Saunders Comprehensive Review for the NCLEX-PN®
Examination
9th Edition
Questions (1–20)
1 — Cardiovascular (Acute MI — priority intervention)
A 62-year-old man arrives with crushing substernal chest pain
that began 45 minutes ago, diaphoresis, and nausea. ECG shows
ST-segment elevation in leads V2–V4. Which nursing action is
the highest priority?
A. Prepare the patient for immediate cardiac catheterization
(percutaneous coronary intervention).
B. Give scheduled atorvastatin 40 mg PO.
C. Start a continuous heparin infusion immediately.
D. Obtain a chest X-ray and call for respiratory therapy.
Correct answer: A
Rationale:
A. Correct. For ST-elevation myocardial infarction (STEMI) within
the reperfusion window, primary percutaneous coronary
intervention (PCI) is the priority — rapid reperfusion limits
myocardial damage. The nurse prioritizes actions that expedite
transfer to the cath lab (IV access, ECG/handoff, consents) and
,supports time-sensitive reperfusion care. (Evidence-based MI
care emphasizes timely PCI for STEMI.) AHA Journals
B. Atorvastatin is indicated early in MI care but is not the
immediate priority over reperfusion.
C. Heparin may be indicated depending on protocol, but
initiating transfer and PCI is more time-sensitive.
D. Chest X-ray is not required before emergent reperfusion and
would delay definitive care.
2 — Cardiovascular (Heart failure — lab interpretation)
A 74-year-old woman with chronic heart failure is admitted for
worsening dyspnea. Her labs show BNP 1,200 pg/mL (reference
<100 pg/mL) and serum sodium 128 mEq/L. Which
interpretation is most accurate?
A. BNP is mildly elevated; hyponatremia indicates adrenal
insufficiency.
B. Elevated BNP supports decompensated heart failure;
hyponatremia reflects neurohormonal activation and volume
overload severity.
C. BNP is not relevant to heart failure; test for pulmonary
embolism.
D. Low sodium suggests dehydration and negates heart failure
diagnosis.
Correct answer: B
,Rationale:
B. Correct. BNP is released with ventricular stretch and is
commonly elevated in decompensated heart failure; markedly
elevated BNP supports volume overload/ventricular strain.
Hyponatremia in advanced heart failure typically reflects
neurohormonal activation (ADH/RAAS) and dilutional
hyponatremia associated with poorer prognosis. The nurse
recognizes both as markers of severity and prioritizes diuresis,
monitoring, and electrolyte management.
A. BNP is significantly elevated (1,200 pg/mL is high), and
hyponatremia in this context is more consistent with heart-
failure physiology than adrenal insufficiency.
C. BNP is relevant to heart failure assessment.
D. Hyponatremia due to dehydration would typically present
with hypovolemia; clinical context here indicates volume
overload.
3 — Cardiovascular (Anticoagulation — lab monitoring)
A patient on warfarin for a prosthetic valve has an INR of 2.0.
The provider has ordered a change aiming for therapeutic
anticoagulation. For a mechanical mitral valve, which nursing
action aligns with typical target INR and immediate
prioritization?
A. Hold warfarin and notify provider — target INR for
mechanical valves is normally lower than 1.5.
, B. Continue current warfarin — target INR is 1.8–2.2 for
prosthetic valves.
C. Prepare to administer a warfarin dose adjustment because
target INR for mechanical mitral valves is commonly 2.5–3.5.
D. Start low-molecular-weight heparin and stop warfarin
immediately.
Correct answer: C
Rationale:
C. Correct. Mechanical mitral valves generally require higher
therapeutic INR ranges (commonly 2.5–3.5) compared with
some other indications. An INR of 2.0 is below the typical
target; the nurse should anticipate dose adjustment per
protocol and monitor closely. (Nursing practice uses guideline
target ranges tailored to valve type.)
A. Incorrect — target INR is higher than 1.5 for mechanical
valves.
B. Incorrect — 1.8–2.2 is usually inadequate for mechanical
mitral valves.
D. Immediate bridging with LMWH may be used in some
situations (e.g., perioperative), but stopping warfarin without
provider instruction is inappropriate.
4 — Respiratory (COPD exacerbation — priority action)
Examination
9th Edition
Questions (1–20)
1 — Cardiovascular (Acute MI — priority intervention)
A 62-year-old man arrives with crushing substernal chest pain
that began 45 minutes ago, diaphoresis, and nausea. ECG shows
ST-segment elevation in leads V2–V4. Which nursing action is
the highest priority?
A. Prepare the patient for immediate cardiac catheterization
(percutaneous coronary intervention).
B. Give scheduled atorvastatin 40 mg PO.
C. Start a continuous heparin infusion immediately.
D. Obtain a chest X-ray and call for respiratory therapy.
Correct answer: A
Rationale:
A. Correct. For ST-elevation myocardial infarction (STEMI) within
the reperfusion window, primary percutaneous coronary
intervention (PCI) is the priority — rapid reperfusion limits
myocardial damage. The nurse prioritizes actions that expedite
transfer to the cath lab (IV access, ECG/handoff, consents) and
,supports time-sensitive reperfusion care. (Evidence-based MI
care emphasizes timely PCI for STEMI.) AHA Journals
B. Atorvastatin is indicated early in MI care but is not the
immediate priority over reperfusion.
C. Heparin may be indicated depending on protocol, but
initiating transfer and PCI is more time-sensitive.
D. Chest X-ray is not required before emergent reperfusion and
would delay definitive care.
2 — Cardiovascular (Heart failure — lab interpretation)
A 74-year-old woman with chronic heart failure is admitted for
worsening dyspnea. Her labs show BNP 1,200 pg/mL (reference
<100 pg/mL) and serum sodium 128 mEq/L. Which
interpretation is most accurate?
A. BNP is mildly elevated; hyponatremia indicates adrenal
insufficiency.
B. Elevated BNP supports decompensated heart failure;
hyponatremia reflects neurohormonal activation and volume
overload severity.
C. BNP is not relevant to heart failure; test for pulmonary
embolism.
D. Low sodium suggests dehydration and negates heart failure
diagnosis.
Correct answer: B
,Rationale:
B. Correct. BNP is released with ventricular stretch and is
commonly elevated in decompensated heart failure; markedly
elevated BNP supports volume overload/ventricular strain.
Hyponatremia in advanced heart failure typically reflects
neurohormonal activation (ADH/RAAS) and dilutional
hyponatremia associated with poorer prognosis. The nurse
recognizes both as markers of severity and prioritizes diuresis,
monitoring, and electrolyte management.
A. BNP is significantly elevated (1,200 pg/mL is high), and
hyponatremia in this context is more consistent with heart-
failure physiology than adrenal insufficiency.
C. BNP is relevant to heart failure assessment.
D. Hyponatremia due to dehydration would typically present
with hypovolemia; clinical context here indicates volume
overload.
3 — Cardiovascular (Anticoagulation — lab monitoring)
A patient on warfarin for a prosthetic valve has an INR of 2.0.
The provider has ordered a change aiming for therapeutic
anticoagulation. For a mechanical mitral valve, which nursing
action aligns with typical target INR and immediate
prioritization?
A. Hold warfarin and notify provider — target INR for
mechanical valves is normally lower than 1.5.
, B. Continue current warfarin — target INR is 1.8–2.2 for
prosthetic valves.
C. Prepare to administer a warfarin dose adjustment because
target INR for mechanical mitral valves is commonly 2.5–3.5.
D. Start low-molecular-weight heparin and stop warfarin
immediately.
Correct answer: C
Rationale:
C. Correct. Mechanical mitral valves generally require higher
therapeutic INR ranges (commonly 2.5–3.5) compared with
some other indications. An INR of 2.0 is below the typical
target; the nurse should anticipate dose adjustment per
protocol and monitor closely. (Nursing practice uses guideline
target ranges tailored to valve type.)
A. Incorrect — target INR is higher than 1.5 for mechanical
valves.
B. Incorrect — 1.8–2.2 is usually inadequate for mechanical
mitral valves.
D. Immediate bridging with LMWH may be used in some
situations (e.g., perioperative), but stopping warfarin without
provider instruction is inappropriate.
4 — Respiratory (COPD exacerbation — priority action)
