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 / Signs & Symptoms
A 68-year-old man with a history of hypertension and
hyperlipidemia reports exertional dyspnea, fatigue, and
orthopnea. On exam: bilateral inspiratory crackles, JVD, and an
S3 gallop. BNP is elevated. Which physiologic process best
explains his symptoms?
A. Increased left ventricular ejection fraction due to valvular
stenosis
B. Left ventricular systolic dysfunction causing reduced cardiac
output and pulmonary congestion
C. Right ventricular infarction causing pulmonary edema
D. Increased systemic vascular resistance from peripheral
vasodilation
,Correct answer: B
Rationales:
A. Incorrect — valvular stenosis alone doesn’t produce
increased EF; stenosis often reduces forward flow and can
cause symptoms but not increased EF.
B. Correct — systolic dysfunction reduces forward output →
increased left heart filling pressures → pulmonary congestion
(crackles, elevated BNP), orthopnea and S3.
C. Incorrect — right ventricular infarction causes systemic
venous congestion (JVD, peripheral edema), not pulmonary
edema predominantly.
D. Incorrect — peripheral vasodilation reduces afterload and
would not explain pulmonary congestion and reduced output.
2 (MCQ) — Diagnostic Interpretation / Nursing Action
A client with suspected acute coronary syndrome (ACS) arrives
complaining of chest pressure. Which immediate nursing action
is highest priority?
A. Obtain a 12-lead ECG and apply continuous cardiac
monitoring
B. Administer high-dose oral aspirin if not contraindicated
C. Draw serum cardiac biomarkers (troponin)
D. Administer sublingual nitroglycerin
Correct answer: A
,Rationales:
A. Correct — immediate 12-lead ECG is the priority in chest pain
to identify STEMI vs NSTEMI; continuous monitoring is also
essential.
B. Incorrect (but important) — early aspirin is recommended,
but ECG to triage emergent reperfusion takes priority.
C. Incorrect — troponin is important for diagnosis but is not
immediately diagnostic; ECG guides immediate management.
D. Incorrect — nitroglycerin may relieve ischemic pain but must
be used after assessing BP and ECG; ECG remains priority.
3 (MCQ) — Nursing Intervention / Teaching
A client with heart failure is prescribed furosemide. Which
statement by the client indicates correct understanding?
A. “I will avoid foods high in potassium and take extra salt.”
B. “I will weigh myself daily and call my provider for a 3-pound
gain in 24 hours.”
C. “I will take the diuretic at bedtime to reduce daytime
urination.”
D. “I should stop the medication when my breathing improves.”
Correct answer: B
Rationales:
A. Incorrect — loop diuretics can cause hypokalemia; client
should consume potassium-rich foods unless contraindicated,
not avoid them.
, B. Correct — daily weights for early detection of fluid retention;
a gain of ~2–3 lb (≈1–1.5 kg) in 24 hours is clinically significant.
C. Incorrect — diuretics are usually taken in the morning to
avoid nocturia and falls at night.
D. Incorrect — do not stop diuretics without provider guidance;
abrupt cessation can cause fluid overload.
4 (NGN — Unfolding Case: Prioritization & Diagnostic
Interpretation)
You receive these data for a 72-year-old female admitted with
acute decompensated heart failure: RR 26, SpO₂ 88% on room
air, HR 110 irregular, BP 150/86, urinary output 20 mL/hr,
crackles to mid-lung fields, weight +4 kg from baseline. Labs: K⁺
3.2 mEq/L, creatinine 1.6 mg/dL (baseline 1.0), BNP markedly
elevated.
Part A: List, in order of priority, the first four nursing actions you
would take (use numbered list 1–4).
Part B: Interpret the low urine output and rising creatinine —
what complication is the patient at risk for, and how does this
guide your diuretic plan?
Answers — Part A (priority order)
1. Apply oxygen and titrate to SpO₂ ≥ 92% (or as ordered) and
place on continuous cardiac/pulse oximetry monitoring.
2. Call the provider/rapid response team to report acute
decompensation and receive orders (IV diuretics likely).
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 / Signs & Symptoms
A 68-year-old man with a history of hypertension and
hyperlipidemia reports exertional dyspnea, fatigue, and
orthopnea. On exam: bilateral inspiratory crackles, JVD, and an
S3 gallop. BNP is elevated. Which physiologic process best
explains his symptoms?
A. Increased left ventricular ejection fraction due to valvular
stenosis
B. Left ventricular systolic dysfunction causing reduced cardiac
output and pulmonary congestion
C. Right ventricular infarction causing pulmonary edema
D. Increased systemic vascular resistance from peripheral
vasodilation
,Correct answer: B
Rationales:
A. Incorrect — valvular stenosis alone doesn’t produce
increased EF; stenosis often reduces forward flow and can
cause symptoms but not increased EF.
B. Correct — systolic dysfunction reduces forward output →
increased left heart filling pressures → pulmonary congestion
(crackles, elevated BNP), orthopnea and S3.
C. Incorrect — right ventricular infarction causes systemic
venous congestion (JVD, peripheral edema), not pulmonary
edema predominantly.
D. Incorrect — peripheral vasodilation reduces afterload and
would not explain pulmonary congestion and reduced output.
2 (MCQ) — Diagnostic Interpretation / Nursing Action
A client with suspected acute coronary syndrome (ACS) arrives
complaining of chest pressure. Which immediate nursing action
is highest priority?
A. Obtain a 12-lead ECG and apply continuous cardiac
monitoring
B. Administer high-dose oral aspirin if not contraindicated
C. Draw serum cardiac biomarkers (troponin)
D. Administer sublingual nitroglycerin
Correct answer: A
,Rationales:
A. Correct — immediate 12-lead ECG is the priority in chest pain
to identify STEMI vs NSTEMI; continuous monitoring is also
essential.
B. Incorrect (but important) — early aspirin is recommended,
but ECG to triage emergent reperfusion takes priority.
C. Incorrect — troponin is important for diagnosis but is not
immediately diagnostic; ECG guides immediate management.
D. Incorrect — nitroglycerin may relieve ischemic pain but must
be used after assessing BP and ECG; ECG remains priority.
3 (MCQ) — Nursing Intervention / Teaching
A client with heart failure is prescribed furosemide. Which
statement by the client indicates correct understanding?
A. “I will avoid foods high in potassium and take extra salt.”
B. “I will weigh myself daily and call my provider for a 3-pound
gain in 24 hours.”
C. “I will take the diuretic at bedtime to reduce daytime
urination.”
D. “I should stop the medication when my breathing improves.”
Correct answer: B
Rationales:
A. Incorrect — loop diuretics can cause hypokalemia; client
should consume potassium-rich foods unless contraindicated,
not avoid them.
, B. Correct — daily weights for early detection of fluid retention;
a gain of ~2–3 lb (≈1–1.5 kg) in 24 hours is clinically significant.
C. Incorrect — diuretics are usually taken in the morning to
avoid nocturia and falls at night.
D. Incorrect — do not stop diuretics without provider guidance;
abrupt cessation can cause fluid overload.
4 (NGN — Unfolding Case: Prioritization & Diagnostic
Interpretation)
You receive these data for a 72-year-old female admitted with
acute decompensated heart failure: RR 26, SpO₂ 88% on room
air, HR 110 irregular, BP 150/86, urinary output 20 mL/hr,
crackles to mid-lung fields, weight +4 kg from baseline. Labs: K⁺
3.2 mEq/L, creatinine 1.6 mg/dL (baseline 1.0), BNP markedly
elevated.
Part A: List, in order of priority, the first four nursing actions you
would take (use numbered list 1–4).
Part B: Interpret the low urine output and rising creatinine —
what complication is the patient at risk for, and how does this
guide your diuretic plan?
Answers — Part A (priority order)
1. Apply oxygen and titrate to SpO₂ ≥ 92% (or as ordered) and
place on continuous cardiac/pulse oximetry monitoring.
2. Call the provider/rapid response team to report acute
decompensation and receive orders (IV diuretics likely).
