Clinical Pathophysiology Made Ridiculously
Simple: Color Edition
3rd Edition
Author(s)Aaron Berkowitz MD PhD
TEST BANK
1
Reference: Ch. 1: Anatomical Overview — Coronary circulation
and myocardial perfusion
Question Stem: A 68-year-old man complains of severe chest
pain at rest. He has a history of coronary atherosclerosis. Which
physiologic change most directly decreases myocardial oxygen
supply and precipitates ischemia? (Consider nursing assessment
and interventions.)
A. Increased coronary perfusion during diastole
B. Elevated left ventricular end-diastolic pressure (LVEDP)
compressing subendocardial vessels
C. Systemic vasodilation lowering afterload
D. Decreased myocardial oxygen demand from bradycardia
,Correct Answer: B
Rationales:
• Correct (B): Elevated LVEDP (increased intracavitary
pressure) compresses subendocardial coronary vessels,
reducing perfusion during diastole and causing ischemia —
a key mechanism Berkowitz emphasizes for
supply/demand mismatch. Nursing: monitor for pulmonary
congestion and reduce preload.
• A (incorrect): Increased diastolic coronary perfusion would
improve oxygen supply, not reduce it.
• C (incorrect): Systemic vasodilation lowers afterload and
can increase forward flow and perfusion; it does not
directly reduce coronary perfusion.
• D (incorrect): Bradycardia typically reduces myocardial O₂
demand and can improve supply–demand balance.
Teaching Point: Elevated LVEDP reduces subendocardial
perfusion and causes ischemia.
Citation: Berkowitz, 2023, Ch. 1: Anatomical Overview
2
Reference: Ch. 1: Left Heart Failure — Pulmonary edema and
acute decompensation
,Question Stem: A patient with chronic left ventricular systolic
dysfunction develops sudden dyspnea, frothy pink sputum, and
hypoxia. Which immediate nursing action most directly
addresses the pathophysiology of acute pulmonary edema?
A. Place the patient supine and administer a high-flow nasal
cannula
B. Elevate the head of the bed and administer intravenous loop
diuretic
C. Start a beta-blocker infusion to reduce myocardial oxygen
demand
D. Increase IV fluids to improve preload and cardiac output
Correct Answer: B
Rationales:
• Correct (B): Acute pulmonary edema results from elevated
left atrial and pulmonary capillary pressures; diuretics
reduce preload and pulmonary hydrostatic pressure.
Upright positioning improves ventilation/perfusion. This
addresses the primary pathophysiology.
• A (incorrect): Supine position worsens pulmonary
congestion; high-flow oxygen may help oxygenation but
does not reduce preload.
• C (incorrect): Beta-blockers are not first-line in acute
decompensation; they can depress contractility acutely.
• D (incorrect): Increasing IV fluids will worsen pulmonary
congestion by raising preload.
, Teaching Point: In acute left-sided failure, reduce preload
(diuretics, upright position) to relieve pulmonary edema.
Citation: Berkowitz, 2023, Ch. 1: Left Heart Failure
3
Reference: Ch. 1: Right Heart Failure — Systemic venous
congestion
Question Stem: A patient with chronic pulmonary hypertension
develops progressive peripheral edema, jugular venous
distention (JVD), and hepatomegaly. Which mechanism best
explains his right heart failure symptoms?
A. Increased left ventricular preload causing pulmonary
congestion
B. Right ventricular pressure overload causing tricuspid annular
dilation and regurgitation
C. Decreased systemic venous pressure from compensatory
vasodilation
D. Improved right ventricular contractility from hypertrophy
Correct Answer: B
Rationales:
• Correct (B): Pulmonary hypertension causes RV pressure
overload → RV dilation and tricuspid annular dilation →
tricuspid regurgitation and systemic venous congestion
Simple: Color Edition
3rd Edition
Author(s)Aaron Berkowitz MD PhD
TEST BANK
1
Reference: Ch. 1: Anatomical Overview — Coronary circulation
and myocardial perfusion
Question Stem: A 68-year-old man complains of severe chest
pain at rest. He has a history of coronary atherosclerosis. Which
physiologic change most directly decreases myocardial oxygen
supply and precipitates ischemia? (Consider nursing assessment
and interventions.)
A. Increased coronary perfusion during diastole
B. Elevated left ventricular end-diastolic pressure (LVEDP)
compressing subendocardial vessels
C. Systemic vasodilation lowering afterload
D. Decreased myocardial oxygen demand from bradycardia
,Correct Answer: B
Rationales:
• Correct (B): Elevated LVEDP (increased intracavitary
pressure) compresses subendocardial coronary vessels,
reducing perfusion during diastole and causing ischemia —
a key mechanism Berkowitz emphasizes for
supply/demand mismatch. Nursing: monitor for pulmonary
congestion and reduce preload.
• A (incorrect): Increased diastolic coronary perfusion would
improve oxygen supply, not reduce it.
• C (incorrect): Systemic vasodilation lowers afterload and
can increase forward flow and perfusion; it does not
directly reduce coronary perfusion.
• D (incorrect): Bradycardia typically reduces myocardial O₂
demand and can improve supply–demand balance.
Teaching Point: Elevated LVEDP reduces subendocardial
perfusion and causes ischemia.
Citation: Berkowitz, 2023, Ch. 1: Anatomical Overview
2
Reference: Ch. 1: Left Heart Failure — Pulmonary edema and
acute decompensation
,Question Stem: A patient with chronic left ventricular systolic
dysfunction develops sudden dyspnea, frothy pink sputum, and
hypoxia. Which immediate nursing action most directly
addresses the pathophysiology of acute pulmonary edema?
A. Place the patient supine and administer a high-flow nasal
cannula
B. Elevate the head of the bed and administer intravenous loop
diuretic
C. Start a beta-blocker infusion to reduce myocardial oxygen
demand
D. Increase IV fluids to improve preload and cardiac output
Correct Answer: B
Rationales:
• Correct (B): Acute pulmonary edema results from elevated
left atrial and pulmonary capillary pressures; diuretics
reduce preload and pulmonary hydrostatic pressure.
Upright positioning improves ventilation/perfusion. This
addresses the primary pathophysiology.
• A (incorrect): Supine position worsens pulmonary
congestion; high-flow oxygen may help oxygenation but
does not reduce preload.
• C (incorrect): Beta-blockers are not first-line in acute
decompensation; they can depress contractility acutely.
• D (incorrect): Increasing IV fluids will worsen pulmonary
congestion by raising preload.
, Teaching Point: In acute left-sided failure, reduce preload
(diuretics, upright position) to relieve pulmonary edema.
Citation: Berkowitz, 2023, Ch. 1: Left Heart Failure
3
Reference: Ch. 1: Right Heart Failure — Systemic venous
congestion
Question Stem: A patient with chronic pulmonary hypertension
develops progressive peripheral edema, jugular venous
distention (JVD), and hepatomegaly. Which mechanism best
explains his right heart failure symptoms?
A. Increased left ventricular preload causing pulmonary
congestion
B. Right ventricular pressure overload causing tricuspid annular
dilation and regurgitation
C. Decreased systemic venous pressure from compensatory
vasodilation
D. Improved right ventricular contractility from hypertrophy
Correct Answer: B
Rationales:
• Correct (B): Pulmonary hypertension causes RV pressure
overload → RV dilation and tricuspid annular dilation →
tricuspid regurgitation and systemic venous congestion
