Saunders Comprehensive Review for the NCLEX-PN®
Examination
9th Edition
1 — Cardiovascular (Acute MI: priority intervention)
A 62-year-old male is admitted with crushing chest pain and ST-
elevation on ECG. He is hemodynamically stable, and the ED
team prepares for emergent reperfusion. Which nursing action
takes the highest priority immediately while waiting for
reperfusion therapy?
A. Give the prescribed sublingual nitroglycerin.
B. Obtain a 12-lead ECG and compare with previous tracings.
C. Start continuous IV access and prepare for administration of
aspirin and IV heparin per protocol.
D. Administer high-flow oxygen via nonrebreather mask.
Correct answer: C
Rationale — correct (C): In an ST-elevation myocardial
infarction (STEMI) where reperfusion is planned, establishing IV
access and initiating antiplatelet/antithrombotic therapy per
protocol (e.g., chewable aspirin immediately and
anticoagulation as ordered) is a priority to limit thrombus
extension and prepare for PCI/thrombolysis. Rapid vascular
access facilitates medication delivery and potential emergent
interventions (e.g., fibrinolytics, sedation). This action aligns
with evidence-based acute coronary syndrome management
,emphasizing early antiplatelet therapy and rapid reperfusion
readiness. American Heart Association Journals
Why the others are incorrect
A: Sublingual nitroglycerin reduces ischemic pain and preload
but may be contraindicated if taking phosphodiesterase
inhibitors or if hypotensive; it is important but not the single
highest priority over establishing IV access and giving aspirin.
B: A 12-lead ECG is essential and should already be obtained;
however, the stem indicates ST-elevation is identified —
immediate therapy preparations supersede repeating ECG.
D: Routine high-flow oxygen is not recommended for all MI
patients; oxygen is indicated only if hypoxemic (SpO₂ <90%), in
respiratory distress, or other signs of hypoxia.
2 — Cardiovascular (HF: lab interpretation & diuretics)
A patient with acute decompensated heart failure is receiving IV
furosemide. Early this morning the nurse notes the following
labs: Na⁺ 132 mEq/L, K⁺ 3.1 mEq/L, BUN 36 mg/dL, creatinine
1.6 mg/dL (baseline 1.0). The patient reports new muscle
weakness. Which nursing action is best?
A. Hold the furosemide and call the provider to report
hypokalemia and rising creatinine.
B. Give an oral potassium supplement with breakfast.
C. Increase the infusion rate of furosemide to improve fluid
removal and reduce BUN.
,D. Encourage the patient to eat a banana and document
findings.
Correct answer: A
Rationale — correct (A): The patient has hypokalemia (K⁺ 3.1
mEq/L) with muscle weakness and signs of worsening renal
function (creatinine increased from baseline). Holding further
loop diuretic until provider evaluation is appropriate because
ongoing diuresis could worsen electrolyte imbalance and renal
perfusion. The nurse should notify the provider immediately
and prepare for potassium replacement orders and potential
diuretic dose adjustment. Safety and prevention of arrhythmia
due to hypokalemia are priorities.
Why the others are incorrect
B: Oral potassium may be insufficient or contraindicated if GI
absorption concerns or severe deficit; also the provider must be
notified first given rising creatinine and symptoms.
C: Increasing diuresis risks further volume depletion and
worsening renal function and electrolyte losses.
D: Offering a banana alone is an insufficient intervention for
symptomatic hypokalemia and does not substitute for notifying
the provider and ordering replacement.
(Normal lab reference reminders used: K⁺ 3.5–5.0 mEq/L; values
computed per standard guidelines.)
3 — Respiratory (COPD exacerbation: priority)
, A 68-year-old male with COPD arrives with increased dyspnea
and productive cough. His respiratory rate is 30/min, SpO₂ 86%
on room air, and he is anxious. Which nursing action is the
priority?
A. Administer the patient’s prescribed bronchodilator (short-
acting beta₂ agonist) via nebulizer.
B. Place the patient on 2 L/min oxygen via nasal cannula and
reassess SpO₂.
C. Encourage pursed-lip breathing and positioning upright.
D. Obtain an arterial blood gas (ABG) and chest x-ray before
giving medications.
Correct answer: A
Rationale — correct (A): For acute COPD exacerbation with
hypoxemia and tachypnea, rapid bronchodilator administration
(short-acting beta₂ agonist) improves airway bronchospasm and
ventilation. While supplemental oxygen is important, COPD
patients risk CO₂ retention with high-flow oxygen;
bronchodilator therapy is immediate and improves ventilation.
Administering the bronchodilator per standing orders is a
priority while simultaneously preparing oxygen titrated to
target SpO₂ (typically 88–92% in COPD). Evidence-based
practice supports prompt bronchodilators in exacerbation
management.
Why the others are incorrect
B: Giving O₂ is important but must be titrated carefully in COPD
(target 88–92%); immediate bronchodilator typically precedes
Examination
9th Edition
1 — Cardiovascular (Acute MI: priority intervention)
A 62-year-old male is admitted with crushing chest pain and ST-
elevation on ECG. He is hemodynamically stable, and the ED
team prepares for emergent reperfusion. Which nursing action
takes the highest priority immediately while waiting for
reperfusion therapy?
A. Give the prescribed sublingual nitroglycerin.
B. Obtain a 12-lead ECG and compare with previous tracings.
C. Start continuous IV access and prepare for administration of
aspirin and IV heparin per protocol.
D. Administer high-flow oxygen via nonrebreather mask.
Correct answer: C
Rationale — correct (C): In an ST-elevation myocardial
infarction (STEMI) where reperfusion is planned, establishing IV
access and initiating antiplatelet/antithrombotic therapy per
protocol (e.g., chewable aspirin immediately and
anticoagulation as ordered) is a priority to limit thrombus
extension and prepare for PCI/thrombolysis. Rapid vascular
access facilitates medication delivery and potential emergent
interventions (e.g., fibrinolytics, sedation). This action aligns
with evidence-based acute coronary syndrome management
,emphasizing early antiplatelet therapy and rapid reperfusion
readiness. American Heart Association Journals
Why the others are incorrect
A: Sublingual nitroglycerin reduces ischemic pain and preload
but may be contraindicated if taking phosphodiesterase
inhibitors or if hypotensive; it is important but not the single
highest priority over establishing IV access and giving aspirin.
B: A 12-lead ECG is essential and should already be obtained;
however, the stem indicates ST-elevation is identified —
immediate therapy preparations supersede repeating ECG.
D: Routine high-flow oxygen is not recommended for all MI
patients; oxygen is indicated only if hypoxemic (SpO₂ <90%), in
respiratory distress, or other signs of hypoxia.
2 — Cardiovascular (HF: lab interpretation & diuretics)
A patient with acute decompensated heart failure is receiving IV
furosemide. Early this morning the nurse notes the following
labs: Na⁺ 132 mEq/L, K⁺ 3.1 mEq/L, BUN 36 mg/dL, creatinine
1.6 mg/dL (baseline 1.0). The patient reports new muscle
weakness. Which nursing action is best?
A. Hold the furosemide and call the provider to report
hypokalemia and rising creatinine.
B. Give an oral potassium supplement with breakfast.
C. Increase the infusion rate of furosemide to improve fluid
removal and reduce BUN.
,D. Encourage the patient to eat a banana and document
findings.
Correct answer: A
Rationale — correct (A): The patient has hypokalemia (K⁺ 3.1
mEq/L) with muscle weakness and signs of worsening renal
function (creatinine increased from baseline). Holding further
loop diuretic until provider evaluation is appropriate because
ongoing diuresis could worsen electrolyte imbalance and renal
perfusion. The nurse should notify the provider immediately
and prepare for potassium replacement orders and potential
diuretic dose adjustment. Safety and prevention of arrhythmia
due to hypokalemia are priorities.
Why the others are incorrect
B: Oral potassium may be insufficient or contraindicated if GI
absorption concerns or severe deficit; also the provider must be
notified first given rising creatinine and symptoms.
C: Increasing diuresis risks further volume depletion and
worsening renal function and electrolyte losses.
D: Offering a banana alone is an insufficient intervention for
symptomatic hypokalemia and does not substitute for notifying
the provider and ordering replacement.
(Normal lab reference reminders used: K⁺ 3.5–5.0 mEq/L; values
computed per standard guidelines.)
3 — Respiratory (COPD exacerbation: priority)
, A 68-year-old male with COPD arrives with increased dyspnea
and productive cough. His respiratory rate is 30/min, SpO₂ 86%
on room air, and he is anxious. Which nursing action is the
priority?
A. Administer the patient’s prescribed bronchodilator (short-
acting beta₂ agonist) via nebulizer.
B. Place the patient on 2 L/min oxygen via nasal cannula and
reassess SpO₂.
C. Encourage pursed-lip breathing and positioning upright.
D. Obtain an arterial blood gas (ABG) and chest x-ray before
giving medications.
Correct answer: A
Rationale — correct (A): For acute COPD exacerbation with
hypoxemia and tachypnea, rapid bronchodilator administration
(short-acting beta₂ agonist) improves airway bronchospasm and
ventilation. While supplemental oxygen is important, COPD
patients risk CO₂ retention with high-flow oxygen;
bronchodilator therapy is immediate and improves ventilation.
Administering the bronchodilator per standing orders is a
priority while simultaneously preparing oxygen titrated to
target SpO₂ (typically 88–92% in COPD). Evidence-based
practice supports prompt bronchodilators in exacerbation
management.
Why the others are incorrect
B: Giving O₂ is important but must be titrated carefully in COPD
(target 88–92%); immediate bronchodilator typically precedes
