NCLEX-RN Saunders Comprehensive Review for the
NCLEX-RN Examination Prep Question Bank with
Detailed Rationales
Course Code: NCLEX-RN
Course Name: Saunders Comprehensive Review for the NCLEX-RN Examination
Topic: High-Yield Body Systems Mastery Exam Bank(CARDIOVASCULAR
SYSTEM, PEDIATRIC NURSING, GASTROINTESTINAL SYSTEM,
INTENSIVELY COMPREHENSIVE NCLEX-STYLED EXAM QUESTIONS
Academic Year: 2026/2027
PART I: CARDIOVASCULAR SYSTEM
Question 1
A client with a history of infective endocarditis is being evaluated for worsening
heart failure symptoms. The nurse notes a new, loud, blowing pansystolic murmur
loudest at the apex that radiates to the axilla. The nurse recognizes this as
indicative of which valvular complication?
A. Aortic stenosis
B. Mitral regurgitation
C. Tricuspid stenosis
D. Pulmonic regurgitation
CORRECT ANSWER: B. Mitral regurgitation
RATIONALE: Infective endocarditis frequently damages the heart valves,
with the mitral valve being the most commonly affected site. A loud, blowing
pansystolic (holosystolic) murmur heard loudest at the apex that radiates to the
left axilla is the classic sign of acute or worsening mitral regurgitation. Option A
produces a harsh systolic crescendo-decrescendo murmur loudest at the second
right intercostal space that radiates to the carotid arteries. Option C produces a
diastolic rumbling murmur loudest at the lower left sternal border. Option D
produces a diastolic murmur at the upper left sternal border that increases with
inspiration.
Question 2
,The nurse is monitoring an adult client following an abdominal aortic aneurysm
(AAA) repair. Which clinical assessment finding is the most critical indicator of
graft occlusion or failure?
A. A blood pressure reading of 138/82 mmHg
B. Absence of peripheral pulses in the lower extremities
C. Hypoactive bowel sounds in all four quadrants
D. Serosanguineous drainage on the abdominal dressing
CORRECT ANSWER: B. Absence of peripheral pulses in the lower
extremities
RATIONALE: Following a surgical AAA repair, the most critical
complication is the occlusion or rupture of the synthetic graft. A sudden absence
of peripheral pulses (such as the dorsalis pedis or posterior tibial pulses)
accompanied by cool, pale, or cyanotic lower extremities indicates an acute lack of
tissue perfusion driven by graft thrombosis or occlusion and requires immediate
surgical re-exploration. Option A represents an acceptable, mildly elevated blood
pressure that does not compromise the graft line immediately. Option C is a
common, expected finding due to postoperative paralytic ileus. Option D is an
expected postoperative finding on a surgical dressing.
Question 3
A client is admitted to the coronary care unit with a diagnosis of acute
pericarditis. Which physical assessment finding should the nurse expect to note as
a pathognomonic feature of this inflammatory condition?
A. A loud S3 gallop heard best during expiration
B. A harsh, high-pitched pericardial friction rub
C. Jugular venous distention that disappears when sitting up
D. Symmetrical bilateral pitting pedal edema
CORRECT ANSWER: B. A harsh, high-pitched pericardial friction rub
RATIONALE: Pericarditis is an inflammation of the pericardial sac
surrounding the heart. The diagnostic hallmark of this condition is a pericardial
friction rub, which is a scratching, high-pitched, leathery sound produced by the
inflamed layers of the pericardium rubbing against each other. It is best heard with
the diaphragm of the stethoscope placed over the left lower sternal border while the
,client leans forward. Options A, C, and D are classic manifestations of heart failure
or fluid overload, not isolated acute pericarditis.
Question 4
The nurse is reviewing the telemetry monitor of a client admitted with an acute
myocardial infarction and observes ventricular fibrillation. Which action must
the nurse perform first?
A. Administer a 150 mg bolus of amiodarone intravenously.
B. Initiate immediate cardiopulmonary resuscitation (CPR) and prepare to
defibrillate.
C. Check the client's blood pressure and verify the pulse oximetry.
D. Deliver a synchronized cardioversion shock at 50 Joules.
CORRECT ANSWER: B. Initiate immediate cardiopulmonary resuscitation
(CPR) and prepare to defibrillate.
RATIONALE: Ventricular fibrillation (V-fib) is a lethal, pulseless
dysrhythmia characterized by chaotic ventricular quivering with zero cardiac
output. The immediate management priority is to compress the chest via CPR and
deliver an unsynchronized defibrillation shock as fast as possible to reset the
heart's electrical system. Option A is an antiarrhythmic drug used after initial
shocks and epinephrine fail. Option C delays life-saving therapy; a client in V-fib
is always pulseless and unresponsive. Option D is incorrect because synchronized
cardioversion requires an organized R-wave; shocking a chaotic rhythm like V-fib
in synchronized mode will fail to deliver the shock.
Question 5
A client presenting with severe chest pain is diagnosed with an acute inferior wall
myocardial infarction. Which coronary artery does the nurse recognize as the
primary site of occlusion for this specific infarction location?
A. Left anterior descending coronary artery
B. Left circumflex coronary artery
C. Right coronary artery
D. Left main coronary artery
, CORRECT ANSWER: C. Right coronary artery
RATIONALE: The right coronary artery (RCA) supplies blood to the right
ventricle, the sinoatrial (SA) node, the atrioventricular (AV) node, and the inferior
wall of the left ventricle. Therefore, an occlusion of the RCA leads to an inferior
wall MI, which characteristically presents with ST-segment elevations in leads II,
III, and aVF. Option A supplies the anterior wall of the left ventricle. Option B
supplies the lateral wall of the left ventricle. Option D supplies the entire left side
of the heart and causes widespread anterior/lateral damage.
Question 6
The nurse is preparing to care for a client returning from the cardiac catheterization
lab following a coronary artery stent placement via the right radial artery.
Which post-procedure nursing intervention is specific to this access site?
A. Keep the client in a strict supine position with the right leg extended for 6
hours.
B. Monitor the right hand for color, temperature, and capillary refill using a
compression band (TR Band).
C. Keep the right arm completely immobilized on a splint in a dependent position.
D. Apply a heavy 5-pound sandbag over the radial wrist for the first 4 hours.
CORRECT ANSWER: B. Monitor the right hand for color, temperature,
and capillary refill using a compression band (TR Band).
RATIONALE: Transradial access for cardiac catheterization requires
specialized monitoring using a pneumatic compression device like a TR Band to
achieve patent hemostasis without occluding the radial artery. The nurse must
frequently evaluate the radial neurovascular status, checking capillary refill,
color, sensation, and warmth in the fingers. Option A describes post-procedure
care for a femoral artery access site, not radial. Option C is incorrect; the arm
should be kept at heart level or elevated, not dependent, to minimize edema.
Option D is used for femoral sites, whereas radial sites utilize targeted pneumatic
bands.
Question 7
NCLEX-RN Examination Prep Question Bank with
Detailed Rationales
Course Code: NCLEX-RN
Course Name: Saunders Comprehensive Review for the NCLEX-RN Examination
Topic: High-Yield Body Systems Mastery Exam Bank(CARDIOVASCULAR
SYSTEM, PEDIATRIC NURSING, GASTROINTESTINAL SYSTEM,
INTENSIVELY COMPREHENSIVE NCLEX-STYLED EXAM QUESTIONS
Academic Year: 2026/2027
PART I: CARDIOVASCULAR SYSTEM
Question 1
A client with a history of infective endocarditis is being evaluated for worsening
heart failure symptoms. The nurse notes a new, loud, blowing pansystolic murmur
loudest at the apex that radiates to the axilla. The nurse recognizes this as
indicative of which valvular complication?
A. Aortic stenosis
B. Mitral regurgitation
C. Tricuspid stenosis
D. Pulmonic regurgitation
CORRECT ANSWER: B. Mitral regurgitation
RATIONALE: Infective endocarditis frequently damages the heart valves,
with the mitral valve being the most commonly affected site. A loud, blowing
pansystolic (holosystolic) murmur heard loudest at the apex that radiates to the
left axilla is the classic sign of acute or worsening mitral regurgitation. Option A
produces a harsh systolic crescendo-decrescendo murmur loudest at the second
right intercostal space that radiates to the carotid arteries. Option C produces a
diastolic rumbling murmur loudest at the lower left sternal border. Option D
produces a diastolic murmur at the upper left sternal border that increases with
inspiration.
Question 2
,The nurse is monitoring an adult client following an abdominal aortic aneurysm
(AAA) repair. Which clinical assessment finding is the most critical indicator of
graft occlusion or failure?
A. A blood pressure reading of 138/82 mmHg
B. Absence of peripheral pulses in the lower extremities
C. Hypoactive bowel sounds in all four quadrants
D. Serosanguineous drainage on the abdominal dressing
CORRECT ANSWER: B. Absence of peripheral pulses in the lower
extremities
RATIONALE: Following a surgical AAA repair, the most critical
complication is the occlusion or rupture of the synthetic graft. A sudden absence
of peripheral pulses (such as the dorsalis pedis or posterior tibial pulses)
accompanied by cool, pale, or cyanotic lower extremities indicates an acute lack of
tissue perfusion driven by graft thrombosis or occlusion and requires immediate
surgical re-exploration. Option A represents an acceptable, mildly elevated blood
pressure that does not compromise the graft line immediately. Option C is a
common, expected finding due to postoperative paralytic ileus. Option D is an
expected postoperative finding on a surgical dressing.
Question 3
A client is admitted to the coronary care unit with a diagnosis of acute
pericarditis. Which physical assessment finding should the nurse expect to note as
a pathognomonic feature of this inflammatory condition?
A. A loud S3 gallop heard best during expiration
B. A harsh, high-pitched pericardial friction rub
C. Jugular venous distention that disappears when sitting up
D. Symmetrical bilateral pitting pedal edema
CORRECT ANSWER: B. A harsh, high-pitched pericardial friction rub
RATIONALE: Pericarditis is an inflammation of the pericardial sac
surrounding the heart. The diagnostic hallmark of this condition is a pericardial
friction rub, which is a scratching, high-pitched, leathery sound produced by the
inflamed layers of the pericardium rubbing against each other. It is best heard with
the diaphragm of the stethoscope placed over the left lower sternal border while the
,client leans forward. Options A, C, and D are classic manifestations of heart failure
or fluid overload, not isolated acute pericarditis.
Question 4
The nurse is reviewing the telemetry monitor of a client admitted with an acute
myocardial infarction and observes ventricular fibrillation. Which action must
the nurse perform first?
A. Administer a 150 mg bolus of amiodarone intravenously.
B. Initiate immediate cardiopulmonary resuscitation (CPR) and prepare to
defibrillate.
C. Check the client's blood pressure and verify the pulse oximetry.
D. Deliver a synchronized cardioversion shock at 50 Joules.
CORRECT ANSWER: B. Initiate immediate cardiopulmonary resuscitation
(CPR) and prepare to defibrillate.
RATIONALE: Ventricular fibrillation (V-fib) is a lethal, pulseless
dysrhythmia characterized by chaotic ventricular quivering with zero cardiac
output. The immediate management priority is to compress the chest via CPR and
deliver an unsynchronized defibrillation shock as fast as possible to reset the
heart's electrical system. Option A is an antiarrhythmic drug used after initial
shocks and epinephrine fail. Option C delays life-saving therapy; a client in V-fib
is always pulseless and unresponsive. Option D is incorrect because synchronized
cardioversion requires an organized R-wave; shocking a chaotic rhythm like V-fib
in synchronized mode will fail to deliver the shock.
Question 5
A client presenting with severe chest pain is diagnosed with an acute inferior wall
myocardial infarction. Which coronary artery does the nurse recognize as the
primary site of occlusion for this specific infarction location?
A. Left anterior descending coronary artery
B. Left circumflex coronary artery
C. Right coronary artery
D. Left main coronary artery
, CORRECT ANSWER: C. Right coronary artery
RATIONALE: The right coronary artery (RCA) supplies blood to the right
ventricle, the sinoatrial (SA) node, the atrioventricular (AV) node, and the inferior
wall of the left ventricle. Therefore, an occlusion of the RCA leads to an inferior
wall MI, which characteristically presents with ST-segment elevations in leads II,
III, and aVF. Option A supplies the anterior wall of the left ventricle. Option B
supplies the lateral wall of the left ventricle. Option D supplies the entire left side
of the heart and causes widespread anterior/lateral damage.
Question 6
The nurse is preparing to care for a client returning from the cardiac catheterization
lab following a coronary artery stent placement via the right radial artery.
Which post-procedure nursing intervention is specific to this access site?
A. Keep the client in a strict supine position with the right leg extended for 6
hours.
B. Monitor the right hand for color, temperature, and capillary refill using a
compression band (TR Band).
C. Keep the right arm completely immobilized on a splint in a dependent position.
D. Apply a heavy 5-pound sandbag over the radial wrist for the first 4 hours.
CORRECT ANSWER: B. Monitor the right hand for color, temperature,
and capillary refill using a compression band (TR Band).
RATIONALE: Transradial access for cardiac catheterization requires
specialized monitoring using a pneumatic compression device like a TR Band to
achieve patent hemostasis without occluding the radial artery. The nurse must
frequently evaluate the radial neurovascular status, checking capillary refill,
color, sensation, and warmth in the fingers. Option A describes post-procedure
care for a femoral artery access site, not radial. Option C is incorrect; the arm
should be kept at heart level or elevated, not dependent, to minimize edema.
Option D is used for femoral sites, whereas radial sites utilize targeted pneumatic
bands.
Question 7
