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 questions
1. (MCQ — Pathophysiology / HF exacerbation)
A 72-year-old man with chronic heart failure presents with
progressive dyspnea, orthopnea, bibasilar crackles, and 3+
pitting edema. BNP is elevated. Which pathophysiologic process
best explains his symptoms?
A. Reduced preload due to dehydration
B. Left ventricular systolic dysfunction causing decreased
ejection fraction and pulmonary congestion
C. Primary pulmonary disease causing secondary right heart
strain
D. Atrial fibrillation causing increased cardiac output
Correct: B
Rationales
, • A: Incorrect — dehydration reduces preload and would
usually reduce pulmonary congestion, not cause it.
• B: Correct — LV systolic dysfunction decreases ejection
fraction → increased left-sided pressures → pulmonary
venous congestion, dyspnea, crackles, elevated BNP.
• C: Incorrect — primary pulmonary disease can cause
similar symptoms but BNP elevation and peripheral edema
on this history point to cardiac cause.
• D: Incorrect — AF often reduces cardiac output (loss of
atrial kick) and does not increase output.
Teaching: In systolic HF, treatment targets afterload reduction,
diuresis, and improving contractility as appropriate; assess BNP
and CXR/echocardiogram for confirmation.
2. (MCQ — Diagnostic interpretation)
A patient is admitted with chest pain. ECG shows ST-segment
elevations in leads V1–V4. Troponin I is elevated. Which
coronary artery is most likely occluded?
A. Right coronary artery (RCA)
B. Left circumflex (LCx) artery
C. Left anterior descending (LAD) artery
D. Posterior descending artery (PDA)
Correct: C
Rationales
, • A: Incorrect — RCA occlusion typically affects inferior leads
(II, III, aVF).
• B: Incorrect — LCx commonly affects lateral leads (I, aVL,
V5–V6).
• C: Correct — ST elevations in V1–V4 localize to the anterior
wall supplied by the LAD.
• D: Incorrect — PDA affects inferior/posterior regions, not
V1–V4.
Teaching: Rapid recognition of anterior STEMI (LAD) is critical —
emergent reperfusion (PCI) within guideline timeframes saves
myocardium.
3. (NGN-style — Prioritization / acute chest pain)
Unfolding data: 58-year-old female with hypertension presents
with sudden, severe chest pain radiating to jaw; diaphoresis; BP
90/60, HR 120; ECG: ST-elevations in leads II, III, aVF; bedside
ultrasound: RV hypokinesis. Her airway is patent; she is anxious
and pale.
Question: Which nursing action is highest priority now?
A. Administer sublingual nitroglycerin immediately
B. Prepare for emergent percutaneous coronary intervention
(PCI) and notify cath lab while giving aspirin chewed
C. Lay the patient flat and give a fluid bolus to increase BP
, D. Obtain a chest CT angiogram to rule out pulmonary
embolism
Correct: B
Rationales
• A: Incorrect — NTG may worsen hypotension in right
ventricular infarction (inferior MI with RV involvement) and
is contraindicated with hypotension.
• B: Correct — chewed aspirin and rapid activation of cath
lab for reperfusion is priority; prepare for PCI while
monitoring hemodynamics.
• C: Incorrect — laying flat and fluid might be considered if
RV infarct with hypotension, but the nurse must first
prepare for definitive reperfusion and avoid blind volume
unless ordered after assessment.
• D: Incorrect — CT angiogram would delay reperfusion and
is lower priority for confirmed STEMI.
Teaching: Inferior STEMI with RV involvement requires caution
with nitrates; aspirin and rapid reperfusion are lifesaving
priorities.
4. (MCQ — Medication understanding)
A patient with atrial fibrillation is started on warfarin. Which lab
is used to monitor therapeutic anticoagulation for this patient
and which value is target?
PN® EXAMINATION
9TH EDITION
• AUTHOR(S)LINDA ANNE SILVESTRI; ANGELA
SILVESTRI
System-Specific Test Bank (Cardiovascular, Respiratory,
Neurological, Endocrine, GI, Musculoskeletal, Oncology)
Cardiovascular — 10 questions
1. (MCQ — Pathophysiology / HF exacerbation)
A 72-year-old man with chronic heart failure presents with
progressive dyspnea, orthopnea, bibasilar crackles, and 3+
pitting edema. BNP is elevated. Which pathophysiologic process
best explains his symptoms?
A. Reduced preload due to dehydration
B. Left ventricular systolic dysfunction causing decreased
ejection fraction and pulmonary congestion
C. Primary pulmonary disease causing secondary right heart
strain
D. Atrial fibrillation causing increased cardiac output
Correct: B
Rationales
, • A: Incorrect — dehydration reduces preload and would
usually reduce pulmonary congestion, not cause it.
• B: Correct — LV systolic dysfunction decreases ejection
fraction → increased left-sided pressures → pulmonary
venous congestion, dyspnea, crackles, elevated BNP.
• C: Incorrect — primary pulmonary disease can cause
similar symptoms but BNP elevation and peripheral edema
on this history point to cardiac cause.
• D: Incorrect — AF often reduces cardiac output (loss of
atrial kick) and does not increase output.
Teaching: In systolic HF, treatment targets afterload reduction,
diuresis, and improving contractility as appropriate; assess BNP
and CXR/echocardiogram for confirmation.
2. (MCQ — Diagnostic interpretation)
A patient is admitted with chest pain. ECG shows ST-segment
elevations in leads V1–V4. Troponin I is elevated. Which
coronary artery is most likely occluded?
A. Right coronary artery (RCA)
B. Left circumflex (LCx) artery
C. Left anterior descending (LAD) artery
D. Posterior descending artery (PDA)
Correct: C
Rationales
, • A: Incorrect — RCA occlusion typically affects inferior leads
(II, III, aVF).
• B: Incorrect — LCx commonly affects lateral leads (I, aVL,
V5–V6).
• C: Correct — ST elevations in V1–V4 localize to the anterior
wall supplied by the LAD.
• D: Incorrect — PDA affects inferior/posterior regions, not
V1–V4.
Teaching: Rapid recognition of anterior STEMI (LAD) is critical —
emergent reperfusion (PCI) within guideline timeframes saves
myocardium.
3. (NGN-style — Prioritization / acute chest pain)
Unfolding data: 58-year-old female with hypertension presents
with sudden, severe chest pain radiating to jaw; diaphoresis; BP
90/60, HR 120; ECG: ST-elevations in leads II, III, aVF; bedside
ultrasound: RV hypokinesis. Her airway is patent; she is anxious
and pale.
Question: Which nursing action is highest priority now?
A. Administer sublingual nitroglycerin immediately
B. Prepare for emergent percutaneous coronary intervention
(PCI) and notify cath lab while giving aspirin chewed
C. Lay the patient flat and give a fluid bolus to increase BP
, D. Obtain a chest CT angiogram to rule out pulmonary
embolism
Correct: B
Rationales
• A: Incorrect — NTG may worsen hypotension in right
ventricular infarction (inferior MI with RV involvement) and
is contraindicated with hypotension.
• B: Correct — chewed aspirin and rapid activation of cath
lab for reperfusion is priority; prepare for PCI while
monitoring hemodynamics.
• C: Incorrect — laying flat and fluid might be considered if
RV infarct with hypotension, but the nurse must first
prepare for definitive reperfusion and avoid blind volume
unless ordered after assessment.
• D: Incorrect — CT angiogram would delay reperfusion and
is lower priority for confirmed STEMI.
Teaching: Inferior STEMI with RV involvement requires caution
with nitrates; aspirin and rapid reperfusion are lifesaving
priorities.
4. (MCQ — Medication understanding)
A patient with atrial fibrillation is started on warfarin. Which lab
is used to monitor therapeutic anticoagulation for this patient
and which value is target?
