ATI Adult Medical-Surgical
Practice Assessment B:
Version 3.1 well written one
year 2025 /2026 updated
graded A+Comprehensive 150-Question
Exam Bank with Detailed Rationales
Target Audience: RN Nursing Students & Professionals
Difficulty Level: Advanced / Complex / Next-Generation NCLEX Style
Content Focus: Cardiovascular, Respiratory, Neurological, Gastrointestinal, Renal, Endocrine, Immune,
Musculoskeletal, Oncology, Perioperative Care, Fluid/Electrolyte Balance, Pharmacology, Prioritization,
Delegation, Clinical Judgment, and NGN-Style Unfolding Cases
Rationale:
,Questions 1–150
Cardiovascular System
1. A nurse is assessing a client with peripheral arterial disease (PAD). Which of the following
findingsshould the nurse expect?
A) Bounding peripheral pulses with warm, erythematous skin
B) Hair loss on the lower legs with thin, shiny skin
C) Brownish discoloration around the ankles with edema
D) Superficial, dilated, tortuous veins with aching pain
- detailed answer 100% correct:_B
Rationale: PAD causes decreased arterial blood flow, leading to hair loss, thin/shiny skin, thickened
nails, diminished pulses, and cool extremities. Brownish discoloration and edema are characteristic of
venous insufficiency; dilated tortuous veins indicate varicose veins.
2. A nurse is reviewing laboratory findings of a client who developed chest pain 6 hours ago.
Whichfinding indicates a myocardial infarction (MI)?
A) Myoglobin 50 ng/mL
B) CK-MB 2 ng/mL
C) Troponin I 8 ng/mL
D) BNP 100 pg/mL
- detailed answer 100% correct:_C
Troponin I is highly specific for myocardial injury, rising 3–6 hours after MI and remaining
elevated for 7–10 days. Normal is <0.03 ng/mL; 8 ng/mL is significantly elevated. CK-MB rises later and
is less specific; myoglobin is early but nonspecific; BNP indicates heart failure.
3. A nurse is providing teaching to a client who is perimenopausal and has a prescription
forhormone replacement therapy. For which adverse effects should the nurse instruct the
client to notify the provider? (Select all that apply.)
Rationale:
, A) Hot flashes
B) Calf pain
C) Vaginal dryness
D) Numbness in the arms
E) Intense headache
- detailed answer 100% correct:_B, D, E
Rationale: Calf pain may indicate DVT; numbness in arms and intense headaches may signal stroke or
thromboembolic events. Hot flashes and vaginal dryness are expected side effects of hormone
therapy.
4. A nurse is caring for a client with an arterial line. Which action should the nurse take?
A) Place a pressure bag around the flush solution inflated to 300 mm Hg
B) Zero the transducer at the level of the client's right atrium
C) Maintain the client in a supine position at all times
D) Both A and B
- detailed answer 100% correct:_D
Rationale: A pressure bag (300 mm Hg) maintains continuous flow through the arterial line. The
transducer should be zeroed at the phlebostatic axis (level of the right atrium). The client does not
need to remain supine at all times.
5. A nurse is assessing a client with pericarditis. Which finding is most characteristic?
A) Chest pain that worsens with leaning forwardB) Chest pain that improves with lying flat
C) Chest pain that is relieved by leaning forward
D) Dull, constant chest pain unrelieved by position changes
- detailed answer 100% correct:_C
Pericarditis pain is typically sharp and pleuritic, worsened by lying flat and deep inspiration,
and relieved by leaning forward. This position reduces pressure on the inflamed pericardium.
6. A nurse is caring for a client with heart failure who has gained 3 kg in 2 days. Which is
thepriority action?
Rationale:
, A) Notify the provider immediately
B) Administer furosemide as prescribed
C) Restrict sodium intake to 2 g/day
D) Monitor blood pressure every 4 hours
- detailed answer 100% correct:_B
Rationale: Rapid weight gain of 2–3 kg indicates significant fluid retention, which can lead to
pulmonary edema. Administering a diuretic (furosemide) is the priority intervention to remove excess
fluid. While notifying the provider and monitoring are important, the immediate action is to
administer the diuretic.
7. A nurse is monitoring a client receiving IV heparin for a pulmonary embolism. Which
laboratoryvalue best indicates therapeutic anticoagulation?
A) INR 2.5
B) aPTT 65 seconds (normal 25–35 seconds)
C) Platelet count 100,000/mm³
D) PT 15 seconds (normal 11–13 seconds)
- detailed answer 100% correct:_B
Rationale: Therapeutic aPTT for heparin is 1.5–2.5 times the normal control (60–80 seconds with
normal 25–35 seconds). INR monitors warfarin; platelet count monitors for heparin-induced
thrombocytopenia.
8. A nurse is assessing a client 24 hours post-cardiac catheterization via femoral artery.
Whichfinding requires immediate intervention?
A) Pulse at insertion site 2+
B) Expanding hematoma at insertion site
C) Slight bruising around insertion site
D) Client reports mild discomfort at site
- detailed answer 100% correct:_B
An expanding hematoma indicates bleeding or pseudoaneurysm formation and requires
Rationale:
Practice Assessment B:
Version 3.1 well written one
year 2025 /2026 updated
graded A+Comprehensive 150-Question
Exam Bank with Detailed Rationales
Target Audience: RN Nursing Students & Professionals
Difficulty Level: Advanced / Complex / Next-Generation NCLEX Style
Content Focus: Cardiovascular, Respiratory, Neurological, Gastrointestinal, Renal, Endocrine, Immune,
Musculoskeletal, Oncology, Perioperative Care, Fluid/Electrolyte Balance, Pharmacology, Prioritization,
Delegation, Clinical Judgment, and NGN-Style Unfolding Cases
Rationale:
,Questions 1–150
Cardiovascular System
1. A nurse is assessing a client with peripheral arterial disease (PAD). Which of the following
findingsshould the nurse expect?
A) Bounding peripheral pulses with warm, erythematous skin
B) Hair loss on the lower legs with thin, shiny skin
C) Brownish discoloration around the ankles with edema
D) Superficial, dilated, tortuous veins with aching pain
- detailed answer 100% correct:_B
Rationale: PAD causes decreased arterial blood flow, leading to hair loss, thin/shiny skin, thickened
nails, diminished pulses, and cool extremities. Brownish discoloration and edema are characteristic of
venous insufficiency; dilated tortuous veins indicate varicose veins.
2. A nurse is reviewing laboratory findings of a client who developed chest pain 6 hours ago.
Whichfinding indicates a myocardial infarction (MI)?
A) Myoglobin 50 ng/mL
B) CK-MB 2 ng/mL
C) Troponin I 8 ng/mL
D) BNP 100 pg/mL
- detailed answer 100% correct:_C
Troponin I is highly specific for myocardial injury, rising 3–6 hours after MI and remaining
elevated for 7–10 days. Normal is <0.03 ng/mL; 8 ng/mL is significantly elevated. CK-MB rises later and
is less specific; myoglobin is early but nonspecific; BNP indicates heart failure.
3. A nurse is providing teaching to a client who is perimenopausal and has a prescription
forhormone replacement therapy. For which adverse effects should the nurse instruct the
client to notify the provider? (Select all that apply.)
Rationale:
, A) Hot flashes
B) Calf pain
C) Vaginal dryness
D) Numbness in the arms
E) Intense headache
- detailed answer 100% correct:_B, D, E
Rationale: Calf pain may indicate DVT; numbness in arms and intense headaches may signal stroke or
thromboembolic events. Hot flashes and vaginal dryness are expected side effects of hormone
therapy.
4. A nurse is caring for a client with an arterial line. Which action should the nurse take?
A) Place a pressure bag around the flush solution inflated to 300 mm Hg
B) Zero the transducer at the level of the client's right atrium
C) Maintain the client in a supine position at all times
D) Both A and B
- detailed answer 100% correct:_D
Rationale: A pressure bag (300 mm Hg) maintains continuous flow through the arterial line. The
transducer should be zeroed at the phlebostatic axis (level of the right atrium). The client does not
need to remain supine at all times.
5. A nurse is assessing a client with pericarditis. Which finding is most characteristic?
A) Chest pain that worsens with leaning forwardB) Chest pain that improves with lying flat
C) Chest pain that is relieved by leaning forward
D) Dull, constant chest pain unrelieved by position changes
- detailed answer 100% correct:_C
Pericarditis pain is typically sharp and pleuritic, worsened by lying flat and deep inspiration,
and relieved by leaning forward. This position reduces pressure on the inflamed pericardium.
6. A nurse is caring for a client with heart failure who has gained 3 kg in 2 days. Which is
thepriority action?
Rationale:
, A) Notify the provider immediately
B) Administer furosemide as prescribed
C) Restrict sodium intake to 2 g/day
D) Monitor blood pressure every 4 hours
- detailed answer 100% correct:_B
Rationale: Rapid weight gain of 2–3 kg indicates significant fluid retention, which can lead to
pulmonary edema. Administering a diuretic (furosemide) is the priority intervention to remove excess
fluid. While notifying the provider and monitoring are important, the immediate action is to
administer the diuretic.
7. A nurse is monitoring a client receiving IV heparin for a pulmonary embolism. Which
laboratoryvalue best indicates therapeutic anticoagulation?
A) INR 2.5
B) aPTT 65 seconds (normal 25–35 seconds)
C) Platelet count 100,000/mm³
D) PT 15 seconds (normal 11–13 seconds)
- detailed answer 100% correct:_B
Rationale: Therapeutic aPTT for heparin is 1.5–2.5 times the normal control (60–80 seconds with
normal 25–35 seconds). INR monitors warfarin; platelet count monitors for heparin-induced
thrombocytopenia.
8. A nurse is assessing a client 24 hours post-cardiac catheterization via femoral artery.
Whichfinding requires immediate intervention?
A) Pulse at insertion site 2+
B) Expanding hematoma at insertion site
C) Slight bruising around insertion site
D) Client reports mild discomfort at site
- detailed answer 100% correct:_B
An expanding hematoma indicates bleeding or pseudoaneurysm formation and requires
Rationale:
