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Quizzes > Health & Medicine

Heart Failure NCLEX Questions: CHF, MI, and Lung Sounds Quiz

Quick, timed congestive heart failure practice questions with MI cases. Instant results.

Editorial: Review CompletedCreated By: Amigas De Habla HispanaUpdated Aug 26, 2025
Difficulty: Moderate
2-5mins
Learning OutcomesCheat Sheet
Paper art heart graphic with ECG and syringe icons on teal background for congestive heart failure MI NCLEX quiz

Use this quiz to strengthen your NCLEX skills on heart failure and MI, including key lung sounds and priority actions. When you finish, review more congestive heart failure practice questions, take a heart failure quiz, or drill NCLEX cardiovascular questions. Get instant feedback to spot gaps and build speed.

Which finding is most characteristic of left-sided heart failure?
Pulmonary crackles
Hepatomegaly
Jugular venous distension
Peripheral pitting edema
Left-sided heart failure causes fluid to back up into the lungs, leading to pulmonary congestion and crackles on auscultation. Jugular venous distension and hepatomegaly are more indicative of right-sided failure. Recognizing crackles helps target interventions to improve left ventricular function.
What is the normal ejection fraction (EF) range in a healthy adult?
55% to 70%
40% to 50%
Greater than 75%
Less than 40%
Ejection fraction measures the percentage of blood ejected from the left ventricle with each beat. A normal EF ranges from 55% to 70%. Values below this range suggest heart failure with reduced ejection fraction.
A B-type natriuretic peptide (BNP) level suggestive of heart failure is:
50 to 100 pg/mL
Greater than 100 pg/mL
Less than 50 pg/mL
Between 20 and 40 pg/mL
BNP is released by ventricles in response to increased stretch and volume overload. Levels above 100 pg/mL are consistent with heart failure. Serial measurements can help monitor treatment response.
Which of the following medications is an ACE inhibitor commonly used in heart failure management?
Lisinopril
Metoprolol
Spironolactone
Furosemide
Lisinopril is an ACE inhibitor that reduces afterload and inhibits remodeling in heart failure. Metoprolol is a beta blocker, furosemide is a loop diuretic, and spironolactone is an aldosterone antagonist. ACE inhibitors are first-line therapy for HFrEF.
A patient with right-sided heart failure commonly exhibits which of the following findings?
Pulmonary crackles
Jugular venous distension
Orthopnea
Tachypnea
Right-sided failure leads to systemic venous congestion, causing jugular venous distension. Pulmonary crackles and orthopnea are signs of left-sided failure. Recognizing JVD guides interventions to reduce preload.
Which dietary recommendation is most appropriate for a patient with chronic heart failure?
Increase potassium intake
Avoid carbohydrates
Restrict sodium intake
Limit protein consumption
Sodium restriction helps decrease fluid retention and preload in heart failure. Protein and carbohydrates are not generally restricted unless other conditions exist. Monitoring fluid balance and sodium intake reduces exacerbations.
Which medication primarily reduces preload in patients with heart failure?
Metoprolol
Lisinopril
Furosemide
Digoxin
Furosemide is a loop diuretic that reduces circulating volume and preload. ACE inhibitors reduce afterload, beta blockers slow heart rate, and digoxin increases contractility. Diuretics are cornerstone therapy for fluid overload.
To help relieve orthopnea in a heart failure patient, the nurse should position the patient in which manner?
Left lateral position
Flat in bed
Supine with legs elevated
High-Fowler's position
High-Fowler's position decreases venous return and eases breathing in orthopnea. Flat positioning can worsen pulmonary congestion, and leg elevation increases preload. Proper positioning improves oxygenation.
Which of the following is an early sign of digoxin toxicity?
Blurred vision
Hypertension
Anorexia
Tinnitus
Anorexia, nausea, and vomiting are often early signs of digoxin toxicity. Visual disturbances like blurred or yellow vision appear later. Monitoring GI symptoms helps detect toxicity before severe effects.
A client receiving spironolactone for heart failure requires monitoring of which laboratory value?
Serum magnesium
Serum sodium
Serum potassium
Serum calcium
Spironolactone is a potassium-sparing diuretic and can cause hyperkalemia. Regular monitoring of serum potassium is essential. Adjust doses or discontinue medication if levels rise dangerously.
What is the first medication the nurse should administer to a client with suspected acute myocardial infarction?
Morphine
Heparin
Nitroglycerin
Aspirin
Aspirin reduces platelet aggregation and limits infarct size when given early. It is the first-line medication in suspected MI unless contraindicated. Nitroglycerin and morphine address symptoms but aspirin is priority.
Which assessment finding most strongly indicates cardiogenic shock in a post-MI patient?
Blood pressure 100/60 mmHg, urine output 40 mL/h
Blood pressure 120/80 mmHg, urine output 50 mL/h
Blood pressure 90/70 mmHg, urine output 60 mL/h
Blood pressure 80/50 mmHg, urine output 20 mL/h
Cardiogenic shock is marked by hypotension (SBP <90 mmHg) and oliguria (urine output <30 mL/h), reflecting poor perfusion. Cool, clammy skin and altered mental status often accompany these findings. Early recognition guides aggressive support.
A decrease in which laboratory value indicates improvement in chronic heart failure?
BNP
Creatine kinase-MB
Troponin I
Lactate dehydrogenase
Brain natriuretic peptide (BNP) correlates with ventricular stretch and volume overload. A falling BNP suggests effective therapy and improved heart function. Other enzymes reflect myocardial injury, not ongoing heart failure status.
Which compensatory mechanism temporarily increases stroke volume in heart failure?
Ventricular hypertrophy
Increased heart rate
Peripheral vasoconstriction
Frank-Starling mechanism
The Frank-Starling mechanism increases stroke volume by enhancing myocardial fiber stretch with greater preload. This compensatory response eventually fails as overload progresses. Recognizing early compensation helps in management planning.
When assessing orthopnea, the nurse should ask the client which of the following?
Number of pillows used to sleep
Presence of ankle edema
Frequency of nocturnal urination
Duration of morning cough
Orthopnea is quantified by the number of pillows required to relieve shortness of breath when lying flat. This direct patient report helps gauge severity. Other questions assess different symptoms but not orthopnea.
A common side effect of enalapril therapy in heart failure is:
Peripheral neuropathy
Bradycardia
Dry cough
Constipation
ACE inhibitors like enalapril often cause a persistent dry cough due to increased bradykinin levels. Bradycardia is more associated with beta blockers. Recognizing this effect can prompt a switch to an ARB if needed.
Hyponatremia in heart failure patients is primarily due to which mechanism?
Low dietary sodium intake
Loop diuretic therapy
Increased atrial natriuretic peptide
Excessive ADH secretion
In heart failure, decreased cardiac output triggers nonosmotic ADH release leading to water retention and dilutional hyponatremia. Diuretics can contribute but ADH is the primary cause. Managing volume status helps correct sodium levels.
In cardiogenic shock treated with a dobutamine infusion, an increase in which parameter indicates improved perfusion?
Heart rate
Peripheral edema
Respiratory rate
Urine output
Dobutamine increases cardiac output, and improved perfusion is reflected by increased urine output. Other vital signs may change but UO is a direct measure of renal perfusion. Monitoring UO guides titration of inotropes.
Troponin I levels typically peak approximately how many hours after the onset of myocardial infarction?
48 hours
24 hours
6 to 12 hours
2 to 4 hours
Troponin I begins to rise within 3 - 4 hours of MI onset and peaks around 24 hours. It remains elevated for up to 7 - 10 days. Understanding timing aids in diagnostic interpretation.
ST-segment elevation in which electrocardiogram leads indicates an anterior myocardial infarction?
V1 to V4
I and aVL
II, III, aVF
V5 and V6
ST elevation in leads V1 through V4 indicates anterior wall infarction supplied by the left anterior descending artery. Inferior MI shows II, III, aVF lead changes. Accurate lead interpretation guides reperfusion strategy.
A patient on digoxin has a serum potassium level of 3.0 mEq/L. This finding places the patient at greatest risk for which complication?
Digoxin toxicity
Hypertension
Hyperkalemia
Second-degree heart block
Hypokalemia increases the risk of digoxin binding to cardiac receptors, potentiating toxicity. Symptoms include arrhythmias and GI upset. Maintaining normal potassium mitigates this risk.
Following administration of tissue plasminogen activator (tPA) for acute MI, the nurse's priority intervention is:
Checking serum electrolytes
Assessing blood glucose
Monitoring for signs of bleeding
Measuring oxygen saturation
tPA can cause life-threatening hemorrhage. Frequent neurological checks and assessment for bleeding at access sites are critical. Other monitoring is important but bleeding risk is paramount.
In acute pulmonary edema secondary to decompensated heart failure, which medication is contraindicated?
Metoprolol
Nitroglycerin
Furosemide
Morphine
In acute pulmonary edema, reducing preload and afterload quickly is critical. Beta blockers like metoprolol are contraindicated initially because they may depress contractility further. Diuretics, nitrates, and morphine are indicated to stabilize the patient.
Which hemodynamic measurement most accurately reflects left ventricular preload?
Pulmonary capillary wedge pressure
Systemic vascular resistance
Cardiac index
Central venous pressure
Pulmonary capillary wedge pressure (PCWP) approximates left atrial pressure and left ventricular end-diastolic pressure, making it the best measure of left preload. CVP reflects right-sided preload. Accurate measurement guides volume management.
Milrinone, used in acute decompensated heart failure, primarily exerts which effects?
Positive inotropy and vasodilation
Negative inotropy and vasoconstriction
Increased preload and afterload
Selective coronary vasodilation only
Milrinone is a phosphodiesterase-3 inhibitor that increases intracellular cAMP, leading to positive inotropic effects and systemic vasodilation. This dual action improves cardiac output and reduces vascular resistance. Monitoring for hypotension and arrhythmias is essential.
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Study Outcomes

  1. Analyze clinical presentations -

    Differentiate between congestive heart failure and myocardial infarction by recognizing key symptoms and signs in diverse NCLEX scenarios.

  2. Interpret diagnostic data -

    Assess ECG readings, lab values, and imaging results to accurately answer myocardial infarction NCLEX questions and identify acute cardiac events.

  3. Apply evidence-based interventions -

    Determine appropriate pharmacologic and nonpharmacologic treatments for congestive heart failure using core principles from congestive heart failure NCLEX questions and best practices.

  4. Prioritize nursing actions -

    Sequence critical care steps for patients experiencing decompensated congestive heart failure or myocardial infarction during timed quiz challenges.

  5. Evaluate patient education strategies -

    Formulate clear teaching plans on lifestyle modifications, medication adherence, and self-monitoring to support recovery and prevent rehospitalization.

Cheat Sheet

  1. Systolic vs. Diastolic Dysfunction -

    Understanding ejection fraction (EF) is key: EF < 40% indicates systolic failure, while EF ≥ 50% with stiff ventricles suggests diastolic failure (AHA guidelines). Many congestive heart failure NCLEX questions hinge on distinguishing "pump" versus "filling" problems. Remember "squeeze versus relax" to anchor your answer quickly.

  2. Core Pharmacotherapy Mnemonic -

    Use the "ABCD" mnemonic - ACE inhibitors/ARBs, Beta-blockers, Calcium-channel blockers (for HFpEF), Diuretics - to recall first-line agents (ACC/AHA). In congestive heart failure nclex questions, identify drug actions: ACEIs reduce afterload, beta-blockers decrease sympathetic stress, and diuretics relieve volume overload. This simple trick helps you choose meds under time pressure.

  3. Key Clinical Signs -

    Recognize hallmark findings: jugular venous distension, an S3 gallop, crackles in lung bases, and peripheral edema (UpToDate). Many NCLEX questions on myocardial infarction scenarios also test your ability to differentiate acute MI pulmonary crackles from chronic CHF fluid overload. Linking physical exam with pathophysiology boosts both speed and accuracy.

  4. MI Recognition & MONA -

    For acute MI, apply MONA - Morphine, Oxygen, Nitroglycerin, Aspirin - immediately and check EKG for ST-elevation in contiguous leads (II, III, aVF for inferior MI). NCLEX questions on myocardial infarction often present chest pain plus diaphoresis; identifying ST-elevations >1 mm quickly guides your next action. This structured approach keeps you calm and systematic under timer pressure.

  5. Lab Markers & Trends -

    Differentiate CHF from MI with biomarkers: BNP > 100 pg/mL supports heart failure, while troponin I/T rises and falls over hours in myocardial injury (ESC guidelines). Many mi nclex questions quiz you on peak troponin timing (usually 12 - 24 hr) versus immediate BNP levels. Mastering normal vs. abnormal values is a quick NCLEX boost!

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