SAUNDERS COMPREHENSIVE REVIEW FOR THE NCLEX-
PN® EXAMINATION
9TH EDITION
• AUTHOR(S)LINDA ANNE SILVESTRI; ANGELA
SILVESTRI
System-Specific Test Bank (Cardiovascular, Respiratory,
Neurological, Endocrine, GI, Musculoskeletal, Oncology)
Cardiovascular (10 items)
1. (MCQ — Pathophysiology / Diagnostics)
A 68-year-old man with longstanding hypertension and
hyperlipidemia reports sudden onset of chest pressure radiating
to his left jaw and diaphoresis. ECG in triage shows ST-segment
elevation in leads II, III, and aVF. Which immediate nursing
action is highest priority?
A. Administer sublingual nitroglycerin.
B. Initiate continuous cardiac monitoring and prepare for
emergent reperfusion therapy (PCI).
C. Obtain a chest x-ray.
D. Draw blood for comprehensive metabolic panel and lipid
panel.
,Correct: B. Initiate continuous cardiac monitoring and prepare
for emergent reperfusion therapy (PCI).
Rationales:
A. Nitroglycerin can relieve ischemic pain but is not highest
priority—reperfusion within guideline door-to-balloon time is
critical for inferior STEMI. Nitroglycerin is contraindicated if
hypotensive or on PDE5 inhibitors.
B. Correct. ST elevations in II, III, aVF indicate inferior STEMI —
rapid reperfusion (PCI) and cardiac monitoring for arrhythmias
are priorities to reduce myocardial damage.
C. Chest x-ray is not urgent for STEMI and delays reperfusion.
D. Labs are important but not urgent compared with
reperfusion; drawing them should not delay PCI.
2. (MCQ — Signs/Symptoms / Nursing interventions)
A client with chronic heart failure (reduced EF) is admitted with
increasing dyspnea, orthopnea, and 4+ pitting edema. Which
nursing intervention addresses the pathophysiology of fluid
overload most directly?
A. Encourage frequent ambulation.
B. Administer IV loop diuretic as ordered.
C. Place client on low-fat diet.
D. Promote oral fluid intake.
Correct: B. Administer IV loop diuretic as ordered.
Rationales:
A. Ambulation can help venous return but does not remove
,excess intravascular volume.
B. Correct. Loop diuretics reduce preload by promoting diuresis,
relieving pulmonary and peripheral edema in decompensated
heart failure. Monitor electrolytes and renal function.
C. Low-fat diet does not address acute fluid retention.
D. Promoting fluids worsens volume overload.
3. (MCQ — Diagnostics / Interpretation)
A 55-year-old woman presents with palpitations and
lightheadedness. ECG shows irregularly irregular rhythm with
no P waves and variable R-R intervals. Which diagnostic test
best evaluates thromboembolic risk in this patient?
A. Troponin I level.
B. Echocardiogram.
C. D-dimer.
D. Calculate the CHA₂DS₂-VASc score.
Correct: D. Calculate the CHA₂DS₂-VASc score.
Rationales:
A. Troponin assesses myocardial injury, not stroke risk.
B. Echocardiogram can show structural abnormalities and
thrombus but isn't the initial thromboembolic risk calculator.
C. D-dimer is for VTE evaluation; not used for stroke risk in atrial
fibrillation.
D. Correct. The CHA₂DS₂-VASc score estimates stroke risk in
atrial fibrillation and guides anticoagulation decisions.
, 4. (NGN — Unfolding case, Step 1)
Background: A 72-year-old woman with a history of aortic
stenosis (AS) is scheduled for elective aortic valve replacement.
Preop nurse finds the patient anxious and reports exertional
syncope last week. VS: BP 110/60, HR 68, RR 16, O₂ 97% on
room air. Which assessment finding is most concerning and
requires immediate reporting to the surgical team? (Select one)
A. New harsh systolic crescendo-decrescendo murmur radiating
to the carotids.
B. Reported exertional syncope.
C. Elevated cholesterol level on chart.
D. Anxiety about surgery.
Correct: B. Reported exertional syncope.
Rationales:
A. Murmur is consistent with AS but expected.
B. Correct. Exertional syncope suggests critical AS with high risk
for sudden decompensation; must be communicated urgently
for periop planning.
C. Hyperlipidemia is chronic risk factor but not immediate.
D. Anxiety is important but not immediately life-threatening.
5. (NGN — Unfolding case, Step 2)
Same patient develops sudden hypotension (BP 78/40) and
diaphoresis in preop holding. Which is the priority nursing
PN® EXAMINATION
9TH EDITION
• AUTHOR(S)LINDA ANNE SILVESTRI; ANGELA
SILVESTRI
System-Specific Test Bank (Cardiovascular, Respiratory,
Neurological, Endocrine, GI, Musculoskeletal, Oncology)
Cardiovascular (10 items)
1. (MCQ — Pathophysiology / Diagnostics)
A 68-year-old man with longstanding hypertension and
hyperlipidemia reports sudden onset of chest pressure radiating
to his left jaw and diaphoresis. ECG in triage shows ST-segment
elevation in leads II, III, and aVF. Which immediate nursing
action is highest priority?
A. Administer sublingual nitroglycerin.
B. Initiate continuous cardiac monitoring and prepare for
emergent reperfusion therapy (PCI).
C. Obtain a chest x-ray.
D. Draw blood for comprehensive metabolic panel and lipid
panel.
,Correct: B. Initiate continuous cardiac monitoring and prepare
for emergent reperfusion therapy (PCI).
Rationales:
A. Nitroglycerin can relieve ischemic pain but is not highest
priority—reperfusion within guideline door-to-balloon time is
critical for inferior STEMI. Nitroglycerin is contraindicated if
hypotensive or on PDE5 inhibitors.
B. Correct. ST elevations in II, III, aVF indicate inferior STEMI —
rapid reperfusion (PCI) and cardiac monitoring for arrhythmias
are priorities to reduce myocardial damage.
C. Chest x-ray is not urgent for STEMI and delays reperfusion.
D. Labs are important but not urgent compared with
reperfusion; drawing them should not delay PCI.
2. (MCQ — Signs/Symptoms / Nursing interventions)
A client with chronic heart failure (reduced EF) is admitted with
increasing dyspnea, orthopnea, and 4+ pitting edema. Which
nursing intervention addresses the pathophysiology of fluid
overload most directly?
A. Encourage frequent ambulation.
B. Administer IV loop diuretic as ordered.
C. Place client on low-fat diet.
D. Promote oral fluid intake.
Correct: B. Administer IV loop diuretic as ordered.
Rationales:
A. Ambulation can help venous return but does not remove
,excess intravascular volume.
B. Correct. Loop diuretics reduce preload by promoting diuresis,
relieving pulmonary and peripheral edema in decompensated
heart failure. Monitor electrolytes and renal function.
C. Low-fat diet does not address acute fluid retention.
D. Promoting fluids worsens volume overload.
3. (MCQ — Diagnostics / Interpretation)
A 55-year-old woman presents with palpitations and
lightheadedness. ECG shows irregularly irregular rhythm with
no P waves and variable R-R intervals. Which diagnostic test
best evaluates thromboembolic risk in this patient?
A. Troponin I level.
B. Echocardiogram.
C. D-dimer.
D. Calculate the CHA₂DS₂-VASc score.
Correct: D. Calculate the CHA₂DS₂-VASc score.
Rationales:
A. Troponin assesses myocardial injury, not stroke risk.
B. Echocardiogram can show structural abnormalities and
thrombus but isn't the initial thromboembolic risk calculator.
C. D-dimer is for VTE evaluation; not used for stroke risk in atrial
fibrillation.
D. Correct. The CHA₂DS₂-VASc score estimates stroke risk in
atrial fibrillation and guides anticoagulation decisions.
, 4. (NGN — Unfolding case, Step 1)
Background: A 72-year-old woman with a history of aortic
stenosis (AS) is scheduled for elective aortic valve replacement.
Preop nurse finds the patient anxious and reports exertional
syncope last week. VS: BP 110/60, HR 68, RR 16, O₂ 97% on
room air. Which assessment finding is most concerning and
requires immediate reporting to the surgical team? (Select one)
A. New harsh systolic crescendo-decrescendo murmur radiating
to the carotids.
B. Reported exertional syncope.
C. Elevated cholesterol level on chart.
D. Anxiety about surgery.
Correct: B. Reported exertional syncope.
Rationales:
A. Murmur is consistent with AS but expected.
B. Correct. Exertional syncope suggests critical AS with high risk
for sudden decompensation; must be communicated urgently
for periop planning.
C. Hyperlipidemia is chronic risk factor but not immediate.
D. Anxiety is important but not immediately life-threatening.
5. (NGN — Unfolding case, Step 2)
Same patient develops sudden hypotension (BP 78/40) and
diaphoresis in preop holding. Which is the priority nursing
