Saunders Comprehensive Review for the NCLEX-PN®
Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
ANATOMY AND PHYSIOLOGY TEST BANK
1 (Cardiovascular — preload / Frank-Starling)
A nurse explains to a nursing student how increased venous
return affects stroke volume. Which statement best describes
the physiological mechanism?
A. Increased venous return decreases end-diastolic volume and
reduces stroke volume.
B. Increased venous return stretches ventricular muscle fibers,
increasing stroke volume.
C. Increased venous return triggers baroreceptors to
permanently lower contractility.
D. Increased venous return reduces myocardial oxygen demand
and lowers cardiac output.
Correct: B
Rationales:
, • B (correct): According to the Frank-Starling mechanism,
increased venous return increases end-diastolic volume,
stretching ventricular fibers and increasing force of
contraction and stroke volume.
• A (incorrect): Increased venous return increases (not
decreases) end-diastolic volume.
• C (incorrect): Baroreceptor reflexes adjust heart
rate/vasomotor tone transiently, but they do not
permanently lower contractility in response to increased
venous return.
• D (incorrect): Increased venous return generally increases
cardiac output and myocardial oxygen demand (not
reduces it).
2 (Cardiovascular — left heart failure signs)
A patient presents with dyspnea, bibasilar crackles, orthopnea,
and pink frothy sputum. Which physiological process best
explains these findings?
A. Right ventricular failure causing systemic venous congestion.
B. Left ventricular failure causing increased pulmonary capillary
hydrostatic pressure.
C. Hypovolemia leading to decreased pulmonary capillary
pressure.
D. Decreased pulmonary vascular resistance causing fluid
reabsorption.
,Correct: B
Rationales:
• B (correct): Left ventricular failure elevates left atrial and
pulmonary venous pressures → increased pulmonary
capillary hydrostatic pressure → pulmonary edema
(crackles, dyspnea, pink frothy sputum).
• A (incorrect): Right ventricular failure produces systemic
signs (JVD, peripheral edema), not pulmonary edema.
• C (incorrect): Hypovolemia would decrease pulmonary
hydrostatic pressures, not cause these symptoms.
• D (incorrect): Decreased pulmonary vascular resistance
does not cause fluid accumulation; increased hydrostatic
pressure does.
3 (Cardiac conduction / ECG)
An ECG shows peaked T waves and a widened QRS. Which
electrolyte imbalance is most likely responsible?
A. Hypokalemia.
B. Hyperkalemia.
C. Hypocalcemia.
D. Hypermagnesemia.
Correct: B
Rationales:
, • B (correct): Hyperkalemia causes peaked T waves,
progressive QRS widening, and can lead to arrhythmias.
This is due to altered resting membrane potential and
slowed ventricular conduction.
• A (incorrect): Hypokalemia classically produces U waves
and flattened T waves, not peaked T waves.
• C (incorrect): Hypocalcemia affects QT interval
(prolongation) rather than peaked T waves and widened
QRS typical of hyperkalemia.
• D (incorrect): Hypermagnesemia can depress
neuromuscular and cardiac conduction but is less
classically associated with peaked T waves and early QRS
widening like hyperkalemia.
4 (Respiratory — V/Q mismatch)
A patient with lobar pneumonia has hypoxemia that does not
fully correct with supplemental oxygen. Which physiologic
concept best explains this?
A. Increased dead space ventilation.
B. Complete alveolar shunt (perfusion without ventilation).
C. Diffusion limitation due to pulmonary fibrosis.
D. Decreased tidal volume from neuromuscular weakness.
Correct: B
Rationales:
Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
ANATOMY AND PHYSIOLOGY TEST BANK
1 (Cardiovascular — preload / Frank-Starling)
A nurse explains to a nursing student how increased venous
return affects stroke volume. Which statement best describes
the physiological mechanism?
A. Increased venous return decreases end-diastolic volume and
reduces stroke volume.
B. Increased venous return stretches ventricular muscle fibers,
increasing stroke volume.
C. Increased venous return triggers baroreceptors to
permanently lower contractility.
D. Increased venous return reduces myocardial oxygen demand
and lowers cardiac output.
Correct: B
Rationales:
, • B (correct): According to the Frank-Starling mechanism,
increased venous return increases end-diastolic volume,
stretching ventricular fibers and increasing force of
contraction and stroke volume.
• A (incorrect): Increased venous return increases (not
decreases) end-diastolic volume.
• C (incorrect): Baroreceptor reflexes adjust heart
rate/vasomotor tone transiently, but they do not
permanently lower contractility in response to increased
venous return.
• D (incorrect): Increased venous return generally increases
cardiac output and myocardial oxygen demand (not
reduces it).
2 (Cardiovascular — left heart failure signs)
A patient presents with dyspnea, bibasilar crackles, orthopnea,
and pink frothy sputum. Which physiological process best
explains these findings?
A. Right ventricular failure causing systemic venous congestion.
B. Left ventricular failure causing increased pulmonary capillary
hydrostatic pressure.
C. Hypovolemia leading to decreased pulmonary capillary
pressure.
D. Decreased pulmonary vascular resistance causing fluid
reabsorption.
,Correct: B
Rationales:
• B (correct): Left ventricular failure elevates left atrial and
pulmonary venous pressures → increased pulmonary
capillary hydrostatic pressure → pulmonary edema
(crackles, dyspnea, pink frothy sputum).
• A (incorrect): Right ventricular failure produces systemic
signs (JVD, peripheral edema), not pulmonary edema.
• C (incorrect): Hypovolemia would decrease pulmonary
hydrostatic pressures, not cause these symptoms.
• D (incorrect): Decreased pulmonary vascular resistance
does not cause fluid accumulation; increased hydrostatic
pressure does.
3 (Cardiac conduction / ECG)
An ECG shows peaked T waves and a widened QRS. Which
electrolyte imbalance is most likely responsible?
A. Hypokalemia.
B. Hyperkalemia.
C. Hypocalcemia.
D. Hypermagnesemia.
Correct: B
Rationales:
, • B (correct): Hyperkalemia causes peaked T waves,
progressive QRS widening, and can lead to arrhythmias.
This is due to altered resting membrane potential and
slowed ventricular conduction.
• A (incorrect): Hypokalemia classically produces U waves
and flattened T waves, not peaked T waves.
• C (incorrect): Hypocalcemia affects QT interval
(prolongation) rather than peaked T waves and widened
QRS typical of hyperkalemia.
• D (incorrect): Hypermagnesemia can depress
neuromuscular and cardiac conduction but is less
classically associated with peaked T waves and early QRS
widening like hyperkalemia.
4 (Respiratory — V/Q mismatch)
A patient with lobar pneumonia has hypoxemia that does not
fully correct with supplemental oxygen. Which physiologic
concept best explains this?
A. Increased dead space ventilation.
B. Complete alveolar shunt (perfusion without ventilation).
C. Diffusion limitation due to pulmonary fibrosis.
D. Decreased tidal volume from neuromuscular weakness.
Correct: B
Rationales:
