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 male
presents with sudden left-sided weakness and slurred speech.
BP 190/110 mmHg, HR 88 irregular, O₂ sat 96% RA. CT head
pending. Which immediate nursing action is highest priority?
A. Administer aspirin 325 mg chewed.
B. Start IV labetalol to lower BP toward 140–150 mmHg.
C. Prepare patient for thrombolytic therapy evaluation (door-to-
needle).
D. Obtain fingerstick blood glucose.
Answer: D. Obtain fingerstick blood glucose.
Rationale:
A: Aspirin is given for ischemic stroke after hemorrhage
excluded; not before CT.
,B: Aggressive BP lowering can worsen ischemic penumbra; only
lower if >220/120 or per protocol.
C: Thrombolysis eligibility must be confirmed after CT and labs;
premature.
D: Correct — hypoglycemia can mimic stroke; rapid glucose
check is immediate and essential.
2 (MCQ — CAD / chest pain triage). A 56-year-old woman with
chest pressure, diaphoresis, and nausea arrives ED. ECG shows
ST elevation in leads II, III, aVF. Which intervention has highest
immediate priority?
A. Give sublingual nitroglycerin.
B. Prepare for emergent percutaneous coronary intervention
(PCI).
C. Start high-dose IV morphine.
D. Administer beta-blocker immediately.
Answer: B. Prepare for emergent PCI.
Rationale:
A: NTG relieves ischemic pain but PCI within door-to-balloon
timeframe saves myocardium — priority.
B: Correct — STEMI requires emergent reperfusion (PCI
preferred).
C: Morphine is analgesic but can mask symptoms and increase
mortality if overused.
D: Beta-blockers are indicated carefully; not highest immediate
priority before reperfusion planning.
,3 (NGN-style case). Mrs. K, 72, with CHF presents with
progressive dyspnea, orthopnea, and 4+ pitting edema. ABG: pH
7.34, PaCO₂ 46, PaO₂ 60. CXR: cardiomegaly and pulmonary
vascular congestion. BNP elevated. RN is planning care.
Question: Which initial nursing action best addresses acute
decompensated heart failure and improves oxygenation?
A. Elevate head of bed to 45–90° and apply supplemental O₂.
B. Restrict fluids to 1 L/day immediately.
C. Start high-dose IV furosemide push and Foley catheter.
D. Place patient on strict bedrest and call for daily weights only.
Answer: A. Elevate head of bed to 45–90° and apply
supplemental O₂.
Rationale:
A: Correct — improves ventilation, reduces preload, and
improves oxygenation quickly.
B: Fluid restriction is chronic management; not immediate
relief.
C: IV diuresis often needed but must assess benefits/renal
status — initial priority is airway/oxygenation and positioning.
D: Bedrest alone does not relieve pulmonary edema.
4 (MCQ — arrhythmia/diagnostic). A patient on digoxin
presents with nausea, visual halos, and AV block on ECG. Serum
potassium is 3.0 mEq/L. Which statement is correct?
, A. Hypokalemia increases digoxin toxicity risk; treat K+ and
consider digoxin level.
B. Visual halos are unrelated to digoxin; check ophthalmology.
C. Continue the dose; symptoms are age-related.
D. Give IV calcium to reverse AV block.
Answer: A. Hypokalemia increases digoxin toxicity risk; treat K+
and consider digoxin level.
Rationale:
A: Correct — low K+ potentiates digoxin toxicity; hold drug,
correct electrolytes, check level.
B: Visual changes are classic digoxin toxicity signs.
C: Incorrect — discontinue if toxicity suspected.
D: IV calcium is not indicated for digoxin-induced AV block; may
be harmful.
5 (MCQ — nursing teaching). A patient discharged after MI will
receive atorvastatin. Which teaching point is highest priority?
A. Stop the medication if muscle pain occurs.
B. Take at bedtime and report unexplained muscle pain or dark
urine.
C. It will immediately reduce chest pain.
D. Avoid grapefruit juice entirely.
Answer: B. Take at bedtime and report unexplained muscle pain
or dark urine.
Rationale:
A: Don’t abruptly stop; report symptoms.
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 male
presents with sudden left-sided weakness and slurred speech.
BP 190/110 mmHg, HR 88 irregular, O₂ sat 96% RA. CT head
pending. Which immediate nursing action is highest priority?
A. Administer aspirin 325 mg chewed.
B. Start IV labetalol to lower BP toward 140–150 mmHg.
C. Prepare patient for thrombolytic therapy evaluation (door-to-
needle).
D. Obtain fingerstick blood glucose.
Answer: D. Obtain fingerstick blood glucose.
Rationale:
A: Aspirin is given for ischemic stroke after hemorrhage
excluded; not before CT.
,B: Aggressive BP lowering can worsen ischemic penumbra; only
lower if >220/120 or per protocol.
C: Thrombolysis eligibility must be confirmed after CT and labs;
premature.
D: Correct — hypoglycemia can mimic stroke; rapid glucose
check is immediate and essential.
2 (MCQ — CAD / chest pain triage). A 56-year-old woman with
chest pressure, diaphoresis, and nausea arrives ED. ECG shows
ST elevation in leads II, III, aVF. Which intervention has highest
immediate priority?
A. Give sublingual nitroglycerin.
B. Prepare for emergent percutaneous coronary intervention
(PCI).
C. Start high-dose IV morphine.
D. Administer beta-blocker immediately.
Answer: B. Prepare for emergent PCI.
Rationale:
A: NTG relieves ischemic pain but PCI within door-to-balloon
timeframe saves myocardium — priority.
B: Correct — STEMI requires emergent reperfusion (PCI
preferred).
C: Morphine is analgesic but can mask symptoms and increase
mortality if overused.
D: Beta-blockers are indicated carefully; not highest immediate
priority before reperfusion planning.
,3 (NGN-style case). Mrs. K, 72, with CHF presents with
progressive dyspnea, orthopnea, and 4+ pitting edema. ABG: pH
7.34, PaCO₂ 46, PaO₂ 60. CXR: cardiomegaly and pulmonary
vascular congestion. BNP elevated. RN is planning care.
Question: Which initial nursing action best addresses acute
decompensated heart failure and improves oxygenation?
A. Elevate head of bed to 45–90° and apply supplemental O₂.
B. Restrict fluids to 1 L/day immediately.
C. Start high-dose IV furosemide push and Foley catheter.
D. Place patient on strict bedrest and call for daily weights only.
Answer: A. Elevate head of bed to 45–90° and apply
supplemental O₂.
Rationale:
A: Correct — improves ventilation, reduces preload, and
improves oxygenation quickly.
B: Fluid restriction is chronic management; not immediate
relief.
C: IV diuresis often needed but must assess benefits/renal
status — initial priority is airway/oxygenation and positioning.
D: Bedrest alone does not relieve pulmonary edema.
4 (MCQ — arrhythmia/diagnostic). A patient on digoxin
presents with nausea, visual halos, and AV block on ECG. Serum
potassium is 3.0 mEq/L. Which statement is correct?
, A. Hypokalemia increases digoxin toxicity risk; treat K+ and
consider digoxin level.
B. Visual halos are unrelated to digoxin; check ophthalmology.
C. Continue the dose; symptoms are age-related.
D. Give IV calcium to reverse AV block.
Answer: A. Hypokalemia increases digoxin toxicity risk; treat K+
and consider digoxin level.
Rationale:
A: Correct — low K+ potentiates digoxin toxicity; hold drug,
correct electrolytes, check level.
B: Visual changes are classic digoxin toxicity signs.
C: Incorrect — discontinue if toxicity suspected.
D: IV calcium is not indicated for digoxin-induced AV block; may
be harmful.
5 (MCQ — nursing teaching). A patient discharged after MI will
receive atorvastatin. Which teaching point is highest priority?
A. Stop the medication if muscle pain occurs.
B. Take at bedtime and report unexplained muscle pain or dark
urine.
C. It will immediately reduce chest pain.
D. Avoid grapefruit juice entirely.
Answer: B. Take at bedtime and report unexplained muscle pain
or dark urine.
Rationale:
A: Don’t abruptly stop; report symptoms.
