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
1. (Standard MCQ) A 72-year-old man with long-standing
hypertension reports sudden onset of severe chest pain
radiating to his jaw and diaphoresis. ECG shows ST-segment
elevation in leads II, III, and aVF. Which action should the nurse
implement first?
A. Give sublingual nitroglycerin.
B. Administer chewable aspirin 325 mg.
C. Start IV morphine for pain control.
D. Obtain a 12-lead ECG.
Correct: B. Administer chewable aspirin 325 mg.
Rationales:
A. Nitroglycerin may relieve ischemic pain but is contraindicated
if hypotensive or with recent phosphodiesterase inhibitor use;
,not the highest priority before antiplatelet therapy.
B. Correct. Aspirin reduces platelet aggregation and early
mortality in suspected STEMI — immediate chewable aspirin is
priority while activating reperfusion pathway. (Pathophys: acute
plaque rupture with thrombosis → occlusion). Nursing
intervention: give, document, and prepare for reperfusion;
teach patient why aspirin was given.
C. Morphine manages pain but may obscure assessment and is
secondary to life-saving antiplatelet therapy.
D. ECG is essential but the vignette already reports ST-elevation;
immediate antiplatelet therapy should not be delayed.
2. (Standard MCQ) A client with chronic heart failure (EF 28%)
is taking lisinopril, furosemide, and carvedilol. He reports
increased shortness of breath and 3-kg weight gain over 3 days.
Which assessment finding most strongly indicates fluid
overload?
A. HR 88 bpm, irregular.
B. JVD at 45° with positive hepatojugular reflux.
C. Bibasilar crackles only audible after deep inspiration.
D. Warm, dry extremities with capillary refill <2 sec.
Correct: B. JVD at 45° with positive hepatojugular reflux.
Rationales:
A. Heart rate irregularity may reflect arrhythmia but not specific
for fluid overload.
B. Correct. Jugular venous distention and positive hepatojugular
,reflux indicate elevated right-sided filling pressures and volume
overload in HF. Diagnostic interpretation: correlates with
elevated CVP. Nursing intervention: notify provider, evaluate
diuretic adequacy, daily weights, restrict sodium/fluids, monitor
electrolytes. Teach: daily weight tracking and when to call.
C. Bibasilar crackles suggest mild pulmonary congestion but JVD
with positive HJR is a stronger sign of systemic congestion.
D. Warm, dry extremities suggest adequate perfusion, not fluid
overload.
3. (NGN unfolding case, Part A) A 59-year-old woman presents
with sudden left arm weakness and aphasia. She has a history
of atrial fibrillation and is on warfarin (INR last month 2.3). CT
head shows ischemic stroke in the right MCA territory. Which
immediate collaborative action is MOST appropriate?
A. Administer alteplase if within 4.5 hours of symptom onset.
B. Start aspirin 325 mg immediately.
C. Reverse warfarin with vitamin K and prothrombin complex
concentrate (PCC) before any reperfusion.
D. Schedule urgent carotid endarterectomy.
Correct: A. Administer alteplase if within 4.5 hours of symptom
onset.
Rationales:
A. Correct. For ischemic stroke within window and no
contraindications, IV alteplase (thrombolysis) is indicated;
warfarin with therapeutic INR may be a relative contraindication
, if INR >1.7 — but the last known INR 2.3 raises concern. Nursing
intervention: verify current INR urgently; if INR ≤1.7, proceed; if
>1.7, alteplase contraindicated. Teach family about
risks/benefits.
B. Aspirin is given if thrombolysis not performed; do not give
before alteplase.
C. Reversing warfarin delays thrombolysis and may be indicated
if hemorrhage risk; PCC reversal is for hemorrhage, not routine
pre-thrombolysis.
D. Carotid surgery is for symptomatic carotid stenosis, not
immediate acute MCA therapy.
4. (NGN unfolding case, Part B — same patient as #3) Rapid
INR testing shows INR = 2.5 and last known time of onset was 2
hours ago. What should nurse do next?
A. Prepare to administer IV alteplase.
B. Notify the team that alteplase is contraindicated and prepare
for mechanical thrombectomy consult.
C. Give aspirin and start heparin infusion.
D. Administer vitamin K to lower INR then give alteplase.
Correct: B. Notify the team that alteplase is contraindicated and
prepare for mechanical thrombectomy consult.
Rationales:
A. Alteplase is contraindicated if INR >1.7 due to bleeding risk.
B. Correct. With INR 2.5, systemic thrombolysis is
contraindicated; mechanical thrombectomy may be an option
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
1. (Standard MCQ) A 72-year-old man with long-standing
hypertension reports sudden onset of severe chest pain
radiating to his jaw and diaphoresis. ECG shows ST-segment
elevation in leads II, III, and aVF. Which action should the nurse
implement first?
A. Give sublingual nitroglycerin.
B. Administer chewable aspirin 325 mg.
C. Start IV morphine for pain control.
D. Obtain a 12-lead ECG.
Correct: B. Administer chewable aspirin 325 mg.
Rationales:
A. Nitroglycerin may relieve ischemic pain but is contraindicated
if hypotensive or with recent phosphodiesterase inhibitor use;
,not the highest priority before antiplatelet therapy.
B. Correct. Aspirin reduces platelet aggregation and early
mortality in suspected STEMI — immediate chewable aspirin is
priority while activating reperfusion pathway. (Pathophys: acute
plaque rupture with thrombosis → occlusion). Nursing
intervention: give, document, and prepare for reperfusion;
teach patient why aspirin was given.
C. Morphine manages pain but may obscure assessment and is
secondary to life-saving antiplatelet therapy.
D. ECG is essential but the vignette already reports ST-elevation;
immediate antiplatelet therapy should not be delayed.
2. (Standard MCQ) A client with chronic heart failure (EF 28%)
is taking lisinopril, furosemide, and carvedilol. He reports
increased shortness of breath and 3-kg weight gain over 3 days.
Which assessment finding most strongly indicates fluid
overload?
A. HR 88 bpm, irregular.
B. JVD at 45° with positive hepatojugular reflux.
C. Bibasilar crackles only audible after deep inspiration.
D. Warm, dry extremities with capillary refill <2 sec.
Correct: B. JVD at 45° with positive hepatojugular reflux.
Rationales:
A. Heart rate irregularity may reflect arrhythmia but not specific
for fluid overload.
B. Correct. Jugular venous distention and positive hepatojugular
,reflux indicate elevated right-sided filling pressures and volume
overload in HF. Diagnostic interpretation: correlates with
elevated CVP. Nursing intervention: notify provider, evaluate
diuretic adequacy, daily weights, restrict sodium/fluids, monitor
electrolytes. Teach: daily weight tracking and when to call.
C. Bibasilar crackles suggest mild pulmonary congestion but JVD
with positive HJR is a stronger sign of systemic congestion.
D. Warm, dry extremities suggest adequate perfusion, not fluid
overload.
3. (NGN unfolding case, Part A) A 59-year-old woman presents
with sudden left arm weakness and aphasia. She has a history
of atrial fibrillation and is on warfarin (INR last month 2.3). CT
head shows ischemic stroke in the right MCA territory. Which
immediate collaborative action is MOST appropriate?
A. Administer alteplase if within 4.5 hours of symptom onset.
B. Start aspirin 325 mg immediately.
C. Reverse warfarin with vitamin K and prothrombin complex
concentrate (PCC) before any reperfusion.
D. Schedule urgent carotid endarterectomy.
Correct: A. Administer alteplase if within 4.5 hours of symptom
onset.
Rationales:
A. Correct. For ischemic stroke within window and no
contraindications, IV alteplase (thrombolysis) is indicated;
warfarin with therapeutic INR may be a relative contraindication
, if INR >1.7 — but the last known INR 2.3 raises concern. Nursing
intervention: verify current INR urgently; if INR ≤1.7, proceed; if
>1.7, alteplase contraindicated. Teach family about
risks/benefits.
B. Aspirin is given if thrombolysis not performed; do not give
before alteplase.
C. Reversing warfarin delays thrombolysis and may be indicated
if hemorrhage risk; PCC reversal is for hemorrhage, not routine
pre-thrombolysis.
D. Carotid surgery is for symptomatic carotid stenosis, not
immediate acute MCA therapy.
4. (NGN unfolding case, Part B — same patient as #3) Rapid
INR testing shows INR = 2.5 and last known time of onset was 2
hours ago. What should nurse do next?
A. Prepare to administer IV alteplase.
B. Notify the team that alteplase is contraindicated and prepare
for mechanical thrombectomy consult.
C. Give aspirin and start heparin infusion.
D. Administer vitamin K to lower INR then give alteplase.
Correct: B. Notify the team that alteplase is contraindicated and
prepare for mechanical thrombectomy consult.
Rationales:
A. Alteplase is contraindicated if INR >1.7 due to bleeding risk.
B. Correct. With INR 2.5, systemic thrombolysis is
contraindicated; mechanical thrombectomy may be an option
