ATI QUESTIONS 231 (COMPLETE) ATI/RN/ATI RN TARGETED MEDICAL SURGICAL CARDIOVASCULAR, RESPIRATORY, PERIOPERATIVE/ PREOPERATIVE, FLUID, ELECTROLYTE, ACID-BASE, NEUROSENSORY, MUSCULOSKELETAL, GASTROINTESTINAL, ENDOCRINE AND IMMUNE: QUESTIONS AND ANSWERS | LA

ATI QUESTIONS 231 (COMPLETE) ATI/RN/ATI RN TARGETED MEDICAL SURGICAL CARDIOVASCULAR, RESPIRATORY, PERIOPERATIVE/ PREOPERATIVE, FLUID, ELECTROLYTE, ACID-BASE, NEUROSENSORY, MUSCULOSKELETAL, GASTROINTESTINAL, ENDOCRINE AND IMMUNE: QUESTIONS AND ANSWERS | LATEST UPDATE 2026/2027 | (SOLVED) 1. A 68-year-old man with chronic heart failure reports sudden worsening dyspnea, cough producing frothy sputum, and anxiety. Vital signs: T 37.2°C, HR 120, RR 28, BP 160/96, SpO₂ 86% on room air. Which action should the nurse take first? A. Administer IV morphine per order. B. Place the client in high-fowler's position and give oxygen. C. Start IV furosemide 40 mg push. D. Obtain a stat portable chest x-ray. Answer: B. Rationale: Airway/oxygenation is first priority in acute pulmonary edema; high-fowler's + oxygen improves ventilation and gas exchange immediately. (Medications follow after initial support.) 2. A client in sinus tachycardia (HR 130) is anxious and diaphoretic. Which assessment finding best indicates that the tachycardia is hemodynamically significant? A. Bounding peripheral pulses. B. Urine output 50 mL/hr. C. Altered mental status and hypotension. D. Complaints of palpitations. Answer: C. Rationale: Altered mental status and hypotension show reduced perfusion and hemodynamic compromise requiring urgent intervention. 3. A nurse reviews morning labs for a client taking warfarin (coumadin). Which lab result requires immediate notification of the provider? A. INR 1.5 B. INR 2.8 C. INR 4.2 D. Platelet count 200,000/mm³ Answer: C. Rationale: INR 4.0 increases bleeding risk; provider should be notified to consider dose adjustment or reversal. 4. After a myocardial infarction, a client is started on a beta-blocker. The nurse teaches the client to report which immediate symptom? A. Dry cough. B. Weight gain of 2 lb in one day. C. Worsening shortness of breath and wheezing. D. Constipation. Answer: C. Rationale: Beta-blockers may worsen bronchospasm in reactive airway disease — acute worsening dyspnea/wheezing is concerning. 5. Which finding best differentiates pericarditis from myocardial infarction (MI)? A. Chest pain that improves when leaning forward. B. Elevated troponin I. C. ST elevation on ECG. D. Hypotension. Answer: A. Rationale: Chest pain that improves when leaning forward is classic for pericarditis; MI pain typically not position dependent. 6. A client with a new left ventricular assist device (LVAD) has a continuous pump. Which nursing assessment is most important? A. Palpate for a peripheral pulse every 4 hours. B. Measure BP with Doppler and monitor mean arterial pressure. C. Check for bowel sounds. D. Take orthostatic vital signs hourly. Answer: B. Rationale: With continuous-flow LVADs, BP by standard cuff can be inaccurate; use Doppler to obtain MAP (target often 60–90 mmHg). 7. A client on IV nitroprusside for hypertensive emergency becomes agitated and tachycardic and has metabolic acidosis. What toxicity is the nurse most concerned about? A. Cyanide toxicity. B. Digoxin toxicity. C. Hemolytic anemia. D. Acute renal failure. Answer: A. Rationale: Nitroprusside can produce cyanide; signs include agitation, tachycardia, metabolic acidosis, and altered mental status. 8. A client with COPD has chronic hypercapnia. Which arterial blood gas pattern would you expect at baseline? A. pH 7.50, PaCO₂ 30 mmHg, HCO₃⁻ 28 mEq/L B. pH 7.38, PaCO₂ 55 mmHg, HCO₃⁻ 34 mEq/L C. pH 7.25, PaCO₂ 70 mmHg, HCO₃⁻ 22 mEq/L D. pH 7.60, PaCO₂ 20 mmHg, HCO₃⁻ 24 mEq/L Answer: B. Rationale: Chronic respiratory acidosis with metabolic compensation: elevated PaCO₂ with near-normal pH and increased HCO₃⁻. 9. A client develops sudden pleuritic chest pain and tachycardia after a long flight. The nurse suspects pulmonary embolism (PE). Which is the most appropriate immediate nursing action? A. Administer subcutaneous heparin. B. Prepare for emergent chest CT with contrast. C. Elevate the client's legs. D. Give high-flow oxygen and notify provider. Answer: D. Rationale: Support airway and oxygenation first; notify provider for further diagnostics/intervention (CT, anticoagulation). 10. A client with peripheral arterial disease (PAD) asks which symptom most commonly indicates critical limb ischemia. The nurse responds: A. Intermittent claudication only when walking uphill. B. Rest pain and nonhealing foot ulcer. C. Bilateral ankle edema. D. Varicose veins and leg heaviness. Answer: B. Rationale: Rest pain and nonhealing ulcers indicate severe arterial insufficiency and need urgent vascular evaluation. 11. A client has ARDS and is receiving mechanical ventilation with low tidal volume strategy. Which ventilator setting supports lung protective ventilation? A. Tidal volume 10 mL/kg predicted body weight. B. Tidal volume 6 mL/kg predicted body weight. C. High FiO₂ 100% only strategy. D. Zero PEEP to increase minute ventilation. Answer: B. Rationale: Low tidal volume (~6 mL/kg predicted body weight) reduces ventilator-induced lung injury in ARDS. 12. A client with acute asthma exacerbation has ABGs: pH 7.48, PaCO₂ 30 mmHg, PaO₂ 85 mmHg. The nurse interprets this as: A. Respiratory acidosis, patient worsening. B. Respiratory alkalosis from hyperventilation — likely responding to treatment. C. Metabolic alkalosis. D. Mixed acidosis. Answer: B. Rationale: Low PaCO₂ and alkalemic pH indicate respiratory alkalosis from hyperventilation; in early asthma improvement, PaCO₂ may be low. 13. A postop patient is at risk for atelectasis. The nurse should include which intervention in the plan of care? A. Limit ambulation to conserve energy. B. Encourage incentive spirometry and early ambulation. C. Keep patient supine for 24 hours. D. Restrict fluids to prevent overload. Answer: B. Rationale: Incentive spirometry and early ambulation improve lung expansion and reduce atelectasis risk. 14. For a client with obstructive sleep apnea (OSA), which statement indicates effective teaching about continuous positive airway pressure (CPAP)? A. "I only need to use the mask when I nap during the day." B. "I should use CPAP every night and during naps to maintain airway patency." C. "I can stop CPAP after I lose 5 kg." D. "I can use CPAP only when I have daytime sleepiness." Answer: B. Rationale: CPAP should be used nightly and as needed to prevent airway collapse and symptoms. 15. A client with emphysema is advised to use pursed-lip breathing. The best rationale to give is: A. It increases oxygen concentration in inspired air. B. It reduces airway collapse during exhalation and improves ventilation. C. It forces more air into the lungs, increasing tidal volume. D. It keeps the glottis open during inspiration. Answer: B. Rationale: Pursed-lip breathing increases expiratory pressure, prevents airway collapse, and improves gas exchange.