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 — STEMI recognition
(pathophysiology/diagnostic/intervention/teaching)
A 62-year-old male presents with crushing substernal chest pain
radiating to the left arm, diaphoresis, and nausea for 45
minutes. ECG shows ST elevation in leads V1–V4. Initial
troponin pending. Which immediate nursing action is highest
priority?
A. Administer sublingual nitroglycerin.
B. Give chewable aspirin 325 mg.
C. Prepare for immediate percutaneous coronary intervention
(PCI).
D. Start IV morphine for pain control.
Answer: C
,Rationales:
A. Nitroglycerin is appropriate unless hypotensive; but PCI
preparation (reperfusion) is highest priority for STEMI to salvage
myocardium.
B. Aspirin should be given promptly (and is correct clinically),
but arranging definitive reperfusion (PCI within 90 minutes) is
higher priority.
C. Correct. STEMI with anterior leads requires urgent
reperfusion (PCI). Nursing role: activate cath lab, maintain IV
access, monitor vitals/EKG.
D. Morphine can be used for pain but is not top priority over
reperfusion.
MCQ 2 — Heart failure
(pathophysiology/S&S/diagnostics/interventions/teaching)
A client with chronic left-sided HF has increasing orthopnea,
bibasilar crackles, and a BNP of 950 pg/mL. Which intervention
should the nurse implement first?
A. Place the client in high-Fowler’s position.
B. Instruct the client to restrict dietary sodium.
C. Schedule a daily weight each morning.
D. Provide a PRN dose of a bronchodilator.
Answer: A
Rationales:
A. Correct. High-Fowler’s improves ventilation and reduces
venous return in acute pulmonary congestion. Immediate
,respiratory support takes priority.
B. Sodium restriction is important long-term but not the
immediate priority in pulmonary congestion.
C. Daily weights are essential for chronic management but are
not an immediate intervention for dyspnea.
D. Bronchodilators may not address pulmonary edema from HF
and are lower priority.
MCQ 3 — Atrial fibrillation (diagnostic/meds/teaching)
Atrial fibrillation with rapid ventricular response (HR 150) —
nurse anticipates which medication to control rate in the acute
setting?
A. Intravenous diltiazem (a calcium channel blocker).
B. IV amiodarone only.
C. Oral aspirin for thromboprophylaxis.
D. Sublingual nitroglycerin.
Answer: A
Rationales:
A. Correct. IV diltiazem is used to slow AV conduction and
control ventricular rate in AF with RVR, unless contraindicated.
B. Amiodarone can convert rhythm and slow rate but is not
always first-line for initial rate control.
C. Aspirin does not provide adequate anticoagulation for AF
stroke prevention in most patients.
D. Nitroglycerin is for ischemia/angina, not AF rate control.
,MCQ 4 — Peripheral arterial disease
(S&S/diagnostic/intervention/teaching)
A patient reports intermittent claudication in the calf when
walking 100 yards. Which finding is consistent with PAD and
needs nursing follow-up?
A. Warm, edematous lower extremities with palpable pulses.
B. Shiny hairless skin on the shins and dorsum of the foot.
C. Thickened, yellow nails with pedal pulses present.
D. Bilateral dependent rubor that improves with elevation.
Answer: B
Rationales:
A. Warm, edematous limbs with good pulses are more
consistent with venous insufficiency.
B. Correct. Hairless, shiny skin suggests chronic arterial
insufficiency (PAD). Nurse should assess pulses and refer for
ABI.
C. Thickened nails can be fungal; pulses present doesn't exclude
PAD, but hairless skin is more specific.
D. Dependent rubor occurs in PAD but it worsens with
dependency and improves with elevation (not the reverse
described); the option is phrased confusingly—B is most
definitive.
,NGN Case A (Acute chest pain) — Scenario:
A 55-year-old woman arrives to ED with sudden substernal
chest pain, nausea, and lightheadedness. Vitals: BP 88/56, HR
110, SpO₂ 95% on RA. ECG: ST elevations in II, III, aVF. Troponin
pending.
Q5A (Priority action): Which action should nurse perform first?
(Select one)
A. Give chewable aspirin 325 mg PO.
B. Administer IV morphine.
C. Give sublingual nitroglycerin now.
D. Prepare for emergent PCI and notify cardiology.
Answer: D
Rationale: Emergent reperfusion for inferior STEMI is priority;
hypotension (BP 88/56) may contraindicate nitrates. Activate
cath lab first. Aspirin is correct but cath lab activation is highest
priority. Morphine and nitrates are lower priority when
hypotensive.
Q5B (Medication contraindication): Given BP 88/56, which
med from the ED standing orders is contraindicated now?
A. IV heparin bolus.
B. Sublingual nitroglycerin.
C. Chewable aspirin.
D. Beta-blocker IV push.
Answer: B
,Rationale: Nitrates can dangerously lower BP; avoid when SBP
<90. Heparin and aspirin are acceptable; IV beta-blocker is also
generally avoided with hypotension or signs of heart failure—
however nitrates are most clearly contraindicated.
NGN Case B (CHF exacerbation) — Scenario:
A 70-year-old man with Hx ischemic cardiomyopathy reports
worsening DOE and orthopnea. O₂ 88% on RA, bilateral
crackles, JVD present. BNP elevated.
Q6A (Immediate priority): Which is the nurse’s immediate
intervention?
A. Place on high-flow oxygen via non-rebreather.
B. Elevate head of bed and administer loop diuretic IV per order.
C. Teach low-sodium diet and weigh daily.
D. Send for chest x-ray only.
Answer: B
Rationale: Elevating HOB improves respiratory effort; IV loop
diuretic (e.g., furosemide) reduces preload and pulmonary
edema — immediate priority. Non-rebreather may be
unnecessary if nasal cannula supports oxygenation; diet
teaching is long-term.
Q6B (Patient teaching on diuretics): Which teaching point is
most important?
A. Take the diuretic at night to avoid daytime trips to bathroom.
B. Expect decreased urine output after diuretic starts.
,C. Monitor daily weights and report gain of >2 lb in 24 hours.
D. Avoid potassium-rich foods if taking loop diuretics.
Answer: C
Rationale: Daily weight monitoring and reporting significant
gain indicates fluid retention and is essential. Loop diuretics
increase urine output (so B incorrect). Take diuretics in morning
to avoid nocturia (A incorrect). Loop diuretics may cause
hypokalemia — encourage potassium-rich foods unless
contraindicated (D incorrect).
NGN Case C (Post-op valve replacement) — Scenario:
A 68-year-old with a mechanical aortic valve returns post-op.
On warfarin with target INR 2.5–3.5. Post-op day 2, nurse notes
bruising and oozing at IV site. INR comes back 6.0.
Q7A (Immediate action): Which action is highest priority?
A. Hold warfarin and notify surgeon.
B. Administer vitamin K per protocol and prepare for possible
PCC.
C. Apply pressure to IV site and document.
D. Continue current dose and recheck INR in 24 hours.
Answer: B
Rationale: INR 6 with active bleeding (oozing/bruising) requires
reversal with vitamin K and possibly prothrombin complex
concentrate (PCC). Holding warfarin is necessary but reversal is
priority. Local pressure alone is insufficient.
,Q7B (Teaching about anticoagulation): Which statement by the
patient indicates correct understanding?
A. “I should avoid all green leafy vegetables while on warfarin.”
B. “I will report any unusual bleeding, such as nosebleeds or
black stools.”
C. “I can take aspirin for aches while on warfarin—no problem.”
D. “My INR should always stay at zero.”
Answer: B
Rationale: Reporting bleeding is correct. Avoiding all green
leafy vegetables is unnecessary; consistency in vitamin K intake
is recommended (A incorrect). Aspirin increases bleeding risk
with warfarin and should be avoided unless prescribed (C
incorrect). INR of zero is impossible; INR target is therapeutic
range (D incorrect).
Respiratory — 10 items
MCQ 1 — COPD exacerbation
(pathophysiology/S&S/diagnostics/interventions/teaching)
A 68-year-old with emphysema is admitted with increased
dyspnea and productive cough. ABG: pH 7.32, PaCO₂ 58 mm Hg,
HCO₃⁻ 30 mEq/L. What does this ABG indicate?
A. Metabolic acidosis with respiratory compensation.
B. Acute on chronic respiratory acidosis with partial metabolic
compensation.
,C. Fully compensated respiratory alkalosis.
D. Normal gas exchange for COPD — no action required.
Answer: B
Rationales:
A. pH low with elevated PaCO₂ indicates respiratory acidosis,
not metabolic.
B. Correct. Elevated PaCO₂ with pH slightly acid and elevated
HCO₃⁻ indicates chronic CO₂ retention with partial renal
compensation — acute exacerbation on chronic baseline.
C. Respiratory alkalosis would have low PaCO₂.
D. ABG is abnormal and requires intervention (bronchodilator,
steroids, possible ventilation).
MCQ 2 — Pulmonary embolism
(S&S/diagnostics/interventions/teaching)
A patient with sudden pleuritic chest pain and unexplained
hypoxemia after hip surgery is suspected of having a PE. Which
diagnostic test gives the most rapid bedside information?
A. D-dimer.
B. CT pulmonary angiography.
C. Ventilation-perfusion (V/Q) scan.
D. Point-of-care arterial blood gas and pulse oximetry.
Answer: D
Rationales:
A. D-dimer is sensitive but nonspecific and not diagnostic,
, especially post-op.
B. CT angiography is diagnostic but may not be immediately
bedside.
C. V/Q scan requires transport and time.
D. Correct. ABG and pulse oximetry provide immediate info on
oxygenation and gas exchange; combined with clinical suspicion
they guide urgent management while awaiting definitive
imaging.
MCQ 3 — Asthma (medications/teaching)
When teaching an adolescent about an inhaled corticosteroid
(fluticasone) for persistent asthma, which instruction is
essential?
A. Use the inhaled steroid as needed for acute attacks.
B. Rinse mouth and spit after inhalation.
C. Stop the steroid when symptoms are controlled.
D. This medicine works immediately to relieve bronchospasm.
Answer: B
Rationales:
A. Inhaled steroids are controller meds, not for rescue.
B. Correct. Rinsing prevents oral candidiasis and hoarseness.
C. Long-term controller therapy is often needed; abrupt
stopping not advised.
D. Steroids have delayed action; short-acting bronchodilators
relieve acute bronchospasm.
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 — STEMI recognition
(pathophysiology/diagnostic/intervention/teaching)
A 62-year-old male presents with crushing substernal chest pain
radiating to the left arm, diaphoresis, and nausea for 45
minutes. ECG shows ST elevation in leads V1–V4. Initial
troponin pending. Which immediate nursing action is highest
priority?
A. Administer sublingual nitroglycerin.
B. Give chewable aspirin 325 mg.
C. Prepare for immediate percutaneous coronary intervention
(PCI).
D. Start IV morphine for pain control.
Answer: C
,Rationales:
A. Nitroglycerin is appropriate unless hypotensive; but PCI
preparation (reperfusion) is highest priority for STEMI to salvage
myocardium.
B. Aspirin should be given promptly (and is correct clinically),
but arranging definitive reperfusion (PCI within 90 minutes) is
higher priority.
C. Correct. STEMI with anterior leads requires urgent
reperfusion (PCI). Nursing role: activate cath lab, maintain IV
access, monitor vitals/EKG.
D. Morphine can be used for pain but is not top priority over
reperfusion.
MCQ 2 — Heart failure
(pathophysiology/S&S/diagnostics/interventions/teaching)
A client with chronic left-sided HF has increasing orthopnea,
bibasilar crackles, and a BNP of 950 pg/mL. Which intervention
should the nurse implement first?
A. Place the client in high-Fowler’s position.
B. Instruct the client to restrict dietary sodium.
C. Schedule a daily weight each morning.
D. Provide a PRN dose of a bronchodilator.
Answer: A
Rationales:
A. Correct. High-Fowler’s improves ventilation and reduces
venous return in acute pulmonary congestion. Immediate
,respiratory support takes priority.
B. Sodium restriction is important long-term but not the
immediate priority in pulmonary congestion.
C. Daily weights are essential for chronic management but are
not an immediate intervention for dyspnea.
D. Bronchodilators may not address pulmonary edema from HF
and are lower priority.
MCQ 3 — Atrial fibrillation (diagnostic/meds/teaching)
Atrial fibrillation with rapid ventricular response (HR 150) —
nurse anticipates which medication to control rate in the acute
setting?
A. Intravenous diltiazem (a calcium channel blocker).
B. IV amiodarone only.
C. Oral aspirin for thromboprophylaxis.
D. Sublingual nitroglycerin.
Answer: A
Rationales:
A. Correct. IV diltiazem is used to slow AV conduction and
control ventricular rate in AF with RVR, unless contraindicated.
B. Amiodarone can convert rhythm and slow rate but is not
always first-line for initial rate control.
C. Aspirin does not provide adequate anticoagulation for AF
stroke prevention in most patients.
D. Nitroglycerin is for ischemia/angina, not AF rate control.
,MCQ 4 — Peripheral arterial disease
(S&S/diagnostic/intervention/teaching)
A patient reports intermittent claudication in the calf when
walking 100 yards. Which finding is consistent with PAD and
needs nursing follow-up?
A. Warm, edematous lower extremities with palpable pulses.
B. Shiny hairless skin on the shins and dorsum of the foot.
C. Thickened, yellow nails with pedal pulses present.
D. Bilateral dependent rubor that improves with elevation.
Answer: B
Rationales:
A. Warm, edematous limbs with good pulses are more
consistent with venous insufficiency.
B. Correct. Hairless, shiny skin suggests chronic arterial
insufficiency (PAD). Nurse should assess pulses and refer for
ABI.
C. Thickened nails can be fungal; pulses present doesn't exclude
PAD, but hairless skin is more specific.
D. Dependent rubor occurs in PAD but it worsens with
dependency and improves with elevation (not the reverse
described); the option is phrased confusingly—B is most
definitive.
,NGN Case A (Acute chest pain) — Scenario:
A 55-year-old woman arrives to ED with sudden substernal
chest pain, nausea, and lightheadedness. Vitals: BP 88/56, HR
110, SpO₂ 95% on RA. ECG: ST elevations in II, III, aVF. Troponin
pending.
Q5A (Priority action): Which action should nurse perform first?
(Select one)
A. Give chewable aspirin 325 mg PO.
B. Administer IV morphine.
C. Give sublingual nitroglycerin now.
D. Prepare for emergent PCI and notify cardiology.
Answer: D
Rationale: Emergent reperfusion for inferior STEMI is priority;
hypotension (BP 88/56) may contraindicate nitrates. Activate
cath lab first. Aspirin is correct but cath lab activation is highest
priority. Morphine and nitrates are lower priority when
hypotensive.
Q5B (Medication contraindication): Given BP 88/56, which
med from the ED standing orders is contraindicated now?
A. IV heparin bolus.
B. Sublingual nitroglycerin.
C. Chewable aspirin.
D. Beta-blocker IV push.
Answer: B
,Rationale: Nitrates can dangerously lower BP; avoid when SBP
<90. Heparin and aspirin are acceptable; IV beta-blocker is also
generally avoided with hypotension or signs of heart failure—
however nitrates are most clearly contraindicated.
NGN Case B (CHF exacerbation) — Scenario:
A 70-year-old man with Hx ischemic cardiomyopathy reports
worsening DOE and orthopnea. O₂ 88% on RA, bilateral
crackles, JVD present. BNP elevated.
Q6A (Immediate priority): Which is the nurse’s immediate
intervention?
A. Place on high-flow oxygen via non-rebreather.
B. Elevate head of bed and administer loop diuretic IV per order.
C. Teach low-sodium diet and weigh daily.
D. Send for chest x-ray only.
Answer: B
Rationale: Elevating HOB improves respiratory effort; IV loop
diuretic (e.g., furosemide) reduces preload and pulmonary
edema — immediate priority. Non-rebreather may be
unnecessary if nasal cannula supports oxygenation; diet
teaching is long-term.
Q6B (Patient teaching on diuretics): Which teaching point is
most important?
A. Take the diuretic at night to avoid daytime trips to bathroom.
B. Expect decreased urine output after diuretic starts.
,C. Monitor daily weights and report gain of >2 lb in 24 hours.
D. Avoid potassium-rich foods if taking loop diuretics.
Answer: C
Rationale: Daily weight monitoring and reporting significant
gain indicates fluid retention and is essential. Loop diuretics
increase urine output (so B incorrect). Take diuretics in morning
to avoid nocturia (A incorrect). Loop diuretics may cause
hypokalemia — encourage potassium-rich foods unless
contraindicated (D incorrect).
NGN Case C (Post-op valve replacement) — Scenario:
A 68-year-old with a mechanical aortic valve returns post-op.
On warfarin with target INR 2.5–3.5. Post-op day 2, nurse notes
bruising and oozing at IV site. INR comes back 6.0.
Q7A (Immediate action): Which action is highest priority?
A. Hold warfarin and notify surgeon.
B. Administer vitamin K per protocol and prepare for possible
PCC.
C. Apply pressure to IV site and document.
D. Continue current dose and recheck INR in 24 hours.
Answer: B
Rationale: INR 6 with active bleeding (oozing/bruising) requires
reversal with vitamin K and possibly prothrombin complex
concentrate (PCC). Holding warfarin is necessary but reversal is
priority. Local pressure alone is insufficient.
,Q7B (Teaching about anticoagulation): Which statement by the
patient indicates correct understanding?
A. “I should avoid all green leafy vegetables while on warfarin.”
B. “I will report any unusual bleeding, such as nosebleeds or
black stools.”
C. “I can take aspirin for aches while on warfarin—no problem.”
D. “My INR should always stay at zero.”
Answer: B
Rationale: Reporting bleeding is correct. Avoiding all green
leafy vegetables is unnecessary; consistency in vitamin K intake
is recommended (A incorrect). Aspirin increases bleeding risk
with warfarin and should be avoided unless prescribed (C
incorrect). INR of zero is impossible; INR target is therapeutic
range (D incorrect).
Respiratory — 10 items
MCQ 1 — COPD exacerbation
(pathophysiology/S&S/diagnostics/interventions/teaching)
A 68-year-old with emphysema is admitted with increased
dyspnea and productive cough. ABG: pH 7.32, PaCO₂ 58 mm Hg,
HCO₃⁻ 30 mEq/L. What does this ABG indicate?
A. Metabolic acidosis with respiratory compensation.
B. Acute on chronic respiratory acidosis with partial metabolic
compensation.
,C. Fully compensated respiratory alkalosis.
D. Normal gas exchange for COPD — no action required.
Answer: B
Rationales:
A. pH low with elevated PaCO₂ indicates respiratory acidosis,
not metabolic.
B. Correct. Elevated PaCO₂ with pH slightly acid and elevated
HCO₃⁻ indicates chronic CO₂ retention with partial renal
compensation — acute exacerbation on chronic baseline.
C. Respiratory alkalosis would have low PaCO₂.
D. ABG is abnormal and requires intervention (bronchodilator,
steroids, possible ventilation).
MCQ 2 — Pulmonary embolism
(S&S/diagnostics/interventions/teaching)
A patient with sudden pleuritic chest pain and unexplained
hypoxemia after hip surgery is suspected of having a PE. Which
diagnostic test gives the most rapid bedside information?
A. D-dimer.
B. CT pulmonary angiography.
C. Ventilation-perfusion (V/Q) scan.
D. Point-of-care arterial blood gas and pulse oximetry.
Answer: D
Rationales:
A. D-dimer is sensitive but nonspecific and not diagnostic,
, especially post-op.
B. CT angiography is diagnostic but may not be immediately
bedside.
C. V/Q scan requires transport and time.
D. Correct. ABG and pulse oximetry provide immediate info on
oxygenation and gas exchange; combined with clinical suspicion
they guide urgent management while awaiting definitive
imaging.
MCQ 3 — Asthma (medications/teaching)
When teaching an adolescent about an inhaled corticosteroid
(fluticasone) for persistent asthma, which instruction is
essential?
A. Use the inhaled steroid as needed for acute attacks.
B. Rinse mouth and spit after inhalation.
C. Stop the steroid when symptoms are controlled.
D. This medicine works immediately to relieve bronchospasm.
Answer: B
Rationales:
A. Inhaled steroids are controller meds, not for rescue.
B. Correct. Rinsing prevents oral candidiasis and hoarseness.
C. Long-term controller therapy is often needed; abrupt
stopping not advised.
D. Steroids have delayed action; short-acting bronchodilators
relieve acute bronchospasm.
