Saunders Comprehensive Review for the NCLEX-PN®
Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
ANATOMY AND PHYSIOLOGY TEST BANK
1 — Cardiovascular: Heart valve & murmurs
A nurse auscultates a harsh, systolic murmur best heard at the
right second intercostal space that radiates to the carotids.
Which structural abnormality most likely explains this finding?
A. Mitral valve prolapse
B. Aortic stenosis with calcification of the aortic valve cusps
C. Tricuspid regurgitation
D. Patent ductus arteriosus
Correct Answer: B
Rationale:
• Correct (B): Aortic stenosis produces a systolic murmur
heard at the right second intercostal space that often
radiates to the carotids. Calcification narrows the aortic
valve orifice, increasing velocity of blood ejected across
the valve and producing a harsh systolic ejection murmur.
, • Incorrect (A): Mitral valve prolapse causes a midsystolic
click and late systolic murmur heard at the apex, not the
right upper sternal border with carotid radiation.
• Incorrect (C): Tricuspid regurgitation produces a
holosystolic murmur best heard at the left lower sternal
border and increases with inspiration.
• Incorrect (D): Patent ductus arteriosus produces a
continuous “machinery” murmur, not a systolic murmur
radiating to carotids.
2 — Cardiovascular: Cardiac output components
A patient has an acute drop in stroke volume. Which immediate
physiologic change will most directly maintain cardiac output
(CO = HR × SV)?
A. Increased systemic vascular resistance
B. Decreased heart rate
C. Reflex tachycardia (increased heart rate)
D. Increased central venous pressure
Correct Answer: C
Rationale:
• Correct (C): Cardiac output is the product of heart rate and
stroke volume. If stroke volume falls acutely, reflex
sympathetic stimulation increases heart rate (tachycardia)
to maintain CO.
, • Incorrect (A): Increased systemic vascular resistance may
decrease stroke volume by increasing afterload and
worsens CO unless compensated long-term.
• Incorrect (B): Decreasing heart rate would lower CO
further.
• Incorrect (D): Increased central venous pressure indicates
volume backup and does not directly restore CO; it may
reflect right-sided failure.
3 — Cardiovascular: Myocardial oxygen demand
Which physiologic factor most increases myocardial oxygen
consumption (MVO₂)?
A. Decreased heart rate
B. Lower left ventricular wall tension
C. Increased contractility (inotropy)
D. Decreased afterload
Correct Answer: C
Rationale:
• Correct (C): Increased contractility raises the energy (and
oxygen) demand of myocardial cells because they generate
greater force and use more ATP.
• Incorrect (A): Decreased heart rate lowers oxygen
demand.
, • Incorrect (B): Lower wall tension reduces oxygen demand
(Laplace’s law: wall stress ∝ pressure × radius / (2 × wall
thickness)).
• Incorrect (D): Decreased afterload reduces myocardial
work and oxygen consumption.
4 — Respiratory: V/Q mismatch basics
A client with pneumonia has consolidation in the right lower
lobe. Which V/Q (ventilation/perfusion) abnormality best
describes the affected area?
A. High V/Q (dead space)
B. Low V/Q (shunt-like)
C. Normal V/Q
D. Absolute shunt (zero V/Q)
Correct Answer: B
Rationale:
• Correct (B): Consolidation reduces ventilation to alveoli
but perfusion remains, producing a low V/Q region (shunt-
like), causing hypoxemia that may partially respond to
oxygen.
• Incorrect (A): High V/Q (dead space) occurs when
ventilation exceeds perfusion (e.g., pulmonary embolus),
not consolidation.
Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
ANATOMY AND PHYSIOLOGY TEST BANK
1 — Cardiovascular: Heart valve & murmurs
A nurse auscultates a harsh, systolic murmur best heard at the
right second intercostal space that radiates to the carotids.
Which structural abnormality most likely explains this finding?
A. Mitral valve prolapse
B. Aortic stenosis with calcification of the aortic valve cusps
C. Tricuspid regurgitation
D. Patent ductus arteriosus
Correct Answer: B
Rationale:
• Correct (B): Aortic stenosis produces a systolic murmur
heard at the right second intercostal space that often
radiates to the carotids. Calcification narrows the aortic
valve orifice, increasing velocity of blood ejected across
the valve and producing a harsh systolic ejection murmur.
, • Incorrect (A): Mitral valve prolapse causes a midsystolic
click and late systolic murmur heard at the apex, not the
right upper sternal border with carotid radiation.
• Incorrect (C): Tricuspid regurgitation produces a
holosystolic murmur best heard at the left lower sternal
border and increases with inspiration.
• Incorrect (D): Patent ductus arteriosus produces a
continuous “machinery” murmur, not a systolic murmur
radiating to carotids.
2 — Cardiovascular: Cardiac output components
A patient has an acute drop in stroke volume. Which immediate
physiologic change will most directly maintain cardiac output
(CO = HR × SV)?
A. Increased systemic vascular resistance
B. Decreased heart rate
C. Reflex tachycardia (increased heart rate)
D. Increased central venous pressure
Correct Answer: C
Rationale:
• Correct (C): Cardiac output is the product of heart rate and
stroke volume. If stroke volume falls acutely, reflex
sympathetic stimulation increases heart rate (tachycardia)
to maintain CO.
, • Incorrect (A): Increased systemic vascular resistance may
decrease stroke volume by increasing afterload and
worsens CO unless compensated long-term.
• Incorrect (B): Decreasing heart rate would lower CO
further.
• Incorrect (D): Increased central venous pressure indicates
volume backup and does not directly restore CO; it may
reflect right-sided failure.
3 — Cardiovascular: Myocardial oxygen demand
Which physiologic factor most increases myocardial oxygen
consumption (MVO₂)?
A. Decreased heart rate
B. Lower left ventricular wall tension
C. Increased contractility (inotropy)
D. Decreased afterload
Correct Answer: C
Rationale:
• Correct (C): Increased contractility raises the energy (and
oxygen) demand of myocardial cells because they generate
greater force and use more ATP.
• Incorrect (A): Decreased heart rate lowers oxygen
demand.
, • Incorrect (B): Lower wall tension reduces oxygen demand
(Laplace’s law: wall stress ∝ pressure × radius / (2 × wall
thickness)).
• Incorrect (D): Decreased afterload reduces myocardial
work and oxygen consumption.
4 — Respiratory: V/Q mismatch basics
A client with pneumonia has consolidation in the right lower
lobe. Which V/Q (ventilation/perfusion) abnormality best
describes the affected area?
A. High V/Q (dead space)
B. Low V/Q (shunt-like)
C. Normal V/Q
D. Absolute shunt (zero V/Q)
Correct Answer: B
Rationale:
• Correct (B): Consolidation reduces ventilation to alveoli
but perfusion remains, producing a low V/Q region (shunt-
like), causing hypoxemia that may partially respond to
oxygen.
• Incorrect (A): High V/Q (dead space) occurs when
ventilation exceeds perfusion (e.g., pulmonary embolus),
not consolidation.
