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ATI Medical-Surgical Nursing Proctored Exam 2026 |
Questions and Rationales
Domain 1: Cardiovascular Disorders (Questions 1-25)
Question 1
A nurse is assessing a client who is 12 hours postoperative following a colon resection.
Which of the following findings should the nurse report to the surgeon?
A. Heart rate 90/min
B. Absent bowel sounds
C. Hgb 8.2 g/dL
D. Gastric pH of 3.0
Correct Answer: C
Rationale: Normal Hgb is 13-18 g/dL for males and 12-16 g/dL for females. A level of
8.2 g/dL is significantly low and may indicate postoperative hemorrhage, requiring
immediate surgeon notification. Absent bowel sounds are expected after bowel surgery
and may take several days to return.
Question 2
A nurse is admitting a client who reports chest pain and has been placed on a telemetry
monitor. Which of the following should the nurse analyze to determine whether the
client is experiencing a myocardial infarction?
A. PR interval
B. QRS duration
C. T wave
D. ST segment
,2
Correct Answer: D
Rationale: ST segment elevation indicates myocardial infarction. ST segment depression
indicates ischemia. PR interval relates to heart block, QRS duration indicates ventricular
conduction issues, and T wave changes may indicate electrolyte imbalances or ischemia
but are not diagnostic for MI.
Question 3
A nurse is caring for a client who has left-sided heart failure. Which of the following
assessment findings should the nurse expect?
A. Jugular vein distention
B. Peripheral edema
C. Crackles in the lungs
D. Hepatomegaly
Correct Answer: C
Rationale: Left-sided heart failure results in pulmonary congestion because the left
ventricle cannot effectively pump blood forward, causing backup into the pulmonary
circulation. Crackles (rales) in the lungs indicate pulmonary edema. JVD, peripheral
edema, and hepatomegaly are signs of right-sided heart failure.
Question 4
A nurse is teaching a client who is taking an ACE inhibitor for heart failure. Which of the
following instructions should the nurse include for home management?
A. Obtain daily weight
B. Use salt substitute liberally
,3
C. Monitor intake and output
D. Limit daily activity
Correct Answer: A
Rationale: Daily weight is the most accurate indicator of fluid status. A weight gain of 2-
3 lbs in 24 hours or 5 lbs in 1 week indicates fluid retention and worsening heart failure.
Salt substitutes (potassium-based) should be avoided with ACE inhibitors due to risk of
hyperkalemia.
Question 5
A nurse is caring for a client who has heart failure and has been taking digoxin 0.25 mg
daily. The client refuses breakfast and reports nausea. Which of the following actions
should the nurse take first?
A. Check the client's vital signs
B. Notify the provider
C. Administer an antiemetic
D. Hold the digoxin dose
Correct Answer: A
Rationale: Nausea and anorexia are early signs of digoxin toxicity. The nurse should first
check the client's vital signs, particularly the apical pulse, and assess for other signs of
toxicity such as visual changes or dysrhythmias before notifying the provider.
Question 6
A nurse is providing discharge teaching to a client who has a permanent pacemaker.
Which of the following statements by the client indicates an understanding of the
teaching?
, 4
A. "I need to maintain pressure over the pacemaker site with an elastic bandage"
B. "I need to check my pulse rate every day for a full minute"
C. "The pacemaker will deliver a shock if I develop a dysrhythmia"
D. "I cannot use a microwave oven anymore"
Correct Answer: B
Rationale: The client should check their pulse daily for a full minute and report any
significant changes or irregularities to the provider. Microwave ovens are safe with
modern pacemakers. Pacemakers do not deliver shocks (that's an ICD).
Question 7
A nurse is assessing a client who has right-sided heart failure. Which of the following
findings should the nurse expect?
A. Oliguria
B. S3/S4 galloping heart sounds
C. Poor skin turgor
D. Pitting edema
Correct Answer: D
Rationale: Right-sided heart failure causes systemic congestion, leading to dependent
edema (pitting edema in lower extremities), JVD, hepatomegaly, and ascites. Oliguria
and S3/S4 sounds are associated with left-sided heart failure.
Question 8
A nurse in the emergency department is assessing a client with chest pain. Which of the
following actions should the nurse take first?
A. Obtain a sputum sample for culture
ATI Medical-Surgical Nursing Proctored Exam 2026 |
Questions and Rationales
Domain 1: Cardiovascular Disorders (Questions 1-25)
Question 1
A nurse is assessing a client who is 12 hours postoperative following a colon resection.
Which of the following findings should the nurse report to the surgeon?
A. Heart rate 90/min
B. Absent bowel sounds
C. Hgb 8.2 g/dL
D. Gastric pH of 3.0
Correct Answer: C
Rationale: Normal Hgb is 13-18 g/dL for males and 12-16 g/dL for females. A level of
8.2 g/dL is significantly low and may indicate postoperative hemorrhage, requiring
immediate surgeon notification. Absent bowel sounds are expected after bowel surgery
and may take several days to return.
Question 2
A nurse is admitting a client who reports chest pain and has been placed on a telemetry
monitor. Which of the following should the nurse analyze to determine whether the
client is experiencing a myocardial infarction?
A. PR interval
B. QRS duration
C. T wave
D. ST segment
,2
Correct Answer: D
Rationale: ST segment elevation indicates myocardial infarction. ST segment depression
indicates ischemia. PR interval relates to heart block, QRS duration indicates ventricular
conduction issues, and T wave changes may indicate electrolyte imbalances or ischemia
but are not diagnostic for MI.
Question 3
A nurse is caring for a client who has left-sided heart failure. Which of the following
assessment findings should the nurse expect?
A. Jugular vein distention
B. Peripheral edema
C. Crackles in the lungs
D. Hepatomegaly
Correct Answer: C
Rationale: Left-sided heart failure results in pulmonary congestion because the left
ventricle cannot effectively pump blood forward, causing backup into the pulmonary
circulation. Crackles (rales) in the lungs indicate pulmonary edema. JVD, peripheral
edema, and hepatomegaly are signs of right-sided heart failure.
Question 4
A nurse is teaching a client who is taking an ACE inhibitor for heart failure. Which of the
following instructions should the nurse include for home management?
A. Obtain daily weight
B. Use salt substitute liberally
,3
C. Monitor intake and output
D. Limit daily activity
Correct Answer: A
Rationale: Daily weight is the most accurate indicator of fluid status. A weight gain of 2-
3 lbs in 24 hours or 5 lbs in 1 week indicates fluid retention and worsening heart failure.
Salt substitutes (potassium-based) should be avoided with ACE inhibitors due to risk of
hyperkalemia.
Question 5
A nurse is caring for a client who has heart failure and has been taking digoxin 0.25 mg
daily. The client refuses breakfast and reports nausea. Which of the following actions
should the nurse take first?
A. Check the client's vital signs
B. Notify the provider
C. Administer an antiemetic
D. Hold the digoxin dose
Correct Answer: A
Rationale: Nausea and anorexia are early signs of digoxin toxicity. The nurse should first
check the client's vital signs, particularly the apical pulse, and assess for other signs of
toxicity such as visual changes or dysrhythmias before notifying the provider.
Question 6
A nurse is providing discharge teaching to a client who has a permanent pacemaker.
Which of the following statements by the client indicates an understanding of the
teaching?
, 4
A. "I need to maintain pressure over the pacemaker site with an elastic bandage"
B. "I need to check my pulse rate every day for a full minute"
C. "The pacemaker will deliver a shock if I develop a dysrhythmia"
D. "I cannot use a microwave oven anymore"
Correct Answer: B
Rationale: The client should check their pulse daily for a full minute and report any
significant changes or irregularities to the provider. Microwave ovens are safe with
modern pacemakers. Pacemakers do not deliver shocks (that's an ICD).
Question 7
A nurse is assessing a client who has right-sided heart failure. Which of the following
findings should the nurse expect?
A. Oliguria
B. S3/S4 galloping heart sounds
C. Poor skin turgor
D. Pitting edema
Correct Answer: D
Rationale: Right-sided heart failure causes systemic congestion, leading to dependent
edema (pitting edema in lower extremities), JVD, hepatomegaly, and ascites. Oliguria
and S3/S4 sounds are associated with left-sided heart failure.
Question 8
A nurse in the emergency department is assessing a client with chest pain. Which of the
following actions should the nurse take first?
A. Obtain a sputum sample for culture
