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
Q1 (MCQ — pathophysiology/diagnostic)
A 68-year-old male with hypertension presents with exertional
dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. On
exam: bibasilar crackles and S3 gallop. BNP is elevated. Which
best explains his symptoms?
A. Left-sided heart failure causing pulmonary congestion.
B. Right-sided heart failure causing systemic venous congestion.
C. Diastolic dysfunction causing decreased right ventricular
output.
D. Acute myocardial infarction causing papillary muscle rupture.
Answer: A
Rationale:
A — Correct. Left ventricular (LV) systolic or diastolic failure
,causes pulmonary venous congestion → dyspnea, orthopnea,
elevated BNP, S3.
B — Incorrect. Right-sided failure produces JVD, hepatomegaly,
peripheral edema rather than pulmonary crackles.
C — Incorrect. Diastolic dysfunction decreases LV filling and
causes pulmonary symptoms, but phrasing “decreased right
ventricular output” is wrong.
D — Incorrect. MI with papillary muscle rupture causes acute
MR and pulmonary edema but would present more acutely and
with murmur/hemodynamic collapse.
Q2 (MCQ — diagnostics/nursing intervention)
A patient with suspected acute coronary syndrome has 12-lead
ECG showing ST-elevation in V2–V4. Which is the immediate
nursing priority?
A. Give aspirin and prepare for reperfusion therapy.
B. Obtain a chest x-ray to confirm cardiomegaly.
C. Begin beta-blocker therapy immediately at home dose.
D. Schedule an echocardiogram next week.
Answer: A
Rationale:
A — Correct. ST-elevation MI (anterior leads) requires
immediate antiplatelet (aspirin) and urgent reperfusion (PCI)
per guidelines.
B — Incorrect. Chest x-ray is not immediate priority for STEMI.
,C — Incorrect. Beta-blockers are used, but initiating without
hemodynamic assessment can be harmful acutely.
D — Incorrect. Delay would risk myocardial damage.
Q3 (NGN unfolding case — triage/prioritization)
Case: A 54-year-old woman postoperative day 2 after CABG has
sudden chest pain, hypotension (BP 82/50), muffled heart
sounds, and JVD.
Item 1: What is the most likely diagnosis?
Item 2: Which immediate nursing action is priority?
Item 3: Which diagnostic test confirms the diagnosis?
Answers & Rationales:
1. Cardiac tamponade — Beck’s triad (hypotension, muffled
heart sounds, JVD) after cardiac surgery suggests
pericardial tamponade.
2. Notify MD/activate rapid response and prepare for
emergent pericardiocentesis — Immediate drainage is life-
saving; stabilize with IV fluids if ordered to improve
preload.
3. Stat transthoracic echocardiogram (TTE) — Echo confirms
pericardial effusion and tamponade physiology. Chest x-ray
is not diagnostic.
Q4 (MCQ — pharmacology/patient teaching)
, A patient with chronic heart failure is prescribed
spironolactone. Which teaching point is most important?
A. Expect improved kidney function immediately.
B. Avoid foods high in potassium and monitor potassium.
C. Stop taking ACE inhibitor when starting spironolactone.
D. Spironolactone causes severe hypotension in all patients.
Answer: B
Rationale:
A — Incorrect. Spironolactone is potassium-sparing and does
not improve kidney function immediately.
B — Correct. Hyperkalemia risk—avoid K supplements/high-K
foods and monitor serum K.
C — Incorrect. ACE inhibitors may be continued but potassium
must be monitored; do not stop without order.
D — Incorrect. Hypotension is not universal; main risk is
hyperkalemia.
Q5 (MCQ — diagnostic interpretation)
A 72-year-old with exertional syncope has an echocardiogram
showing aortic valve area 0.7 cm², mean gradient 55 mmHg.
What is the appropriate interpretation?
A. Severe aortic stenosis.
B. Mild aortic stenosis.
C. Aortic regurgitation.
D. Normal age-related changes.
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
Q1 (MCQ — pathophysiology/diagnostic)
A 68-year-old male with hypertension presents with exertional
dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. On
exam: bibasilar crackles and S3 gallop. BNP is elevated. Which
best explains his symptoms?
A. Left-sided heart failure causing pulmonary congestion.
B. Right-sided heart failure causing systemic venous congestion.
C. Diastolic dysfunction causing decreased right ventricular
output.
D. Acute myocardial infarction causing papillary muscle rupture.
Answer: A
Rationale:
A — Correct. Left ventricular (LV) systolic or diastolic failure
,causes pulmonary venous congestion → dyspnea, orthopnea,
elevated BNP, S3.
B — Incorrect. Right-sided failure produces JVD, hepatomegaly,
peripheral edema rather than pulmonary crackles.
C — Incorrect. Diastolic dysfunction decreases LV filling and
causes pulmonary symptoms, but phrasing “decreased right
ventricular output” is wrong.
D — Incorrect. MI with papillary muscle rupture causes acute
MR and pulmonary edema but would present more acutely and
with murmur/hemodynamic collapse.
Q2 (MCQ — diagnostics/nursing intervention)
A patient with suspected acute coronary syndrome has 12-lead
ECG showing ST-elevation in V2–V4. Which is the immediate
nursing priority?
A. Give aspirin and prepare for reperfusion therapy.
B. Obtain a chest x-ray to confirm cardiomegaly.
C. Begin beta-blocker therapy immediately at home dose.
D. Schedule an echocardiogram next week.
Answer: A
Rationale:
A — Correct. ST-elevation MI (anterior leads) requires
immediate antiplatelet (aspirin) and urgent reperfusion (PCI)
per guidelines.
B — Incorrect. Chest x-ray is not immediate priority for STEMI.
,C — Incorrect. Beta-blockers are used, but initiating without
hemodynamic assessment can be harmful acutely.
D — Incorrect. Delay would risk myocardial damage.
Q3 (NGN unfolding case — triage/prioritization)
Case: A 54-year-old woman postoperative day 2 after CABG has
sudden chest pain, hypotension (BP 82/50), muffled heart
sounds, and JVD.
Item 1: What is the most likely diagnosis?
Item 2: Which immediate nursing action is priority?
Item 3: Which diagnostic test confirms the diagnosis?
Answers & Rationales:
1. Cardiac tamponade — Beck’s triad (hypotension, muffled
heart sounds, JVD) after cardiac surgery suggests
pericardial tamponade.
2. Notify MD/activate rapid response and prepare for
emergent pericardiocentesis — Immediate drainage is life-
saving; stabilize with IV fluids if ordered to improve
preload.
3. Stat transthoracic echocardiogram (TTE) — Echo confirms
pericardial effusion and tamponade physiology. Chest x-ray
is not diagnostic.
Q4 (MCQ — pharmacology/patient teaching)
, A patient with chronic heart failure is prescribed
spironolactone. Which teaching point is most important?
A. Expect improved kidney function immediately.
B. Avoid foods high in potassium and monitor potassium.
C. Stop taking ACE inhibitor when starting spironolactone.
D. Spironolactone causes severe hypotension in all patients.
Answer: B
Rationale:
A — Incorrect. Spironolactone is potassium-sparing and does
not improve kidney function immediately.
B — Correct. Hyperkalemia risk—avoid K supplements/high-K
foods and monitor serum K.
C — Incorrect. ACE inhibitors may be continued but potassium
must be monitored; do not stop without order.
D — Incorrect. Hypotension is not universal; main risk is
hyperkalemia.
Q5 (MCQ — diagnostic interpretation)
A 72-year-old with exertional syncope has an echocardiogram
showing aortic valve area 0.7 cm², mean gradient 55 mmHg.
What is the appropriate interpretation?
A. Severe aortic stenosis.
B. Mild aortic stenosis.
C. Aortic regurgitation.
D. Normal age-related changes.
