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 NCLEX/NGN-style questions
1 (MCQ — Pathophysiology / S/S / Diagnostic)
A 68-year-old man with a history of coronary artery disease
presents with sudden, crushing chest pain radiating to his left
arm, diaphoresis, and nausea. ECG shows ST-segment elevation
in leads V2–V4. Which is the most appropriate immediate
nursing action?
A. Administer sublingual nitroglycerin and reassess in 5
minutes.
B. Obtain a 12-lead ECG to confirm ST-elevation myocardial
infarction (STEMI).
C. Prepare the patient for emergent percutaneous coronary
intervention (PCI) and notify the cath lab.
,D. Give high-dose oral aspirin and schedule cardiac enzymes in
24 hours.
Correct answer: C. Prepare the patient for emergent PCI and
notify the cath lab.
Rationales
• A. Nitroglycerin can relieve ischemic pain but does not
replace reperfusion; in suspected anterior STEMI,
immediate reperfusion is priority. Also nitroglycerin is
contraindicated if hypotension or recent
phosphodiesterase inhibitor use.
• B. A 12-lead ECG is essential, but the vignette already
reports ECG evidence of anterior STEMI. Repeating delays
reperfusion; the priority is activating the cath lab.
• C. Correct. For STEMI (ST elevation in V2–V4) rapid
reperfusion via PCI is indicated (goal: door-to-balloon ≤90
minutes). Nursing actions include activating cath lab,
preparing IV access, O₂ as needed, and coordinating team.
• D. Aspirin is indicated (chewable 162–325 mg)
immediately, but delaying reperfusion for enzyme
scheduling is inappropriate; enzymes are diagnostic but
not treatment.
2 (MCQ — Diagnostics / Interpretation)
,A nurse reviews lab results for a patient with suspected heart
failure: BNP 1,200 pg/mL (normal <100), serum creatinine 1.0
mg/dL, SaO₂ 94% on room air. Which statement is most
appropriate?
A. The elevated BNP supports the diagnosis of heart failure
exacerbation.
B. BNP is not useful because oxygen saturation is normal.
C. The BNP level indicates renal failure rather than heart failure.
D. Diuretics are contraindicated because creatinine is elevated.
Correct answer: A. The elevated BNP supports the diagnosis of
heart failure exacerbation.
Rationales
• A. Correct. BNP is released in response to ventricular
stretch; markedly elevated values (e.g., >400–500) support
HF exacerbation.
• B. Normal SaO₂ does not exclude HF; BNP remains useful
diagnostically.
• C. BNP can rise with renal dysfunction, but creatinine is
normal here. The large BNP is more consistent with HF.
• D. A creatinine of 1.0 mg/dL is within normal limits;
diuretics may be indicated in volume overload.
3 (MCQ — Nursing interventions)
, A patient with acute decompensated heart failure is receiving IV
furosemide. Which assessment finding warrants immediate
intervention?
A. Urine output 40 mL/hr for 2 hours.
B. Potassium 3.0 mEq/L on bedside lab.
C. Blood pressure 132/78 mm Hg.
D. Presence of pink frothy sputum.
Correct answer: D. Presence of pink frothy sputum.
Rationales
• A. 40 mL/hr is acceptable (target often >30 mL/hr);
continue to monitor.
• B. Important, hypokalemia (3.0) requires prompt
replacement, but pink frothy sputum indicates pulmonary
edema and imminent respiratory compromise — higher
priority.
• C. BP is acceptable.
• D. Correct. Pink frothy sputum signals acute pulmonary
edema; immediate actions include upright positioning,
oxygen, diuretics, and notify provider.
4 (MCQ — Patient teaching)
Which instruction is most important for a patient newly started
on warfarin after a mechanical valve replacement?
PN® EXAMINATION
9TH EDITION
• AUTHOR(S)LINDA ANNE SILVESTRI; ANGELA
SILVESTRI
System-Specific Test Bank (Cardiovascular, Respiratory,
Neurological, Endocrine, GI, Musculoskeletal, Oncology)
Cardiovascular — 10 NCLEX/NGN-style questions
1 (MCQ — Pathophysiology / S/S / Diagnostic)
A 68-year-old man with a history of coronary artery disease
presents with sudden, crushing chest pain radiating to his left
arm, diaphoresis, and nausea. ECG shows ST-segment elevation
in leads V2–V4. Which is the most appropriate immediate
nursing action?
A. Administer sublingual nitroglycerin and reassess in 5
minutes.
B. Obtain a 12-lead ECG to confirm ST-elevation myocardial
infarction (STEMI).
C. Prepare the patient for emergent percutaneous coronary
intervention (PCI) and notify the cath lab.
,D. Give high-dose oral aspirin and schedule cardiac enzymes in
24 hours.
Correct answer: C. Prepare the patient for emergent PCI and
notify the cath lab.
Rationales
• A. Nitroglycerin can relieve ischemic pain but does not
replace reperfusion; in suspected anterior STEMI,
immediate reperfusion is priority. Also nitroglycerin is
contraindicated if hypotension or recent
phosphodiesterase inhibitor use.
• B. A 12-lead ECG is essential, but the vignette already
reports ECG evidence of anterior STEMI. Repeating delays
reperfusion; the priority is activating the cath lab.
• C. Correct. For STEMI (ST elevation in V2–V4) rapid
reperfusion via PCI is indicated (goal: door-to-balloon ≤90
minutes). Nursing actions include activating cath lab,
preparing IV access, O₂ as needed, and coordinating team.
• D. Aspirin is indicated (chewable 162–325 mg)
immediately, but delaying reperfusion for enzyme
scheduling is inappropriate; enzymes are diagnostic but
not treatment.
2 (MCQ — Diagnostics / Interpretation)
,A nurse reviews lab results for a patient with suspected heart
failure: BNP 1,200 pg/mL (normal <100), serum creatinine 1.0
mg/dL, SaO₂ 94% on room air. Which statement is most
appropriate?
A. The elevated BNP supports the diagnosis of heart failure
exacerbation.
B. BNP is not useful because oxygen saturation is normal.
C. The BNP level indicates renal failure rather than heart failure.
D. Diuretics are contraindicated because creatinine is elevated.
Correct answer: A. The elevated BNP supports the diagnosis of
heart failure exacerbation.
Rationales
• A. Correct. BNP is released in response to ventricular
stretch; markedly elevated values (e.g., >400–500) support
HF exacerbation.
• B. Normal SaO₂ does not exclude HF; BNP remains useful
diagnostically.
• C. BNP can rise with renal dysfunction, but creatinine is
normal here. The large BNP is more consistent with HF.
• D. A creatinine of 1.0 mg/dL is within normal limits;
diuretics may be indicated in volume overload.
3 (MCQ — Nursing interventions)
, A patient with acute decompensated heart failure is receiving IV
furosemide. Which assessment finding warrants immediate
intervention?
A. Urine output 40 mL/hr for 2 hours.
B. Potassium 3.0 mEq/L on bedside lab.
C. Blood pressure 132/78 mm Hg.
D. Presence of pink frothy sputum.
Correct answer: D. Presence of pink frothy sputum.
Rationales
• A. 40 mL/hr is acceptable (target often >30 mL/hr);
continue to monitor.
• B. Important, hypokalemia (3.0) requires prompt
replacement, but pink frothy sputum indicates pulmonary
edema and imminent respiratory compromise — higher
priority.
• C. BP is acceptable.
• D. Correct. Pink frothy sputum signals acute pulmonary
edema; immediate actions include upright positioning,
oxygen, diuretics, and notify provider.
4 (MCQ — Patient teaching)
Which instruction is most important for a patient newly started
on warfarin after a mechanical valve replacement?
