Saunders Comprehensive Review for the NCLEX-PN®
Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
ANATOMY AND PHYSIOLOGY TEST BANK
1 — Cardiovascular (Cardiac output & clinical finding)
A 72-year-old patient with long-standing hypertension is found
to have an S3 heart sound on auscultation and reports
increasing exertional dyspnea. Which physiologic change best
explains the S3 sound in this patient?
A. Increased atrial contraction causing turbulence in late
diastole.
B. Rapid passive filling of a dilated, noncompliant left ventricle.
C. Stenosis of the mitral valve causing turbulent flow during
systole.
D. Increased closure force of the aortic valve during diastole.
Correct: B
Rationales
• B (Correct): An S3 is produced by rapid passive filling of a
volume-overloaded or noncompliant ventricle in early
diastole. In chronic hypertension, left ventricular
, remodeling and decreased compliance cause abrupt
deceleration of inflow and reverberation (S3). This also
aligns with symptoms of congestive physiology (exertional
dyspnea).
• A (Incorrect): Increased atrial contraction produces an S4
(late diastolic sound), not S3. S4 indicates a stiff ventricle
being forced by atrial contraction.
• C (Incorrect): Mitral stenosis causes a diastolic rumble and
often an opening snap, but the physical mechanism differs
(narrow orifice causing turbulent flow) and does not
produce classic S3.
• D (Incorrect): The aortic valve closes at the start of diastole
producing S2; increased closure force does not produce an
S3.
2 — Cardiovascular (Coronary perfusion and chest pain)
A patient complains of chest pain that worsens with exertion
and is relieved by rest. Which physiologic mechanism explains
exertional angina?
A. Increased myocardial oxygen supply during exercise.
B. Fixed atherosclerotic narrowing causing mismatch between
oxygen supply and demand.
C. Increased coronary venous pressure improving coronary
perfusion.
,D. Enhanced parasympathetic tone increasing coronary blood
flow.
Correct: B
Rationales
• B (Correct): Exertional (stable) angina results from a fixed
coronary artery stenosis (atherosclerosis) that limits
coronary blood flow; during exercise myocardial oxygen
demand rises and supply becomes inadequate, causing
ischemic chest pain.
• A (Incorrect): Exercise increases myocardial oxygen
demand, not supply; coronary vasculature may dilate but
fixed stenosis prevents adequate increase in supply.
• C (Incorrect): Increased coronary venous pressure would
impair perfusion (reduces pressure gradient), not improve
it.
• D (Incorrect): Parasympathetic stimulation tends to reduce
heart rate and metabolic demand; coronary vasodilation is
primarily sympathetic and metabolic—this option
misstates physiology.
3 — Respiratory (V/P mismatch)
A patient with a lobar pneumonia has cyanosis and a low
arterial PaO₂ despite supplemental oxygen. Which mechanism
best explains persistent hypoxemia?
, A. Increased dead space ventilation leading to CO₂ retention.
B. Right-to-left shunt physiology due to air trapping.
C. Ventilation/perfusion (V/Q) mismatch with areas of low
ventilation (shunt effect).
D. Increased diffusion distance from alveolar edema causing
immediate correction with oxygen.
Correct: C
Rationales
• C (Correct): Consolidated lung tissue (pneumonia) is
perfused but poorly ventilated—creating low V/Q regions
that function like physiologic shunt. Because blood passes
through unventilated or poorly ventilated alveoli,
supplemental O₂ has limited effect, explaining persistent
hypoxemia.
• A (Incorrect): Increased dead space is ventilation without
perfusion (e.g., pulmonary embolus), causing wasted
ventilation and CO₂ retention; this is not the dominant
mechanism in lobar consolidation.
• B (Incorrect): A true anatomic right-to-left shunt bypasses
the lungs (e.g., VSD with Eisenmenger) and is not “air
trapping” from pneumonia. While physiology may be
shunt-like, calling it a right-to-left shunt is incorrect here.
• D (Incorrect): Diffusion impairment due to edema can
cause hypoxemia, but with pneumonia the major problem
Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
ANATOMY AND PHYSIOLOGY TEST BANK
1 — Cardiovascular (Cardiac output & clinical finding)
A 72-year-old patient with long-standing hypertension is found
to have an S3 heart sound on auscultation and reports
increasing exertional dyspnea. Which physiologic change best
explains the S3 sound in this patient?
A. Increased atrial contraction causing turbulence in late
diastole.
B. Rapid passive filling of a dilated, noncompliant left ventricle.
C. Stenosis of the mitral valve causing turbulent flow during
systole.
D. Increased closure force of the aortic valve during diastole.
Correct: B
Rationales
• B (Correct): An S3 is produced by rapid passive filling of a
volume-overloaded or noncompliant ventricle in early
diastole. In chronic hypertension, left ventricular
, remodeling and decreased compliance cause abrupt
deceleration of inflow and reverberation (S3). This also
aligns with symptoms of congestive physiology (exertional
dyspnea).
• A (Incorrect): Increased atrial contraction produces an S4
(late diastolic sound), not S3. S4 indicates a stiff ventricle
being forced by atrial contraction.
• C (Incorrect): Mitral stenosis causes a diastolic rumble and
often an opening snap, but the physical mechanism differs
(narrow orifice causing turbulent flow) and does not
produce classic S3.
• D (Incorrect): The aortic valve closes at the start of diastole
producing S2; increased closure force does not produce an
S3.
2 — Cardiovascular (Coronary perfusion and chest pain)
A patient complains of chest pain that worsens with exertion
and is relieved by rest. Which physiologic mechanism explains
exertional angina?
A. Increased myocardial oxygen supply during exercise.
B. Fixed atherosclerotic narrowing causing mismatch between
oxygen supply and demand.
C. Increased coronary venous pressure improving coronary
perfusion.
,D. Enhanced parasympathetic tone increasing coronary blood
flow.
Correct: B
Rationales
• B (Correct): Exertional (stable) angina results from a fixed
coronary artery stenosis (atherosclerosis) that limits
coronary blood flow; during exercise myocardial oxygen
demand rises and supply becomes inadequate, causing
ischemic chest pain.
• A (Incorrect): Exercise increases myocardial oxygen
demand, not supply; coronary vasculature may dilate but
fixed stenosis prevents adequate increase in supply.
• C (Incorrect): Increased coronary venous pressure would
impair perfusion (reduces pressure gradient), not improve
it.
• D (Incorrect): Parasympathetic stimulation tends to reduce
heart rate and metabolic demand; coronary vasodilation is
primarily sympathetic and metabolic—this option
misstates physiology.
3 — Respiratory (V/P mismatch)
A patient with a lobar pneumonia has cyanosis and a low
arterial PaO₂ despite supplemental oxygen. Which mechanism
best explains persistent hypoxemia?
, A. Increased dead space ventilation leading to CO₂ retention.
B. Right-to-left shunt physiology due to air trapping.
C. Ventilation/perfusion (V/Q) mismatch with areas of low
ventilation (shunt effect).
D. Increased diffusion distance from alveolar edema causing
immediate correction with oxygen.
Correct: C
Rationales
• C (Correct): Consolidated lung tissue (pneumonia) is
perfused but poorly ventilated—creating low V/Q regions
that function like physiologic shunt. Because blood passes
through unventilated or poorly ventilated alveoli,
supplemental O₂ has limited effect, explaining persistent
hypoxemia.
• A (Incorrect): Increased dead space is ventilation without
perfusion (e.g., pulmonary embolus), causing wasted
ventilation and CO₂ retention; this is not the dominant
mechanism in lobar consolidation.
• B (Incorrect): A true anatomic right-to-left shunt bypasses
the lungs (e.g., VSD with Eisenmenger) and is not “air
trapping” from pneumonia. While physiology may be
shunt-like, calling it a right-to-left shunt is incorrect here.
• D (Incorrect): Diffusion impairment due to edema can
cause hypoxemia, but with pneumonia the major problem
