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
MCQ 1
Context: A 68-year-old man with atherosclerotic CAD presents
with chest pressure, diaphoresis, and nausea. ECG shows ST-
elevation in leads II, III, aVF. Troponin I elevated.
Question: The priority nursing action during the initial 10
minutes of arrival is:
A. Administer sublingual nitroglycerin.
B. Give chewable aspirin 325 mg (unless contraindicated).
C. Obtain a chest x-ray.
D. Start high-flow oxygen via non-rebreather at 10 L/min.
Answer: B. Give chewable aspirin 325 mg (unless
contraindicated).
Rationales:
,A. Nitroglycerin may relieve ischemia but you must first assess
for hypotension/ PDE-5 med use; not the single highest priority.
B. Correct. Aspirin reduces mortality by inhibiting platelet
aggregation and should be given quickly for suspected STEMI
unless allergy/active bleeding.
C. Chest x-ray is not time-sensitive for reperfusion decisions in
STEMI.
D. Oxygen should be given only if hypoxemic (SpO₂ <90%) —
routine high-flow oxygen is not recommended for normoxic MI
patients.
MCQ 2
Context: 72-year-old woman after CABG has chest tube
drainage 250 mL in first hour, HR 110, BP 90/58, cold clammy
skin.
Question: The nurse’s first action is:
A. Call the surgeon.
B. Check for cardiac tamponade (assess JVD, muffled heart
sounds, hypotension).
C. Increase IV fluids to raise BP.
D. Remove and reposition chest tubes.
Answer: B. Check for cardiac tamponade (assess JVD, muffled
heart sounds, hypotension).
Rationales:
A. Calling surgeon is appropriate but assessment to identify
tamponade is immediate priority.
,B. Correct. Rapid assessment for tamponade is needed because
bleeding/tamponade is life-threatening after CABG.
C. IV fluids may be temporizing but without assessment could
worsen bleeding; do after evaluation.
D. Removing/repositioning tubes without order is unsafe.
MCQ 3
Context: 58-year-old with heart failure on ACE inhibitor and
furosemide reports dizziness and cough. Labs: K⁺ 3.1 mEq/L,
Na⁺ 132.
Question: The most important nursing intervention now is:
A. Teach patient to avoid potassium-rich foods.
B. Hold furosemide and notify provider.
C. Encourage increased fluid intake.
D. Administer a potassium binder.
Answer: B. Hold furosemide and notify provider.
Rationales:
A. Potassium-rich foods would be recommended for
hypokalemia, not avoided.
B. Correct. Furosemide can cause hypokalemia; hold and notify
for reassessment/possible K⁺ replacement.
C. Increased fluids may worsen HF and is inappropriate without
provider guidance.
D. Potassium binders lower K⁺ — contraindicated with
hypokalemia.
, MCQ 4
Context: 45-year-old with atrial fibrillation undergoing warfarin
therapy. INR last checked 2.0. Patient asks about diet.
Question: Which statement from the patient indicates correct
understanding?
A. “I should avoid all green leafy vegetables.”
B. “I’ll keep my vitamin K intake consistent.”
C. “I’ll stop taking warfarin before any dental visit.”
D. “I can double the dose if I miss one day.”
Answer: B. “I’ll keep my vitamin K intake consistent.”
Rationales:
A. Avoiding all greens is unnecessary; consistency is key.
B. Correct. Stable vitamin K intake helps maintain therapeutic
INR.
C. Stopping warfarin before dental work requires provider
guidance and risk assessment.
D. Doubling dose for missed warfarin is unsafe.
MCQ 5
Context: A 60-year-old post-PCI patient has new onset of
holosystolic murmur, acute dyspnea, hypotension.
Question: Most likely complication causing these findings is:
A. Papillary muscle rupture causing acute MR.
B. Ventricular septal defect.
C. Left ventricular aneurysm.
D. Pericarditis.
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
MCQ 1
Context: A 68-year-old man with atherosclerotic CAD presents
with chest pressure, diaphoresis, and nausea. ECG shows ST-
elevation in leads II, III, aVF. Troponin I elevated.
Question: The priority nursing action during the initial 10
minutes of arrival is:
A. Administer sublingual nitroglycerin.
B. Give chewable aspirin 325 mg (unless contraindicated).
C. Obtain a chest x-ray.
D. Start high-flow oxygen via non-rebreather at 10 L/min.
Answer: B. Give chewable aspirin 325 mg (unless
contraindicated).
Rationales:
,A. Nitroglycerin may relieve ischemia but you must first assess
for hypotension/ PDE-5 med use; not the single highest priority.
B. Correct. Aspirin reduces mortality by inhibiting platelet
aggregation and should be given quickly for suspected STEMI
unless allergy/active bleeding.
C. Chest x-ray is not time-sensitive for reperfusion decisions in
STEMI.
D. Oxygen should be given only if hypoxemic (SpO₂ <90%) —
routine high-flow oxygen is not recommended for normoxic MI
patients.
MCQ 2
Context: 72-year-old woman after CABG has chest tube
drainage 250 mL in first hour, HR 110, BP 90/58, cold clammy
skin.
Question: The nurse’s first action is:
A. Call the surgeon.
B. Check for cardiac tamponade (assess JVD, muffled heart
sounds, hypotension).
C. Increase IV fluids to raise BP.
D. Remove and reposition chest tubes.
Answer: B. Check for cardiac tamponade (assess JVD, muffled
heart sounds, hypotension).
Rationales:
A. Calling surgeon is appropriate but assessment to identify
tamponade is immediate priority.
,B. Correct. Rapid assessment for tamponade is needed because
bleeding/tamponade is life-threatening after CABG.
C. IV fluids may be temporizing but without assessment could
worsen bleeding; do after evaluation.
D. Removing/repositioning tubes without order is unsafe.
MCQ 3
Context: 58-year-old with heart failure on ACE inhibitor and
furosemide reports dizziness and cough. Labs: K⁺ 3.1 mEq/L,
Na⁺ 132.
Question: The most important nursing intervention now is:
A. Teach patient to avoid potassium-rich foods.
B. Hold furosemide and notify provider.
C. Encourage increased fluid intake.
D. Administer a potassium binder.
Answer: B. Hold furosemide and notify provider.
Rationales:
A. Potassium-rich foods would be recommended for
hypokalemia, not avoided.
B. Correct. Furosemide can cause hypokalemia; hold and notify
for reassessment/possible K⁺ replacement.
C. Increased fluids may worsen HF and is inappropriate without
provider guidance.
D. Potassium binders lower K⁺ — contraindicated with
hypokalemia.
, MCQ 4
Context: 45-year-old with atrial fibrillation undergoing warfarin
therapy. INR last checked 2.0. Patient asks about diet.
Question: Which statement from the patient indicates correct
understanding?
A. “I should avoid all green leafy vegetables.”
B. “I’ll keep my vitamin K intake consistent.”
C. “I’ll stop taking warfarin before any dental visit.”
D. “I can double the dose if I miss one day.”
Answer: B. “I’ll keep my vitamin K intake consistent.”
Rationales:
A. Avoiding all greens is unnecessary; consistency is key.
B. Correct. Stable vitamin K intake helps maintain therapeutic
INR.
C. Stopping warfarin before dental work requires provider
guidance and risk assessment.
D. Doubling dose for missed warfarin is unsafe.
MCQ 5
Context: A 60-year-old post-PCI patient has new onset of
holosystolic murmur, acute dyspnea, hypotension.
Question: Most likely complication causing these findings is:
A. Papillary muscle rupture causing acute MR.
B. Ventricular septal defect.
C. Left ventricular aneurysm.
D. Pericarditis.
