Clinical Pathophysiology Made Ridiculously
Simple: Color Edition
3rd Edition
Author(s)Aaron Berkowitz MD PhD
TEST BANK
Reference: Ch. 1: Anatomical Overview — Heart chambers &
circulation
Question stem: A 68-year-old man with chronic mitral
regurgitation complains of progressive exertional dyspnea and
orthopnea. On assessment you note a displaced PMI and
bibasilar crackles. Which pathophysiologic mechanism best
explains his symptoms?
A. Increased left ventricular preload leading to pulmonary
venous congestion
B. Reduced right ventricular afterload producing systemic
,hypoperfusion
C. Decreased left atrial pressure lowering pulmonary capillary
hydrostatic pressure
D. Increased aortic afterload causing pulmonary edema
Correct answer: A
Rationales:
• Correct (A): Mitral regurgitation returns blood to the left
atrium during systole, increasing left ventricular preload
and left atrial pressure; elevated pulmonary venous
pressure causes pulmonary congestion and orthopnea.
(Berkowitz: regurgitant lesions increase preload and
pulmonary symptoms.)
• Incorrect (B): Right ventricular afterload being reduced
would not cause pulmonary venous congestion or left-
sided symptoms.
• Incorrect (C): Left atrial pressure is increased, not
decreased, in mitral regurgitation; pulmonary capillary
hydrostatic pressure rises.
• Incorrect (D): Aortic afterload affects LV systolic workload
but does not directly produce pulmonary edema the way
backward flow across the mitral valve does.
Teaching point: Mitral regurgitation raises left atrial pressure →
pulmonary congestion.
,Citation: Berkowitz, 2023, Ch. 1: The Cardiovascular System —
Valves and Their Diseases (Mitral Regurgitation)
2.
Reference: Ch. 1: Heart Failure — Left Heart Failure
Question stem: A patient with long-standing hypertension
presents with fatigue, dyspnea on exertion, and bilateral basal
crackles. Echocardiogram demonstrates concentric LV
hypertrophy with preserved EF. Which nursing priority best
addresses the underlying pathophysiology?
A. Monitor for volume overload and teach sodium restriction
B. Prepare for immediate inotropic therapy to increase EF
C. Provide anticoagulation to prevent mural thrombi from
dilation
D. Encourage high-intensity exercise to reverse hypertrophy
Correct answer: A
Rationales:
• Correct (A): Hypertensive, concentric hypertrophy
commonly causes diastolic dysfunction (preserved EF) with
impaired filling and pulmonary congestion; controlling
preload (volume) and sodium reduces pulmonary edema
risk.
, • Incorrect (B): Inotropic agents target systolic failure with
reduced EF; preserved EF diastolic HF benefit more from
rate control, volume management, and BP control.
• Incorrect (C): Anticoagulation is not routine for concentric
hypertrophy without atrial fibrillation or mural thrombus.
• Incorrect (D): High-intensity exercise is not an immediate
nursing priority and may be unsafe in decompensated HF.
Teaching point: Diastolic HF (concentric hypertrophy) needs
preload and blood pressure control.
Citation: Berkowitz, 2023, Ch. 1: The Cardiovascular System —
Heart Failure (Left Heart Failure; Cardiac Hypertrophy)
3.
Reference: Ch. 1: Preload, Afterload, and Treatment of Heart
Failure
Question stem: A patient with acute decompensated heart
failure is tachypneic and hypertensive. The physician orders
intravenous nitroprusside. Which physiologic effect aligns with
its mechanism and nursing reassessment parameter?
A. Decreases afterload — reassess blood pressure and improved
urine output
B. Increases preload — reassess for pulmonary edema and neck
vein distension
C. Increases contractility — reassess heart rate and core
Simple: Color Edition
3rd Edition
Author(s)Aaron Berkowitz MD PhD
TEST BANK
Reference: Ch. 1: Anatomical Overview — Heart chambers &
circulation
Question stem: A 68-year-old man with chronic mitral
regurgitation complains of progressive exertional dyspnea and
orthopnea. On assessment you note a displaced PMI and
bibasilar crackles. Which pathophysiologic mechanism best
explains his symptoms?
A. Increased left ventricular preload leading to pulmonary
venous congestion
B. Reduced right ventricular afterload producing systemic
,hypoperfusion
C. Decreased left atrial pressure lowering pulmonary capillary
hydrostatic pressure
D. Increased aortic afterload causing pulmonary edema
Correct answer: A
Rationales:
• Correct (A): Mitral regurgitation returns blood to the left
atrium during systole, increasing left ventricular preload
and left atrial pressure; elevated pulmonary venous
pressure causes pulmonary congestion and orthopnea.
(Berkowitz: regurgitant lesions increase preload and
pulmonary symptoms.)
• Incorrect (B): Right ventricular afterload being reduced
would not cause pulmonary venous congestion or left-
sided symptoms.
• Incorrect (C): Left atrial pressure is increased, not
decreased, in mitral regurgitation; pulmonary capillary
hydrostatic pressure rises.
• Incorrect (D): Aortic afterload affects LV systolic workload
but does not directly produce pulmonary edema the way
backward flow across the mitral valve does.
Teaching point: Mitral regurgitation raises left atrial pressure →
pulmonary congestion.
,Citation: Berkowitz, 2023, Ch. 1: The Cardiovascular System —
Valves and Their Diseases (Mitral Regurgitation)
2.
Reference: Ch. 1: Heart Failure — Left Heart Failure
Question stem: A patient with long-standing hypertension
presents with fatigue, dyspnea on exertion, and bilateral basal
crackles. Echocardiogram demonstrates concentric LV
hypertrophy with preserved EF. Which nursing priority best
addresses the underlying pathophysiology?
A. Monitor for volume overload and teach sodium restriction
B. Prepare for immediate inotropic therapy to increase EF
C. Provide anticoagulation to prevent mural thrombi from
dilation
D. Encourage high-intensity exercise to reverse hypertrophy
Correct answer: A
Rationales:
• Correct (A): Hypertensive, concentric hypertrophy
commonly causes diastolic dysfunction (preserved EF) with
impaired filling and pulmonary congestion; controlling
preload (volume) and sodium reduces pulmonary edema
risk.
, • Incorrect (B): Inotropic agents target systolic failure with
reduced EF; preserved EF diastolic HF benefit more from
rate control, volume management, and BP control.
• Incorrect (C): Anticoagulation is not routine for concentric
hypertrophy without atrial fibrillation or mural thrombus.
• Incorrect (D): High-intensity exercise is not an immediate
nursing priority and may be unsafe in decompensated HF.
Teaching point: Diastolic HF (concentric hypertrophy) needs
preload and blood pressure control.
Citation: Berkowitz, 2023, Ch. 1: The Cardiovascular System —
Heart Failure (Left Heart Failure; Cardiac Hypertrophy)
3.
Reference: Ch. 1: Preload, Afterload, and Treatment of Heart
Failure
Question stem: A patient with acute decompensated heart
failure is tachypneic and hypertensive. The physician orders
intravenous nitroprusside. Which physiologic effect aligns with
its mechanism and nursing reassessment parameter?
A. Decreases afterload — reassess blood pressure and improved
urine output
B. Increases preload — reassess for pulmonary edema and neck
vein distension
C. Increases contractility — reassess heart rate and core
