,Herzing NU 623 Quiz 3 | Adult Healthcare
(2026) Q&A
1. A 62-year-old male with hypertension and hyperlipidemia reports substernal chest
pressure radiating to his left arm while mowing the lawn, which lasted 5 minutes and
resolved with rest. His ECG shows no acute changes. What is the most appropriate
initial diagnostic test?
A) Exercise stress test
B) Cardiac catheterization
C) CT angiography of the chest
D) Resting echocardiogram
Correct Answer: A) Exercise stress test
Rationale: An exercise stress test is the most appropriate initial diagnostic test for
stable angina, as it evaluates for ischemia during exertion. Cardiac catheterization is
reserved for high-risk patients or after noninvasive testing indicates significant
disease. CT angiography visualizes anatomy but does not assess functional ischemia.
2. A 55-year-old female presents with palpitations and lightheadedness. Her heart
rate is 152 bpm and irregularly irregular. Blood pressure is 118/72 mmHg. What is
the most important immediate priority in managing this patient?
A) Prescribing a beta-blocker and discharging home
B) Assessing hemodynamic stability and determining the need for rate control versus
cardioversion
C) Starting anticoagulation immediately
D) Ordering an echocardiogram
,Correct Answer: B) Assessing hemodynamic stability and determining the need for
rate control versus cardioversion
Rationale: The immediate priority in atrial fibrillation is assessing hemodynamic
stability. If unstable with hypotension or altered mental status, urgent cardioversion
is indicated. If stable, rate control and anticoagulation decisions can follow.
Anticoagulation is important but not the first action before stability is determined.
3. A 68-year-old male with a history of heart failure reports worsening dyspnea,
orthopnea, and bilateral leg edema after running out of furosemide 10 days ago.
Examination reveals jugular venous distension and crackles. What is the primary
pathophysiologic mechanism responsible for his symptoms?
A) Myocardial infarction causing acute pump failure
B) Pulmonary embolism causing right heart strain
C) Volume overload from sodium and water retention due to discontinued diuretic
therapy
D) Decreased afterload from medication nonadherence
Correct Answer: C) Volume overload from sodium and water retention due to
discontinued diuretic therapy
Rationale: Discontinuation of loop diuretics leads to sodium and water retention,
causing volume overload. This increases preload, leading to pulmonary congestion
(crackles, dyspnea) and systemic venous congestion (JVD, edema). Nonadherence to
diuretics is a common cause of heart failure decompensation.
4. According to the ACC/AHA guidelines, patients with left ventricular dysfunction
and current or prior symptoms of heart failure are classified in which stage?
A) Stage A
B) Stage B
, C) Stage C
D) Stage D
Correct Answer: C) Stage C
Rationale: Stage C includes patients with structural heart disease (left ventricular
dysfunction) and current or prior symptoms of heart failure. Stage A includes patients
at high risk without structural heart disease. Stage B includes those with structural
heart disease but no symptoms. Stage D includes patients with refractory symptoms
requiring specialized interventions.
5. A patient with heart failure is receiving furosemide. Which finding indicates that
the medication is achieving its desired therapeutic effect?
A) Increased jugular venous distension
B) Decreased peripheral edema and improved dyspnea
C) Elevated serum potassium level
D) Increased blood pressure
Correct Answer: B) Decreased peripheral edema and improved dyspnea
Rationale: Furosemide is a loop diuretic that reduces fluid overload. Desired
therapeutic effects include decreased peripheral edema, reduced pulmonary
congestion (improved dyspnea), and decreased jugular venous distension.
Hypokalemia is a common side effect, not an indication of therapeutic effect.
6. A patient with heart failure and reduced ejection fraction is started on carvedilol.
What is the most important monitoring parameter when initiating this medication?
A) Serum potassium
B) Blood pressure and heart rate
(2026) Q&A
1. A 62-year-old male with hypertension and hyperlipidemia reports substernal chest
pressure radiating to his left arm while mowing the lawn, which lasted 5 minutes and
resolved with rest. His ECG shows no acute changes. What is the most appropriate
initial diagnostic test?
A) Exercise stress test
B) Cardiac catheterization
C) CT angiography of the chest
D) Resting echocardiogram
Correct Answer: A) Exercise stress test
Rationale: An exercise stress test is the most appropriate initial diagnostic test for
stable angina, as it evaluates for ischemia during exertion. Cardiac catheterization is
reserved for high-risk patients or after noninvasive testing indicates significant
disease. CT angiography visualizes anatomy but does not assess functional ischemia.
2. A 55-year-old female presents with palpitations and lightheadedness. Her heart
rate is 152 bpm and irregularly irregular. Blood pressure is 118/72 mmHg. What is
the most important immediate priority in managing this patient?
A) Prescribing a beta-blocker and discharging home
B) Assessing hemodynamic stability and determining the need for rate control versus
cardioversion
C) Starting anticoagulation immediately
D) Ordering an echocardiogram
,Correct Answer: B) Assessing hemodynamic stability and determining the need for
rate control versus cardioversion
Rationale: The immediate priority in atrial fibrillation is assessing hemodynamic
stability. If unstable with hypotension or altered mental status, urgent cardioversion
is indicated. If stable, rate control and anticoagulation decisions can follow.
Anticoagulation is important but not the first action before stability is determined.
3. A 68-year-old male with a history of heart failure reports worsening dyspnea,
orthopnea, and bilateral leg edema after running out of furosemide 10 days ago.
Examination reveals jugular venous distension and crackles. What is the primary
pathophysiologic mechanism responsible for his symptoms?
A) Myocardial infarction causing acute pump failure
B) Pulmonary embolism causing right heart strain
C) Volume overload from sodium and water retention due to discontinued diuretic
therapy
D) Decreased afterload from medication nonadherence
Correct Answer: C) Volume overload from sodium and water retention due to
discontinued diuretic therapy
Rationale: Discontinuation of loop diuretics leads to sodium and water retention,
causing volume overload. This increases preload, leading to pulmonary congestion
(crackles, dyspnea) and systemic venous congestion (JVD, edema). Nonadherence to
diuretics is a common cause of heart failure decompensation.
4. According to the ACC/AHA guidelines, patients with left ventricular dysfunction
and current or prior symptoms of heart failure are classified in which stage?
A) Stage A
B) Stage B
, C) Stage C
D) Stage D
Correct Answer: C) Stage C
Rationale: Stage C includes patients with structural heart disease (left ventricular
dysfunction) and current or prior symptoms of heart failure. Stage A includes patients
at high risk without structural heart disease. Stage B includes those with structural
heart disease but no symptoms. Stage D includes patients with refractory symptoms
requiring specialized interventions.
5. A patient with heart failure is receiving furosemide. Which finding indicates that
the medication is achieving its desired therapeutic effect?
A) Increased jugular venous distension
B) Decreased peripheral edema and improved dyspnea
C) Elevated serum potassium level
D) Increased blood pressure
Correct Answer: B) Decreased peripheral edema and improved dyspnea
Rationale: Furosemide is a loop diuretic that reduces fluid overload. Desired
therapeutic effects include decreased peripheral edema, reduced pulmonary
congestion (improved dyspnea), and decreased jugular venous distension.
Hypokalemia is a common side effect, not an indication of therapeutic effect.
6. A patient with heart failure and reduced ejection fraction is started on carvedilol.
What is the most important monitoring parameter when initiating this medication?
A) Serum potassium
B) Blood pressure and heart rate
