Saunders Comprehensive Review for the NCLEX-PN®
Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
ANATOMY AND PHYSIOLOGY TEST BANK
Cardiovascular (1–4)
1. A 68-year-old man reports sudden onset of crushing chest
pain radiating to the left arm. Which coronary artery occlusion
most commonly results in myocardial ischemia of the anterior
wall of the left ventricle?
A. Right coronary artery (RCA)
B. Left anterior descending artery (LAD)
C. Circumflex artery
D. Posterior descending artery (PDA)
Answer: B — Left anterior descending artery (LAD)
Rationale (correct): The LAD supplies the anterior wall and
interventricular septum of the left ventricle. Occlusion causes
ischemia/infarction in this territory, producing classic anterior
MI symptoms (crushing chest pain, left arm radiation) and
characteristic ECG changes in precordial leads.
Rationale (incorrect):
, • A: RCA supplies right ventricle and inferior wall in most
people; RCA occlusion more often causes inferior MI signs
(e.g., ST elevation in II, III, aVF), not isolated anterior wall
ischemia.
• C: Circumflex supplies lateral wall; lateral ischemia
presents with different ECG leads (I, aVL, V5–V6).
• D: PDA supplies inferior/posterior aspects (variable origin);
PDA occlusion causes inferior/posterior defects rather than
anterior.
2. A nurse assesses a client with chronic left ventricular failure.
Which physical finding best reflects increased left ventricular
end-diastolic pressure?
A. Jugular venous distention (JVD)
B. Peripheral pitting edema
C. Orthopnea and pulmonary crackles
D. Hepatomegaly
Answer: C — Orthopnea and pulmonary crackles
Rationale (correct): Elevated left ventricular end-diastolic
pressure causes blood to back up into the pulmonary
circulation, increasing hydrostatic pressure in pulmonary
capillaries and producing pulmonary edema, manifested as
orthopnea and crackles.
Rationale (incorrect):
, • A: JVD reflects right-sided filling pressures/backflow into
systemic venous system — more indicative of right heart
failure.
• B: Peripheral edema is a sign of systemic venous
congestion from right heart failure or severe
hypoalbuminemia, not primary left ventricular end-
diastolic pressure.
• D: Hepatomegaly occurs with chronic right-sided failure
from systemic venous congestion, not isolated left
ventricular failure.
3. A client with atrial fibrillation (AF) is at risk for
thromboembolism because AF directly causes:
A. Increased cardiac output
B. Decreased blood stasis in the atria
C. Loss of coordinated atrial contraction leading to stasis
D. Elevated left ventricular ejection fraction
Answer: C — Loss of coordinated atrial contraction leading to
stasis
Rationale (correct): AF causes chaotic electrical activity in the
atria, eliminating effective atrial contraction (atrial kick) and
resulting in pooling of blood—especially in the left atrial
appendage—predisposing to thrombus formation and
embolization.
Rationale (incorrect):
, • A: AF often decreases effective cardiac output because loss
of atrial contribution and irregular ventricular response
can reduce stroke volume.
• B: AF increases, not decreases, blood stasis in the atria.
• D: LV ejection fraction may be normal, decreased, or
variable; AF does not inherently elevate ejection fraction.
4. A client’s arterial blood gas (ABG) shows the following: pH
7.22, PaCO₂ 28 mm Hg, HCO₃⁻ 10 mEq/L. Which best describes
the acid-base disturbance and the primary physiological cause?
A. Respiratory acidosis due to hypoventilation
B. Metabolic acidosis with respiratory compensation
(hyperventilation)
C. Metabolic alkalosis with hypoventilation
D. Respiratory alkalosis due to hyperventilation
Answer: B — Metabolic acidosis with respiratory compensation
(hyperventilation)
Rationale (correct): Low pH (<7.35) and low HCO₃⁻ indicate
primary metabolic acidosis. Low PaCO₂ shows compensatory
respiratory alkalosis via hyperventilation (Kussmaul
respirations) to blow off CO₂.
Rationale (incorrect):
• A: Respiratory acidosis would have elevated PaCO₂.
• C: Metabolic alkalosis would have elevated HCO₃⁻, not low.
Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
ANATOMY AND PHYSIOLOGY TEST BANK
Cardiovascular (1–4)
1. A 68-year-old man reports sudden onset of crushing chest
pain radiating to the left arm. Which coronary artery occlusion
most commonly results in myocardial ischemia of the anterior
wall of the left ventricle?
A. Right coronary artery (RCA)
B. Left anterior descending artery (LAD)
C. Circumflex artery
D. Posterior descending artery (PDA)
Answer: B — Left anterior descending artery (LAD)
Rationale (correct): The LAD supplies the anterior wall and
interventricular septum of the left ventricle. Occlusion causes
ischemia/infarction in this territory, producing classic anterior
MI symptoms (crushing chest pain, left arm radiation) and
characteristic ECG changes in precordial leads.
Rationale (incorrect):
, • A: RCA supplies right ventricle and inferior wall in most
people; RCA occlusion more often causes inferior MI signs
(e.g., ST elevation in II, III, aVF), not isolated anterior wall
ischemia.
• C: Circumflex supplies lateral wall; lateral ischemia
presents with different ECG leads (I, aVL, V5–V6).
• D: PDA supplies inferior/posterior aspects (variable origin);
PDA occlusion causes inferior/posterior defects rather than
anterior.
2. A nurse assesses a client with chronic left ventricular failure.
Which physical finding best reflects increased left ventricular
end-diastolic pressure?
A. Jugular venous distention (JVD)
B. Peripheral pitting edema
C. Orthopnea and pulmonary crackles
D. Hepatomegaly
Answer: C — Orthopnea and pulmonary crackles
Rationale (correct): Elevated left ventricular end-diastolic
pressure causes blood to back up into the pulmonary
circulation, increasing hydrostatic pressure in pulmonary
capillaries and producing pulmonary edema, manifested as
orthopnea and crackles.
Rationale (incorrect):
, • A: JVD reflects right-sided filling pressures/backflow into
systemic venous system — more indicative of right heart
failure.
• B: Peripheral edema is a sign of systemic venous
congestion from right heart failure or severe
hypoalbuminemia, not primary left ventricular end-
diastolic pressure.
• D: Hepatomegaly occurs with chronic right-sided failure
from systemic venous congestion, not isolated left
ventricular failure.
3. A client with atrial fibrillation (AF) is at risk for
thromboembolism because AF directly causes:
A. Increased cardiac output
B. Decreased blood stasis in the atria
C. Loss of coordinated atrial contraction leading to stasis
D. Elevated left ventricular ejection fraction
Answer: C — Loss of coordinated atrial contraction leading to
stasis
Rationale (correct): AF causes chaotic electrical activity in the
atria, eliminating effective atrial contraction (atrial kick) and
resulting in pooling of blood—especially in the left atrial
appendage—predisposing to thrombus formation and
embolization.
Rationale (incorrect):
, • A: AF often decreases effective cardiac output because loss
of atrial contribution and irregular ventricular response
can reduce stroke volume.
• B: AF increases, not decreases, blood stasis in the atria.
• D: LV ejection fraction may be normal, decreased, or
variable; AF does not inherently elevate ejection fraction.
4. A client’s arterial blood gas (ABG) shows the following: pH
7.22, PaCO₂ 28 mm Hg, HCO₃⁻ 10 mEq/L. Which best describes
the acid-base disturbance and the primary physiological cause?
A. Respiratory acidosis due to hypoventilation
B. Metabolic acidosis with respiratory compensation
(hyperventilation)
C. Metabolic alkalosis with hypoventilation
D. Respiratory alkalosis due to hyperventilation
Answer: B — Metabolic acidosis with respiratory compensation
(hyperventilation)
Rationale (correct): Low pH (<7.35) and low HCO₃⁻ indicate
primary metabolic acidosis. Low PaCO₂ shows compensatory
respiratory alkalosis via hyperventilation (Kussmaul
respirations) to blow off CO₂.
Rationale (incorrect):
• A: Respiratory acidosis would have elevated PaCO₂.
• C: Metabolic alkalosis would have elevated HCO₃⁻, not low.
