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)
1. (MCQ — Pathophysiology/Diagnostics) A 68-year-old man
with chest pressure, diaphoresis, and nausea arrives to ED.
ECG shows ST-segment elevation in leads II, III, and aVF.
Troponin I is elevated. Which coronary artery is most likely
occluded?
• A. Left anterior descending (LAD)
• B. Circumflex (LCx)
• C. Right coronary artery (RCA)
• D. Left main coronary artery (LMCA)
Answer: C. Right coronary artery (RCA).
Rationales:
A. LAD — supplies anterior wall and V1–V4; causes anterior MI,
,not inferior.
B. LCx — may cause lateral MI (I, aVL, V5–V6).
C. RCA — supplies inferior wall; ST-elevations in II, III, aVF
indicate inferior MI. (Correct; explains ECG hint and pathophys.)
D. LMCA — widespread ischemia; would produce extensive
changes, not isolated inferior leads.
2. (MCQ — Nursing intervention/Medication teaching) A
patient started on IV tissue plasminogen activator (tPA) for
acute MI — which nursing action has highest priority?
• A. Monitor for reperfusion arrhythmias.
• B. Check neurological status and observe for intracranial
bleeding.
• C. Encourage early ambulation.
• D. Teach the patient to avoid NSAIDs.
Answer: B. Check neurological status and observe for
intracranial bleeding.
Rationales:
A. Monitoring for reperfusion arrhythmias is important, but
immediate priority is bleeding risk.
B. tPA increases intracranial hemorrhage risk; neurological
checks are priority. (Correct.)
C. Early ambulation is contraindicated during acute
thrombolysis period.
D. Teaching about NSAID avoidance is relevant long-term but
not immediate priority.
, 3. (MCQ — Signs/symptoms/diagnostic interpretation) A
client with heart failure has crackles bilaterally, jugular
venous distention, and peripheral edema. BNP is markedly
elevated. Which intervention should the nurse implement
first?
• A. Administer IV furosemide as ordered.
• B. Place client in Trendelenburg position.
• C. Restrict oxygen to room air only.
• D. Encourage high-sodium snacks to maintain appetite.
Answer: A. Administer IV furosemide as ordered.
Rationales:
A. Diuresis reduces preload and pulmonary congestion; first-line
acute action. (Correct.)
B. Trendelenburg increases venous return and worsens
pulmonary edema.
C. Supplemental oxygen (not restricting) may be needed if
hypoxic.
D. High-sodium snacks would worsen fluid retention.
4. (MCQ — Diagnostic interpretation/ECG) A 54-year-old has
sudden palpitations and lightheadedness. ECG shows a
regular, narrow QRS tachycardia at 180 bpm with P waves
buried. The RN recognizes likely SVT. The first
nonpharmacologic maneuver to attempt is:
• A. Carotid sinus massage (performed by competent
clinician)
, • B. Immediate synchronized cardioversion
• C. IV amiodarone bolus
• D. Valsalva maneuver (modified)
Answer: D. Valsalva maneuver (modified).
Rationales:
A. Carotid massage may terminate SVT but is risky (stroke) and
should be done by experienced clinician; Valsalva is safer first.
B. Cardioversion reserved for unstable patients.
C. Amiodarone is not first-line for narrow-complex SVT.
D. Valsalva can increase vagal tone and convert SVT; noninvasive
first step. (Correct.)
5. (MCQ — Patient teaching/anticoagulation) A patient with
atrial fibrillation is started on warfarin. Which patient
statement indicates correct understanding?
• A. "I'll stop my warfarin if my INR is above 2."
• B. "I'll keep foods with vitamin K consistent in my diet."
• C. "I should take extra aspirin if I miss a dose."
• D. "I can stop the medication once I feel better."
Answer: B. "I'll keep foods with vitamin K consistent in my
diet."
Rationales:
A. Stopping based on a single INR is unsafe — management is
provider-directed.
B. Vitamin K intake affects INR; consistency prevents INR
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)
1. (MCQ — Pathophysiology/Diagnostics) A 68-year-old man
with chest pressure, diaphoresis, and nausea arrives to ED.
ECG shows ST-segment elevation in leads II, III, and aVF.
Troponin I is elevated. Which coronary artery is most likely
occluded?
• A. Left anterior descending (LAD)
• B. Circumflex (LCx)
• C. Right coronary artery (RCA)
• D. Left main coronary artery (LMCA)
Answer: C. Right coronary artery (RCA).
Rationales:
A. LAD — supplies anterior wall and V1–V4; causes anterior MI,
,not inferior.
B. LCx — may cause lateral MI (I, aVL, V5–V6).
C. RCA — supplies inferior wall; ST-elevations in II, III, aVF
indicate inferior MI. (Correct; explains ECG hint and pathophys.)
D. LMCA — widespread ischemia; would produce extensive
changes, not isolated inferior leads.
2. (MCQ — Nursing intervention/Medication teaching) A
patient started on IV tissue plasminogen activator (tPA) for
acute MI — which nursing action has highest priority?
• A. Monitor for reperfusion arrhythmias.
• B. Check neurological status and observe for intracranial
bleeding.
• C. Encourage early ambulation.
• D. Teach the patient to avoid NSAIDs.
Answer: B. Check neurological status and observe for
intracranial bleeding.
Rationales:
A. Monitoring for reperfusion arrhythmias is important, but
immediate priority is bleeding risk.
B. tPA increases intracranial hemorrhage risk; neurological
checks are priority. (Correct.)
C. Early ambulation is contraindicated during acute
thrombolysis period.
D. Teaching about NSAID avoidance is relevant long-term but
not immediate priority.
, 3. (MCQ — Signs/symptoms/diagnostic interpretation) A
client with heart failure has crackles bilaterally, jugular
venous distention, and peripheral edema. BNP is markedly
elevated. Which intervention should the nurse implement
first?
• A. Administer IV furosemide as ordered.
• B. Place client in Trendelenburg position.
• C. Restrict oxygen to room air only.
• D. Encourage high-sodium snacks to maintain appetite.
Answer: A. Administer IV furosemide as ordered.
Rationales:
A. Diuresis reduces preload and pulmonary congestion; first-line
acute action. (Correct.)
B. Trendelenburg increases venous return and worsens
pulmonary edema.
C. Supplemental oxygen (not restricting) may be needed if
hypoxic.
D. High-sodium snacks would worsen fluid retention.
4. (MCQ — Diagnostic interpretation/ECG) A 54-year-old has
sudden palpitations and lightheadedness. ECG shows a
regular, narrow QRS tachycardia at 180 bpm with P waves
buried. The RN recognizes likely SVT. The first
nonpharmacologic maneuver to attempt is:
• A. Carotid sinus massage (performed by competent
clinician)
, • B. Immediate synchronized cardioversion
• C. IV amiodarone bolus
• D. Valsalva maneuver (modified)
Answer: D. Valsalva maneuver (modified).
Rationales:
A. Carotid massage may terminate SVT but is risky (stroke) and
should be done by experienced clinician; Valsalva is safer first.
B. Cardioversion reserved for unstable patients.
C. Amiodarone is not first-line for narrow-complex SVT.
D. Valsalva can increase vagal tone and convert SVT; noninvasive
first step. (Correct.)
5. (MCQ — Patient teaching/anticoagulation) A patient with
atrial fibrillation is started on warfarin. Which patient
statement indicates correct understanding?
• A. "I'll stop my warfarin if my INR is above 2."
• B. "I'll keep foods with vitamin K consistent in my diet."
• C. "I should take extra aspirin if I miss a dose."
• D. "I can stop the medication once I feel better."
Answer: B. "I'll keep foods with vitamin K consistent in my
diet."
Rationales:
A. Stopping based on a single INR is unsafe — management is
provider-directed.
B. Vitamin K intake affects INR; consistency prevents INR
