Saunders Comprehensive Review for the NCLEX-PN®
Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
MEDICAL-SURGICAL NURSING (ADULT HEALTH
DISORDERS & MANAGEMENT) TEST BANK
1 — Cardiovascular: Acute chest pain (prioritization)
Case: A 64-yr old man with hx HTN and hyperlipidemia arrives
to ED with 90 minutes of substernal chest pressure, diaphoresis,
and left arm numbness. Vitals: BP 150/88, HR 98, SpO₂ 96% RA.
ECG shows ST elevation in leads II, III, aVF.
Question: Which action should the nurse perform first?
A. Administer chewable aspirin 325 mg PO.
B. Prepare the client for emergent PCI (activate cath lab).
C. Give sublingual nitroglycerin.
D. Start a peripheral IV and give morphine.
Correct: B. Prepare for emergent PCI (activate cath lab).
Rationale (stepwise):
, • Key goal: reperfusion for STEMI — door-to-balloon time
critical. Activating cath lab is highest priority to minimize
myocardial damage.
• A: Aspirin is essential (antiplatelet), but activation of PCI
team is time-sensitive and should occur immediately while
aspirin is given concurrently — not instead of activating
team.
• C: Nitroglycerin may relieve ischemia and is often given,
but contraindicated if right ventricular infarct or
hypotension; nitro can be given after activation. Activation
still first.
• D: IV access is important, and morphine can relieve pain,
but morphine is not priority over reperfusion and may
mask pain changes; start IV while activating cath lab.
Clinical reasoning: simultaneous actions occur, but activate cath
lab first to ensure definitive reperfusion; other interventions
can be performed in parallel.
2 — Cardiovascular: Heart failure medication teaching
Case: A client with chronic HFrEF (EF 32%) is discharged on
lisinopril, carvedilol, furosemide, and spironolactone. He calls
asking why his potassium was low (3.1 mEq/L) last week and
whether to take extra potassium.
,Question: Best nursing response?
A. Instruct to take over-the-counter potassium chloride 99 mg
daily.
B. Advise to eat potassium-rich foods and schedule follow-up
labs.
C. Stop furosemide and continue other meds.
D. Increase spironolactone dose without notifying provider.
Correct: B. Advise to eat potassium-rich foods and schedule
follow-up labs.
Rationale:
• B: Loop diuretics cause hypokalemia; dietary potassium
and repeat labs are appropriate; provider may adjust
therapy.
• A: OTC potassium chloride doses vary; absolute dosing and
safety must be provider-directed—nurse should not advise
an unprescribed supplement.
• C: Stopping furosemide could cause volume overload and
worsening HF—must consult provider first.
• D: Increasing spironolactone (a K-sparing diuretic) without
provider order risks hyperkalemia—never change doses
independently.
Clinical reasoning: identify loop diuretic as cause, prioritize safe,
collaborative plan (diet, labs, provider notification).
, 3 — Cardiovascular: Anticoagulation teaching (SATA)
Case: 72-yr old woman with new atrial fibrillation discharged on
warfarin.
Question: Which instructions should the nurse include? (Select
all that apply.)
A. Have INR checked regularly as scheduled.
B. Stop leafy green vegetables while on warfarin.
C. Report any unusual bleeding or bruising.
D. Use an electric razor for shaving.
E. Begin aspirin 81 mg daily if you miss a dose.
Correct: A, C, D.
Rationale:
• A: Correct — INR monitoring is essential.
• B: Incorrect — do not stop green vegetables; instead
maintain consistent vitamin K intake to avoid INR
fluctuations.
• C: Correct — bleeding is a major adverse effect and must
be reported.
• D: Correct — electric razors reduce skin cuts/bleeding risk.
• E: Incorrect — adding aspirin increases bleeding risk; never
add antiplatelet without provider order.
Clinical reasoning: focus on INR, bleeding precautions, and
stable diet.
Examination
9th Edition
• Author(s)Linda Anne Silvestri; Angela Silvestri
MEDICAL-SURGICAL NURSING (ADULT HEALTH
DISORDERS & MANAGEMENT) TEST BANK
1 — Cardiovascular: Acute chest pain (prioritization)
Case: A 64-yr old man with hx HTN and hyperlipidemia arrives
to ED with 90 minutes of substernal chest pressure, diaphoresis,
and left arm numbness. Vitals: BP 150/88, HR 98, SpO₂ 96% RA.
ECG shows ST elevation in leads II, III, aVF.
Question: Which action should the nurse perform first?
A. Administer chewable aspirin 325 mg PO.
B. Prepare the client for emergent PCI (activate cath lab).
C. Give sublingual nitroglycerin.
D. Start a peripheral IV and give morphine.
Correct: B. Prepare for emergent PCI (activate cath lab).
Rationale (stepwise):
, • Key goal: reperfusion for STEMI — door-to-balloon time
critical. Activating cath lab is highest priority to minimize
myocardial damage.
• A: Aspirin is essential (antiplatelet), but activation of PCI
team is time-sensitive and should occur immediately while
aspirin is given concurrently — not instead of activating
team.
• C: Nitroglycerin may relieve ischemia and is often given,
but contraindicated if right ventricular infarct or
hypotension; nitro can be given after activation. Activation
still first.
• D: IV access is important, and morphine can relieve pain,
but morphine is not priority over reperfusion and may
mask pain changes; start IV while activating cath lab.
Clinical reasoning: simultaneous actions occur, but activate cath
lab first to ensure definitive reperfusion; other interventions
can be performed in parallel.
2 — Cardiovascular: Heart failure medication teaching
Case: A client with chronic HFrEF (EF 32%) is discharged on
lisinopril, carvedilol, furosemide, and spironolactone. He calls
asking why his potassium was low (3.1 mEq/L) last week and
whether to take extra potassium.
,Question: Best nursing response?
A. Instruct to take over-the-counter potassium chloride 99 mg
daily.
B. Advise to eat potassium-rich foods and schedule follow-up
labs.
C. Stop furosemide and continue other meds.
D. Increase spironolactone dose without notifying provider.
Correct: B. Advise to eat potassium-rich foods and schedule
follow-up labs.
Rationale:
• B: Loop diuretics cause hypokalemia; dietary potassium
and repeat labs are appropriate; provider may adjust
therapy.
• A: OTC potassium chloride doses vary; absolute dosing and
safety must be provider-directed—nurse should not advise
an unprescribed supplement.
• C: Stopping furosemide could cause volume overload and
worsening HF—must consult provider first.
• D: Increasing spironolactone (a K-sparing diuretic) without
provider order risks hyperkalemia—never change doses
independently.
Clinical reasoning: identify loop diuretic as cause, prioritize safe,
collaborative plan (diet, labs, provider notification).
, 3 — Cardiovascular: Anticoagulation teaching (SATA)
Case: 72-yr old woman with new atrial fibrillation discharged on
warfarin.
Question: Which instructions should the nurse include? (Select
all that apply.)
A. Have INR checked regularly as scheduled.
B. Stop leafy green vegetables while on warfarin.
C. Report any unusual bleeding or bruising.
D. Use an electric razor for shaving.
E. Begin aspirin 81 mg daily if you miss a dose.
Correct: A, C, D.
Rationale:
• A: Correct — INR monitoring is essential.
• B: Incorrect — do not stop green vegetables; instead
maintain consistent vitamin K intake to avoid INR
fluctuations.
• C: Correct — bleeding is a major adverse effect and must
be reported.
• D: Correct — electric razors reduce skin cuts/bleeding risk.
• E: Incorrect — adding aspirin increases bleeding risk; never
add antiplatelet without provider order.
Clinical reasoning: focus on INR, bleeding precautions, and
stable diet.
