart rate times the stroke
volume. Stroke volume is the amount of blood pumped from the left ventricle with each BEAT (50-100
ml). It’s determined by the preload, afterload, and contractility of the heart. These factors in a patient
with cardiogenic shock can be manipulated with medications to increase the cardiac output.

5. _____________ is the force the heart has to pump against to get blood out of the ventricle.

A. Cardiac output

B. Cardiac index

C. Preload

D. Afterload

The answer is D. Afterload is the pressure the ventricle must pump against to squeeze blood out. In
other words, it’s the force the heart has to pump against to get blood out of the ventricle.

6. True or False: If a patient with cardiogenic shock is given a medication that will decrease cardiac
afterload, it will decrease stroke volume.

The answer is FALSE. If a patient with cardiogenic shock is given a medication that will decrease cardiac
afterload, it will INCREASE (not decrease) stroke volume. HOW? Remember afterload is the resistance
the ventricle must pump against to get blood out of the heart. If we DECREASE the resistance the heart
must pump against (make it easier for the heart squeeze blood out of the ventricle), it will increase how
much blood it will pump out, hence increase the stroke volume.

7. Which patient below is at MOST risk for developing cardiogenic shock?

A. A 52-year-old male who is experiencing a severe allergic reaction from shellfish.

B. A 25-year-old female who has experienced an upper thoracic spinal cord injury.

C. A 72-year-old male who is post-op from a liver transplant.

D. A 49-year-old female who is experiencing an acute myocardial infarction.

The answer is D. An acute MI (heart attack) is the main cause of cardiogenic shock. It happens because a
coronary artery has become blocked. Coronary arteries supply the heart muscle’s cells with oxygenated
blood. If they don’t receive this oxygenated blood they will die, which causes the heart muscle to quit
working (hence pumping efficiently). When the heart muscle fails to pump efficiently, cardiac output fails
and cardiogenic shock occur.

8. You’re caring for a patient with cardiogenic shock. Which finding below suggests the patient’s
condition is worsening? Select all that apply:

A. Blood pressure 95/68

B. Urinary output 20 mL/hr

C. Cardiac Index 3.2 L/min/m2

D. Pulmonary artery wedge pressure 30 mmHg

The answer is B and D. When answering this question look for values that are abnormal and that point to
worsening tissue perfusion (urinary output should be 30 mL/hr or greater….if it’s lower than this it show
the kidneys are not being perfused) and worsening cardiac output (the blood pressure and cardiac index
are within normal limits BUT pulmonary artery wedge pressure is NOT). A pulmonary artery wedge
pressure (also called pulmonary capillary wedge pressure) is the pressure reading of the filling pressure
in the left atrium. A normal PAWP is 4-12 mmHg and if it’s >18 mmHg this indicates cardiogenic shock. If
it reads high, that means there is back-flowing of blood into the heart and lungs (hence the left ventricle
is failing to pump efficiently and increasing the pressure in the left atrium).

9. A patient with cardiogenic shock has a blood pressure of 70/38. In addition, the patient is experiencing
dyspnea with a respiratory rate of 32 breaths per minute and has an oxygen saturation of 82% on room
air. On auscultation, you note crackles throughout the lung fields. You notify the physician. What order
below would you ask for an order clarification?

A. Dopamine IV stat

B. Normal saline IV bolus stat

C. Furosemide IV stat

D. Place patient on CPAP (continuous positive airway pressure)

The answer is B. This patient with cardiogenic shock is experiencing a decrease in cardiac output (hence
the blood pressure), so an order for Dopamine can help provide a positive inotropic effect (increase the
contractility of the heart which will increase stroke volume and cardiac output). The patient is also
experiencing pulmonary congestion due to the cardiogenic shock. The heart is failing to pump blood
forward, so it is backing up in the lungs. This is leading to an increased respiratory rate, dyspnea, and low
oxygen saturation. The order for Furosemide (which is a diuretic) will help remove the extra fluid volume
from the lungs and the CPAP (continuous positive airway pressure) will help with oxygenation. The nurse
would question the order for a normal saline IV bolus. This bolus would add more fluid to the lungs and
further congest the fluids.

10. You’re assessing your patient with cardiogenic shock, what signs and symptoms do you expect to find
in this condition? Select all that apply:

A. Warm, flushed skin

B. Prolonged capillary refill

C. Urinary output >30 mL/hr

D. Systolic blood pressure <90 mmHg

E. Crackles in lung fields

F. Dyspnea

D. Decreased BUN and creatinine

G. Strong peripheral pulses

H. Chest pain

The answers are B, D, E, F, and H. Signs and symptoms of cardiogenic shock will be related to LOW
cardiac output and decreased perfusion to organs/tissues. Capillary refill will be prolonged >2 seconds,
urinary output will be <30 mL/hr, systolic blood pressure will be <90 mmHg, pulmonary edema will
present with fluid in the lungs (hence crackles in the lungs), dyspnea, and chest pain (due to decreased
blood flow to the heart muscle).

11. A patient is receiving treatment for an acute myocardial infarction. The nurse is closely monitoring
the patient for signs and symptoms associated with cardiogenic shock. Which value below is associated
with cardiogenic shock?

A. Cardiac index 1.5 L/min/m2

B. Pulmonary capillary wedge pressure (PCWP) 10 mmHg

C. Central venous pressure (CVP) 4 mmHg

D. Troponin <0.01 ng/mL

The answer is A. A patient who has experienced an acute myocardial infarction is at risk for cardiogenic
shock. A normal cardiac index should be 2.5-4 L/min/m2. Cardiac index is the specific cardiac output
based on the patient’s size. Any number less than 2.2 L/min/m2 can be associated with cardiogenic
shock. All the other values are within normal limits. PCWP would be >18 mmHg in cardiogenic shock,
and CVP would be high.

12. A patient who has cardiogenic shock is experiencing labored breathing and low oxygen levels. A STAT
chest x-ray is ordered. The x-ray results show pulmonary edema. The physician orders Furosemide IV.
What finding would require immediate nursing action?

A. Blood pressure 98/54

B. Urinary output 45 mL/hr

C. Potassium 1.8 mEq/L

D. Heart rate 110 bpm

The answer is C. Furosemide (Lasix) is a diuretic which wastes potassium. The nurse would want to
ensure the potassium level is normal (3.5 to 5 mEq/L) before administering IV Furosemide. The nurse
would need to notify the physician of the potassium level so supplementation can be provided.

13. They physician orders a Dobutamine IV drip on a patient in cardiogenic shock. After starting the IV
drip, the nurse would make it priority to monitor for?

A. Rebound hypertension

B. Ringing in the ears

C. Worsening hypotension

D. severe headache

The answer is C. Dobutamine increases contractility and cardiac output, BUT causes vasodilation due to
the way it acts on receptors and this may make hypotension WORSE. The patient may be started on
norepinephrine or dopamine if worsening of hypotension occurs.

14. Which medications below are used in cardiogenic shock that provide a positive inotropic effect on
the heart? Select all that apply:

A. Nitroglycerin

B. Sodium Nitroprussidde

C. Dobutamine

D. Norepinephrine

E. Dopamine

The answers are C and E. Dobutamine and Dopamine are vasopressors that have a POSITIVE inotropic
effect on the heart. This means these medications increase the strength of the heart’s contractions
(increases contractility), which increases stroke volume.

15. A patient with cardiogenic shock has an intra-aortic balloon pump. As the nurse you know that
during ________ the balloon deflates and during _____ the balloon inflates in a section of the aorta.
A. systole, diastole

B. diastole, systole

C. inspiration, expiration

D. expiration, inspiration

The answer is A. An intra-aortic balloon pump is a balloon attached to the catheter inside a section of
the aorta. It will inflate and deflate during systole (contraction) and diastole (relaxation). When the
balloon deflates during systole it creates a suction-like pressure that will draw blood out of the weak
heart and into the coronary arteries and systemic circulation (hence increasing cardiac output and blood
supply to the heart muscle). When the balloon inflates during diastole it will create pressure that will
push blood into the coronary arteries (hence further increasing blood supply to the heart muscle).

16. You’re precepting a new nurse. You ask the new nurse to list the purpose of why a patient with
cardiogenic shock may benefit from an intra-aortic balloon pump. What responses below indicate the
new nurse understands the purpose of an intra-aortic balloon pump? Select all that apply:

A. “This device increases the cardiac afterload, which will increase cardiac output.”

B. “This device will help increase blood flow to the coronary arteries.”

C. “The balloon pump will help remove extra fluid from the heart and lungs.”

D. “The balloon pump will help increase cardiac output.”

The answers are B and D. An intra-aortic balloon pump increases coronary artery blood flow and cardiac
output.

HYPOVOLEMIC SHOCK
1. True or False: Hypovolemic shock occurs where there is low fluid volume in the interstitial
compartment.

Answer: FALSE Hypovolemic shock occurs where there is low fluid volume in the INTRAVASCULAR (not
interstitial) system.

2. As the nurse you know that in order for hypovolemic shock to occur the patient would need to lose
__________ of their blood volume.

A. <30%

B. >25%

C. >15%

D. >10%

The answer is C. As the nurse you know that in order for hypovolemic shock to occur the patient would
need to lose 15% or more of their blood volume.
3. If a patient has a blood volume of 5 Liters and loses 2 Liters, what is the percentage amount of volume
loss this patient has experienced?

A. 25%

B. 40%

C. 30%

D. 10%

The answer is B. This patient has lost 40% of blood volume. Based on this amount of fluid loss, this
patient would be in class III (stage 3 of hypovolemic shock). Class III occurs when volume loss is 30-40%
or 1,500-2,000 mL in an adult.

4. A patient who is experiencing hypovolemic shock has decreased cardiac output, which contributes to
ineffective tissue perfusion. The decrease in cardiac output occurs due to?

A. An increase in cardiac preload

B. An increase in stroke volume

C. A decrease in cardiac preload

D. A decrease in cardiac contractility

The answer is C. Because there is a major depletion of volume in the intravascular system, there will be a
decrease in the amount of venous return to the heart (this is the amount of blood draining back to the
heart). Hence, this will lead to a DECREASE in preload. Remember preload is the amount the ventricles
stretch once their filled with blood. The ventricle won’t be stretching too much because there isn’t
enough fluid to fill them. This will decrease stroke volume and in turn decrease cardiac output.

5. True or False: A patient with acute pancreatitis is presenting with Turner and Cullen’s Sign. This patient
is at risk for absolute hypovolemic shock.

The answer is FALSE: The statement should read: A patient with acute pancreatitis is presenting with
Turner and Cullen’s Sign. This patient is at risk for RELATIVE (not absolute) hypovolemic shock. Relative
hypovolemic shock is an INSIDE fluid shift from the intravascular system, which occurs in cases of acute
pancreatitis. If a patient has Turner’s Sign (bruising on the flanks) or Cullen’s Sign (bruising around the
umbilicus) this can indicate internal hemorrhage and this places the patient at risk for RELATIVE
hypovolemic shock. Absolute hypovolemic shock occurs when there is an OUTSIDE fluid shift out of the
body from the intravascular system.

6. Select all the conditions below that increases a patient’s risk for absolute hypovolemic shock:

A. Burns

B. Vomiting

C. Long bone fracture

D. Surgery
E. Diarrhea

F. Sepsis

The answers are: B, D, and E. Vomiting, diarrhea, and surgery can all increase the loss of fluid volume
outside the body, which are absolute hypovolemic shock types. Burns, long bone fracture, and sepsis can
lead to an inside fluid shift of fluid from the intravascular system and are relative hypovolemic shock
types.

7. A patient has a 10% loss of their blood volume. Select all the signs and symptoms this patient may
present with?

A. Cool, clammy skin

B. Blood pressure within normal limits

C. Anxiety

D. Capillary refill less than 2 seconds

E. Urinary output greater than 30 mL/hr

F. Mild tachycardia

The answers are: B, D, and E. The body can compensate for a volume loss of <15% to maintain cardiac
output. Therefore, the patient will be asymptomatic until blood loss is greater than 15% and you would
select normal findings for this question, which are: blood pressure within normal limits, capillary refill
less than 2 seconds, urinary output greater than 30 mL/hr. Anxiety, cool/clammy skin, and mild
tachycardia may present when volume loss is higher.

8. During what stage (or class) of hypovolemic shock does the sympathetic nervous system attempt to
maintain cardiac output?

A. I

B. III

C. IV

D. II

The answer is D. During stage 2 or class II of hypovolemic shock, the cardiac output is falling even more
due to volume loss. This is when the patient has lost 15-30% of volume. During this time the sympathetic
nervous system will take over and attempt to maintain cardiac output.

9. One of your patients begins to vomit large amounts of bright red blood. The patient is taking Warfarin.
You call a rapid response. Which assessment findings indicate this patient is developing hypovolemic
shock? Select all that apply:

\A. Temperature 104.8 ‘F

B. Heart rate 40 bpm

C. Heart rate 140 bpm

D. Anxiety, restlessness

E. Urinary output 15 mL/hr

F. Blood pressure 70/56

G. Pale, cool skin

H. Weak peripheral pulses

I. Blood pressure 220/106

The answers are: C, D, E, F, G, and H. Signs and symptoms of hypovolemic shock include: tachycardia,
hypotension, increased respiratory rate, cool/pale/clammy skin, anxiety, decreased urinary output
(normal UOP is >30 mL/hr), weak peripheral pulses

10. You’re providing care to a patient who has experienced a 45% loss of their fluid volume and is
experiencing hypovolemic shock. The patient has hemodynamic monitoring and fluid resuscitation is
being attempted. Which finding indicates the patient is still in hypovolemic shock?

A. Low central venous pressure

B. High pulmonary artery wedge pressure

C. Elevated mean arterial pressure

D. Low systemic vascular resistance

The answer is A. Central venous pressure is the measurement of the pressure in the right atrium and
superior vena cava. If fluid volume is low (as in hypovolemic shock) the pressure in this area will also be
low. This indicates the patient is still in hypovolemic shock.

11. A patient is 1 hour post-op from abdominal surgery and had lost 20% of their blood volume during
surgery. The patient is experiencing signs and symptoms of hypovolemic shock. What position is best for
this patient?

A. Modified Trendelenburg

B. Trendelenburg

C. High Fowler’s

D. Supine

The answer is A. Modified Trendelenburg position is where the patient is supine with their legs elevated
at 45 degrees. This will help increase venous return to the heart (hence increase preload), which will
help increase cardiac output.

12. A 35-year-old male arrives to the emergency room with multiple long bone fractures and an internal
abdominal injury. The patient is anxious. Patient’s vital signs are: Blood pressure 70/54, heart rate 125
bpm, respirations 30, oxygen saturation on 2 L nasal cannula 96%, temperature 99.3 ‘F, pain 6 on 1-10
scale. During assessment it is noted the skin is cool and clammy. The nurse will make it priority to?

A. Collect a urine sample

B. Obtain an EKG

C. Establish 2 large-bore IV access sites

D. Place a warming blanket on the patient

The answer is C. This patient is at major risk for hypovolemic shock due to the multiple long bone
fractures and an internal abdominal injury (this can lead to relative hypovolemic shock…where fluid is
loss inside the body). The patient is already showing signs and symptoms of hypovolemic shock.
Therefore, it should be a nursing priority to establish IV access (at least two sites should be obtained
using a large-bore cannula….18 gauge or higher). Fluids and possibly blood products will need to be
given to this patient along with pain medication etc.

13. A patient in hypovolemic shock is receiving rapid infusions of crystalloid fluids. Which patient finding
requires immediate nursing action?

A. Patient heart rate is 115 bpm

B. Patient experiences dyspnea and crackles in lung fields

C. Patient is anxious

D. Patient’s urinary output is 35 mL/hr

The answer is B. When crystalloid fluids are given there is a risk for fluid volume overload even though
the patient is hypovolemic, especially with rapid infusions. Therefore, the nurse should monitor the
patient for this. If a patient develops difficulty breathing (dyspnea) and has crackles in the lung fields
(this represents edema in the lungs), fluid is backing up in the lungs. This requires immediate nursing
action. Option A and C are expected finding in hypovolemic shock, and option D is a normal
finding…urinary output should be >30 mL/hr.

14. A patient has lost 750 mL of blood volume. The MD orders Normal Saline infusion. Using the 3:1 rule,
how much crystalloid solution should be prescribed by the doctor?

A. 2,250 mL of Normal Saline

B. 250 mL of Normal Saline

C. 375 mL of Normal Saline

C. 1,225 mL of Normal Saline

The answer is A. For crystalloid solutions (this includes normal saline and lactated ringer’s), a 3:1 rule is
used. This rule states for every 1 mL of approximate blood loss 3 mL of crystalloid solution is given.
Therefore, if the patient loses 750 mL of blood, the patient would receive 2,250 mL of saline. 750 x 3 =
2,250
15. You’re providing an in-service to new nurse graduates on the fluid treatment for hypovolemic shock.
You ask the participants to list the types of crystalloid solutions used in hypovolemic shock. Which
responses are INCORRECT? Select all that apply:

A. Albumin

B. Lactated Ringer’s

C. Normal Saline

D. Hetastarch

The answers are A and D. Albumin and Hetastarch are COLLOID solutions…not crystalloid. Lactated
Ringer’s and Normal Saline are considered crystalloid solutions and are used in the treatment of
hypovolemic shock.

16. Select all the fluid types below that are NOT considered colloids?

A. Fresh Frozen Plasma

B. Albumin

C. Normal Saline

D. Lactated Ringer’s

E. Hetastarch

F. Platelets

The answers are C and D. These are considered crystalloids solutions. The other options are considered
colloids (including the blood products).

17. Which statement is true about colloid solutions? Select all that apply:

A. These solutions are made up of large molecules that cannot diffuse through the capillary wall, so
more fluid stays in the intravascular space longer when compared with the action of a crystalloid
solution.

B. These solutions can diffuse through the capillary wall so less fluid stays in the intravascular system
when compared to the action of a crystalloid solution.

C. The nurse should monitor for an anaphylactic reaction when these products are administered.

D. These fluids are considered hypertonic solutions.

The answers are A and C. These are true statements about colloid solutions. Options B and D are
incorrect.

18. A patient is receiving large amounts of fluids for aggressive treatment of hypovolemic shock. The
nurse makes it PRIORITY to?

A. Rapidly infuse the fluids

B. Warm the fluids

C. Change tubing in between bags

D. Keep the patient supine

The answer is B. It is very important when giving large amount of fluids that the nurse ensures the fluids
are warm. WHY? To prevent the patient from developing hypothermia. If this develops, clotting enzymes
can become altered along with leukopenia and thrombocytopenia. Keep the patient warm, but not too
hot.

19. The patient with hypovolemic shock is in need of clotting factors. Which type of fluid would best
benefit this patient?

A. Platelets

B. Albumin

C. Fresh Frozen Plasma

D. Packed Red Blood Cells

The answer is C. A patient who needs clotting factors would benefit from fresh frozen plasma (FFP).

RAAS
1. What is the goal of the renin-angiotensin-aldosterone system (RAAS)?

A. Decrease blood pressure

B. Increase the heart rate

C. Increase the blood pressure

D. Decrease the heart rate

The answer is C.

2. When the RAAS is activated due to a change in body hemodynamics, the __________________
stimulates the ___________________ cells in the kidneys to release _______________.

A. parasympathetic nervous system; mesangial; aldosterone

B. sympathetic nervous system; podocytes; renin

C. parasympathetic nervous system; juxtaglomerular; aldosterone

D. sympathetic nervous system; juxtaglomerular; renin

The answer is D. The sympathetic nervous system stimulates the juxtaglomerular cells in the kidneys to
release renin.
3. What component of the RAAS (renin-angiotensin-aldosterone system) is created and found in the
liver that is activated by renin?

A. Aldosterone

B. Angiotensin I

C. Angiotensinogen

D. Angiotensin II

The answer is C.

4. What is the role of ACE in the renin-angiotensin-aldosterone system?

A. It activates angiotensinogen which turns into angiotensin I.

B. It causes the kidney cells to release renin.

C. It causes angiotensin II to trigger the adrenal glands to produce aldosterone.

D. It converts angiotensin I into angiotensin II.

The answer is D.

5. Select all the roles of angiotensin II when it is activated in the renin-angiotensin-aldosterone

system:

A. Activates bradykinin

B. Triggers the release of aldosterone

C. Increases the blood volume

D. Causes vasodilation

E. Increases systemic vascular resistance

F. Causes the release of ADH (antidiuretic hormone)

The answers are B, C, E, and F. Angiotensin II causes vasoconstriction (not dilation) which will increase
systemic vascular resistance and blood pressure. It also increases blood volume by triggering the release
of aldosterone by the adrenal cortex (which causes the kidneys to keep sodium and water) and
antidiuretic hormone (ADH) by the pituitary gland, which causes the kidneys to keep water. It does not
activate bradykinin.

6. During RAAS activation, what gland releases aldosterone?

A. Hypothalamus

B. Thymus

C. Adrenal cortex

D. Pituitary
The answer is C.

7. What is the role of aldosterone?

A. It causes constriction of vessels.

B. It causes the kidneys to keep sodium and water.

C. It causes the kidneys to keep potassium and water.

D. It causes the kidneys to only keep water.

The answer is B. Aldosterone helps to increase blood volume by causing the kidneys to keep sodium and
water. When blood volume is increased it will help increase the blood pressure.

8. During the renin-angiotensin-aldosterone system activation, what gland releases antidiuretic

hormone (ADH)?

A. Pituitary

B. Thyroid

C. Hypothalamus

D. Adrenal cortex

The answer is A.

9. What is the role of the antidiuretic hormone during RAAS?

A. Causes the kidneys to keep water

B. Leads to vasoconstriction of vessels

C. Activates the release of angiotensin I

D. Prevents the activation of the parasympathetic nervous system

The answer is A.

10. Select below the CORRECT sequence in how the renin-angiotensin-aldosterone system works:

A. Angiotensin I -> Angiotensin II -> ACE -> Renin -> Angiotensinogen

B. Renin-> Angiotensinogen -> Angiotensin I -> ACE -> Angiotensin II

C. Renin -> Angiotensin I -> Angiotensinogen -> ACE -> Angiotensin II

D. Angiotensinogen -> Renin -> ACE -> Angiotensin I -> Angiotensin II

The answer is B.

PRELOAD AND AFTERLOAD

1. Which statement below best describes the term cardiac preload?

A. The pressure the ventricles stretch at the end of systole.

B. The amount the ventricles stretch at the end of diastole.

C. The pressure the ventricles must work against to pump blood out of the heart.

D. The strength of the myocardial cells to shorten with each beat.

The answer is B. Cardiac preload is the amount the ventricles stretch at the end of diastole (the filling or
relaxation phase of the heart).

2. Select the statement below that best describes cardiac afterload:

A. It’s the volume amount that fills the ventricles at the end of diastole.

B. It’s the volume the ventricles must work against to pump blood out of the body.

C. It’s the amount of blood the left ventricle pumps per beat.

D. It’s the pressure the ventricles must work against to open the semilunar valves so blood can be
pumped out of the heart.

The answer is D. Cardiac afterload is the pressure the ventricles must work against to pump blood out of
the heart by opening up through the semilunar valves. So, it’s the pressure the ventricles must overcome
to open the semilunar valves to push blood out of the heart.

3. What two factors are used to calculate cardiac output? Select all that apply:

A. Heart rate

B. Blood pressure

C. Stroke volume

D. Mean arterial pressure

The answers are A and C. Cardiac output is calculated by taking the heart rate and multiplying it by
stroke volume. CO = HR x SV

4. A patient with hypovolemic shock is given IV fluids. IV fluids will help _________ cardiac output by:

A. decrease; decreasing preload

B. increase, increasing preload

C. increase, decreasing afterload

D. decrease, increasing contractility

The answer is B. IV fluids will increase venous return to the heart. This will increase the amount of fluid
that will fill the ventricles at the end of diastole…hence increasing preload and increasing cardiac output.

5. ___________ is the amount of blood pumped by the left ventricle with each beat.
A. Cardiac output

B. Preload

C. Afterload

D. Stroke volume

The answer is D. Stroke volume is the amount of blood pumped by the left ventricle with each beat.

6. Stroke volume plays an important part in cardiac output. Select all the factors below that influence
stroke volume:

A. Heart rate

B. Preload

C. Contractility

D. Afterload

E. Blood pressure

The answers are B, C, and D. Preload, afterload, and contractility all have a role with influencing stroke
volume.

7. Which treatments below would decrease cardiac preload? Select all that apply:

A. IV fluid bolus

B. Norepinephrine

C. Nitroglycerin

D. Furosemide

The answers are C and D. Nitroglycerin is a vasodilator that will dilate vessels, which will decrease venous
return to the heart and this will decrease preload. Furosemide is a diuretic which will remove extra fluid
from the body via the kidneys. This will decrease venous return to the heart and decrease preload. An IV
fluid bolus and Norepinephrine (a vasoconstrictor) will increase venous return to the heart and increase
preload.

8. A patient has a blood pressure of 220/140. The physician prescribes a vasodilator. This medication
will?

A. Decrease the patient’s blood pressure and increase cardiac afterload

B. Decrease the patient’s blood pressure and decrease cardiac afterload

C. Decrease the patient’s blood pressure and increase cardiac preload

D. Increase the patient’s blood pressure but decrease cardiac output.

The answer is B. The patient has a high systemic vascular resistance…as evidence by the patient’s blood
blood….there is vasoconstriction and this is resulting in the high blood pressure. Therefore, right now,
the cardiac afterload is high because the ventricle must overcome this high pressure in order to pump
blood out of the heart. If a vasodilator is given, it will decrease the blood pressure (hence the systemic
vascular resistance) and this will decrease the cardiac afterload. The amount of the pressure the
ventricle must pump against will decrease (cardiac afterload decrease) because the blood pressure will
go down (hence the systemic vascular resistance).

9. What conditions below can result in an increased cardiac afterload? Select all that apply:

A. Vasoconstriction

B. Aortic stenosis

C. Vasodilation

D. Dehydration

E. Pulmonary Hypertension

The answers are A, B, and E. Vasoconstriction increases systemic vascular resistance which will increase
cardiac afterload. It will increase the pressure the ventricle must pump against to open the semilunar
valves to get blood out of the heart. Aortic stenosis creates an outflow of blood obstruction for the
ventricle (specifically the left ventricle) and this will increase the pressure the ventricle must pump
against to get blood out through the aortic valve. Pulmonary hypertension increases pulmonary vascular
resistance which will increase the pressure the right ventricle must overcome to open the pulmonic valve
to get blood out of the heart….all of this increase cardiac afterload.

10. True or False: Pulmonary and systemic vascular resistance both play a role with influencing cardiac
afterload.

The answer is True. If pulmonary vascular resistance or systemic vascular resistance is high, it will create
an increased cardiac afterload. If pulmonary vascular resistance or systemic vascular resistance is low, it
will create a decreased cardiac afterload.