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 (6 MCQs + 4 NGN cases)
MCQ 1 — Pathophysiology / Signs
A 72-year-old man has increasing dyspnea on exertion,
orthopnea, and 2+ pitting edema of the ankles. BNP is 1,200
pg/mL (elevated), chest x-ray shows cardiomegaly, and
echocardiogram shows LVEF 30%. What is the most likely
primary diagnosis?
A. Restrictive cardiomyopathy
B. Left-sided systolic heart failure (HFrEF)
C. Right-sided heart failure only
D. Hypertrophic cardiomyopathy
Answer: B
Rationale:
A: Restrictive shows preserved EF, not low LVEF — wrong.
,B: Correct — low EF, pulmonary congestion symptoms, elevated
BNP indicate systolic left-sided HF.
C: Right-sided would cause systemic congestion but not
orthopnea/low LVEF primarily.
D: Hypertrophic usually causes preserved or hyperdynamic EF
and outflow obstruction features — wrong.
MCQ 2 — Diagnostic interpretation
A patient with suspected acute MI has chest pain and ST
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) only
Answer: C
Rationale:
A: LAD causes anterior leads (V1–V4) changes — wrong.
B: LCx often causes lateral leads (I, aVL, V5–V6) — wrong.
C: Correct — inferior leads II, III, aVF point to RCA occlusion in
most patients.
D: PDA supplies posterior wall; isolated PDA ST-elevation
pattern differs and often accompanies RCA/LCx lesions — less
likely.
,MCQ 3 — Nursing intervention
A patient with chronic HF is prescribed furosemide 40 mg daily.
Which assessment finding requires immediate action before
giving the dose?
A. Blood pressure 110/70 mm Hg
B. Serum potassium 2.9 mEq/L
C. Weight gain of 1 kg since yesterday
D. Pulse 68 bpm, regular
Answer: B
Rationale:
A: BP acceptable — not urgent.
B: Correct — hypokalemia (<3.5) increases risk with loop
diuretics; hold and notify prescriber.
C: 1 kg gain is noteworthy but not immediate contraindication—
monitor.
D: Pulse normal — OK to give.
MCQ 4 — Patient teaching
A patient starting warfarin asks what foods to avoid. Best
teaching statement:
A. “Avoid all green vegetables — they will make the drug
ineffective.”
B. “You should maintain a consistent intake of vitamin K–rich
foods.”
C. “Stop eating fruits; they increase bleeding risk.”
D. “There are no dietary interactions with warfarin.”
, Answer: B
Rationale:
A: Avoiding all greens is unnecessary; consistency is key —
incorrect.
B: Correct — stable vitamin K intake helps keep INR predictable.
C: Fruits aren’t categorically contraindicated — wrong.
D: Incorrect — many foods and herbs interact with warfarin.
MCQ 5 — Diagnostic interpretation (labs)
A patient on heparin infusion has an aPTT of 140 seconds
(therapeutic range normally ~60–80 for this protocol). The
nurse should:
A. Continue infusion — aPTT is therapeutic.
B. Decrease or stop the infusion and notify provider due to
excessive anticoagulation.
C. Administer protamine immediately without notifying
provider.
D. Increase the infusion rate.
Answer: B
Rationale:
A: 140 is above typical therapeutic target — not safe.
B: Correct — excessive aPTT warrants holding/reducing heparin
and notifying prescriber.
C: Protamine is reversal and requires provider order; immediate
admin without order is not appropriate.
D: Increasing will worsen anticoagulation — wrong.
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 (6 MCQs + 4 NGN cases)
MCQ 1 — Pathophysiology / Signs
A 72-year-old man has increasing dyspnea on exertion,
orthopnea, and 2+ pitting edema of the ankles. BNP is 1,200
pg/mL (elevated), chest x-ray shows cardiomegaly, and
echocardiogram shows LVEF 30%. What is the most likely
primary diagnosis?
A. Restrictive cardiomyopathy
B. Left-sided systolic heart failure (HFrEF)
C. Right-sided heart failure only
D. Hypertrophic cardiomyopathy
Answer: B
Rationale:
A: Restrictive shows preserved EF, not low LVEF — wrong.
,B: Correct — low EF, pulmonary congestion symptoms, elevated
BNP indicate systolic left-sided HF.
C: Right-sided would cause systemic congestion but not
orthopnea/low LVEF primarily.
D: Hypertrophic usually causes preserved or hyperdynamic EF
and outflow obstruction features — wrong.
MCQ 2 — Diagnostic interpretation
A patient with suspected acute MI has chest pain and ST
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) only
Answer: C
Rationale:
A: LAD causes anterior leads (V1–V4) changes — wrong.
B: LCx often causes lateral leads (I, aVL, V5–V6) — wrong.
C: Correct — inferior leads II, III, aVF point to RCA occlusion in
most patients.
D: PDA supplies posterior wall; isolated PDA ST-elevation
pattern differs and often accompanies RCA/LCx lesions — less
likely.
,MCQ 3 — Nursing intervention
A patient with chronic HF is prescribed furosemide 40 mg daily.
Which assessment finding requires immediate action before
giving the dose?
A. Blood pressure 110/70 mm Hg
B. Serum potassium 2.9 mEq/L
C. Weight gain of 1 kg since yesterday
D. Pulse 68 bpm, regular
Answer: B
Rationale:
A: BP acceptable — not urgent.
B: Correct — hypokalemia (<3.5) increases risk with loop
diuretics; hold and notify prescriber.
C: 1 kg gain is noteworthy but not immediate contraindication—
monitor.
D: Pulse normal — OK to give.
MCQ 4 — Patient teaching
A patient starting warfarin asks what foods to avoid. Best
teaching statement:
A. “Avoid all green vegetables — they will make the drug
ineffective.”
B. “You should maintain a consistent intake of vitamin K–rich
foods.”
C. “Stop eating fruits; they increase bleeding risk.”
D. “There are no dietary interactions with warfarin.”
, Answer: B
Rationale:
A: Avoiding all greens is unnecessary; consistency is key —
incorrect.
B: Correct — stable vitamin K intake helps keep INR predictable.
C: Fruits aren’t categorically contraindicated — wrong.
D: Incorrect — many foods and herbs interact with warfarin.
MCQ 5 — Diagnostic interpretation (labs)
A patient on heparin infusion has an aPTT of 140 seconds
(therapeutic range normally ~60–80 for this protocol). The
nurse should:
A. Continue infusion — aPTT is therapeutic.
B. Decrease or stop the infusion and notify provider due to
excessive anticoagulation.
C. Administer protamine immediately without notifying
provider.
D. Increase the infusion rate.
Answer: B
Rationale:
A: 140 is above typical therapeutic target — not safe.
B: Correct — excessive aPTT warrants holding/reducing heparin
and notifying prescriber.
C: Protamine is reversal and requires provider order; immediate
admin without order is not appropriate.
D: Increasing will worsen anticoagulation — wrong.
