Page 1 of 60
HEART FAILURE NCLEX EXAMINATION – 2026 –
LATEST VERIFIED 100 PRACTICE QUESTIONS WITH
ANSWERS AND DETAILED RATIONALES (PART 1:
PATHOPHYSIOLOGY AND RISK FACTORS)
1. A nurse is explaining the pathophysiology of
heart failure to a client. Which statement by the
nurse is most accurate?
A. "Heart failure means your heart has stopped
beating."
B. "Your heart is pumping too much blood too
quickly."
C. "Your heart is not pumping blood as well as it
should, causing fluid to back up."
D. "Heart failure is a sudden blockage of the
coronary arteries."
Answer: C. Heart failure is a chronic, progressive
condition where the heart muscle is unable to pump
enough blood to meet the body's demands, leading
to fluid congestion and inadequate perfusion.
, Page 2 of 60
2. Which condition is the most common cause of
left-sided heart failure?
A. Chronic obstructive pulmonary disease
B. Pulmonary stenosis
C. Hypertension
D. Liver cirrhosis
Answer: C. Hypertension is a leading cause of left-
sided heart failure. Chronic high blood pressure
increases the workload of the left ventricle, leading
to hypertrophy and eventual failure.
3. A client with a history of myocardial infarction
(MI) is at high risk for heart failure because:
A. The infarction causes vasodilation and
hypotension.
B. Damaged cardiac muscle cannot contract
effectively.
C. The client will develop fluid overload
immediately.
D. MI always leads to right-sided failure only.
Answer: B. An MI causes death of cardiac myocytes,
which are replaced by non-contractile scar tissue.
, Page 3 of 60
This reduces the heart's pumping efficiency
(contractility), leading to heart failure.
4. Which of the following is a primary cause of right-
sided heart failure?
A. Aortic stenosis
B. Left-sided heart failure
C. Pulmonary embolism
D. Mitral valve prolapse
Answer: B. The most common cause of right-sided
heart failure is left-sided heart failure. When the left
ventricle fails, blood backs up into the pulmonary
circulation, eventually causing increased pressure
and failure on the right side.
5. A client asks, "What does it mean when the
doctor says I have systolic heart failure?" Which
response is best?
A. "Your heart has difficulty relaxing and filling with
blood."
B. "The main problem is that your heart is too stiff."
C. "Your heart does not squeeze (contract)
forcefully enough."
, Page 4 of 60
D. "This means you have fluid only in your arms and
legs."
Answer: C. Systolic heart failure (HFrEF) is
characterized by a reduced ejection fraction. The
ventricle contracts weakly and cannot pump
adequate blood out. Diastolic failure (HFpEF) is a
problem with relaxation/filling.
6. Which laboratory test, when elevated, confirms
the diagnosis of heart failure by indicating
ventricular wall stretch?
A. Troponin
B. Creatinine kinase-MB (CK-MB)
C. B-type Natriuretic Peptide (BNP)
D. C-reactive protein (CRP)
Answer: C. BNP and NT-proBNP are neurohormones
released from the ventricles in response to increased
volume and pressure (stretch). They are highly
sensitive and specific for heart failure.
7. A 65-year-old client with diabetes and a 30-pack-
year smoking history presents with fatigue and mild
dyspnea. The nurse understands these are:
HEART FAILURE NCLEX EXAMINATION – 2026 –
LATEST VERIFIED 100 PRACTICE QUESTIONS WITH
ANSWERS AND DETAILED RATIONALES (PART 1:
PATHOPHYSIOLOGY AND RISK FACTORS)
1. A nurse is explaining the pathophysiology of
heart failure to a client. Which statement by the
nurse is most accurate?
A. "Heart failure means your heart has stopped
beating."
B. "Your heart is pumping too much blood too
quickly."
C. "Your heart is not pumping blood as well as it
should, causing fluid to back up."
D. "Heart failure is a sudden blockage of the
coronary arteries."
Answer: C. Heart failure is a chronic, progressive
condition where the heart muscle is unable to pump
enough blood to meet the body's demands, leading
to fluid congestion and inadequate perfusion.
, Page 2 of 60
2. Which condition is the most common cause of
left-sided heart failure?
A. Chronic obstructive pulmonary disease
B. Pulmonary stenosis
C. Hypertension
D. Liver cirrhosis
Answer: C. Hypertension is a leading cause of left-
sided heart failure. Chronic high blood pressure
increases the workload of the left ventricle, leading
to hypertrophy and eventual failure.
3. A client with a history of myocardial infarction
(MI) is at high risk for heart failure because:
A. The infarction causes vasodilation and
hypotension.
B. Damaged cardiac muscle cannot contract
effectively.
C. The client will develop fluid overload
immediately.
D. MI always leads to right-sided failure only.
Answer: B. An MI causes death of cardiac myocytes,
which are replaced by non-contractile scar tissue.
, Page 3 of 60
This reduces the heart's pumping efficiency
(contractility), leading to heart failure.
4. Which of the following is a primary cause of right-
sided heart failure?
A. Aortic stenosis
B. Left-sided heart failure
C. Pulmonary embolism
D. Mitral valve prolapse
Answer: B. The most common cause of right-sided
heart failure is left-sided heart failure. When the left
ventricle fails, blood backs up into the pulmonary
circulation, eventually causing increased pressure
and failure on the right side.
5. A client asks, "What does it mean when the
doctor says I have systolic heart failure?" Which
response is best?
A. "Your heart has difficulty relaxing and filling with
blood."
B. "The main problem is that your heart is too stiff."
C. "Your heart does not squeeze (contract)
forcefully enough."
, Page 4 of 60
D. "This means you have fluid only in your arms and
legs."
Answer: C. Systolic heart failure (HFrEF) is
characterized by a reduced ejection fraction. The
ventricle contracts weakly and cannot pump
adequate blood out. Diastolic failure (HFpEF) is a
problem with relaxation/filling.
6. Which laboratory test, when elevated, confirms
the diagnosis of heart failure by indicating
ventricular wall stretch?
A. Troponin
B. Creatinine kinase-MB (CK-MB)
C. B-type Natriuretic Peptide (BNP)
D. C-reactive protein (CRP)
Answer: C. BNP and NT-proBNP are neurohormones
released from the ventricles in response to increased
volume and pressure (stretch). They are highly
sensitive and specific for heart failure.
7. A 65-year-old client with diabetes and a 30-pack-
year smoking history presents with fatigue and mild
dyspnea. The nurse understands these are:
