Saunders Comprehensive Review for the NCLEX-PN®
Examination
9th Edition
1 — Cardiovascular (Acute Coronary Syndrome / Priority)
A 62-year-old man is admitted with chest pain radiating to his
left jaw. ECG shows ST-segment elevation in leads II, III, and aVF.
He is pale, diaphoretic, and anxious. Vital signs: BP 100/64
mmHg, HR 110 bpm, RR 22, SpO₂ 95% on room air. Which
nursing action has highest priority now?
A. Give sublingual nitroglycerin and reassess pain.
B. Obtain baseline troponin and send for STAT lab.
C. Prepare the patient for emergent reperfusion therapy (PCI)
and notify cardiology.
D. Administer chewable aspirin 325 mg per protocol.
Correct answer: C
Rationale (correct): ST-elevation myocardial infarction (STEMI)
requires rapid reperfusion to limit myocardial necrosis;
preparing the patient for emergent percutaneous coronary
intervention (PCI) and notifying cardiology takes priority
because reperfusion within guideline time frames (door-to-
balloon) reduces mortality. The nurse’s first priority is to initiate
,the chain for definitive reperfusion while simultaneously
implementing other interventions.
Rationale (incorrect options):
A — Sublingual nitroglycerin can reduce ischemic chest pain but
must be used cautiously if hypotension or right ventricular
infarct is suspected; it is not the single highest priority when
STEMI reperfusion is needed immediately.
B — Troponin is important for diagnosis but awaiting labs
should not delay reperfusion activation.
D — Aspirin is standard and should be given early (if not
contraindicated), but activation/prep for PCI is higher priority to
restore perfusion rapidly.
2 — Cardiovascular (Heart Failure / Lab interpretation &
patient education)
A client with chronic heart failure (left-sided) is admitted with
worsening dyspnea and orthopnea. Latest labs show BNP 1450
pg/mL (elevated), serum Na 132 mEq/L, K 3.1 mEq/L. Which
finding requires the nurse to intervene first?
A. Patient reports two pillow orthopnea and PND last night.
B. Potassium 3.1 mEq/L and the patient is receiving oral
furosemide 40 mg daily.
C. BNP elevated to 1450 pg/mL.
D. Serum sodium 132 mEq/L.
Correct answer: B
,Rationale (correct): Hypokalemia (K 3.1) increases risk for
ventricular arrhythmias, especially in heart failure patients
taking loop diuretics (furosemide). The nurse must address
potassium (replace and monitor) promptly. This is the most
immediate correctable safety concern.
Rationale (incorrect options):
A — Orthopnea/PND indicate severity of heart failure but are
part of assessment and management; not the most immediate
lab-based risk.
C — Elevated BNP supports HF diagnosis and severity; it is not
an immediate life-threatening value requiring urgent correction.
D — Mild hyponatremia is common in HF, clinically important
for chronic management but less immediately dangerous than
hypokalemia.
Nursing actions/education: Replace potassium per facility
protocol, monitor telemetry, assess for digoxin use (increases
arrhythmia risk with hypokalemia), and teach regarding diuretic
adherence and dietary potassium sources.
3 — Respiratory (Asthma / Priority & patient education)
A 28-year-old with moderate persistent asthma presents with
increased wheeze and cough. Peak expiratory flow (PEF) is 55%
of personal best. He uses an albuterol inhaler PRN and takes
low-dose inhaled corticosteroid (ICS) daily. Which instruction is
the most important for the nurse to provide right now?
, A. “Use your albuterol nebulizer now and then reassess; if PEF
remains <60% of personal best, start your prescribed oral
steroid.”
B. “Begin taking antibiotics in case this is a bacterial bronchitis.”
C. “Stop using the ICS; it can increase your risk of infection.”
D. “Use your albuterol inhaler every 30 minutes for the next 3
doses at home.”
Correct answer: A
Rationale (correct): A PEF 55% indicates a moderate to severe
exacerbation (yellow/red zone depending on action plan).
Short-acting beta-agonist (SABA) administration (nebulized or
inhaler with spacer) and reassessment are immediate actions;
systemic corticosteroids are indicated if SABA response is
inadequate or moderate/severe exacerbation, as per asthma
action plans. This instruction prioritizes bronchodilation and
escalation per standard asthma management.
Rationale (incorrect options):
B — Antibiotics are not routinely indicated for asthma
exacerbations unless evidence of bacterial infection.
C — Stoping ICS is incorrect — ICS is controller therapy and
stopping would worsen control.
D — Suggesting fixed dosing at home (every 30 minutes)
without clinical reassessment is unsafe; initial SABA is
appropriate but further doses should be based on response and
guidelines.
Examination
9th Edition
1 — Cardiovascular (Acute Coronary Syndrome / Priority)
A 62-year-old man is admitted with chest pain radiating to his
left jaw. ECG shows ST-segment elevation in leads II, III, and aVF.
He is pale, diaphoretic, and anxious. Vital signs: BP 100/64
mmHg, HR 110 bpm, RR 22, SpO₂ 95% on room air. Which
nursing action has highest priority now?
A. Give sublingual nitroglycerin and reassess pain.
B. Obtain baseline troponin and send for STAT lab.
C. Prepare the patient for emergent reperfusion therapy (PCI)
and notify cardiology.
D. Administer chewable aspirin 325 mg per protocol.
Correct answer: C
Rationale (correct): ST-elevation myocardial infarction (STEMI)
requires rapid reperfusion to limit myocardial necrosis;
preparing the patient for emergent percutaneous coronary
intervention (PCI) and notifying cardiology takes priority
because reperfusion within guideline time frames (door-to-
balloon) reduces mortality. The nurse’s first priority is to initiate
,the chain for definitive reperfusion while simultaneously
implementing other interventions.
Rationale (incorrect options):
A — Sublingual nitroglycerin can reduce ischemic chest pain but
must be used cautiously if hypotension or right ventricular
infarct is suspected; it is not the single highest priority when
STEMI reperfusion is needed immediately.
B — Troponin is important for diagnosis but awaiting labs
should not delay reperfusion activation.
D — Aspirin is standard and should be given early (if not
contraindicated), but activation/prep for PCI is higher priority to
restore perfusion rapidly.
2 — Cardiovascular (Heart Failure / Lab interpretation &
patient education)
A client with chronic heart failure (left-sided) is admitted with
worsening dyspnea and orthopnea. Latest labs show BNP 1450
pg/mL (elevated), serum Na 132 mEq/L, K 3.1 mEq/L. Which
finding requires the nurse to intervene first?
A. Patient reports two pillow orthopnea and PND last night.
B. Potassium 3.1 mEq/L and the patient is receiving oral
furosemide 40 mg daily.
C. BNP elevated to 1450 pg/mL.
D. Serum sodium 132 mEq/L.
Correct answer: B
,Rationale (correct): Hypokalemia (K 3.1) increases risk for
ventricular arrhythmias, especially in heart failure patients
taking loop diuretics (furosemide). The nurse must address
potassium (replace and monitor) promptly. This is the most
immediate correctable safety concern.
Rationale (incorrect options):
A — Orthopnea/PND indicate severity of heart failure but are
part of assessment and management; not the most immediate
lab-based risk.
C — Elevated BNP supports HF diagnosis and severity; it is not
an immediate life-threatening value requiring urgent correction.
D — Mild hyponatremia is common in HF, clinically important
for chronic management but less immediately dangerous than
hypokalemia.
Nursing actions/education: Replace potassium per facility
protocol, monitor telemetry, assess for digoxin use (increases
arrhythmia risk with hypokalemia), and teach regarding diuretic
adherence and dietary potassium sources.
3 — Respiratory (Asthma / Priority & patient education)
A 28-year-old with moderate persistent asthma presents with
increased wheeze and cough. Peak expiratory flow (PEF) is 55%
of personal best. He uses an albuterol inhaler PRN and takes
low-dose inhaled corticosteroid (ICS) daily. Which instruction is
the most important for the nurse to provide right now?
, A. “Use your albuterol nebulizer now and then reassess; if PEF
remains <60% of personal best, start your prescribed oral
steroid.”
B. “Begin taking antibiotics in case this is a bacterial bronchitis.”
C. “Stop using the ICS; it can increase your risk of infection.”
D. “Use your albuterol inhaler every 30 minutes for the next 3
doses at home.”
Correct answer: A
Rationale (correct): A PEF 55% indicates a moderate to severe
exacerbation (yellow/red zone depending on action plan).
Short-acting beta-agonist (SABA) administration (nebulized or
inhaler with spacer) and reassessment are immediate actions;
systemic corticosteroids are indicated if SABA response is
inadequate or moderate/severe exacerbation, as per asthma
action plans. This instruction prioritizes bronchodilation and
escalation per standard asthma management.
Rationale (incorrect options):
B — Antibiotics are not routinely indicated for asthma
exacerbations unless evidence of bacterial infection.
C — Stoping ICS is incorrect — ICS is controller therapy and
stopping would worsen control.
D — Suggesting fixed dosing at home (every 30 minutes)
without clinical reassessment is unsafe; initial SABA is
appropriate but further doses should be based on response and
guidelines.
