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
Q1 — Type: MCQ
Focus areas: pathophysiology (atherosclerosis → myocardial
ischemia), S/S, diagnostics (ECG, troponin), nursing
interventions, patient teaching.
A 62-year-old man presents with substernal chest pressure
radiating to his left arm, diaphoresis, and nausea for 40
minutes. ECG shows ST-elevation in leads II, III, aVF. Troponin is
elevated. Which intervention should the nurse prioritize first?
A. Administer chewable aspirin 325 mg.
B. Start IV morphine for pain control.
C. Prepare for emergent percutaneous coronary intervention
(PCI).
D. Give sublingual nitroglycerin.
,Answer: C. Prepare for emergent percutaneous coronary
intervention (PCI).
Rationales:
A. Aspirin is correct and important (antiplatelet) but in a patient
with STEMI, preparing for emergent reperfusion (PCI) is the
priority for definitive care.
B. Morphine can relieve pain and reduce anxiety but should not
delay reperfusion.
C. Correct — early reperfusion via PCI within guideline door-to-
balloon times saves myocardium and reduces mortality.
D. Sublingual nitroglycerin may relieve ischemic pain but is
secondary to reperfusion and contraindicated if hypotensive or
recent phosphodiesterase inhibitors used.
Q2 — Type: MCQ
Focus: heart failure pathophysiology (reduced EF), S/S,
diagnostics (BNP, CXR), interventions (diuretics), teaching
(fluid/salt restriction).
A client with chronic systolic heart failure (EF 30%) reports
increasing shortness of breath, orthopnea, and 3-pound weight
gain overnight. BNP elevated; CXR shows pulmonary
congestion. Which order should nurse implement first?
A. Administer IV furosemide as ordered.
B. Teach low-sodium diet.
C. Obtain daily weights.
D. Schedule echocardiogram.
,Answer: A. Administer IV furosemide as ordered.
Rationales:
A. Correct — diuretics relieve pulmonary congestion and acute
symptoms rapidly.
B. Teaching is important but not immediate for acute
decompensation.
C. Daily weights should be ongoing, but in acute respiratory
distress immediate diuresis is priority.
D. Echo is useful for assessment but not for acute symptom
relief.
Q3 — Type: NGN-style unfolding case (Part 1 of 2)
Focus: arrhythmia pathophysiology (Atrial fibrillation), S/S,
diagnostics (ECG), interventions (rate vs rhythm control,
anticoagulation), teaching.
Case: A 78-year-old woman admitted after palpitations and
lightheadedness. Vitals: HR 145 irregularly irregular, BP 110/68.
ECG shows rapid atrial fibrillation. She has a history of
hypertension and prior GI bleed 3 years ago.
Step 1: Which immediate nursing action is best?
A. Prepare for synchronized cardioversion now.
B. Administer IV diltiazem per PRN order to control rate.
C. Give oral warfarin now.
D. Encourage Valsalva maneuver.
, Answer: B. Administer IV diltiazem per PRN order to control
rate.
Rationales:
A. Cardioversion may be necessary for unstable patients —
she’s borderline but not clearly unstable. Prepare only if
unstable or refractory.
B. Correct — rapid rate control with IV diltiazem is appropriate
to stabilize hemodynamics.
C. Anticoagulation requires assessment of bleeding risk and is
not immediate emergent therapy to control rate.
D. Valsalva rarely effective in new rapid AF and may be
contraindicated if hemodynamically compromised.
Step 2: After rate control, the team discusses anticoagulation.
Which factor most influences whether to anticoagulate now?
A. Age alone.
B. CHA₂DS₂-VASc and recent GI bleed history.
C. Heart rate.
D. Presence of palpitations.
Answer: B. CHA₂DS₂-VASc and recent GI bleed history.
Rationales:
A. Age contributes but is not the only determinant.
B. Correct — stroke risk (CHA₂DS₂-VASc) vs bleeding risk (HAS-
BLED, GI bleed history) guides anticoagulation timing and agent
choice.
C. Heart rate affects hemodynamic management, not
anticoagulation need.
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
Q1 — Type: MCQ
Focus areas: pathophysiology (atherosclerosis → myocardial
ischemia), S/S, diagnostics (ECG, troponin), nursing
interventions, patient teaching.
A 62-year-old man presents with substernal chest pressure
radiating to his left arm, diaphoresis, and nausea for 40
minutes. ECG shows ST-elevation in leads II, III, aVF. Troponin is
elevated. Which intervention should the nurse prioritize first?
A. Administer chewable aspirin 325 mg.
B. Start IV morphine for pain control.
C. Prepare for emergent percutaneous coronary intervention
(PCI).
D. Give sublingual nitroglycerin.
,Answer: C. Prepare for emergent percutaneous coronary
intervention (PCI).
Rationales:
A. Aspirin is correct and important (antiplatelet) but in a patient
with STEMI, preparing for emergent reperfusion (PCI) is the
priority for definitive care.
B. Morphine can relieve pain and reduce anxiety but should not
delay reperfusion.
C. Correct — early reperfusion via PCI within guideline door-to-
balloon times saves myocardium and reduces mortality.
D. Sublingual nitroglycerin may relieve ischemic pain but is
secondary to reperfusion and contraindicated if hypotensive or
recent phosphodiesterase inhibitors used.
Q2 — Type: MCQ
Focus: heart failure pathophysiology (reduced EF), S/S,
diagnostics (BNP, CXR), interventions (diuretics), teaching
(fluid/salt restriction).
A client with chronic systolic heart failure (EF 30%) reports
increasing shortness of breath, orthopnea, and 3-pound weight
gain overnight. BNP elevated; CXR shows pulmonary
congestion. Which order should nurse implement first?
A. Administer IV furosemide as ordered.
B. Teach low-sodium diet.
C. Obtain daily weights.
D. Schedule echocardiogram.
,Answer: A. Administer IV furosemide as ordered.
Rationales:
A. Correct — diuretics relieve pulmonary congestion and acute
symptoms rapidly.
B. Teaching is important but not immediate for acute
decompensation.
C. Daily weights should be ongoing, but in acute respiratory
distress immediate diuresis is priority.
D. Echo is useful for assessment but not for acute symptom
relief.
Q3 — Type: NGN-style unfolding case (Part 1 of 2)
Focus: arrhythmia pathophysiology (Atrial fibrillation), S/S,
diagnostics (ECG), interventions (rate vs rhythm control,
anticoagulation), teaching.
Case: A 78-year-old woman admitted after palpitations and
lightheadedness. Vitals: HR 145 irregularly irregular, BP 110/68.
ECG shows rapid atrial fibrillation. She has a history of
hypertension and prior GI bleed 3 years ago.
Step 1: Which immediate nursing action is best?
A. Prepare for synchronized cardioversion now.
B. Administer IV diltiazem per PRN order to control rate.
C. Give oral warfarin now.
D. Encourage Valsalva maneuver.
, Answer: B. Administer IV diltiazem per PRN order to control
rate.
Rationales:
A. Cardioversion may be necessary for unstable patients —
she’s borderline but not clearly unstable. Prepare only if
unstable or refractory.
B. Correct — rapid rate control with IV diltiazem is appropriate
to stabilize hemodynamics.
C. Anticoagulation requires assessment of bleeding risk and is
not immediate emergent therapy to control rate.
D. Valsalva rarely effective in new rapid AF and may be
contraindicated if hemodynamically compromised.
Step 2: After rate control, the team discusses anticoagulation.
Which factor most influences whether to anticoagulate now?
A. Age alone.
B. CHA₂DS₂-VASc and recent GI bleed history.
C. Heart rate.
D. Presence of palpitations.
Answer: B. CHA₂DS₂-VASc and recent GI bleed history.
Rationales:
A. Age contributes but is not the only determinant.
B. Correct — stroke risk (CHA₂DS₂-VASc) vs bleeding risk (HAS-
BLED, GI bleed history) guides anticoagulation timing and agent
choice.
C. Heart rate affects hemodynamic management, not
anticoagulation need.
