Saunders Comprehensive Review for the NCLEX-PN®
Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
Test-bank style items — Medical-Surgical Nursing
(Cardiovascular, Respiratory, Neurological, GI,
Renal, Endocrine, Musculoskeletal)
Question 1 — Cardiovascular (Acute MI
prioritization)
A 62-year-old man arrives to the ED with crushing
chest pain radiating to his left arm, diaphoresis, and
an ECG showing ST-segment elevation in leads II, III,
and aVF. Which nursing action has the highest
priority?
,A. Administer sublingual nitroglycerin per protocol.
B. Obtain a 12-lead ECG and report to the provider.
C. Prepare the client for immediate percutaneous
coronary intervention (PCI).
D. Give chewable aspirin 325 mg unless
contraindicated.
E. Start IV access and begin continuous cardiac
monitoring.
Answer: D. Give chewable aspirin 325 mg unless
contraindicated.
Rationale — correct (D): Chewable aspirin
(antiplatelet) immediately reduces mortality in
suspected STEMI and is an evidence-based, time-
sensitive intervention that emergency nurses
administer while arranging definitive reperfusion.
Administering aspirin is a priority to reduce
thrombus propagation.
Rationale — incorrect:
A. Sublingual nitroglycerin decreases myocardial
oxygen demand and pain but is secondary to
immediate antiplatelet therapy and may be
,contraindicated if hypotensive or on
phosphodiesterase inhibitors.
B. A 12-lead ECG is essential, but the scenario
already gives ECG evidence; immediate aspirin still
has higher immediate mortality benefit while other
steps proceed.
C. Preparing for PCI is critical, but aspirin should be
given prior to transfer/PCI when not
contraindicated.
E. IV access and monitoring are necessary but are
supportive—aspirin administration is the most time-
critical, evidence-based immediate action.
Question 2 — Cardiovascular (HF lab
interpretation)
A 70-year-old woman with chronic heart failure
reports increased dyspnea and edema. Lab: BNP
1,050 pg/mL (normal <100), serum sodium 130
mEq/L. Which statement best interprets these
results?
, A. BNP is normal; hyponatremia indicates renal
failure.
B. Elevated BNP supports worsening heart failure;
hyponatremia reflects neurohormonal activation
and worse prognosis.
C. BNP of 1,050 suggests pulmonary embolism;
sodium 130 is unrelated.
D. BNP elevation indicates myocardial infarction;
treat with high-dose IV fluids for hyponatremia.
E. Results indicate primary endocrine disorder
rather than heart failure.
Answer: B. Elevated BNP supports worsening heart
failure; hyponatremia reflects neurohormonal
activation and worse prognosis.
Rationale — correct (B): BNP rises with ventricular
stretch and is a sensitive marker for heart failure
exacerbation; hyponatremia in HF commonly results
from ADH and RAAS activation and is associated
with severity and poorer outcomes.
Rationale — incorrect:
A. BNP of 1,050 is markedly elevated (not normal);
Examination
9th Edition
Author(s)Linda Anne Silvestri; Angela Silvestri
TEST BANK
Test-bank style items — Medical-Surgical Nursing
(Cardiovascular, Respiratory, Neurological, GI,
Renal, Endocrine, Musculoskeletal)
Question 1 — Cardiovascular (Acute MI
prioritization)
A 62-year-old man arrives to the ED with crushing
chest pain radiating to his left arm, diaphoresis, and
an ECG showing ST-segment elevation in leads II, III,
and aVF. Which nursing action has the highest
priority?
,A. Administer sublingual nitroglycerin per protocol.
B. Obtain a 12-lead ECG and report to the provider.
C. Prepare the client for immediate percutaneous
coronary intervention (PCI).
D. Give chewable aspirin 325 mg unless
contraindicated.
E. Start IV access and begin continuous cardiac
monitoring.
Answer: D. Give chewable aspirin 325 mg unless
contraindicated.
Rationale — correct (D): Chewable aspirin
(antiplatelet) immediately reduces mortality in
suspected STEMI and is an evidence-based, time-
sensitive intervention that emergency nurses
administer while arranging definitive reperfusion.
Administering aspirin is a priority to reduce
thrombus propagation.
Rationale — incorrect:
A. Sublingual nitroglycerin decreases myocardial
oxygen demand and pain but is secondary to
immediate antiplatelet therapy and may be
,contraindicated if hypotensive or on
phosphodiesterase inhibitors.
B. A 12-lead ECG is essential, but the scenario
already gives ECG evidence; immediate aspirin still
has higher immediate mortality benefit while other
steps proceed.
C. Preparing for PCI is critical, but aspirin should be
given prior to transfer/PCI when not
contraindicated.
E. IV access and monitoring are necessary but are
supportive—aspirin administration is the most time-
critical, evidence-based immediate action.
Question 2 — Cardiovascular (HF lab
interpretation)
A 70-year-old woman with chronic heart failure
reports increased dyspnea and edema. Lab: BNP
1,050 pg/mL (normal <100), serum sodium 130
mEq/L. Which statement best interprets these
results?
, A. BNP is normal; hyponatremia indicates renal
failure.
B. Elevated BNP supports worsening heart failure;
hyponatremia reflects neurohormonal activation
and worse prognosis.
C. BNP of 1,050 suggests pulmonary embolism;
sodium 130 is unrelated.
D. BNP elevation indicates myocardial infarction;
treat with high-dose IV fluids for hyponatremia.
E. Results indicate primary endocrine disorder
rather than heart failure.
Answer: B. Elevated BNP supports worsening heart
failure; hyponatremia reflects neurohormonal
activation and worse prognosis.
Rationale — correct (B): BNP rises with ventricular
stretch and is a sensitive marker for heart failure
exacerbation; hyponatremia in HF commonly results
from ADH and RAAS activation and is associated
with severity and poorer outcomes.
Rationale — incorrect:
A. BNP of 1,050 is markedly elevated (not normal);
