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
1 — MCQ (Acute MI — pathophysiology & initial care)
A 62-year-old man presents with 90 minutes of crushing
substernal chest pain, diaphoresis, and nausea. ECG shows ST-
segment elevation in leads V2–V4. Which nursing action has the
highest priority?
A. Obtain serum troponin and CK-MB.
B. Administer chewable aspirin 325 mg (unless contraindicated).
C. Start a continuous cardiac monitor and 12-lead telemetry.
D. Give IV morphine for pain control.
Correct answer: B
Rationale:
, • A: Troponin & CK-MB are essential for diagnosis but do not
change immediate reperfusion priorities. Labs are
important but not highest priority.
• B (Correct): Chewable aspirin should be given immediately
for suspected STEMI to inhibit platelet aggregation and
reduce infarct size; it’s a time-critical intervention.
• C: Cardiac monitoring is important but secondary to
immediate antiplatelet therapy and preparing for
reperfusion.
• D: Morphine can relieve pain and reduce sympathetic
response, but analgesia is lower priority than aspirin and
reperfusion planning.
2 — NGN unfolding case (STEMI — reperfusion decisions &
patient teaching)
Scenario: A 58-year-old woman arrives 75 minutes after onset
of crushing chest pain. ECG: ST elevation in II, III, aVF. She has a
history of hypertension and a subarachnoid hemorrhage 8 years
ago. Allergies: none. Vitals: BP 140/86, HR 96. Percutaneous
coronary intervention (PCI) is available in 30 minutes.
Part A — Single best answer: What is the optimal reperfusion
strategy?
A. Administer fibrinolytic therapy immediately.
B. Transport for emergent PCI (preferred).
,C. Give tPA and arrange transfer for PCI.
D. Manage conservatively with anticoagulation and nitrates.
Correct answer: B
Rationale:
• A: Fibrinolytic therapy is used when PCI is not available
within appropriate time window or contraindications are
absent. However, patient has history of subarachnoid
hemorrhage (prior hemorrhagic stroke) — a
contraindication to fibrinolytics.
• B (Correct): Primary PCI is preferred for STEMI when
available in an appropriate timeframe. It avoids fibrinolytic
contraindication.
• C: Giving tPA is contraindicated due to prior hemorrhagic
stroke.
• D: Conservative management risks larger infarct — not
acceptable for STEMI.
Part B — Multiple response (select all that apply): Which
actions should the nurse perform immediately while preparing
for PCI?
1. Give chewable aspirin 325 mg.
2. Administer a loading dose of clopidogrel (unless
contraindicated).
3. Start IV heparin infusion per protocol.
4. Give alteplase because PCI will take >30 minutes.
, Correct answers: 1, 2, 3
Rationale:
• 1 (Correct): Aspirin is immediate standard.
• 2 (Correct): A P2Y12 inhibitor (clopidogrel/ticagrelor) is
commonly given as a loading dose pre-PCI unless
contraindicated.
• 3 (Correct): Anticoagulation (heparin) is given per protocol
to prevent thrombus propagation.
• 4: Alteplase is contraindicated (prior hemorrhagic stroke)
and unnecessary when PCI is planned.
Part C — Patient teaching (single best): Which teaching point
about PCI and post-procedure care is most important to
include?
A. "You will need to stay flat for 24 hours after the procedure."
B. "You should expect to take antiplatelet medication for at
least 12 months."
C. "You will not need to change any of your daily medications."
D. "You should immediately stop taking your statin."
Correct answer: B
Rationale:
• A: Immobilization time depends on access site (femoral vs
radial). Radial access allows early mobilization. Saying 24
hours is inaccurate.
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
1 — MCQ (Acute MI — pathophysiology & initial care)
A 62-year-old man presents with 90 minutes of crushing
substernal chest pain, diaphoresis, and nausea. ECG shows ST-
segment elevation in leads V2–V4. Which nursing action has the
highest priority?
A. Obtain serum troponin and CK-MB.
B. Administer chewable aspirin 325 mg (unless contraindicated).
C. Start a continuous cardiac monitor and 12-lead telemetry.
D. Give IV morphine for pain control.
Correct answer: B
Rationale:
, • A: Troponin & CK-MB are essential for diagnosis but do not
change immediate reperfusion priorities. Labs are
important but not highest priority.
• B (Correct): Chewable aspirin should be given immediately
for suspected STEMI to inhibit platelet aggregation and
reduce infarct size; it’s a time-critical intervention.
• C: Cardiac monitoring is important but secondary to
immediate antiplatelet therapy and preparing for
reperfusion.
• D: Morphine can relieve pain and reduce sympathetic
response, but analgesia is lower priority than aspirin and
reperfusion planning.
2 — NGN unfolding case (STEMI — reperfusion decisions &
patient teaching)
Scenario: A 58-year-old woman arrives 75 minutes after onset
of crushing chest pain. ECG: ST elevation in II, III, aVF. She has a
history of hypertension and a subarachnoid hemorrhage 8 years
ago. Allergies: none. Vitals: BP 140/86, HR 96. Percutaneous
coronary intervention (PCI) is available in 30 minutes.
Part A — Single best answer: What is the optimal reperfusion
strategy?
A. Administer fibrinolytic therapy immediately.
B. Transport for emergent PCI (preferred).
,C. Give tPA and arrange transfer for PCI.
D. Manage conservatively with anticoagulation and nitrates.
Correct answer: B
Rationale:
• A: Fibrinolytic therapy is used when PCI is not available
within appropriate time window or contraindications are
absent. However, patient has history of subarachnoid
hemorrhage (prior hemorrhagic stroke) — a
contraindication to fibrinolytics.
• B (Correct): Primary PCI is preferred for STEMI when
available in an appropriate timeframe. It avoids fibrinolytic
contraindication.
• C: Giving tPA is contraindicated due to prior hemorrhagic
stroke.
• D: Conservative management risks larger infarct — not
acceptable for STEMI.
Part B — Multiple response (select all that apply): Which
actions should the nurse perform immediately while preparing
for PCI?
1. Give chewable aspirin 325 mg.
2. Administer a loading dose of clopidogrel (unless
contraindicated).
3. Start IV heparin infusion per protocol.
4. Give alteplase because PCI will take >30 minutes.
, Correct answers: 1, 2, 3
Rationale:
• 1 (Correct): Aspirin is immediate standard.
• 2 (Correct): A P2Y12 inhibitor (clopidogrel/ticagrelor) is
commonly given as a loading dose pre-PCI unless
contraindicated.
• 3 (Correct): Anticoagulation (heparin) is given per protocol
to prevent thrombus propagation.
• 4: Alteplase is contraindicated (prior hemorrhagic stroke)
and unnecessary when PCI is planned.
Part C — Patient teaching (single best): Which teaching point
about PCI and post-procedure care is most important to
include?
A. "You will need to stay flat for 24 hours after the procedure."
B. "You should expect to take antiplatelet medication for at
least 12 months."
C. "You will not need to change any of your daily medications."
D. "You should immediately stop taking your statin."
Correct answer: B
Rationale:
• A: Immobilization time depends on access site (femoral vs
radial). Radial access allows early mobilization. Saying 24
hours is inaccurate.
