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
A 68-year-old man with a history of hypertension presents with
progressive exertional dyspnea and lower extremity edema.
BNP is elevated, chest x-ray shows cardiomegaly. Which
pathophysiologic mechanism best explains his symptoms?
A. Decreased preload due to hypovolemia
B. Left ventricular systolic dysfunction causing reduced ejection
fraction and pulmonary congestion
C. Right ventricular infarction causing isolated systemic venous
congestion
D. Pericardial tamponade causing increased stroke volume
Answer: B
,Rationales:
A. Incorrect — hypovolemia causes decreased preload and
hypotension, not edema and pulmonary congestion.
B. Correct — LV systolic dysfunction → reduced EF → increased
LVEDP → pulmonary venous congestion → dyspnea and
elevated BNP.
C. Incorrect — RV infarction causes systemic venous congestion
but commonly without primary pulmonary edema.
D. Incorrect — tamponade reduces stroke volume and cardiac
output but does not increase stroke volume; it causes
equalization of pressures and hypotension.
MCQ 2
A patient with suspected acute myocardial infarction arrives 45
minutes after chest pain onset. Which immediate nursing action
MOST reduces myocardial injury?
A. Obtain detailed psychosocial history
B. Administer aspirin chewable (162–325 mg) unless
contraindicated
C. Draw blood for total cholesterol and triglycerides
D. Encourage bed exercise to relieve anxiety
Answer: B
Rationales:
A. Incorrect — psychosocial history is important but not
immediately life-saving.
B. Correct — early aspirin reduces platelet aggregation and
,limits infarct size; give immediately unless allergy.
C. Incorrect — lipid labs are irrelevant in the acute management
window.
D. Incorrect — activity increases myocardial demand and is
contraindicated.
MCQ 3
A 55-year-old woman on lisinopril reports dry cough and
dizziness on standing. Which nursing action is priority?
A. Advise to stop ACE inhibitor immediately and never use again
B. Educate on orthostatic precautions and report severe cough
or syncope; notify prescriber for possible ACE inhibitor
substitution
C. Tell the patient cough is unrelated to lisinopril and continue
medication
D. Recommend doubling the dose to improve blood pressure
control
Answer: B
Rationales:
A. Incorrect — do not instruct abrupt discontinuation without
prescriber input; side effects may require substitution.
B. Correct — ACE inhibitors commonly cause dry cough;
orthostatic hypotension is possible — nurse should teach
precautions and notify prescriber for alternative (e.g., ARB) if
symptoms intolerable.
C. Incorrect — cough is a known ACE inhibitor adverse effect;
, ignoring it risks nonadherence.
D. Incorrect — doubling dose could worsen adverse effects.
MCQ 4
An ECG shows peaked T waves and widened QRS in a patient
with end-stage renal disease. The nurse recognizes this as a sign
of:
A. Hypokalemia
B. Hyperkalemia requiring immediate attention
C. Hypocalcemia causing decreased membrane excitability
D. Normal variant in chronic dialysis patients
Answer: B
Rationales:
A. Incorrect — hypokalemia causes U waves and flattened T
waves, not peaked T waves.
B. Correct — peaked T waves and widened QRS suggest
hyperkalemia, which is life-threatening and requires immediate
treatment.
C. Incorrect — hypocalcemia affects QT interval but not peaked
T waves/widened QRS in this pattern.
D. Incorrect — ECG changes of hyperkalemia are not a benign
chronic variant.
MCQ 5
A patient started on high-dose IV furosemide for acute
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
A 68-year-old man with a history of hypertension presents with
progressive exertional dyspnea and lower extremity edema.
BNP is elevated, chest x-ray shows cardiomegaly. Which
pathophysiologic mechanism best explains his symptoms?
A. Decreased preload due to hypovolemia
B. Left ventricular systolic dysfunction causing reduced ejection
fraction and pulmonary congestion
C. Right ventricular infarction causing isolated systemic venous
congestion
D. Pericardial tamponade causing increased stroke volume
Answer: B
,Rationales:
A. Incorrect — hypovolemia causes decreased preload and
hypotension, not edema and pulmonary congestion.
B. Correct — LV systolic dysfunction → reduced EF → increased
LVEDP → pulmonary venous congestion → dyspnea and
elevated BNP.
C. Incorrect — RV infarction causes systemic venous congestion
but commonly without primary pulmonary edema.
D. Incorrect — tamponade reduces stroke volume and cardiac
output but does not increase stroke volume; it causes
equalization of pressures and hypotension.
MCQ 2
A patient with suspected acute myocardial infarction arrives 45
minutes after chest pain onset. Which immediate nursing action
MOST reduces myocardial injury?
A. Obtain detailed psychosocial history
B. Administer aspirin chewable (162–325 mg) unless
contraindicated
C. Draw blood for total cholesterol and triglycerides
D. Encourage bed exercise to relieve anxiety
Answer: B
Rationales:
A. Incorrect — psychosocial history is important but not
immediately life-saving.
B. Correct — early aspirin reduces platelet aggregation and
,limits infarct size; give immediately unless allergy.
C. Incorrect — lipid labs are irrelevant in the acute management
window.
D. Incorrect — activity increases myocardial demand and is
contraindicated.
MCQ 3
A 55-year-old woman on lisinopril reports dry cough and
dizziness on standing. Which nursing action is priority?
A. Advise to stop ACE inhibitor immediately and never use again
B. Educate on orthostatic precautions and report severe cough
or syncope; notify prescriber for possible ACE inhibitor
substitution
C. Tell the patient cough is unrelated to lisinopril and continue
medication
D. Recommend doubling the dose to improve blood pressure
control
Answer: B
Rationales:
A. Incorrect — do not instruct abrupt discontinuation without
prescriber input; side effects may require substitution.
B. Correct — ACE inhibitors commonly cause dry cough;
orthostatic hypotension is possible — nurse should teach
precautions and notify prescriber for alternative (e.g., ARB) if
symptoms intolerable.
C. Incorrect — cough is a known ACE inhibitor adverse effect;
, ignoring it risks nonadherence.
D. Incorrect — doubling dose could worsen adverse effects.
MCQ 4
An ECG shows peaked T waves and widened QRS in a patient
with end-stage renal disease. The nurse recognizes this as a sign
of:
A. Hypokalemia
B. Hyperkalemia requiring immediate attention
C. Hypocalcemia causing decreased membrane excitability
D. Normal variant in chronic dialysis patients
Answer: B
Rationales:
A. Incorrect — hypokalemia causes U waves and flattened T
waves, not peaked T waves.
B. Correct — peaked T waves and widened QRS suggest
hyperkalemia, which is life-threatening and requires immediate
treatment.
C. Incorrect — hypocalcemia affects QT interval but not peaked
T waves/widened QRS in this pattern.
D. Incorrect — ECG changes of hyperkalemia are not a benign
chronic variant.
MCQ 5
A patient started on high-dose IV furosemide for acute
