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 — STEMI recognition & initial care)
A 62-year-old man arrives with sudden severe substernal chest
pain radiating to the left jaw, diaphoresis and nausea. ECG
shows ST-segment elevation in leads V2–V4. Troponin later
returns elevated. Which initial nursing action is highest priority?
A. Administer chewable aspirin if not given and prepare for
emergent reperfusion pathway.
B. Start high-dose atorvastatin and schedule echocardiogram.
C. Give IV morphine and place patient on strict bedrest.
D. Obtain orthogonal chest x-rays before any medications.
Answer: A.
Rationale (pathophys & teaching included):
, • ST-elevation MI (STEMI) indicates acute coronary artery
occlusion → immediate reperfusion reduces myocardial
necrosis. Aspirin (162–325 mg chewed) is standard
immediate therapy unless contraindicated; activate cath
lab/PCI pathway. (AHA guideline alignment).
www.heart.org
• B: Statin is indicated but not highest immediate priority.
• C: Morphine may relieve pain but giving aspirin and
reperfusion activation take priority. Morphine also has
risks; use only as ordered.
• D: Chest x-ray is not required before giving aspirin or
activating reperfusion.
Patient teaching: Explain aspirin purpose (reduce clotting),
importance of rapid treatment, and that reperfusion
(angioplasty) aims to restore blood flow and limit heart
damage.
Q2 (MCQ — Heart failure exacerbation: assessment &
diagnostics)
A patient with chronic HFrEF (EF 30%) reports increasing
dyspnea on exertion, orthopnea, and 3-kg weight gain over 3
days. Which diagnostic result best correlates with fluid
overload?
A. BNP elevated to 850 pg/mL.
B. Hemoglobin mildly decreased.
,C. Serum sodium 142 mEq/L.
D. Troponin normal.
Answer: A.
Rationale:
• Pathophys: Worsening heart failure → ↑ ventricular wall
stress → release of BNP/NT-proBNP. Elevated BNP supports
decompensation.
• B: Mild anemia not specific.
• C: Sodium normal.
• D: Normal troponin does not rule out congestion.
Nursing interventions: Monitor daily weights, I/O, diuretics as
ordered, oxygen if hypoxic, position upright, assess for JVD and
crackles.
Patient teaching: Low-sodium diet, daily weight tracking, when
to call provider (e.g., ≥2-kg gain in 48–72 hrs).
Q3 (MCQ — Anticoagulation in atrial fibrillation)
A 76-year-old woman with nonvalvular atrial fibrillation
(CHA₂DS₂-VASc = 3) asks why she needs anticoagulation. Which
statement is best nursing teaching?
A. “You need a blood thinner to reduce your stroke risk because
atrial fibrillation causes blood to pool.”
B. “Anticoagulants will make your heart rhythm normal again.”
C. “You only need anticoagulation if you develop clots in the
, legs.”
D. “Anticoagulation replaces the need for rate control
medications.”
Answer: A.
Rationale:
• AF causes stasis in atria → thrombus formation → ischemic
stroke risk. Anticoagulants reduce stroke risk.
• B: Anticoagulants don’t restore rhythm.
• C: Anticoagulation is indicated for stroke prevention,
regardless of documented DVT.
• D: Anticoagulation does not substitute for rate/rhythm
control.
Patient teaching: Discuss bleeding risk, monitoring (if warfarin:
INR), adherence, and when to seek care for bleeding.
Q4 (MCQ — Interpreting cardiac enzymes after suspected MI)
A patient’s serial troponin values: 0.02 ng/mL on arrival, 0.18
ng/mL at 3 hours, 1.2 ng/mL at 6 hours. The nurse interprets
these findings as:
A. Consistent with evolving myocardial injury; correlate clinically
and with ECG.
B. Troponin values are within normal limits; no MI.
C. Lab error — values should not rise.
D. Indicative of pulmonary embolism only.
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 — STEMI recognition & initial care)
A 62-year-old man arrives with sudden severe substernal chest
pain radiating to the left jaw, diaphoresis and nausea. ECG
shows ST-segment elevation in leads V2–V4. Troponin later
returns elevated. Which initial nursing action is highest priority?
A. Administer chewable aspirin if not given and prepare for
emergent reperfusion pathway.
B. Start high-dose atorvastatin and schedule echocardiogram.
C. Give IV morphine and place patient on strict bedrest.
D. Obtain orthogonal chest x-rays before any medications.
Answer: A.
Rationale (pathophys & teaching included):
, • ST-elevation MI (STEMI) indicates acute coronary artery
occlusion → immediate reperfusion reduces myocardial
necrosis. Aspirin (162–325 mg chewed) is standard
immediate therapy unless contraindicated; activate cath
lab/PCI pathway. (AHA guideline alignment).
www.heart.org
• B: Statin is indicated but not highest immediate priority.
• C: Morphine may relieve pain but giving aspirin and
reperfusion activation take priority. Morphine also has
risks; use only as ordered.
• D: Chest x-ray is not required before giving aspirin or
activating reperfusion.
Patient teaching: Explain aspirin purpose (reduce clotting),
importance of rapid treatment, and that reperfusion
(angioplasty) aims to restore blood flow and limit heart
damage.
Q2 (MCQ — Heart failure exacerbation: assessment &
diagnostics)
A patient with chronic HFrEF (EF 30%) reports increasing
dyspnea on exertion, orthopnea, and 3-kg weight gain over 3
days. Which diagnostic result best correlates with fluid
overload?
A. BNP elevated to 850 pg/mL.
B. Hemoglobin mildly decreased.
,C. Serum sodium 142 mEq/L.
D. Troponin normal.
Answer: A.
Rationale:
• Pathophys: Worsening heart failure → ↑ ventricular wall
stress → release of BNP/NT-proBNP. Elevated BNP supports
decompensation.
• B: Mild anemia not specific.
• C: Sodium normal.
• D: Normal troponin does not rule out congestion.
Nursing interventions: Monitor daily weights, I/O, diuretics as
ordered, oxygen if hypoxic, position upright, assess for JVD and
crackles.
Patient teaching: Low-sodium diet, daily weight tracking, when
to call provider (e.g., ≥2-kg gain in 48–72 hrs).
Q3 (MCQ — Anticoagulation in atrial fibrillation)
A 76-year-old woman with nonvalvular atrial fibrillation
(CHA₂DS₂-VASc = 3) asks why she needs anticoagulation. Which
statement is best nursing teaching?
A. “You need a blood thinner to reduce your stroke risk because
atrial fibrillation causes blood to pool.”
B. “Anticoagulants will make your heart rhythm normal again.”
C. “You only need anticoagulation if you develop clots in the
, legs.”
D. “Anticoagulation replaces the need for rate control
medications.”
Answer: A.
Rationale:
• AF causes stasis in atria → thrombus formation → ischemic
stroke risk. Anticoagulants reduce stroke risk.
• B: Anticoagulants don’t restore rhythm.
• C: Anticoagulation is indicated for stroke prevention,
regardless of documented DVT.
• D: Anticoagulation does not substitute for rate/rhythm
control.
Patient teaching: Discuss bleeding risk, monitoring (if warfarin:
INR), adherence, and when to seek care for bleeding.
Q4 (MCQ — Interpreting cardiac enzymes after suspected MI)
A patient’s serial troponin values: 0.02 ng/mL on arrival, 0.18
ng/mL at 3 hours, 1.2 ng/mL at 6 hours. The nurse interprets
these findings as:
A. Consistent with evolving myocardial injury; correlate clinically
and with ECG.
B. Troponin values are within normal limits; no MI.
C. Lab error — values should not rise.
D. Indicative of pulmonary embolism only.
