Clinical Pathophysiology Made Ridiculously
Simple: Color Edition
3rd Edition
Author(s)Aaron Berkowitz MD PhD
TEST BANK
Q1
Reference: Ch. 1: Heart Failure — Left Heart Failure / Symptoms
and Signs of Heart Failure
Stem: A 72-year-old man with chronic ischemic cardiomyopathy
reports progressive dyspnea on exertion and orthopnea; exam
shows bibasilar crackles and an S3 gallop. Which nursing
priority best addresses the primary pathophysiologic problem?
A. Administer IV morphine to reduce anxiety.
B. Give a loop diuretic (e.g., IV furosemide) to reduce
pulmonary congestion.
,C. Start broad-spectrum antibiotics for possible pneumonia.
D. Apply oxygen by nasal cannula and discharge home if sats
improve.
Correct Answer: B
Rationales:
• Correct (B): Left heart failure causes elevated left-sided
filling pressures leading to pulmonary edema; loop
diuretics reduce preload and pulmonary congestion
quickly, improving gas exchange and relieving dyspnea.
(Berkowitz discusses preload-driven pulmonary edema).
• A: Morphine may reduce anxiety and venodilation but is
not first-line for loading reduction and carries respiratory
depression risk in older adults.
• C: There is no evidence of infection; treating presumed
pneumonia would delay addressing hydrostatic pulmonary
edema.
• D: Supplemental oxygen is supportive but not definitive;
discharge is unsafe until hemodynamics and volume status
are addressed.
Teaching Point: Reduce preload (diuresis) to relieve
pulmonary edema in left-sided heart failure.
Citation: Berkowitz, A. (2023). Clinical Pathophysiology
Made Ridiculously Simple: Color Edition (3rd Ed.), Ch. 1:
Left Heart Failure.
,Q2
Reference: Ch. 1: Preload, Afterload, and Treatment of Heart
Failure
Stem: A patient with decompensated heart failure is
hypotensive (BP 88/54) after receiving IV nitroprusside for
hypertensive emergency. Which mechanism explains his
worsened hypotension?
A. Nitric oxide donor decreased venous return, lowering
preload.
B. Increased myocardial contractility caused reflex bradycardia.
C. Nitroprusside increased afterload, worsening stroke volume.
D. The drug increased systemic vascular resistance via
vasoconstriction.
Correct Answer: A
Rationales:
• Correct (A): Nitroprusside is a potent arterial and venous
vasodilator; venodilation reduces preload (venous return),
which can drop cardiac output and cause hypotension in
patients dependent on preload.
• B: Nitroprusside does not directly increase contractility;
reflex tachycardia, not bradycardia, is more likely.
• C: Nitroprusside decreases afterload (not increases), which
normally improves stroke volume unless preload becomes
limiting.
, • D: The drug decreases systemic vascular resistance
(vasodilation), not increases it.
Teaching Point: Venodilation can dangerously lower
preload and cardiac output in preload-dependent patients.
Citation: Berkowitz, A. (2023). Clinical Pathophysiology
Made Ridiculously Simple: Color Edition (3rd Ed.), Ch. 1:
Preload, Afterload, and Treatment of Heart Failure.
Q3
Reference: Ch. 1: The Kidneys in Heart Failure — RAAS
activation and diuretic therapy
Stem: A patient with chronic heart failure is taking furosemide
and lisinopril. Labs show K⁺ 5.8 mEq/L and creatinine increased
from 1.0 to 1.9 mg/dL. Which immediate nursing action is most
appropriate?
A. Increase furosemide dose to correct hyperkalemia.
B. Hold ACE inhibitor and notify prescriber due to rising
creatinine and hyperkalemia.
C. Encourage high-potassium diet to normalize electrolytes.
D. Give oral potassium chloride to replace losses.
Correct Answer: B
Rationales:
• Correct (B): ACE inhibitors reduce aldosterone leading to
hyperkalemia; rising creatinine plus serum K⁺ ≥5.5 is
concerning — ACE inhibitor should be held and provider
Simple: Color Edition
3rd Edition
Author(s)Aaron Berkowitz MD PhD
TEST BANK
Q1
Reference: Ch. 1: Heart Failure — Left Heart Failure / Symptoms
and Signs of Heart Failure
Stem: A 72-year-old man with chronic ischemic cardiomyopathy
reports progressive dyspnea on exertion and orthopnea; exam
shows bibasilar crackles and an S3 gallop. Which nursing
priority best addresses the primary pathophysiologic problem?
A. Administer IV morphine to reduce anxiety.
B. Give a loop diuretic (e.g., IV furosemide) to reduce
pulmonary congestion.
,C. Start broad-spectrum antibiotics for possible pneumonia.
D. Apply oxygen by nasal cannula and discharge home if sats
improve.
Correct Answer: B
Rationales:
• Correct (B): Left heart failure causes elevated left-sided
filling pressures leading to pulmonary edema; loop
diuretics reduce preload and pulmonary congestion
quickly, improving gas exchange and relieving dyspnea.
(Berkowitz discusses preload-driven pulmonary edema).
• A: Morphine may reduce anxiety and venodilation but is
not first-line for loading reduction and carries respiratory
depression risk in older adults.
• C: There is no evidence of infection; treating presumed
pneumonia would delay addressing hydrostatic pulmonary
edema.
• D: Supplemental oxygen is supportive but not definitive;
discharge is unsafe until hemodynamics and volume status
are addressed.
Teaching Point: Reduce preload (diuresis) to relieve
pulmonary edema in left-sided heart failure.
Citation: Berkowitz, A. (2023). Clinical Pathophysiology
Made Ridiculously Simple: Color Edition (3rd Ed.), Ch. 1:
Left Heart Failure.
,Q2
Reference: Ch. 1: Preload, Afterload, and Treatment of Heart
Failure
Stem: A patient with decompensated heart failure is
hypotensive (BP 88/54) after receiving IV nitroprusside for
hypertensive emergency. Which mechanism explains his
worsened hypotension?
A. Nitric oxide donor decreased venous return, lowering
preload.
B. Increased myocardial contractility caused reflex bradycardia.
C. Nitroprusside increased afterload, worsening stroke volume.
D. The drug increased systemic vascular resistance via
vasoconstriction.
Correct Answer: A
Rationales:
• Correct (A): Nitroprusside is a potent arterial and venous
vasodilator; venodilation reduces preload (venous return),
which can drop cardiac output and cause hypotension in
patients dependent on preload.
• B: Nitroprusside does not directly increase contractility;
reflex tachycardia, not bradycardia, is more likely.
• C: Nitroprusside decreases afterload (not increases), which
normally improves stroke volume unless preload becomes
limiting.
, • D: The drug decreases systemic vascular resistance
(vasodilation), not increases it.
Teaching Point: Venodilation can dangerously lower
preload and cardiac output in preload-dependent patients.
Citation: Berkowitz, A. (2023). Clinical Pathophysiology
Made Ridiculously Simple: Color Edition (3rd Ed.), Ch. 1:
Preload, Afterload, and Treatment of Heart Failure.
Q3
Reference: Ch. 1: The Kidneys in Heart Failure — RAAS
activation and diuretic therapy
Stem: A patient with chronic heart failure is taking furosemide
and lisinopril. Labs show K⁺ 5.8 mEq/L and creatinine increased
from 1.0 to 1.9 mg/dL. Which immediate nursing action is most
appropriate?
A. Increase furosemide dose to correct hyperkalemia.
B. Hold ACE inhibitor and notify prescriber due to rising
creatinine and hyperkalemia.
C. Encourage high-potassium diet to normalize electrolytes.
D. Give oral potassium chloride to replace losses.
Correct Answer: B
Rationales:
• Correct (B): ACE inhibitors reduce aldosterone leading to
hyperkalemia; rising creatinine plus serum K⁺ ≥5.5 is
concerning — ACE inhibitor should be held and provider
