Saunders Comprehensive Review for the NCLEX-PN®
Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
ANATOMY AND PHYSIOLOGY TEST BANK
1 — Cardiovascular
A 68-year-old client with atherosclerotic coronary artery disease
reports exertional chest tightness that resolves with rest. Which
physiologic explanation best explains the client’s symptoms?
A. Collateral coronary vessels constrict during exertion, reducing
oxygen delivery.
B. Increased myocardial oxygen demand during exertion
outpaces coronary blood flow through narrowed vessels.
C. Atherosclerotic plaques release catecholamines that directly
induce ischemia during exercise.
D. Rest causes an increase in systemic vascular resistance,
improving coronary perfusion.
Answer: B
Rationale — correct (B): During exertion the myocardium’s
oxygen demand rises. Atherosclerotic narrowing limits the
ability of coronary arteries to increase blood flow (flow
,reserve), so demand exceeds supply → transient myocardial
ischemia causing exertional angina.
Why A is wrong: Collateral vessels, if present, usually dilate or
provide alternate flow; they do not specifically constrict during
exertion to cause ischemia.
Why C is wrong: Plaques don’t primarily “release
catecholamines.” Plaque rupture, inflammation, or thrombus
cause acute ischemia; catecholamines are systemic mediators,
not plaque secretions.
Why D is wrong: Increased systemic vascular resistance
(afterload) would increase myocardial work and oxygen
demand, not improve coronary perfusion; coronary perfusion
primarily occurs during diastole and depends on aortic diastolic
pressure and coronary vessel patency.
2 — Cardiovascular
A nurse auscultates a high-pitched, blowing sound at the left
sternal border during systole in a patient following a myocardial
infarction. Which structural/functional change most likely
produces this finding?
A. Mitral valve leaflet thickening causing stenosis.
B. Papillary muscle dysfunction leading to mitral regurgitation.
C. Tricuspid valve prolapse producing a midsystolic click.
D. Aortic root dilation causing aortic stenosis murmur.
,Answer: B
Rationale — correct (B): Papillary muscle ischemia or rupture
after MI impairs mitral valve coaptation, producing
regurgitation — a high-pitched, blowing holosystolic murmur
best heard at the left sternal border or apex that can be loud.
The pathophysiology: incompetence → backflow into left
atrium during systole.
Why A is wrong: Mitral stenosis produces a diastolic rumble
with opening snap; it is not a high-pitched systolic blowing
murmur.
Why C is wrong: Tricuspid valve lesions cause right-sided
murmurs, and prolapse typically involves a click and late systolic
murmur, not a holosystolic left-sided blowing murmur.
Why D is wrong: Aortic root dilation causing aortic regurgitation
yields a diastolic decrescendo murmur, not a systolic blowing
sound.
3 — Cardiovascular
A client’s arterial blood pressure is 90/60 mm Hg and heart rate
120 bpm. Which compensatory physiologic mechanism is most
responsible for maintaining cardiac output in this situation?
A. Increased stroke volume via enhanced ventricular preload.
B. Increased heart rate via sympathetic stimulation to maintain
cardiac output.
, C. Reduced peripheral vascular resistance to improve tissue
perfusion.
D. Increased parasympathetic tone to improve myocardial
efficiency.
Answer: B
Rationale — correct (B): Cardiac output = HR × SV. When blood
pressure falls, baroreceptor reflex increases sympathetic
outflow → tachycardia to maintain cardiac output. In acute
hypotension the primary short-term compensation is increasing
heart rate and contractility.
Why A is wrong: Low BP commonly reflects decreased preload
or cardiac function; preload may not be able to increase, and
stroke volume often falls.
Why C is wrong: Reduced peripheral resistance would lower
blood pressure further; the body typically increases peripheral
resistance (vasoconstriction) to restore BP.
Why D is wrong: Increased parasympathetic tone lowers HR
and would worsen hypotension; sympathetic—not
parasympathetic—tone rises in compensation.
4 — Respiratory
A patient with emphysema demonstrates barrel chest and uses
accessory muscles to breathe. Which structural change explains
this clinical picture?
Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
ANATOMY AND PHYSIOLOGY TEST BANK
1 — Cardiovascular
A 68-year-old client with atherosclerotic coronary artery disease
reports exertional chest tightness that resolves with rest. Which
physiologic explanation best explains the client’s symptoms?
A. Collateral coronary vessels constrict during exertion, reducing
oxygen delivery.
B. Increased myocardial oxygen demand during exertion
outpaces coronary blood flow through narrowed vessels.
C. Atherosclerotic plaques release catecholamines that directly
induce ischemia during exercise.
D. Rest causes an increase in systemic vascular resistance,
improving coronary perfusion.
Answer: B
Rationale — correct (B): During exertion the myocardium’s
oxygen demand rises. Atherosclerotic narrowing limits the
ability of coronary arteries to increase blood flow (flow
,reserve), so demand exceeds supply → transient myocardial
ischemia causing exertional angina.
Why A is wrong: Collateral vessels, if present, usually dilate or
provide alternate flow; they do not specifically constrict during
exertion to cause ischemia.
Why C is wrong: Plaques don’t primarily “release
catecholamines.” Plaque rupture, inflammation, or thrombus
cause acute ischemia; catecholamines are systemic mediators,
not plaque secretions.
Why D is wrong: Increased systemic vascular resistance
(afterload) would increase myocardial work and oxygen
demand, not improve coronary perfusion; coronary perfusion
primarily occurs during diastole and depends on aortic diastolic
pressure and coronary vessel patency.
2 — Cardiovascular
A nurse auscultates a high-pitched, blowing sound at the left
sternal border during systole in a patient following a myocardial
infarction. Which structural/functional change most likely
produces this finding?
A. Mitral valve leaflet thickening causing stenosis.
B. Papillary muscle dysfunction leading to mitral regurgitation.
C. Tricuspid valve prolapse producing a midsystolic click.
D. Aortic root dilation causing aortic stenosis murmur.
,Answer: B
Rationale — correct (B): Papillary muscle ischemia or rupture
after MI impairs mitral valve coaptation, producing
regurgitation — a high-pitched, blowing holosystolic murmur
best heard at the left sternal border or apex that can be loud.
The pathophysiology: incompetence → backflow into left
atrium during systole.
Why A is wrong: Mitral stenosis produces a diastolic rumble
with opening snap; it is not a high-pitched systolic blowing
murmur.
Why C is wrong: Tricuspid valve lesions cause right-sided
murmurs, and prolapse typically involves a click and late systolic
murmur, not a holosystolic left-sided blowing murmur.
Why D is wrong: Aortic root dilation causing aortic regurgitation
yields a diastolic decrescendo murmur, not a systolic blowing
sound.
3 — Cardiovascular
A client’s arterial blood pressure is 90/60 mm Hg and heart rate
120 bpm. Which compensatory physiologic mechanism is most
responsible for maintaining cardiac output in this situation?
A. Increased stroke volume via enhanced ventricular preload.
B. Increased heart rate via sympathetic stimulation to maintain
cardiac output.
, C. Reduced peripheral vascular resistance to improve tissue
perfusion.
D. Increased parasympathetic tone to improve myocardial
efficiency.
Answer: B
Rationale — correct (B): Cardiac output = HR × SV. When blood
pressure falls, baroreceptor reflex increases sympathetic
outflow → tachycardia to maintain cardiac output. In acute
hypotension the primary short-term compensation is increasing
heart rate and contractility.
Why A is wrong: Low BP commonly reflects decreased preload
or cardiac function; preload may not be able to increase, and
stroke volume often falls.
Why C is wrong: Reduced peripheral resistance would lower
blood pressure further; the body typically increases peripheral
resistance (vasoconstriction) to restore BP.
Why D is wrong: Increased parasympathetic tone lowers HR
and would worsen hypotension; sympathetic—not
parasympathetic—tone rises in compensation.
4 — Respiratory
A patient with emphysema demonstrates barrel chest and uses
accessory muscles to breathe. Which structural change explains
this clinical picture?
