Saunders Comprehensive Review for the NCLEX-PN®
Examination
9th Edition
Questions
1. (Cardiovascular — Acute MI / Pathophysiology & Priority
Intervention)
A 62-year-old man arrives to the ED with 45 minutes of crushing
substernal chest pain radiating to his left arm. ECG shows ST-
segment elevations in leads V2–V4. The patient is alert,
breathing comfortably, and has no known medication allergies.
Which action should the nurse perform first?
A. Prepare the patient for immediate percutaneous coronary
intervention (PCI).
B. Administer 325 mg chewable aspirin PO.
C. Give sublingual nitroglycerin for pain.
D. Start a continuous heparin infusion.
Answer: B. Administer 325 mg chewable aspirin PO.
Rationale — Correct: Early, immediate administration of non-
enteric chewable aspirin (unless contraindicated) reduces
mortality in suspected acute myocardial infarction and is among
the first actions in acute chest-pain management while other
interventions are initiated. Aspirin should be given as soon as
possible after arrival. NCBI+1
,Rationale — Incorrect:
• A: Preparing for PCI is essential for STEMI reperfusion, but
initial life-saving measures (including aspirin) are
implemented while the team readies PCI.
• C: Sublingual nitroglycerin is appropriate for ischemic chest
pain unless hypotension or PDE-5 inhibitor use; however,
aspirin has higher immediate mortality benefit and is the
priority first action.
• D: Heparin may be indicated but after initial antiplatelet
therapy and in coordination with the PCI plan; aspirin is
the immediate priority.
Client Needs: Safe and Effective Care Environment —
Management of Care.
Cognitive Level: Application
2. (Respiratory — ABG interpretation / COPD pathophysiology)
A patient with long-standing COPD has the following arterial
blood gas results on room air: pH 7.36, PaCO₂ 58 mm Hg, HCO₃⁻
34 mEq/L. Which interpretation is most accurate?
A. Uncompensated respiratory acidosis
B. Metabolic alkalosis with respiratory compensation
C. Chronic (compensated) respiratory acidosis
D. Mixed metabolic and respiratory acidosis
Answer: C. Chronic (compensated) respiratory acidosis.
,Rationale — Correct: In chronic CO₂ retention (COPD), PaCO₂ is
elevated and the kidneys retain bicarbonate (HCO₃⁻) to
compensate; pH will be near normal (7.35–7.45). An elevated
PaCO₂ with elevated HCO₃⁻ and near-normal pH indicates
chronic respiratory acidosis with metabolic compensation.
Rationale — Incorrect:
• A: Uncompensated respiratory acidosis would show low
pH with high PaCO₂ and normal HCO₃⁻.
• B: Metabolic alkalosis would present with high pH, not
near normal; respiratory compensation would produce
elevated PaCO₂ but not the pattern above.
• D: A mixed acidosis would show low pH and both acidotic
disturbances present.
Client Needs: Physiological Integrity — Reduction of Risk
Potential.
Cognitive Level: Analysis
3. (Neurological — Stroke / Priority nursing action)
A 71-year-old woman arrives with sudden right-sided weakness
and slurred speech that began 1 hour ago. The stroke team is
activated. Before administration of IV alteplase (tPA), which of
the following is the nurse’s immediate priority?
A. Obtain a non-contrast head CT to rule out intracranial
hemorrhage.
, B. Administer aspirin 325 mg PO.
C. Start a continuous heparin infusion.
D. Perform an MRI with gadolinium.
Answer: A. Obtain a non-contrast head CT to rule out
intracranial hemorrhage.
Rationale — Correct: For suspected ischemic stroke in
candidates for IV alteplase, a rapid non-contrast CT is required
to exclude intracranial hemorrhage prior to thrombolytic
therapy. Glucose should also be checked, but imaging is
essential before tPA. www.stroke.org
Rationale — Incorrect:
• B: Aspirin is used for secondary prevention but should not
be given prior to tPA (it may increase bleeding risk in the
acute tPA window).
• C: Heparin is not routinely started before tPA;
anticoagulation decisions depend on later imaging and
etiology.
• D: MRI takes longer and is not required before emergent
tPA; non-contrast CT is the urgent study.
Client Needs: Physiological Integrity — Reduction of Risk
Potential.
Cognitive Level: Application
Examination
9th Edition
Questions
1. (Cardiovascular — Acute MI / Pathophysiology & Priority
Intervention)
A 62-year-old man arrives to the ED with 45 minutes of crushing
substernal chest pain radiating to his left arm. ECG shows ST-
segment elevations in leads V2–V4. The patient is alert,
breathing comfortably, and has no known medication allergies.
Which action should the nurse perform first?
A. Prepare the patient for immediate percutaneous coronary
intervention (PCI).
B. Administer 325 mg chewable aspirin PO.
C. Give sublingual nitroglycerin for pain.
D. Start a continuous heparin infusion.
Answer: B. Administer 325 mg chewable aspirin PO.
Rationale — Correct: Early, immediate administration of non-
enteric chewable aspirin (unless contraindicated) reduces
mortality in suspected acute myocardial infarction and is among
the first actions in acute chest-pain management while other
interventions are initiated. Aspirin should be given as soon as
possible after arrival. NCBI+1
,Rationale — Incorrect:
• A: Preparing for PCI is essential for STEMI reperfusion, but
initial life-saving measures (including aspirin) are
implemented while the team readies PCI.
• C: Sublingual nitroglycerin is appropriate for ischemic chest
pain unless hypotension or PDE-5 inhibitor use; however,
aspirin has higher immediate mortality benefit and is the
priority first action.
• D: Heparin may be indicated but after initial antiplatelet
therapy and in coordination with the PCI plan; aspirin is
the immediate priority.
Client Needs: Safe and Effective Care Environment —
Management of Care.
Cognitive Level: Application
2. (Respiratory — ABG interpretation / COPD pathophysiology)
A patient with long-standing COPD has the following arterial
blood gas results on room air: pH 7.36, PaCO₂ 58 mm Hg, HCO₃⁻
34 mEq/L. Which interpretation is most accurate?
A. Uncompensated respiratory acidosis
B. Metabolic alkalosis with respiratory compensation
C. Chronic (compensated) respiratory acidosis
D. Mixed metabolic and respiratory acidosis
Answer: C. Chronic (compensated) respiratory acidosis.
,Rationale — Correct: In chronic CO₂ retention (COPD), PaCO₂ is
elevated and the kidneys retain bicarbonate (HCO₃⁻) to
compensate; pH will be near normal (7.35–7.45). An elevated
PaCO₂ with elevated HCO₃⁻ and near-normal pH indicates
chronic respiratory acidosis with metabolic compensation.
Rationale — Incorrect:
• A: Uncompensated respiratory acidosis would show low
pH with high PaCO₂ and normal HCO₃⁻.
• B: Metabolic alkalosis would present with high pH, not
near normal; respiratory compensation would produce
elevated PaCO₂ but not the pattern above.
• D: A mixed acidosis would show low pH and both acidotic
disturbances present.
Client Needs: Physiological Integrity — Reduction of Risk
Potential.
Cognitive Level: Analysis
3. (Neurological — Stroke / Priority nursing action)
A 71-year-old woman arrives with sudden right-sided weakness
and slurred speech that began 1 hour ago. The stroke team is
activated. Before administration of IV alteplase (tPA), which of
the following is the nurse’s immediate priority?
A. Obtain a non-contrast head CT to rule out intracranial
hemorrhage.
, B. Administer aspirin 325 mg PO.
C. Start a continuous heparin infusion.
D. Perform an MRI with gadolinium.
Answer: A. Obtain a non-contrast head CT to rule out
intracranial hemorrhage.
Rationale — Correct: For suspected ischemic stroke in
candidates for IV alteplase, a rapid non-contrast CT is required
to exclude intracranial hemorrhage prior to thrombolytic
therapy. Glucose should also be checked, but imaging is
essential before tPA. www.stroke.org
Rationale — Incorrect:
• B: Aspirin is used for secondary prevention but should not
be given prior to tPA (it may increase bleeding risk in the
acute tPA window).
• C: Heparin is not routinely started before tPA;
anticoagulation decisions depend on later imaging and
etiology.
• D: MRI takes longer and is not required before emergent
tPA; non-contrast CT is the urgent study.
Client Needs: Physiological Integrity — Reduction of Risk
Potential.
Cognitive Level: Application
