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 questions (6 MCQs, 4 NGN)
1 (MCQ) — Pathophysiology / Diagnosis
A 68-year-old man with chest pain comes to ED. ECG shows ST-
segment depression in leads V1–V4. Troponin I is 0.05 ng/mL
(upper limit 0.04). Which interpretation is most appropriate?
A. ST-elevation myocardial infarction (STEMI)
B. Non-ST-elevation myocardial infarction (NSTEMI)
C. Unstable angina
D. Pericarditis
Answer: B. NSTEMI
Rationales
• A: STEMI requires ST elevation—absent here.
, • B: Correct — troponin above ULN + ischemic ECG changes
without ST elevation = NSTEMI.
• C: Unstable angina has ischemic ECG changes but normal
troponin.
• D: Pericarditis often shows diffuse ST elevation and PR
depression, not isolated depression in V1–V4.
2 (MCQ) — Nursing intervention / Prioritization
A patient with congestive heart failure (HF) has 3+ pitting
edema, bibasilar crackles, and anuria for 4 hours after diuretic
dose. What is the nurse’s immediate priority?
A. Increase oral fluid intake
B. Auscultate for S3 gallop and obtain weight
C. Notify provider and prepare for electrolyte and renal function
labs
D. Elevate lower extremities and document findings
Answer: C. Notify provider and prepare for electrolyte and
renal function labs
Rationales
• A: Increasing fluids in suspected diuretic-resistant HF with
anuria could worsen pulmonary edema.
• B: Auscultation and weight are useful but not immediate if
renal output is absent—assessments already suggest
urgent concern.
, • C: Correct — anuria post-diuretic suggests possible acute
kidney injury; labs and provider notification are urgent.
• D: Elevation reduces peripheral edema but does not
address possible AKI and hemodynamic instability.
3 (MCQ) — Patient teaching / Medication
A client starting an ACE inhibitor is taught about side effects.
Which statement indicates correct understanding?
A. “I should stop my potassium-sparing diuretic to avoid
hypokalemia.”
B. “A cough that won’t go away is a side effect I should report.”
C. “I’ll take the medication only when I feel short of breath.”
D. “It’s safe to take NSAIDs whenever I need them.”
Answer: B. “A cough that won’t go away is a side effect I
should report.”
Rationales
• A: ACE inhibitors can cause hyperkalemia; stopping
potassium-sparing diuretics may be necessary but should
be provider-directed.
• B: Correct — persistent dry cough is a common ACE
inhibitor adverse effect and should be reported.
• C: ACE inhibitors are scheduled drugs for BP control, not
PRN for dyspnea.
, • D: NSAIDs can blunt ACE inhibitor effects and worsen renal
function—caution is advised.
4 (MCQ) — Diagnostic interpretation (hemodynamics)
Which hemodynamic finding suggests left-sided heart failure?
A. Elevated central venous pressure (CVP) only
B. Pulmonary congestion and elevated pulmonary capillary
wedge pressure (PCWP)
C. Low pulmonary artery pressures with systemic hypertension
D. Elevated systemic vascular resistance with decreased
pulmonary wedge pressure
Answer: B. Pulmonary congestion and elevated PCWP
Rationales
• A: CVP reflects right-sided preload, not specifically left
failure.
• B: Correct — elevated PCWP correlates with left atrial
pressure and pulmonary congestion.
• C: Low PA pressures are not typical of left HF with
congestion.
• D: Elevated SVR may occur, but decreased PCWP
contradicts left failure.
5 (MCQ) — Signs/Symptoms / Teaching
PN® EXAMINATION
9TH EDITION
• AUTHOR(S)LINDA ANNE SILVESTRI; ANGELA
SILVESTRI
System-Specific Test Bank (Cardiovascular, Respiratory,
Neurological, Endocrine, GI, Musculoskeletal, Oncology)
Cardiovascular — 10 questions (6 MCQs, 4 NGN)
1 (MCQ) — Pathophysiology / Diagnosis
A 68-year-old man with chest pain comes to ED. ECG shows ST-
segment depression in leads V1–V4. Troponin I is 0.05 ng/mL
(upper limit 0.04). Which interpretation is most appropriate?
A. ST-elevation myocardial infarction (STEMI)
B. Non-ST-elevation myocardial infarction (NSTEMI)
C. Unstable angina
D. Pericarditis
Answer: B. NSTEMI
Rationales
• A: STEMI requires ST elevation—absent here.
, • B: Correct — troponin above ULN + ischemic ECG changes
without ST elevation = NSTEMI.
• C: Unstable angina has ischemic ECG changes but normal
troponin.
• D: Pericarditis often shows diffuse ST elevation and PR
depression, not isolated depression in V1–V4.
2 (MCQ) — Nursing intervention / Prioritization
A patient with congestive heart failure (HF) has 3+ pitting
edema, bibasilar crackles, and anuria for 4 hours after diuretic
dose. What is the nurse’s immediate priority?
A. Increase oral fluid intake
B. Auscultate for S3 gallop and obtain weight
C. Notify provider and prepare for electrolyte and renal function
labs
D. Elevate lower extremities and document findings
Answer: C. Notify provider and prepare for electrolyte and
renal function labs
Rationales
• A: Increasing fluids in suspected diuretic-resistant HF with
anuria could worsen pulmonary edema.
• B: Auscultation and weight are useful but not immediate if
renal output is absent—assessments already suggest
urgent concern.
, • C: Correct — anuria post-diuretic suggests possible acute
kidney injury; labs and provider notification are urgent.
• D: Elevation reduces peripheral edema but does not
address possible AKI and hemodynamic instability.
3 (MCQ) — Patient teaching / Medication
A client starting an ACE inhibitor is taught about side effects.
Which statement indicates correct understanding?
A. “I should stop my potassium-sparing diuretic to avoid
hypokalemia.”
B. “A cough that won’t go away is a side effect I should report.”
C. “I’ll take the medication only when I feel short of breath.”
D. “It’s safe to take NSAIDs whenever I need them.”
Answer: B. “A cough that won’t go away is a side effect I
should report.”
Rationales
• A: ACE inhibitors can cause hyperkalemia; stopping
potassium-sparing diuretics may be necessary but should
be provider-directed.
• B: Correct — persistent dry cough is a common ACE
inhibitor adverse effect and should be reported.
• C: ACE inhibitors are scheduled drugs for BP control, not
PRN for dyspnea.
, • D: NSAIDs can blunt ACE inhibitor effects and worsen renal
function—caution is advised.
4 (MCQ) — Diagnostic interpretation (hemodynamics)
Which hemodynamic finding suggests left-sided heart failure?
A. Elevated central venous pressure (CVP) only
B. Pulmonary congestion and elevated pulmonary capillary
wedge pressure (PCWP)
C. Low pulmonary artery pressures with systemic hypertension
D. Elevated systemic vascular resistance with decreased
pulmonary wedge pressure
Answer: B. Pulmonary congestion and elevated PCWP
Rationales
• A: CVP reflects right-sided preload, not specifically left
failure.
• B: Correct — elevated PCWP correlates with left atrial
pressure and pulmonary congestion.
• C: Low PA pressures are not typical of left HF with
congestion.
• D: Elevated SVR may occur, but decreased PCWP
contradicts left failure.
5 (MCQ) — Signs/Symptoms / Teaching
