Clinical Pathophysiology Made Ridiculously
Simple: Color Edition
3rd Edition
Author(s)Aaron Berkowitz MD PhD
TEST BANK
1
Reference: Ch. 1 — Preload, Afterload, and Treatment of Heart
Failure
Stem: A 68-year-old man with chronic systolic heart failure
arrives with worsening dyspnea, orthopnea, and bibasilar
crackles. His BP is 110/70 mmHg, HR 92, and he is volume
overloaded. Which action should the nurse prioritize to
decrease preload and improve symptoms?
A. Give intravenous nitroprusside.
B. Administer a loop diuretic IV.
C. Start a beta-blocker infusion.
D. Give a high-flow IV crystalloid bolus.
Correct Answer: B
Rationale — Correct (B): Loop diuretics acutely reduce
intravascular volume and preload, rapidly improving pulmonary
,congestion in volume-overloaded left heart failure. This directly
addresses the pathophysiologic excess preload that drives
pulmonary edema.
Rationale — A: Nitroprusside reduces afterload and can lower
BP; it’s not first-line for acute volume removal and risks
hypotension.
Rationale — C: Beta-blockers are disease-modifying for chronic
HF but may worsen acute decompensation when
started/infused in unstable patients.
Rationale — D: IV crystalloid increases preload and would
worsen pulmonary edema.
Teaching Point: Loop diuretics rapidly reduce preload and
relieve pulmonary congestion in acute left-sided HF.
Citation: Berkowitz, 2023, Ch. 1: Preload, Afterload, and
Treatment of Heart Failure.
2
Reference: Ch. 1 — Left Heart Failure: Symptoms and Signs of
Heart Failure
Stem: A patient with known ischemic cardiomyopathy develops
sudden worsening dyspnea, pink frothy sputum, and crackles.
Oxygen saturation is 82% on room air. Which immediate nursing
action is highest priority?
A. Elevate the patient’s legs and administer a vasodilator.
B. Prepare for urgent intubation and positive-pressure
ventilation.
,C. Apply supplemental oxygen and position upright.
D. Administer oral ACE inhibitor and obtain troponin.
Correct Answer: C
Rationale — Correct (C): In acute pulmonary edema from left
heart failure, upright position and supplemental oxygen
improve ventilation/perfusion and oxygenation immediately
and are rapid, safe first steps. They stabilize the patient while
definitive therapies start.
Rationale — A: Leg elevation increases venous return and
preload — counterproductive in pulmonary edema. Vasodilator
may help after stabilization but is not the immediate priority.
Rationale — B: Intubation may be necessary if respiratory
failure persists, but basic measures (O₂, upright) precede
invasive airway unless impending arrest.
Rationale — D: ACE inhibitors are important long-term therapy
but are not immediate lifesaving measures for acute
hypoxemia; troponin is useful diagnostically but not first
priority.
Teaching Point: Upright positioning + oxygen are immediate,
noninvasive priorities for acute pulmonary edema.
Citation: Berkowitz, 2023, Ch. 1: Left Heart Failure; Symptoms
and Signs of Heart Failure.
3
, Reference: Ch. 1 — Right Heart Failure
Stem: A patient with chronic COPD and cor pulmonale has
increasing peripheral edema, jugular venous distention, and
hepatomegaly. Which physiologic process best explains the
peripheral edema?
A. Left ventricular failure increasing pulmonary capillary
hydrostatic pressure.
B. Right ventricular failure causing systemic venous congestion
and increased hydrostatic pressure.
C. Hypoalbuminemia causing decreased oncotic pressure.
D. Lymphatic obstruction due to pulmonary disease.
Correct Answer: B
Rationale — Correct (B): Right ventricular failure impairs
forward flow from systemic veins, raising systemic venous
hydrostatic pressure and producing peripheral edema, JVD, and
hepatic congestion.
Rationale — A: Left ventricular failure tends to cause
pulmonary edema rather than systemic peripheral edema.
Rationale — C: Hypoalbuminemia causes generalized edema
but isn’t the hallmark mechanism in cor pulmonale with venous
congestion.
Rationale — D: Lymphatic obstruction is an uncommon cause
here and would not explain concurrent JVD and hepatomegaly.
Teaching Point: Right-sided failure causes systemic venous
congestion and dependent edema.
Citation: Berkowitz, 2023, Ch. 1: Right Heart Failure.
Simple: Color Edition
3rd Edition
Author(s)Aaron Berkowitz MD PhD
TEST BANK
1
Reference: Ch. 1 — Preload, Afterload, and Treatment of Heart
Failure
Stem: A 68-year-old man with chronic systolic heart failure
arrives with worsening dyspnea, orthopnea, and bibasilar
crackles. His BP is 110/70 mmHg, HR 92, and he is volume
overloaded. Which action should the nurse prioritize to
decrease preload and improve symptoms?
A. Give intravenous nitroprusside.
B. Administer a loop diuretic IV.
C. Start a beta-blocker infusion.
D. Give a high-flow IV crystalloid bolus.
Correct Answer: B
Rationale — Correct (B): Loop diuretics acutely reduce
intravascular volume and preload, rapidly improving pulmonary
,congestion in volume-overloaded left heart failure. This directly
addresses the pathophysiologic excess preload that drives
pulmonary edema.
Rationale — A: Nitroprusside reduces afterload and can lower
BP; it’s not first-line for acute volume removal and risks
hypotension.
Rationale — C: Beta-blockers are disease-modifying for chronic
HF but may worsen acute decompensation when
started/infused in unstable patients.
Rationale — D: IV crystalloid increases preload and would
worsen pulmonary edema.
Teaching Point: Loop diuretics rapidly reduce preload and
relieve pulmonary congestion in acute left-sided HF.
Citation: Berkowitz, 2023, Ch. 1: Preload, Afterload, and
Treatment of Heart Failure.
2
Reference: Ch. 1 — Left Heart Failure: Symptoms and Signs of
Heart Failure
Stem: A patient with known ischemic cardiomyopathy develops
sudden worsening dyspnea, pink frothy sputum, and crackles.
Oxygen saturation is 82% on room air. Which immediate nursing
action is highest priority?
A. Elevate the patient’s legs and administer a vasodilator.
B. Prepare for urgent intubation and positive-pressure
ventilation.
,C. Apply supplemental oxygen and position upright.
D. Administer oral ACE inhibitor and obtain troponin.
Correct Answer: C
Rationale — Correct (C): In acute pulmonary edema from left
heart failure, upright position and supplemental oxygen
improve ventilation/perfusion and oxygenation immediately
and are rapid, safe first steps. They stabilize the patient while
definitive therapies start.
Rationale — A: Leg elevation increases venous return and
preload — counterproductive in pulmonary edema. Vasodilator
may help after stabilization but is not the immediate priority.
Rationale — B: Intubation may be necessary if respiratory
failure persists, but basic measures (O₂, upright) precede
invasive airway unless impending arrest.
Rationale — D: ACE inhibitors are important long-term therapy
but are not immediate lifesaving measures for acute
hypoxemia; troponin is useful diagnostically but not first
priority.
Teaching Point: Upright positioning + oxygen are immediate,
noninvasive priorities for acute pulmonary edema.
Citation: Berkowitz, 2023, Ch. 1: Left Heart Failure; Symptoms
and Signs of Heart Failure.
3
, Reference: Ch. 1 — Right Heart Failure
Stem: A patient with chronic COPD and cor pulmonale has
increasing peripheral edema, jugular venous distention, and
hepatomegaly. Which physiologic process best explains the
peripheral edema?
A. Left ventricular failure increasing pulmonary capillary
hydrostatic pressure.
B. Right ventricular failure causing systemic venous congestion
and increased hydrostatic pressure.
C. Hypoalbuminemia causing decreased oncotic pressure.
D. Lymphatic obstruction due to pulmonary disease.
Correct Answer: B
Rationale — Correct (B): Right ventricular failure impairs
forward flow from systemic veins, raising systemic venous
hydrostatic pressure and producing peripheral edema, JVD, and
hepatic congestion.
Rationale — A: Left ventricular failure tends to cause
pulmonary edema rather than systemic peripheral edema.
Rationale — C: Hypoalbuminemia causes generalized edema
but isn’t the hallmark mechanism in cor pulmonale with venous
congestion.
Rationale — D: Lymphatic obstruction is an uncommon cause
here and would not explain concurrent JVD and hepatomegaly.
Teaching Point: Right-sided failure causes systemic venous
congestion and dependent edema.
Citation: Berkowitz, 2023, Ch. 1: Right Heart Failure.
