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 (7 MCQs + 3 NGN-style unfolding
cases)
1. (MCQ) A 68-year-old with long-standing hypertension
reports sudden, severe chest pain radiating to the jaw and
diaphoresis. ECG shows ST-segment elevation in leads II, III,
and aVF. Which immediate nursing action has highest
priority?
A. Administer sublingual nitroglycerin.
B. Prepare for emergent percutaneous coronary
intervention (PCI).
C. Give chewable aspirin 325 mg.
D. Start a continuous heparin infusion.
Answer: C. Give chewable aspirin 325 mg.
,Rationales:
A. Nitroglycerin can relieve ischemic pain but is not the single
highest-priority immediate action and is contraindicated if
hypotensive or on PDE-5 inhibitors.
B. Preparing for PCI is essential but providing aspirin now
(antiplatelet) is immediate and reduces mortality.
C. Correct. Chewable aspirin given immediately for suspected
STEMI reduces infarct size and mortality and is a standard first-
line pre-PCI intervention.
D. Heparin may be indicated, but aspirin is first-line immediate
therapy while arranging reperfusion.
(Pathophys/teaching: STEMI from coronary occlusion; teach
patient that aspirin helps stop clot growth and that fund of
emergent reperfusion improves outcomes.)
2. (MCQ) A patient with congestive heart failure (HF) is
admitted with weight gain, bibasilar crackles, and jugular
venous distention. BNP is elevated. The provider orders IV
furosemide 40 mg. Which assessment finding would make
you hold the dose?
A. Serum creatinine increased from 1.0 to 1.8 mg/dL since
admission.
B. Potassium 4.8 mEq/L.
C. Blood pressure 140/78 mm Hg.
D. Heart rate 88 bpm, regular.
Answer: A. Serum creatinine increased from 1.0 to 1.8 mg/dL.
,Rationales:
A. Correct. Acute rise in creatinine suggests possible renal
hypoperfusion or AKI; though diuretics are often used, dose and
route may need reevaluation and provider notification.
B. K 4.8 is slightly high-normal — not a reason to hold
furosemide.
C. BP 140/78 tolerates IV diuresis.
D. HR 88 is acceptable.
(Teaching: Monitor renal function and electrolytes; educate
weight monitoring, low-sodium diet, daily weights.)
3. (MCQ) A 72-year-old with atrial fibrillation on warfarin
presents with hematuria. INR = 6.2. Which intervention is
most appropriate now?
A. Administer vitamin K PO and observe.
B. Hold warfarin and schedule for catheterization.
C. Give IV vitamin K plus prothrombin complex concentrate
(PCC) immediately.
D. Continue warfarin but transfuse PRBCs.
Answer: C. Give IV vitamin K plus PCC immediately.
Rationales:
A. PO vitamin K may be too slow for active bleeding with INR >6
and is not adequate alone.
B. Holding warfarin alone is insufficient with active bleeding and
high INR.
, C. Correct. For major bleeding and high INR, IV vitamin K and
reversal with PCC (or FFP if PCC unavailable) is indicated.
D. Continuing warfarin is contraindicated.
(Teaching: Explain anticoagulation risks, reasons for reversal,
follow-up INR monitoring.)
4. (MCQ) A postoperative patient has a sudden drop in
oxygen saturation to 86%, sudden hypotension, and
distended neck veins. You suspect a massive pulmonary
embolism (PE). Which immediate action is highest priority?
A. Start heparin bolus intravenously.
B. Prepare for immediate CT pulmonary angiography
(CTPA).
C. Administer 100% oxygen and call rapid response/team.
D. Obtain arterial blood gas (ABG).
Answer: C. Administer 100% oxygen and call rapid
response/team.
Rationales:
A. Heparin is indicated for PE but immediate stabilization
(oxygen/support) and activating the emergency response is the
highest priority.
B. CTPA useful diagnostically but should not delay resuscitation.
C. Correct. Airway/oxygenation and emergency team activation
come first in unstable patients.
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 (7 MCQs + 3 NGN-style unfolding
cases)
1. (MCQ) A 68-year-old with long-standing hypertension
reports sudden, severe chest pain radiating to the jaw and
diaphoresis. ECG shows ST-segment elevation in leads II, III,
and aVF. Which immediate nursing action has highest
priority?
A. Administer sublingual nitroglycerin.
B. Prepare for emergent percutaneous coronary
intervention (PCI).
C. Give chewable aspirin 325 mg.
D. Start a continuous heparin infusion.
Answer: C. Give chewable aspirin 325 mg.
,Rationales:
A. Nitroglycerin can relieve ischemic pain but is not the single
highest-priority immediate action and is contraindicated if
hypotensive or on PDE-5 inhibitors.
B. Preparing for PCI is essential but providing aspirin now
(antiplatelet) is immediate and reduces mortality.
C. Correct. Chewable aspirin given immediately for suspected
STEMI reduces infarct size and mortality and is a standard first-
line pre-PCI intervention.
D. Heparin may be indicated, but aspirin is first-line immediate
therapy while arranging reperfusion.
(Pathophys/teaching: STEMI from coronary occlusion; teach
patient that aspirin helps stop clot growth and that fund of
emergent reperfusion improves outcomes.)
2. (MCQ) A patient with congestive heart failure (HF) is
admitted with weight gain, bibasilar crackles, and jugular
venous distention. BNP is elevated. The provider orders IV
furosemide 40 mg. Which assessment finding would make
you hold the dose?
A. Serum creatinine increased from 1.0 to 1.8 mg/dL since
admission.
B. Potassium 4.8 mEq/L.
C. Blood pressure 140/78 mm Hg.
D. Heart rate 88 bpm, regular.
Answer: A. Serum creatinine increased from 1.0 to 1.8 mg/dL.
,Rationales:
A. Correct. Acute rise in creatinine suggests possible renal
hypoperfusion or AKI; though diuretics are often used, dose and
route may need reevaluation and provider notification.
B. K 4.8 is slightly high-normal — not a reason to hold
furosemide.
C. BP 140/78 tolerates IV diuresis.
D. HR 88 is acceptable.
(Teaching: Monitor renal function and electrolytes; educate
weight monitoring, low-sodium diet, daily weights.)
3. (MCQ) A 72-year-old with atrial fibrillation on warfarin
presents with hematuria. INR = 6.2. Which intervention is
most appropriate now?
A. Administer vitamin K PO and observe.
B. Hold warfarin and schedule for catheterization.
C. Give IV vitamin K plus prothrombin complex concentrate
(PCC) immediately.
D. Continue warfarin but transfuse PRBCs.
Answer: C. Give IV vitamin K plus PCC immediately.
Rationales:
A. PO vitamin K may be too slow for active bleeding with INR >6
and is not adequate alone.
B. Holding warfarin alone is insufficient with active bleeding and
high INR.
, C. Correct. For major bleeding and high INR, IV vitamin K and
reversal with PCC (or FFP if PCC unavailable) is indicated.
D. Continuing warfarin is contraindicated.
(Teaching: Explain anticoagulation risks, reasons for reversal,
follow-up INR monitoring.)
4. (MCQ) A postoperative patient has a sudden drop in
oxygen saturation to 86%, sudden hypotension, and
distended neck veins. You suspect a massive pulmonary
embolism (PE). Which immediate action is highest priority?
A. Start heparin bolus intravenously.
B. Prepare for immediate CT pulmonary angiography
(CTPA).
C. Administer 100% oxygen and call rapid response/team.
D. Obtain arterial blood gas (ABG).
Answer: C. Administer 100% oxygen and call rapid
response/team.
Rationales:
A. Heparin is indicated for PE but immediate stabilization
(oxygen/support) and activating the emergency response is the
highest priority.
B. CTPA useful diagnostically but should not delay resuscitation.
C. Correct. Airway/oxygenation and emergency team activation
come first in unstable patients.
