Saunders Comprehensive Review for the NCLEX-PN®
Examination
9th Edition
Questions (1–20)
1 — Cardiovascular (Heart failure — pathophysiology &
priority action)
A 68-year-old man with chronic systolic heart failure (EF
30%) is admitted with increasing dyspnea, orthopnea,
and bilateral crackles. His weight has increased 4 kg in 3
days. Vital signs: BP 110/68, HR 102, RR 24, SpO₂ 91% on
room air. Which nursing action has the highest priority?
A. Teach the patient to restrict sodium to ≤2 g/day
B. Elevate the head of the bed and administer
supplemental oxygen as ordered
C. Weigh the patient daily and document intake/output
D. Administer furosemide (lasix) IV as prescribed
Correct answer: B
Rationale — Correct (B): The patient shows acute
decompensated heart failure with pulmonary congestion
,(dyspnea, orthopnea, crackles, hypoxemia). Immediate
priority is to improve oxygenation and reduce work of
breathing — elevate head of bed and give supplemental
oxygen per order. This addresses the ABCs
(airway/oxygenation) and stabilizes before other
interventions. Evidence-based nursing practice prioritizes
airway and oxygenation in cardiopulmonary compromise.
Why not A: Sodium restriction is important long-term
management but is not the immediate priority in acute
decompensation.
Why not C: Daily weights and I/O are essential for
monitoring fluid status but are monitoring actions, not
the immediate priority to relieve hypoxemia.
Why not D: IV diuretics are often indicated (and may be
next) but oxygenation/positioning must be initiated
immediately; if diuretic administration is already ordered
and available, give it promptly — however
airway/oxygenation remains the first priority action.
Teaching point: For acute pulmonary edema, position
upright, give oxygen, and follow with diuretics and other
orders to reduce preload and afterload.
,2 — Cardiovascular (Acute coronary syndrome:
recognition & priority)
A 58-year-old woman arrives with chest pressure
radiating to jaw and left arm for 45 minutes. ECG shows
ST elevation in leads V2–V4. Which nursing action is
highest priority?
A. Obtain a 12-lead ECG and administer chewable aspirin
per protocol
B. Start IV access and prepare the patient for emergent
reperfusion therapy (PCI) per facility protocol
C. Administer sublingual nitroglycerin and monitor BP
every 5 minutes
D. Give morphine for pain control and anxiety reduction
Correct answer: B
Rationale — Correct (B): ST-elevation myocardial
infarction (STEMI) requires rapid reperfusion (PCI or
fibrinolysis) to limit infarct size. Starting IV access and
preparing for emergent reperfusion is the priority to
expedite definitive treatment. Time to reperfusion
critically affects outcomes.
Why not A: Obtaining ECG and aspirin are important and
usually come earlier, but the stem already indicates ST
elevation (ECG done). The highest priority now is to
, expedite reperfusion (PCI activation). If ECG not done yet,
it would be first — but here activation/prep is top.
Why not C: Nitroglycerin can relieve ischemic pain but
may lower blood pressure and is not the key life-saving
intervention when reperfusion must be initiated urgently.
Why not D: Morphine can help pain but does not
improve survival and is not the priority over reperfusion.
Teaching: For STEMI, door-to-balloon and door-to-needle
times are critical — activate cath lab and prepare patient
(IV, consent, labs, anticoagulation as ordered).
3 — Cardiovascular (Anticoagulation education)
A patient with new atrial fibrillation is prescribed
warfarin. Which statement by the patient indicates
correct understanding of warfarin teaching?
A. “I will stop taking my aspirin now that I am on
warfarin.”
B. “I will have my INR checked regularly and keep my diet
consistent in vitamin K.”
C. “If my gums bleed, I will stop the warfarin
immediately.”
D. “I can take OTC decongestants whenever I need them.”
Examination
9th Edition
Questions (1–20)
1 — Cardiovascular (Heart failure — pathophysiology &
priority action)
A 68-year-old man with chronic systolic heart failure (EF
30%) is admitted with increasing dyspnea, orthopnea,
and bilateral crackles. His weight has increased 4 kg in 3
days. Vital signs: BP 110/68, HR 102, RR 24, SpO₂ 91% on
room air. Which nursing action has the highest priority?
A. Teach the patient to restrict sodium to ≤2 g/day
B. Elevate the head of the bed and administer
supplemental oxygen as ordered
C. Weigh the patient daily and document intake/output
D. Administer furosemide (lasix) IV as prescribed
Correct answer: B
Rationale — Correct (B): The patient shows acute
decompensated heart failure with pulmonary congestion
,(dyspnea, orthopnea, crackles, hypoxemia). Immediate
priority is to improve oxygenation and reduce work of
breathing — elevate head of bed and give supplemental
oxygen per order. This addresses the ABCs
(airway/oxygenation) and stabilizes before other
interventions. Evidence-based nursing practice prioritizes
airway and oxygenation in cardiopulmonary compromise.
Why not A: Sodium restriction is important long-term
management but is not the immediate priority in acute
decompensation.
Why not C: Daily weights and I/O are essential for
monitoring fluid status but are monitoring actions, not
the immediate priority to relieve hypoxemia.
Why not D: IV diuretics are often indicated (and may be
next) but oxygenation/positioning must be initiated
immediately; if diuretic administration is already ordered
and available, give it promptly — however
airway/oxygenation remains the first priority action.
Teaching point: For acute pulmonary edema, position
upright, give oxygen, and follow with diuretics and other
orders to reduce preload and afterload.
,2 — Cardiovascular (Acute coronary syndrome:
recognition & priority)
A 58-year-old woman arrives with chest pressure
radiating to jaw and left arm for 45 minutes. ECG shows
ST elevation in leads V2–V4. Which nursing action is
highest priority?
A. Obtain a 12-lead ECG and administer chewable aspirin
per protocol
B. Start IV access and prepare the patient for emergent
reperfusion therapy (PCI) per facility protocol
C. Administer sublingual nitroglycerin and monitor BP
every 5 minutes
D. Give morphine for pain control and anxiety reduction
Correct answer: B
Rationale — Correct (B): ST-elevation myocardial
infarction (STEMI) requires rapid reperfusion (PCI or
fibrinolysis) to limit infarct size. Starting IV access and
preparing for emergent reperfusion is the priority to
expedite definitive treatment. Time to reperfusion
critically affects outcomes.
Why not A: Obtaining ECG and aspirin are important and
usually come earlier, but the stem already indicates ST
elevation (ECG done). The highest priority now is to
, expedite reperfusion (PCI activation). If ECG not done yet,
it would be first — but here activation/prep is top.
Why not C: Nitroglycerin can relieve ischemic pain but
may lower blood pressure and is not the key life-saving
intervention when reperfusion must be initiated urgently.
Why not D: Morphine can help pain but does not
improve survival and is not the priority over reperfusion.
Teaching: For STEMI, door-to-balloon and door-to-needle
times are critical — activate cath lab and prepare patient
(IV, consent, labs, anticoagulation as ordered).
3 — Cardiovascular (Anticoagulation education)
A patient with new atrial fibrillation is prescribed
warfarin. Which statement by the patient indicates
correct understanding of warfarin teaching?
A. “I will stop taking my aspirin now that I am on
warfarin.”
B. “I will have my INR checked regularly and keep my diet
consistent in vitamin K.”
C. “If my gums bleed, I will stop the warfarin
immediately.”
D. “I can take OTC decongestants whenever I need them.”
