Saunders Comprehensive Review for the NCLEX-PN®
Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
ANATOMY AND PHYSIOLOGY TEST BANK
Cardiovascular (4 items)
1. A client reports sudden onset of chest pain radiating to the
left arm. Which structure’s acute dysfunction most directly
explains ischemic chest pain due to decreased oxygen delivery
to myocardial tissue?
A. Coronary arteries
B. Left atrium
C. Pulmonary vein
D. Aortic valve
Correct: A — Coronary arteries
Rationale:
• Why A (correct): Coronary arteries supply oxygenated
blood directly to the myocardium. Acute occlusion (e.g.,
thrombosis over an atherosclerotic plaque) reduces
myocardial oxygen delivery, causing ischemia and the
classic chest pain radiating to the left arm/neck/jaw. This is
, the direct structural cause of myocardial
ischemia/infarction.
• Why B is incorrect: The left atrium receives pulmonary
venous return and does not directly supply myocardial
tissue with oxygen; its dysfunction causes
congestion/backflow symptoms (e.g., pulmonary edema)
rather than primary myocardial ischemic pain.
• Why C is incorrect: Pulmonary veins carry oxygenated
blood from lungs to the left atrium; while important for
systemic oxygenation, pulmonary vein dysfunction doesn’t
cause focal myocardial ischemia.
• Why D is incorrect: Aortic valve pathology
(stenosis/regurgitation) affects outflow from the left
ventricle and can produce chest pain or syncope over time,
but acute focal myocardial ischemia is most directly due to
compromised coronary arterial flow.
2. A client has aortic stenosis with a reduced left ventricular
outflow area. Over time, which structural cardiac change most
commonly develops to preserve stroke volume?
A. Right ventricular dilation
B. Left ventricular concentric hypertrophy
C. Left ventricular eccentric hypertrophy
D. Atrial septal thickening
Correct: B — Left ventricular concentric hypertrophy
,Rationale:
• Why B (correct): Aortic stenosis increases afterload
(pressure the left ventricle must generate to eject). The
myocardium adapts by adding sarcomeres in parallel,
producing concentric hypertrophy (thicker ventricular wall,
smaller cavity) to generate higher systolic pressures and
maintain stroke volume.
• Why A is incorrect: Right ventricular dilation occurs with
pulmonary hypertension or right-sided volume/pressure
overload, not primary aortic stenosis.
• Why C is incorrect: Eccentric hypertrophy (sarcomeres in
series) occurs with volume overload (e.g., regurgitant
lesions) producing dilation; aortic stenosis is pressure
overload, so concentric hypertrophy is expected.
• Why D is incorrect: Atrial septal thickening is not a typical
adaptation to aortic valve obstruction.
3. The nurse assesses a post-op client with suspected
hemorrhage. Which vital-sign change is an early physiologic
response indicating decreased circulating blood volume?
A. Increased urine output
B. Increased heart rate (tachycardia)
C. Increased blood pressure (hypertension)
D. Bradycardia
Correct: B — Increased heart rate (tachycardia)
, Rationale:
• Why B (correct): Acute blood loss reduces circulating
volume and venous return, lowering stroke volume and
cardiac output. Baroreceptor reflexes (via decreased
arterial pressure) increase sympathetic tone to raise heart
rate (tachycardia) as an early compensatory response to
maintain cardiac output.
• Why A is incorrect: Urine output typically decreases
(oliguria) as kidneys conserve fluid via sympathetic
activation and renin-angiotensin-aldosterone system
(RAAS) activation.
• Why C is incorrect: Blood pressure commonly decreases
(hypotension) as hemorrhage progresses; hypertension is
not an early sign of active bleeding.
• Why D is incorrect: Bradycardia is not a usual early
compensatory response to hypovolemia (except in certain
neurogenic or vagal reflex conditions).
4. A client’s jugular venous pressure (JVP) is elevated and pulses
are prominent on inspection. Which cardiac pathology best
explains these findings?
A. Left ventricular systolic dysfunction
B. Right ventricular failure or tricuspid regurgitation
C. Aortic stenosis
D. Hypovolemia
Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
ANATOMY AND PHYSIOLOGY TEST BANK
Cardiovascular (4 items)
1. A client reports sudden onset of chest pain radiating to the
left arm. Which structure’s acute dysfunction most directly
explains ischemic chest pain due to decreased oxygen delivery
to myocardial tissue?
A. Coronary arteries
B. Left atrium
C. Pulmonary vein
D. Aortic valve
Correct: A — Coronary arteries
Rationale:
• Why A (correct): Coronary arteries supply oxygenated
blood directly to the myocardium. Acute occlusion (e.g.,
thrombosis over an atherosclerotic plaque) reduces
myocardial oxygen delivery, causing ischemia and the
classic chest pain radiating to the left arm/neck/jaw. This is
, the direct structural cause of myocardial
ischemia/infarction.
• Why B is incorrect: The left atrium receives pulmonary
venous return and does not directly supply myocardial
tissue with oxygen; its dysfunction causes
congestion/backflow symptoms (e.g., pulmonary edema)
rather than primary myocardial ischemic pain.
• Why C is incorrect: Pulmonary veins carry oxygenated
blood from lungs to the left atrium; while important for
systemic oxygenation, pulmonary vein dysfunction doesn’t
cause focal myocardial ischemia.
• Why D is incorrect: Aortic valve pathology
(stenosis/regurgitation) affects outflow from the left
ventricle and can produce chest pain or syncope over time,
but acute focal myocardial ischemia is most directly due to
compromised coronary arterial flow.
2. A client has aortic stenosis with a reduced left ventricular
outflow area. Over time, which structural cardiac change most
commonly develops to preserve stroke volume?
A. Right ventricular dilation
B. Left ventricular concentric hypertrophy
C. Left ventricular eccentric hypertrophy
D. Atrial septal thickening
Correct: B — Left ventricular concentric hypertrophy
,Rationale:
• Why B (correct): Aortic stenosis increases afterload
(pressure the left ventricle must generate to eject). The
myocardium adapts by adding sarcomeres in parallel,
producing concentric hypertrophy (thicker ventricular wall,
smaller cavity) to generate higher systolic pressures and
maintain stroke volume.
• Why A is incorrect: Right ventricular dilation occurs with
pulmonary hypertension or right-sided volume/pressure
overload, not primary aortic stenosis.
• Why C is incorrect: Eccentric hypertrophy (sarcomeres in
series) occurs with volume overload (e.g., regurgitant
lesions) producing dilation; aortic stenosis is pressure
overload, so concentric hypertrophy is expected.
• Why D is incorrect: Atrial septal thickening is not a typical
adaptation to aortic valve obstruction.
3. The nurse assesses a post-op client with suspected
hemorrhage. Which vital-sign change is an early physiologic
response indicating decreased circulating blood volume?
A. Increased urine output
B. Increased heart rate (tachycardia)
C. Increased blood pressure (hypertension)
D. Bradycardia
Correct: B — Increased heart rate (tachycardia)
, Rationale:
• Why B (correct): Acute blood loss reduces circulating
volume and venous return, lowering stroke volume and
cardiac output. Baroreceptor reflexes (via decreased
arterial pressure) increase sympathetic tone to raise heart
rate (tachycardia) as an early compensatory response to
maintain cardiac output.
• Why A is incorrect: Urine output typically decreases
(oliguria) as kidneys conserve fluid via sympathetic
activation and renin-angiotensin-aldosterone system
(RAAS) activation.
• Why C is incorrect: Blood pressure commonly decreases
(hypotension) as hemorrhage progresses; hypertension is
not an early sign of active bleeding.
• Why D is incorrect: Bradycardia is not a usual early
compensatory response to hypovolemia (except in certain
neurogenic or vagal reflex conditions).
4. A client’s jugular venous pressure (JVP) is elevated and pulses
are prominent on inspection. Which cardiac pathology best
explains these findings?
A. Left ventricular systolic dysfunction
B. Right ventricular failure or tricuspid regurgitation
C. Aortic stenosis
D. Hypovolemia
