Saunders Comprehensive Review for the NCLEX-PN®
Examination
9th Edition
1 — Cardiovascular (acute chest pain / triage)
A 62-year-old man arrives to the ED reporting 30 minutes of
crushing chest pain radiating to the jaw and left arm. Which
action should the nurse perform first?
A. Administer 325 mg chewable aspirin PO.
B. Obtain a 12-lead ECG and have it interpreted immediately.
C. Give sublingual nitroglycerin for pain.
D. Apply oxygen via nasal cannula at 2 L/min.
Answer: B. Obtain a 12-lead ECG and have it interpreted
immediately.
Rationale (correct): The priority for a patient with chest pain
suggestive of acute coronary syndrome is immediate ECG
acquisition and interpretation (goal: within 10 minutes of
arrival) to identify ST-elevation or other acute ischemic changes
and activate definitive care (e.g., PCI). Rapid ECG guides time-
sensitive interventions. AHA Journals+1
Rationale (incorrect):
A — Aspirin is important and should be given early unless
contraindicated, but diagnosis via ECG (and triage) is the
immediate first action to determine next steps.
,C — Nitroglycerin can relieve ischemic pain but may be
contraindicated (e.g., hypotension, recent PDE-5 inhibitor use)
and should follow rapid assessment/ECG.
D — Oxygen is indicated only if hypoxemia (SpO₂ <90%),
respiratory distress, or other high-risk features; routine
supplemental oxygen for all chest pain is not currently
recommended.
2 — Cardiovascular (HF lab interpretation)
A client with known chronic heart failure presents with
worsening dyspnea. Lab results: BNP 780 pg/mL (reference
<100), Hgb 12.2 g/dL, creatinine 1.1 mg/dL. Which
interpretation is most accurate?
A. BNP is consistent with decompensated heart failure and
supports the diagnosis of acute exacerbation.
B. Normal hemoglobin rules out significant volume overload.
C. Creatinine excludes renal contribution; BNP must be false
positive.
D. BNP is unreliable; rely only on chest x-ray for congestive
failure.
Answer: A. BNP is consistent with decompensated heart
failure and supports the diagnosis of acute exacerbation.
Rationale (correct): BNP (or NT-proBNP) rises with ventricular
stretch/volume overload and values in the several hundreds are
supportive of heart-failure exacerbation in the appropriate
,clinical context. Elevated BNP together with dyspnea increases
diagnostic likelihood of decompensated HF.
Rationale (incorrect):
B — Hemoglobin does not rule out volume overload; Hgb may
be normal while fluid overload exists.
C — Creatinine is one useful index of renal function but a
normal creatinine does not invalidate an elevated BNP;
cardiorenal interactions are complex.
D — BNP is a valid diagnostic adjunct; imaging (CXR) is useful
but not the sole diagnostic tool.
3 — Cardiovascular (post-MI medication teaching)
A client is discharged after an uncomplicated MI and is
prescribed lisinopril (an ACE inhibitor). Which teaching point is
most important for the nurse to emphasize?
A. “Take lisinopril only when you feel chest pain.”
B. “Stop the medication if you develop a dry, persistent cough.”
C. “You may feel dizzy when you first start — rise slowly and call
if severe lightheadedness.”
D. “You do not need to monitor your potassium while on this
medication.”
Answer: C. “You may feel dizzy when you first start — rise
slowly and call if severe lightheadedness.”
Rationale (correct): ACE inhibitors can cause hypotension
(especially after the first doses) and orthostatic symptoms.
, Patients should rise slowly and report severe dizziness or
syncope. Preventing falls and monitoring blood pressure are
priority teaching elements.
Rationale (incorrect):
A — ACE inhibitors are maintenance therapy; they are not for
episodic chest pain.
B — A dry cough is a known ACE inhibitor adverse effect;
however, the patient should notify the prescriber rather than
autonomously stop therapy because ACE inhibitors reduce
remodeling and mortality post-MI.
D — ACE inhibitors can increase potassium; patients (especially
those on other agents that raise potassium) may need
monitoring — it is incorrect to say monitoring isn’t needed.
4 — Cardiovascular (anticoagulation INR interpretation)
A client on warfarin therapy for atrial fibrillation has an INR
result of 1.2. The nurse should interpret this as:
A. Therapeutic anticoagulation.
B. Subtherapeutic — increased risk for thromboembolism.
C. Excessively anticoagulated — risk for bleeding.
D. Within expected variation; continue current dose without
follow-up.
Answer: B. Subtherapeutic — increased risk for
thromboembolism.
Examination
9th Edition
1 — Cardiovascular (acute chest pain / triage)
A 62-year-old man arrives to the ED reporting 30 minutes of
crushing chest pain radiating to the jaw and left arm. Which
action should the nurse perform first?
A. Administer 325 mg chewable aspirin PO.
B. Obtain a 12-lead ECG and have it interpreted immediately.
C. Give sublingual nitroglycerin for pain.
D. Apply oxygen via nasal cannula at 2 L/min.
Answer: B. Obtain a 12-lead ECG and have it interpreted
immediately.
Rationale (correct): The priority for a patient with chest pain
suggestive of acute coronary syndrome is immediate ECG
acquisition and interpretation (goal: within 10 minutes of
arrival) to identify ST-elevation or other acute ischemic changes
and activate definitive care (e.g., PCI). Rapid ECG guides time-
sensitive interventions. AHA Journals+1
Rationale (incorrect):
A — Aspirin is important and should be given early unless
contraindicated, but diagnosis via ECG (and triage) is the
immediate first action to determine next steps.
,C — Nitroglycerin can relieve ischemic pain but may be
contraindicated (e.g., hypotension, recent PDE-5 inhibitor use)
and should follow rapid assessment/ECG.
D — Oxygen is indicated only if hypoxemia (SpO₂ <90%),
respiratory distress, or other high-risk features; routine
supplemental oxygen for all chest pain is not currently
recommended.
2 — Cardiovascular (HF lab interpretation)
A client with known chronic heart failure presents with
worsening dyspnea. Lab results: BNP 780 pg/mL (reference
<100), Hgb 12.2 g/dL, creatinine 1.1 mg/dL. Which
interpretation is most accurate?
A. BNP is consistent with decompensated heart failure and
supports the diagnosis of acute exacerbation.
B. Normal hemoglobin rules out significant volume overload.
C. Creatinine excludes renal contribution; BNP must be false
positive.
D. BNP is unreliable; rely only on chest x-ray for congestive
failure.
Answer: A. BNP is consistent with decompensated heart
failure and supports the diagnosis of acute exacerbation.
Rationale (correct): BNP (or NT-proBNP) rises with ventricular
stretch/volume overload and values in the several hundreds are
supportive of heart-failure exacerbation in the appropriate
,clinical context. Elevated BNP together with dyspnea increases
diagnostic likelihood of decompensated HF.
Rationale (incorrect):
B — Hemoglobin does not rule out volume overload; Hgb may
be normal while fluid overload exists.
C — Creatinine is one useful index of renal function but a
normal creatinine does not invalidate an elevated BNP;
cardiorenal interactions are complex.
D — BNP is a valid diagnostic adjunct; imaging (CXR) is useful
but not the sole diagnostic tool.
3 — Cardiovascular (post-MI medication teaching)
A client is discharged after an uncomplicated MI and is
prescribed lisinopril (an ACE inhibitor). Which teaching point is
most important for the nurse to emphasize?
A. “Take lisinopril only when you feel chest pain.”
B. “Stop the medication if you develop a dry, persistent cough.”
C. “You may feel dizzy when you first start — rise slowly and call
if severe lightheadedness.”
D. “You do not need to monitor your potassium while on this
medication.”
Answer: C. “You may feel dizzy when you first start — rise
slowly and call if severe lightheadedness.”
Rationale (correct): ACE inhibitors can cause hypotension
(especially after the first doses) and orthostatic symptoms.
, Patients should rise slowly and report severe dizziness or
syncope. Preventing falls and monitoring blood pressure are
priority teaching elements.
Rationale (incorrect):
A — ACE inhibitors are maintenance therapy; they are not for
episodic chest pain.
B — A dry cough is a known ACE inhibitor adverse effect;
however, the patient should notify the prescriber rather than
autonomously stop therapy because ACE inhibitors reduce
remodeling and mortality post-MI.
D — ACE inhibitors can increase potassium; patients (especially
those on other agents that raise potassium) may need
monitoring — it is incorrect to say monitoring isn’t needed.
4 — Cardiovascular (anticoagulation INR interpretation)
A client on warfarin therapy for atrial fibrillation has an INR
result of 1.2. The nurse should interpret this as:
A. Therapeutic anticoagulation.
B. Subtherapeutic — increased risk for thromboembolism.
C. Excessively anticoagulated — risk for bleeding.
D. Within expected variation; continue current dose without
follow-up.
Answer: B. Subtherapeutic — increased risk for
thromboembolism.
