WHILE ON A VISUAL APCH TO RWY 7 AT VGT; NV; A PA32 PVT PLT GETS CONFUSED REGARDING THE TWR'S INSTRUCTIONS TO BREAK OFF THE APCH AND 'MAKE L TFC FOR RWY 30.' HE STARTS A TURN TO THE L AND IS CORRECTED BY THE TWR. FURTHER CONFUSED; HE LEAVES THE AREA.

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THE TROUBLE BEGAN WHEN I CALLED NELLIS AFB CTL FOR CLRNC INTO THE LAS CLASS B AIRSPACE. THEIR RADIO WAS QUITE GARBLED; AS IT HAS BEEN FOR MANY MONTHS. THIS MAKES IT VERY EASY TO MISS CALLS AND TAKES EXTRA CONCENTRATION ON THE RADIO THAT COULD BETTER BE USED ELSEWHERE. IN SPITE OF MY REPEATEDLY IDENTING MYSELF AS 'LANCE;' HE CONTINUALLY IDENTED ME AS A CESSNA; THEN CALLED ME AT LEAST 4 DIFFERENT TAIL NUMBERS. ABOUT 20 MI FROM VGT; THE CTLR CALLED A CESSNA AT MY 12 O'CLOCK POS AND 4 MI; WELL ABOVE ME. I SEARCHED FOR ABOUT 4 MINS; THEN HE CALLED THE SAME TFC AT 1 O'CLOCK AND 2 MI; JUST ABOVE ME. A MOMENT LATER; I SPOTTED THE CONTACT AT MY ALT AND DSNDING. NELLIS TOLD ME TO FOLLOW THE CONTACT TO VGT. HIS RADAR MUST HAVE TOLD HIM THAT; THOUGH THE CESSNA WAS DSNDING RAPIDLY; I WAS A GOOD 30 KTS FASTER. I TURNED R TO CLR THAT ACFT; BUT IT MUST HAVE DONE THE SAME; SINCE I CAUGHT A GLIMPSE OF IT UNDER MY NOSE. THE CTLR ASKED IF I SAW THE CESSNA AND I RESPONDED THAT I MUST HAVE BEEN DIRECTLY OVER IT. HE CONFIRMED AND INSTRUCTED ME TO CONTACT VGT TWR. THE TWR SENT ME DIRECT TO THE SANTA FE HOTEL; A RPTING POINT MARKING THE L BASE FOR RWY 7. JUST BEFORE REACHING IT; HE INSTRUCTED ME TO ENTER THE L BASE AND CLRED ME TO LAND. THEN ON FINAL ABOUT 300 FT AGL AND WITHIN 1/2 MI OF THE RWY (AT MY OVER-THE-FENCE SPD OF 100 KIAS); I HEARD 'BREAK OFF AND MAKE L TFC FOR RWY 30; CLRED TO LAND.' ROUTINE LAHSO'S WERE BEING CONDUCTED ON RWYS 7/30; HOWEVER; UNDER THE MOMENT'S PRESSURE AND BECAUSE OF THE STRESS ALREADY ENCOUNTERED OVER NELLIS; I THOUGHT HE WAS TELLING ME TO TURN L TO RWY 12 -- AS I HAVE BEEN INSTRUCTED TO DO SEVERAL TIMES. AFTER STARTING THE TURN; THE CTLR TOLD ME TO MAKE A R TURN; BUT BY THEN I WAS DISORIENTED AND; FEELING THAT THE SIT WAS UNSAFE; I OPTED TO LEAVE THE CLASS D TO REGROUP. I LATER RETURNED AND MADE AN UNEVENTFUL APCH AND LNDG. IN REVIEWING THE SIT; I HAVE CONCLUDED THAT 4 FACTORS WERE INVOLVED. MY RAISED ANXIETY LEVEL FROM 1) THE GARBLED RADIO AT NELLIS; PLUS 2) OVERTAKING AND LOSING SIGHT OF AN ACFT I WAS TOLD TO FOLLOW; PLUS 3) THE (TO ME; AT LEAST) CONFUSING INSTRUCTIONS OF THE TWR WHEN SO LOW AND SO CLOSE TO THE END OF THE RWY COMBINED TO CAUSE 4) MY DISORIENTATION. HAD I NOT BEEN UNDER STRESS ALREADY; OR IF I HAD MORE ALT AND A FEW SECONDS LONGER TO ANALYZE THE SIT; I MIGHT HAVE REALIZED THAT I NEEDED TO MAKE A R TURN. FINALLY; IF THE CTLR HAD SAID SOMETHING LIKE 'TURN R THEN MAKE L TFC FOR RWY 30;' THE SIT MIGHT NOT HAVE DEVELOPED. BUT I BELIEVE THE SAFEST ACTION WOULD HAVE BEEN FOR HIM TO HAVE ME MAKE A ROUTINE GAR PARALLEL TO RWY 7; THEN ENTER R TFC FOR RWY 30 OR STAY IN THE PATTERN FOR RWY 7.