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
Q1 (MCQ — Pathophysiology / Sx / Dx).
A 68-year-old man with long-standing hypertension reports
progressive dyspnea on exertion, orthopnea, and lower-
extremity edema. BNP is elevated, chest x-ray shows
cardiomegaly, and echocardiogram reveals LVEF 35%. Which of
the following is the most appropriate immediate nursing
priority?
A. Educate patient on low-sodium diet.
B. Administer IV furosemide as ordered and monitor urine
output.
C. Schedule cardiac rehabilitation referral.
D. Teach daily weight monitoring.
,Answer: B. Administer IV furosemide as ordered and monitor
urine output.
Rationales:
A. Important for long-term management but not immediate
priority for fluid overload.
B. Correct — diuresis reduces preload, relieves pulmonary
congestion and edema; monitoring urine output assesses
effectiveness and renal perfusion.
C. Cardiac rehab is secondary after hemodynamic stabilization.
D. Daily weights are part of teaching for chronic management,
not immediate stabilization.
Q2 (MCQ — Diagnostics / Interpretation).
A client’s telemetry shows intermittent multifocal PVCs with a
pattern of bigeminy. The client is asymptomatic and
hemodynamically stable. Which interpretation and nursing
action is best?
A. PVCs indicate imminent ventricular fibrillation — prepare
defibrillator.
B. Multifocal PVCs suggest electrolyte disturbance — check
potassium and magnesium.
C. Bigeminy requires immediate cardioversion.
D. No action required — normal variant.
Answer: B. Multifocal PVCs suggest electrolyte disturbance —
check potassium and magnesium.
,Rationales:
A. PVCs alone do not predict imminent VF; context matters.
B. Correct — multifocal PVCs often relate to
hypokalemia/hypomagnesemia, ischemia, or drug effects; labs
and treat electrolyte imbalances.
C. Cardioversion is for unstable tachyarrhythmias, not
asymptomatic PVCs.
D. Not appropriate — PVCs warrant assessment and
investigation.
Q3 (MCQ — Meds / Patient teaching).
A client newly prescribed an ACE inhibitor for heart failure asks
about side effects. Which statement indicates correct
understanding?
A. “I may develop a persistent cough; I should tell my nurse if
that happens.”
B. “I will avoid grapefruit juice while on this med.”
C. “I can take it with potassium supplements to prevent low
potassium.”
D. “It will raise my blood pressure.”
Answer: A. “I may develop a persistent cough; I should tell my
nurse if that happens.”
Rationales:
A. Correct — ACE inhibitors commonly cause dry cough; report
for med review.
B. Grapefruit interactions are with some calcium channel
, blockers and statins, not ACE inhibitors.
C. ACE inhibitors can increase potassium; taking supplements
without provider approval risks hyperkalemia.
D. ACE inhibitors lower blood pressure.
Q4 (NGN unfolding — Case Part 1: Assessment &
Prioritization).
Scenario: 74-year-old woman presents with sudden chest
pressure, diaphoresis, nausea. ECG shows ST-segment elevation
in leads II, III, aVF. Vital signs: BP 90/60, HR 110, RR 22, SpO₂
94% on room air. PCI is available. As the nurse, list the
immediate priorities (choose 3). Options: A. Give chewable
aspirin. B. Start morphine push. C. Prepare for emergent PCI
activation. D. Give high-flow oxygen. E. Insert IV and draw labs
(cardiac enzymes, electrolytes, type and cross).
Answer: A, C, E.
Rationales:
A. ASA chewed immediately reduces platelet aggregation —
standard immediate therapy for suspected STEMI.
B. Morphine may be used for pain but not before life-saving
treatments; use cautiously and after assessment.
C. Correct — STEMI requires rapid reperfusion; activate cath
lab/PCI.
D. Oxygen only if hypoxemic (SpO₂ <90%) — routine high-flow
oxygen not indicated here with SpO₂ 94%.
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
Q1 (MCQ — Pathophysiology / Sx / Dx).
A 68-year-old man with long-standing hypertension reports
progressive dyspnea on exertion, orthopnea, and lower-
extremity edema. BNP is elevated, chest x-ray shows
cardiomegaly, and echocardiogram reveals LVEF 35%. Which of
the following is the most appropriate immediate nursing
priority?
A. Educate patient on low-sodium diet.
B. Administer IV furosemide as ordered and monitor urine
output.
C. Schedule cardiac rehabilitation referral.
D. Teach daily weight monitoring.
,Answer: B. Administer IV furosemide as ordered and monitor
urine output.
Rationales:
A. Important for long-term management but not immediate
priority for fluid overload.
B. Correct — diuresis reduces preload, relieves pulmonary
congestion and edema; monitoring urine output assesses
effectiveness and renal perfusion.
C. Cardiac rehab is secondary after hemodynamic stabilization.
D. Daily weights are part of teaching for chronic management,
not immediate stabilization.
Q2 (MCQ — Diagnostics / Interpretation).
A client’s telemetry shows intermittent multifocal PVCs with a
pattern of bigeminy. The client is asymptomatic and
hemodynamically stable. Which interpretation and nursing
action is best?
A. PVCs indicate imminent ventricular fibrillation — prepare
defibrillator.
B. Multifocal PVCs suggest electrolyte disturbance — check
potassium and magnesium.
C. Bigeminy requires immediate cardioversion.
D. No action required — normal variant.
Answer: B. Multifocal PVCs suggest electrolyte disturbance —
check potassium and magnesium.
,Rationales:
A. PVCs alone do not predict imminent VF; context matters.
B. Correct — multifocal PVCs often relate to
hypokalemia/hypomagnesemia, ischemia, or drug effects; labs
and treat electrolyte imbalances.
C. Cardioversion is for unstable tachyarrhythmias, not
asymptomatic PVCs.
D. Not appropriate — PVCs warrant assessment and
investigation.
Q3 (MCQ — Meds / Patient teaching).
A client newly prescribed an ACE inhibitor for heart failure asks
about side effects. Which statement indicates correct
understanding?
A. “I may develop a persistent cough; I should tell my nurse if
that happens.”
B. “I will avoid grapefruit juice while on this med.”
C. “I can take it with potassium supplements to prevent low
potassium.”
D. “It will raise my blood pressure.”
Answer: A. “I may develop a persistent cough; I should tell my
nurse if that happens.”
Rationales:
A. Correct — ACE inhibitors commonly cause dry cough; report
for med review.
B. Grapefruit interactions are with some calcium channel
, blockers and statins, not ACE inhibitors.
C. ACE inhibitors can increase potassium; taking supplements
without provider approval risks hyperkalemia.
D. ACE inhibitors lower blood pressure.
Q4 (NGN unfolding — Case Part 1: Assessment &
Prioritization).
Scenario: 74-year-old woman presents with sudden chest
pressure, diaphoresis, nausea. ECG shows ST-segment elevation
in leads II, III, aVF. Vital signs: BP 90/60, HR 110, RR 22, SpO₂
94% on room air. PCI is available. As the nurse, list the
immediate priorities (choose 3). Options: A. Give chewable
aspirin. B. Start morphine push. C. Prepare for emergent PCI
activation. D. Give high-flow oxygen. E. Insert IV and draw labs
(cardiac enzymes, electrolytes, type and cross).
Answer: A, C, E.
Rationales:
A. ASA chewed immediately reduces platelet aggregation —
standard immediate therapy for suspected STEMI.
B. Morphine may be used for pain but not before life-saving
treatments; use cautiously and after assessment.
C. Correct — STEMI requires rapid reperfusion; activate cath
lab/PCI.
D. Oxygen only if hypoxemic (SpO₂ <90%) — routine high-flow
oxygen not indicated here with SpO₂ 94%.
