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)
1. (MCQ) Atherosclerotic plaque progression —
pathophysiology & presentation
A 62-year-old with hyperlipidemia reports exertional chest
pain for 3 months. Which physiologic process best explains
his symptoms?
A. Platelet aggregation at coronary microaneurysms
B. Endothelial injury → lipid deposition → fibrous cap
formation → luminal narrowing
C. Vasculitis causing transmural inflammation of coronary
arteries
D. Primary arrhythmogenic focus in the sinoatrial node
causing ischemia
,Answer: B.
Rationale:
A — Platelet aggregation contributes to acute thrombus
formation but does not explain chronic exertional angina from
plaque buildup.
B — Correct. Atherosclerosis: endothelial damage → LDL
infiltration → macrophage foam cells → fibrous cap and plaque
→ progressive luminal narrowing → exertional ischemia.
C — Vasculitis is not the typical mechanism for stable coronary
atherosclerosis.
D — Arrhythmogenic foci cause rhythm issues not chronic
ischemia from stenosis.
2. (MCQ) Acute myocardial infarction — ECG interpretation
A client arrives with 2-hour history of severe chest pain.
ECG shows ST-segment elevation in leads V2–V4. Which
coronary artery is most likely occluded?
A. Right coronary artery (RCA)
B. Left circumflex artery (LCx)
C. Left anterior descending artery (LAD)
D. Posterior descending artery (PDA)
Answer: C.
Rationale:
A — RCA typically affects inferior leads (II, III, aVF).
B — LCx often affects lateral leads (I, aVL, V5–V6).
C — Correct. ST elevation in V2–V4 indicates anteroseptal
,infarct — LAD territory.
D — PDA occlusion results in posterior/inferior changes, not
V2–V4.
3. (NGN-style unfolding case — priority & interventions)
Mr. K, 71, post-PCI (percutaneous coronary intervention) 2
hours ago for STEMI. Vitals: BP 86/52, HR 110, RR 24, SpO₂
92% on 2 L nasal cannula. He is pale and diaphoretic.
Which 3 actions should the nurse do immediately? (Select
and rank priority: 1 = first)
Options:
A. Notify cardiology/primary provider.
B. Check the femoral/ radial access site for
bleeding/hematoma.
C. Give a 500 mL bolus of normal saline IV.
D. Obtain a 12-lead ECG.
E. Start dopamine infusion per standing order for
hypotension.
Answer (priority order): 1) B, 2) D, 3) A. (B first, then D, then A).
C and E only if indicated after assessment/MD order.
Rationale:
A — Notify promptly but after initial assessment to report
findings.
B — Correct first action. Post-PCI hypotension and diaphoresis
require checking access for bleeding/retroperitoneal
hemorrhage which can cause shock.
, C — Fluid bolus may be harmful if cardiogenic shock; only after
assessing for bleeding vs pump failure.
D — 12-lead ECG next to evaluate for re-occlusion or new
ischemia.
E — Vasopressors require provider order and assessment of
cause; not first action.
4. (MCQ) Heart failure — BNP interpretation
A client with dyspnea has BNP = 950 pg/mL (normal <100).
What does this indicate?
A. Unspecific marker — implies dehydration
B. Suggestive of heart failure with volume overload
C. Confirms pulmonary embolism as cause of dyspnea
D. Low sensitivity for acute decompensated heart failure
Answer: B.
Rationale:
A — Elevated BNP correlates with ventricular stretch, not
dehydration.
B — Correct. High BNP suggests increased ventricular wall
stress and supports heart failure diagnosis.
C — PE may raise BNP mildly but this level is more consistent
with HF.
D — BNP has good sensitivity for acute HF; this value is
significantly elevated.
PN® EXAMINATION
9TH EDITION
• AUTHOR(S)LINDA ANNE SILVESTRI; ANGELA
SILVESTRI
System-Specific Test Bank (Cardiovascular, Respiratory,
Neurological, Endocrine, GI, Musculoskeletal, Oncology)
Cardiovascular (10)
1. (MCQ) Atherosclerotic plaque progression —
pathophysiology & presentation
A 62-year-old with hyperlipidemia reports exertional chest
pain for 3 months. Which physiologic process best explains
his symptoms?
A. Platelet aggregation at coronary microaneurysms
B. Endothelial injury → lipid deposition → fibrous cap
formation → luminal narrowing
C. Vasculitis causing transmural inflammation of coronary
arteries
D. Primary arrhythmogenic focus in the sinoatrial node
causing ischemia
,Answer: B.
Rationale:
A — Platelet aggregation contributes to acute thrombus
formation but does not explain chronic exertional angina from
plaque buildup.
B — Correct. Atherosclerosis: endothelial damage → LDL
infiltration → macrophage foam cells → fibrous cap and plaque
→ progressive luminal narrowing → exertional ischemia.
C — Vasculitis is not the typical mechanism for stable coronary
atherosclerosis.
D — Arrhythmogenic foci cause rhythm issues not chronic
ischemia from stenosis.
2. (MCQ) Acute myocardial infarction — ECG interpretation
A client arrives with 2-hour history of severe chest pain.
ECG shows ST-segment elevation in leads V2–V4. Which
coronary artery is most likely occluded?
A. Right coronary artery (RCA)
B. Left circumflex artery (LCx)
C. Left anterior descending artery (LAD)
D. Posterior descending artery (PDA)
Answer: C.
Rationale:
A — RCA typically affects inferior leads (II, III, aVF).
B — LCx often affects lateral leads (I, aVL, V5–V6).
C — Correct. ST elevation in V2–V4 indicates anteroseptal
,infarct — LAD territory.
D — PDA occlusion results in posterior/inferior changes, not
V2–V4.
3. (NGN-style unfolding case — priority & interventions)
Mr. K, 71, post-PCI (percutaneous coronary intervention) 2
hours ago for STEMI. Vitals: BP 86/52, HR 110, RR 24, SpO₂
92% on 2 L nasal cannula. He is pale and diaphoretic.
Which 3 actions should the nurse do immediately? (Select
and rank priority: 1 = first)
Options:
A. Notify cardiology/primary provider.
B. Check the femoral/ radial access site for
bleeding/hematoma.
C. Give a 500 mL bolus of normal saline IV.
D. Obtain a 12-lead ECG.
E. Start dopamine infusion per standing order for
hypotension.
Answer (priority order): 1) B, 2) D, 3) A. (B first, then D, then A).
C and E only if indicated after assessment/MD order.
Rationale:
A — Notify promptly but after initial assessment to report
findings.
B — Correct first action. Post-PCI hypotension and diaphoresis
require checking access for bleeding/retroperitoneal
hemorrhage which can cause shock.
, C — Fluid bolus may be harmful if cardiogenic shock; only after
assessing for bleeding vs pump failure.
D — 12-lead ECG next to evaluate for re-occlusion or new
ischemia.
E — Vasopressors require provider order and assessment of
cause; not first action.
4. (MCQ) Heart failure — BNP interpretation
A client with dyspnea has BNP = 950 pg/mL (normal <100).
What does this indicate?
A. Unspecific marker — implies dehydration
B. Suggestive of heart failure with volume overload
C. Confirms pulmonary embolism as cause of dyspnea
D. Low sensitivity for acute decompensated heart failure
Answer: B.
Rationale:
A — Elevated BNP correlates with ventricular stretch, not
dehydration.
B — Correct. High BNP suggests increased ventricular wall
stress and supports heart failure diagnosis.
C — PE may raise BNP mildly but this level is more consistent
with HF.
D — BNP has good sensitivity for acute HF; this value is
significantly elevated.
