RN VATI Adult Medical Surgical Assessment: Comprehensive
Nursing Practice Exam
Core Domains
Fluid, Electrolyte, and Acid-Base Imbalances
Perioperative Nursing Care
Upper and Lower Respiratory Disorders
Cardiovascular and Hematologic Disorders
Gastrointestinal and Hepatic Systems
Endocrine and Metabolic Disorders
Renal and Urinary Systems
Neurological and Sensory Disorders
Musculoskeletal and Integumentary Systems
Immunology, Oncology, and Infectious Disease
,Introduction
The RN VATI Adult Medical Surgical Assessment is a high-stakes evaluative tool
designed to measure a nursing candidate’s proficiency in managing the complex care of
adult clients. This exam focuses on the integration of pathophysiological concepts with
the nursing process, prioritizing safety, evidence-based interventions, and clinical
judgment. It evaluates a candidate's ability to apply theoretical knowledge to real-world
clinical scenarios, ranging from acute life-threatening emergencies to chronic disease
management. The 140-question format utilizes multiple-choice questions that emphasize
critical thinking, prioritization (using frameworks like ABCs and Maslow’s), and the
professional standards required for competent, entry-level nursing practice.
Section I: Questions 1-35
1. A nurse is caring for a client who is 24 hours postoperative following a
cholecystectomy. The client reports pain in the right shoulder. Which of the following
actions should the nurse take?
A. Apply a heating pad to the client’s shoulder for 20 minutes.
B. Assist the client to ambulate in the hallway.
C. Place the client in a supine position with legs elevated.
, D. Administer an intramuscular opioid analgesic.
Rationale: Laparoscopic surgery involves inflating the abdomen with carbon dioxide.
Residual gas can irritate the phrenic nerve, causing referred shoulder pain.
Ambulation promotes dissipation of the gas.
2. A nurse is assessing a client with a history of heart failure who presents with
dyspnea and crackles in the bilateral lung bases. Which of the following
prescriptions should the nurse clarify with the provider?
A. Furosemide 40 mg IV push.
B. Oxygen at 2 L/min via nasal cannula.
C. 0.9% Sodium Chloride at 125 mL/hr IV.
D. Enalapril 5 mg PO daily.
Rationale: The client is exhibiting signs of fluid volume overload (crackles,
dyspnea). Administering isotonic IV fluids at a continuous rate will worsen
pulmonary edema.
3. A nurse is reviewing the laboratory results of a client receiving heparin via
continuous IV infusion for a pulmonary embolism. The client’s aPTT is 90 seconds
(control 25-35 seconds). Which of the following actions should the nurse take?
B. Stop the infusion and prepare to administer protamine sulfate.
A. Increase the infusion rate by 100 units/hr.
, C. Maintain the current infusion rate and recheck in 4 hours.
D. Decrease the infusion rate and notify the provider.
Rationale: A therapeutic aPTT is typically 1.5 to 2.5 times the control. An aPTT of 90
is above the therapeutic range, increasing bleeding risk. Protamine sulfate is the
antagonist for heparin.
4. A nurse is providing discharge teaching to a client who has a new prescription for
warfarin. Which of the following statements by the client indicates an understanding
of the teaching?
A. "I will increase my intake of dark green leafy vegetables."
B. "I will take aspirin if I develop a headache."
C. "I will use an electric razor for shaving."
D. "I don't need to have my blood checked once the dose is set."
Rationale: Warfarin increases the risk of bleeding; an electric razor minimizes the
risk of skin nicks. Vitamin K (leafy greens) should be kept consistent, not increased.
5. A nurse is caring for a client with end-stage renal disease (ESRD). The client’s
serum potassium level is 6.8 mEq/L. Which of the following ECG changes should
the nurse expect to observe?
A. Prominent U waves.
B. Tall, peaked T waves.
Nursing Practice Exam
Core Domains
Fluid, Electrolyte, and Acid-Base Imbalances
Perioperative Nursing Care
Upper and Lower Respiratory Disorders
Cardiovascular and Hematologic Disorders
Gastrointestinal and Hepatic Systems
Endocrine and Metabolic Disorders
Renal and Urinary Systems
Neurological and Sensory Disorders
Musculoskeletal and Integumentary Systems
Immunology, Oncology, and Infectious Disease
,Introduction
The RN VATI Adult Medical Surgical Assessment is a high-stakes evaluative tool
designed to measure a nursing candidate’s proficiency in managing the complex care of
adult clients. This exam focuses on the integration of pathophysiological concepts with
the nursing process, prioritizing safety, evidence-based interventions, and clinical
judgment. It evaluates a candidate's ability to apply theoretical knowledge to real-world
clinical scenarios, ranging from acute life-threatening emergencies to chronic disease
management. The 140-question format utilizes multiple-choice questions that emphasize
critical thinking, prioritization (using frameworks like ABCs and Maslow’s), and the
professional standards required for competent, entry-level nursing practice.
Section I: Questions 1-35
1. A nurse is caring for a client who is 24 hours postoperative following a
cholecystectomy. The client reports pain in the right shoulder. Which of the following
actions should the nurse take?
A. Apply a heating pad to the client’s shoulder for 20 minutes.
B. Assist the client to ambulate in the hallway.
C. Place the client in a supine position with legs elevated.
, D. Administer an intramuscular opioid analgesic.
Rationale: Laparoscopic surgery involves inflating the abdomen with carbon dioxide.
Residual gas can irritate the phrenic nerve, causing referred shoulder pain.
Ambulation promotes dissipation of the gas.
2. A nurse is assessing a client with a history of heart failure who presents with
dyspnea and crackles in the bilateral lung bases. Which of the following
prescriptions should the nurse clarify with the provider?
A. Furosemide 40 mg IV push.
B. Oxygen at 2 L/min via nasal cannula.
C. 0.9% Sodium Chloride at 125 mL/hr IV.
D. Enalapril 5 mg PO daily.
Rationale: The client is exhibiting signs of fluid volume overload (crackles,
dyspnea). Administering isotonic IV fluids at a continuous rate will worsen
pulmonary edema.
3. A nurse is reviewing the laboratory results of a client receiving heparin via
continuous IV infusion for a pulmonary embolism. The client’s aPTT is 90 seconds
(control 25-35 seconds). Which of the following actions should the nurse take?
B. Stop the infusion and prepare to administer protamine sulfate.
A. Increase the infusion rate by 100 units/hr.
, C. Maintain the current infusion rate and recheck in 4 hours.
D. Decrease the infusion rate and notify the provider.
Rationale: A therapeutic aPTT is typically 1.5 to 2.5 times the control. An aPTT of 90
is above the therapeutic range, increasing bleeding risk. Protamine sulfate is the
antagonist for heparin.
4. A nurse is providing discharge teaching to a client who has a new prescription for
warfarin. Which of the following statements by the client indicates an understanding
of the teaching?
A. "I will increase my intake of dark green leafy vegetables."
B. "I will take aspirin if I develop a headache."
C. "I will use an electric razor for shaving."
D. "I don't need to have my blood checked once the dose is set."
Rationale: Warfarin increases the risk of bleeding; an electric razor minimizes the
risk of skin nicks. Vitamin K (leafy greens) should be kept consistent, not increased.
5. A nurse is caring for a client with end-stage renal disease (ESRD). The client’s
serum potassium level is 6.8 mEq/L. Which of the following ECG changes should
the nurse expect to observe?
A. Prominent U waves.
B. Tall, peaked T waves.
