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
Cardio Q1 — (MCQ, pathophysiology/diagnostics)
A 68-year-old male presents with sudden chest pressure
radiating to his left arm, diaphoresis, nausea, and shortness of
breath. ECG shows ST-segment elevation in leads II, III, and aVF.
Which coronary artery is most likely occluded?
A. Left anterior descending (LAD)
B. Left circumflex (LCx)
C. Right coronary artery (RCA)
D. Posterior descending artery (PDA) arising from LCx
Answer: C. Right coronary artery (RCA)
Rationales:
A. LAD infarcts cause anterior wall changes (V1–V4); not
consistent with II, III, aVF.
,B. LCx often shows lateral changes (I, aVL, V5–V6); not inferior
leads.
C. Correct. ST elevation in II, III, aVF indicates inferior wall MI—
classically due to RCA occlusion. RCA supplies inferior wall and
often right ventricle; anticipate hypotension/bradyarrhythmias.
D. PDA variations exist, but inferior STEMI most commonly from
RCA occlusion; PDA from LCx is less common and would still
correlate with lateral/posterior leads.
Cardio Q2 — (MCQ, labs/diagnostics/nursing interventions)
A client is 6 hours post-percutaneous coronary intervention
(PCI) with a right femoral arterial access site. Which nursing
assessment finding requires the MOST immediate action?
A. Small hematoma at the groin, 2 cm diameter, pain 2/10
B. Decreased pedal pulses on the right compared to the left
C. Client reports chest tightness rated 1/10
D. Urine output 20 mL/hr for the past 2 hours
Answer: B. Decreased pedal pulses on the right compared to
the left
Rationales:
A. Small hematoma is common—monitor size and pain. Not
immediate unless expanding.
B. Correct. Decreased distal pulses post-femoral access suggest
arterial occlusion, hematoma compressing vessel, or limb
ischemia—requires immediate vascular/MD evaluation. Limb
perfusion takes priority to prevent ischemic injury.
,C. Mild chest tightness should be assessed but less immediately
threatening than limb ischemia.
D. Oliguria is concerning; evaluate hydration/renal function—
but limb ischemia is more time-sensitive.
Cardio Q3 — (MCQ, pharmacology/patient teaching)
A patient with heart failure is prescribed lisinopril. Which
patient teaching should the nurse prioritize?
A. “Take lisinopril only when you have chest pain.”
B. “Expect a persistent dry cough—notify us if it occurs.”
C. “Avoid potassium-rich foods while on lisinopril.”
D. “You can stop the medication when you feel better.”
Answer: B. “Expect a persistent dry cough—notify us if it
occurs.”
Rationales:
A. ACE inhibitors are for chronic therapy, not PRN chest pain.
Incorrect.
B. Correct. ACE inhibitors commonly cause dry cough due to
bradykinin accumulation; patient should report it because it
may require medication change (e.g., to ARB). Teaching about
orthostatic hypotension and monitoring BP is also important.
C. ACE inhibitors can cause hyperkalemia—patients should be
cautioned about excessive potassium and avoid potassium
supplements; however “avoid potassium-rich foods” is too
broad; moderation and lab monitoring are emphasized. Option
B is the most prioritized teaching specific to ACE inhibitors.
, D. Stopping ACE inhibitors abruptly can worsen condition—
incorrect.
Cardio Q4 — (NGN unfolding case — multiple-response)
Case: A 74-year-old woman with chronic atrial fibrillation (AF)
on warfarin arrives with sudden onset right lower leg pain,
pallor, and pulselessness. Vitals: HR 110 irregular, BP 140/78, RR
18, SpO₂ 96% RA. INR last week was 2.4. Nurse suspects acute
arterial embolism to the leg.
Select all appropriate immediate nursing actions (multiple-
response):
A. Elevate the affected limb above heart level.
B. Notify the provider/emergency vascular surgery consult.
C. Prepare to administer intravenous tissue plasminogen
activator (tPA) without further orders.
D. Monitor and document neurovascular status of the affected
limb frequently.
E. Apply warm compresses to the limb to increase circulation.
Answers: B and D are essential. A is incorrect. C is incorrect
(requires orders/contraindications). E is incorrect.
Rationales:
A. Elevating above heart level can worsen ischemia in acute
arterial occlusion—keep limb neutral or slightly dependent to
promote collateral flow.
B. Correct. Immediate provider notification and vascular
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
Cardio Q1 — (MCQ, pathophysiology/diagnostics)
A 68-year-old male presents with sudden chest pressure
radiating to his left arm, diaphoresis, nausea, and shortness of
breath. ECG shows ST-segment elevation in leads II, III, and aVF.
Which coronary artery is most likely occluded?
A. Left anterior descending (LAD)
B. Left circumflex (LCx)
C. Right coronary artery (RCA)
D. Posterior descending artery (PDA) arising from LCx
Answer: C. Right coronary artery (RCA)
Rationales:
A. LAD infarcts cause anterior wall changes (V1–V4); not
consistent with II, III, aVF.
,B. LCx often shows lateral changes (I, aVL, V5–V6); not inferior
leads.
C. Correct. ST elevation in II, III, aVF indicates inferior wall MI—
classically due to RCA occlusion. RCA supplies inferior wall and
often right ventricle; anticipate hypotension/bradyarrhythmias.
D. PDA variations exist, but inferior STEMI most commonly from
RCA occlusion; PDA from LCx is less common and would still
correlate with lateral/posterior leads.
Cardio Q2 — (MCQ, labs/diagnostics/nursing interventions)
A client is 6 hours post-percutaneous coronary intervention
(PCI) with a right femoral arterial access site. Which nursing
assessment finding requires the MOST immediate action?
A. Small hematoma at the groin, 2 cm diameter, pain 2/10
B. Decreased pedal pulses on the right compared to the left
C. Client reports chest tightness rated 1/10
D. Urine output 20 mL/hr for the past 2 hours
Answer: B. Decreased pedal pulses on the right compared to
the left
Rationales:
A. Small hematoma is common—monitor size and pain. Not
immediate unless expanding.
B. Correct. Decreased distal pulses post-femoral access suggest
arterial occlusion, hematoma compressing vessel, or limb
ischemia—requires immediate vascular/MD evaluation. Limb
perfusion takes priority to prevent ischemic injury.
,C. Mild chest tightness should be assessed but less immediately
threatening than limb ischemia.
D. Oliguria is concerning; evaluate hydration/renal function—
but limb ischemia is more time-sensitive.
Cardio Q3 — (MCQ, pharmacology/patient teaching)
A patient with heart failure is prescribed lisinopril. Which
patient teaching should the nurse prioritize?
A. “Take lisinopril only when you have chest pain.”
B. “Expect a persistent dry cough—notify us if it occurs.”
C. “Avoid potassium-rich foods while on lisinopril.”
D. “You can stop the medication when you feel better.”
Answer: B. “Expect a persistent dry cough—notify us if it
occurs.”
Rationales:
A. ACE inhibitors are for chronic therapy, not PRN chest pain.
Incorrect.
B. Correct. ACE inhibitors commonly cause dry cough due to
bradykinin accumulation; patient should report it because it
may require medication change (e.g., to ARB). Teaching about
orthostatic hypotension and monitoring BP is also important.
C. ACE inhibitors can cause hyperkalemia—patients should be
cautioned about excessive potassium and avoid potassium
supplements; however “avoid potassium-rich foods” is too
broad; moderation and lab monitoring are emphasized. Option
B is the most prioritized teaching specific to ACE inhibitors.
, D. Stopping ACE inhibitors abruptly can worsen condition—
incorrect.
Cardio Q4 — (NGN unfolding case — multiple-response)
Case: A 74-year-old woman with chronic atrial fibrillation (AF)
on warfarin arrives with sudden onset right lower leg pain,
pallor, and pulselessness. Vitals: HR 110 irregular, BP 140/78, RR
18, SpO₂ 96% RA. INR last week was 2.4. Nurse suspects acute
arterial embolism to the leg.
Select all appropriate immediate nursing actions (multiple-
response):
A. Elevate the affected limb above heart level.
B. Notify the provider/emergency vascular surgery consult.
C. Prepare to administer intravenous tissue plasminogen
activator (tPA) without further orders.
D. Monitor and document neurovascular status of the affected
limb frequently.
E. Apply warm compresses to the limb to increase circulation.
Answers: B and D are essential. A is incorrect. C is incorrect
(requires orders/contraindications). E is incorrect.
Rationales:
A. Elevating above heart level can worsen ischemia in acute
arterial occlusion—keep limb neutral or slightly dependent to
promote collateral flow.
B. Correct. Immediate provider notification and vascular
