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 — STEMI initial action
A 62-year-old male arrives with 45 minutes of crushing
chest pain, diaphoresis, and nausea. EKG shows ST-
segment elevation in leads II, III, aVF. Troponin pending.
Which is the nurse’s highest priority action?
A. Give chewable aspirin 325 mg PO immediately.
B. Administer sublingual nitroglycerin.
C. Prepare for emergent percutaneous coronary
intervention (PCI).
D. Give IV morphine for pain.
Correct: A.
Rationale:
, o A (correct): Chewable aspirin reduces platelet
aggregation quickly and is recommended immediately
for suspected STEMI.
o B: NTG is appropriate for ischemic chest pain but after
aspirin and assessing blood pressure — aspirin is
faster to reduce mortality.
o C: Preparing for PCI is essential, but initial immediate
therapy includes aspirin; arrange transport/activation
concurrently.
o D: Morphine may relieve pain but is not first-line for
reducing mortality; give after aspirin and
hemodynamic assessment.
(Pathophys/S/S/diagnostics/interventions/teaching: STEMI =
acute coronary artery occlusion → ST elevation and troponin
rise; interventions include aspirin, reperfusion
(PCI/thrombolytics), analgesia; teach patient to chew aspirin
and seek immediate care for chest pain.)
2. MCQ — Heart failure assessment
A client with chronic heart failure (reduced ejection
fraction 28%) reports progressive dyspnea on exertion and
3-pillow orthopnea. Which physical finding best
corresponds with worsening left-sided HF?
A. Hepatomegaly and peripheral edema.
B. Crackles at lung bases and S3 gallop.
, C. Jugular venous distention and ascites.
D. Bounding pulses and wide pulse pressure.
Correct: B.
Rationale:
o A: Hepatomegaly and peripheral edema are more
associated with right-sided HF.
o B (correct): Left-sided HF causes pulmonary
congestion → crackles; S3 reflects increased
ventricular filling pressure.
o C: JVD and ascites reflect systemic venous congestion
(right-sided).
o D: Bounding pulses/wide pulse pressure are more
consistent with aortic regurgitation or high-output
states.
(Teach: Monitor weight, limit sodium/fluids as prescribed, take
HF meds daily, report sudden weight gain or increasing
dyspnea.)
3. MCQ — Anticoagulation interpretation
A patient with new atrial fibrillation is started on warfarin.
Which lab and target best reflects appropriate monitoring
and therapeutic goal?
A. Platelet count; >150,000/µL.
B. PT/INR; INR 2.0–3.0.
C. aPTT; 60–80 sec.
D. D-dimer; negative.
, Correct: B.
Rationale:
o A: Platelets are monitored with heparin/LMWH
monitoring for HIT risk, not warfarin therapeutic
effect.
o B (correct): Warfarin is monitored with PT/INR;
therapeutic INR for most AF indications is 2.0–3.0.
o C: aPTT monitors unfractionated heparin therapy, not
warfarin.
o D: D-dimer screens for thrombosis, not used to
monitor warfarin therapy.
(Teach: Keep consistent vitamin K intake; report bleeding;
frequent INR checks until stable.)
4. MCQ — Hypertensive urgency vs emergency
A client has BP 220/130 mm Hg but is awake, no chest pain
or neurologic deficits, and creatinine is 1.0. This is best
classified as:
A. Hypertensive emergency — IV antihypertensives and
ICU care.
B. Hypertensive urgency — oral meds adjustment and
close follow-up.
C. Normal BP for older adults.
D. Malignant hypertension requiring immediate dialysis.
Correct: B.
Rationale:
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 — STEMI initial action
A 62-year-old male arrives with 45 minutes of crushing
chest pain, diaphoresis, and nausea. EKG shows ST-
segment elevation in leads II, III, aVF. Troponin pending.
Which is the nurse’s highest priority action?
A. Give chewable aspirin 325 mg PO immediately.
B. Administer sublingual nitroglycerin.
C. Prepare for emergent percutaneous coronary
intervention (PCI).
D. Give IV morphine for pain.
Correct: A.
Rationale:
, o A (correct): Chewable aspirin reduces platelet
aggregation quickly and is recommended immediately
for suspected STEMI.
o B: NTG is appropriate for ischemic chest pain but after
aspirin and assessing blood pressure — aspirin is
faster to reduce mortality.
o C: Preparing for PCI is essential, but initial immediate
therapy includes aspirin; arrange transport/activation
concurrently.
o D: Morphine may relieve pain but is not first-line for
reducing mortality; give after aspirin and
hemodynamic assessment.
(Pathophys/S/S/diagnostics/interventions/teaching: STEMI =
acute coronary artery occlusion → ST elevation and troponin
rise; interventions include aspirin, reperfusion
(PCI/thrombolytics), analgesia; teach patient to chew aspirin
and seek immediate care for chest pain.)
2. MCQ — Heart failure assessment
A client with chronic heart failure (reduced ejection
fraction 28%) reports progressive dyspnea on exertion and
3-pillow orthopnea. Which physical finding best
corresponds with worsening left-sided HF?
A. Hepatomegaly and peripheral edema.
B. Crackles at lung bases and S3 gallop.
, C. Jugular venous distention and ascites.
D. Bounding pulses and wide pulse pressure.
Correct: B.
Rationale:
o A: Hepatomegaly and peripheral edema are more
associated with right-sided HF.
o B (correct): Left-sided HF causes pulmonary
congestion → crackles; S3 reflects increased
ventricular filling pressure.
o C: JVD and ascites reflect systemic venous congestion
(right-sided).
o D: Bounding pulses/wide pulse pressure are more
consistent with aortic regurgitation or high-output
states.
(Teach: Monitor weight, limit sodium/fluids as prescribed, take
HF meds daily, report sudden weight gain or increasing
dyspnea.)
3. MCQ — Anticoagulation interpretation
A patient with new atrial fibrillation is started on warfarin.
Which lab and target best reflects appropriate monitoring
and therapeutic goal?
A. Platelet count; >150,000/µL.
B. PT/INR; INR 2.0–3.0.
C. aPTT; 60–80 sec.
D. D-dimer; negative.
, Correct: B.
Rationale:
o A: Platelets are monitored with heparin/LMWH
monitoring for HIT risk, not warfarin therapeutic
effect.
o B (correct): Warfarin is monitored with PT/INR;
therapeutic INR for most AF indications is 2.0–3.0.
o C: aPTT monitors unfractionated heparin therapy, not
warfarin.
o D: D-dimer screens for thrombosis, not used to
monitor warfarin therapy.
(Teach: Keep consistent vitamin K intake; report bleeding;
frequent INR checks until stable.)
4. MCQ — Hypertensive urgency vs emergency
A client has BP 220/130 mm Hg but is awake, no chest pain
or neurologic deficits, and creatinine is 1.0. This is best
classified as:
A. Hypertensive emergency — IV antihypertensives and
ICU care.
B. Hypertensive urgency — oral meds adjustment and
close follow-up.
C. Normal BP for older adults.
D. Malignant hypertension requiring immediate dialysis.
Correct: B.
Rationale:
