ATI MEDICAL-SURGICAL PROCTORED
EXAMINATION 2026: COMPREHENSIVE TEST
BANK FOR MEDICAL-SURGICAL NURSING &
NCLEX-RN PREPARATION
SECTION I: CARDIOVASCULAR SYSTEM DISORDERS
Questions 1-40
1. A nurse is assessing a client with heart failure. Which finding is the earliest sign of left-
sided heart failure?
A) Peripheral edema
B) Jugular venous distention
C) Dyspnea on exertion
D) Hepatomegaly
Correct Answer: C
Rationale: Dyspnea on exertion is the earliest sign of left-sided heart failure due to
pulmonary congestion from the left ventricle's inability to pump blood forward. As left
ventricular function declines, blood backs up into the pulmonary circulation, causing
,dyspnea. Peripheral edema, jugular venous distention, and hepatomegaly are signs of
right-sided heart failure .
2. A client with heart failure reports sudden weight gain, dyspnea, and jugular vein
distention. Which action should the nurse take first?
A) Administer furosemide IV push
B) Place the client in high-Fowler's position
C) Increase oxygen to 4 L/min via nasal cannula
D) Notify the healthcare provider
Correct Answer: B
Rationale: Placing the client in high-Fowler's position is the priority intervention to facilitate
breathing and reduce venous return, which decreases preload and pulmonary congestion.
This position uses gravity to help reduce pulmonary edema and improve ventilation.
Oxygen therapy and medication administration should follow positioning .
3. A client with heart failure is receiving furosemide (Lasix). Which laboratory value should
the nurse monitor most closely?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
Correct Answer: B
,Rationale: Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia is a
common and potentially dangerous adverse effect that can lead to cardiac dysrhythmias.
The nurse should monitor serum potassium levels closely and assess for signs of
hypokalemia including muscle weakness, fatigue, and cardiac dysrhythmias .
4. A client is prescribed furosemide and complains of muscle weakness and cramps.
Which laboratory value requires immediate attention?
A) Sodium 140 mEq/L
B) Potassium 2.8 mEq/L
C) Calcium 9.2 mg/dL
D) Magnesium 2.0 mEq/L
Correct Answer: B
Rationale: A potassium level of 2.8 mEq/L is severely low (normal 3.5-5.0 mEq/L) and
indicates hypokalemia. This can cause muscle cramps, weakness, and life-threatening
cardiac dysrhythmias. Immediate intervention is required to correct the hypokalemia. The
other values are within normal limits .
5. A nurse is assessing a client with heart failure. Which finding indicates the medication
furosemide is effective?
A) Decreased blood pressure
B) Weight loss of 2 kg in 24 hours
C) Increased heart rate
D) Presence of crackles in lung bases
, Correct Answer: B
Rationale: Weight loss is the most reliable indicator of fluid loss in heart failure. Each
kilogram (2.2 lb) of weight loss represents approximately 1 liter of fluid loss. Effective
diuresis should result in decreased peripheral edema, improved breath sounds, and
reduced dyspnea. Crackles should decrease, not increase .
6. A client with heart failure has a prescription for digoxin. Which finding indicates digoxin
toxicity?
A) Heart rate of 72 bpm
B) Nausea and yellow vision
C) Blood pressure of 140/90 mm Hg
D) Dry cough
Correct Answer: B
Rationale: Classic signs of digoxin toxicity include gastrointestinal symptoms (nausea,
vomiting, anorexia) and visual disturbances (yellow or green halos, blurred vision).
Bradycardia is also a sign of digoxin toxicity, but a heart rate of 72 bpm is normal. A dry
cough is associated with ACE inhibitors, not digoxin .
7. A client with heart failure and atrial fibrillation is prescribed warfarin (Coumadin). Which
laboratory value should the nurse monitor to evaluate therapeutic effect?
A) aPTT
B) Platelet count
C) INR
EXAMINATION 2026: COMPREHENSIVE TEST
BANK FOR MEDICAL-SURGICAL NURSING &
NCLEX-RN PREPARATION
SECTION I: CARDIOVASCULAR SYSTEM DISORDERS
Questions 1-40
1. A nurse is assessing a client with heart failure. Which finding is the earliest sign of left-
sided heart failure?
A) Peripheral edema
B) Jugular venous distention
C) Dyspnea on exertion
D) Hepatomegaly
Correct Answer: C
Rationale: Dyspnea on exertion is the earliest sign of left-sided heart failure due to
pulmonary congestion from the left ventricle's inability to pump blood forward. As left
ventricular function declines, blood backs up into the pulmonary circulation, causing
,dyspnea. Peripheral edema, jugular venous distention, and hepatomegaly are signs of
right-sided heart failure .
2. A client with heart failure reports sudden weight gain, dyspnea, and jugular vein
distention. Which action should the nurse take first?
A) Administer furosemide IV push
B) Place the client in high-Fowler's position
C) Increase oxygen to 4 L/min via nasal cannula
D) Notify the healthcare provider
Correct Answer: B
Rationale: Placing the client in high-Fowler's position is the priority intervention to facilitate
breathing and reduce venous return, which decreases preload and pulmonary congestion.
This position uses gravity to help reduce pulmonary edema and improve ventilation.
Oxygen therapy and medication administration should follow positioning .
3. A client with heart failure is receiving furosemide (Lasix). Which laboratory value should
the nurse monitor most closely?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
Correct Answer: B
,Rationale: Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia is a
common and potentially dangerous adverse effect that can lead to cardiac dysrhythmias.
The nurse should monitor serum potassium levels closely and assess for signs of
hypokalemia including muscle weakness, fatigue, and cardiac dysrhythmias .
4. A client is prescribed furosemide and complains of muscle weakness and cramps.
Which laboratory value requires immediate attention?
A) Sodium 140 mEq/L
B) Potassium 2.8 mEq/L
C) Calcium 9.2 mg/dL
D) Magnesium 2.0 mEq/L
Correct Answer: B
Rationale: A potassium level of 2.8 mEq/L is severely low (normal 3.5-5.0 mEq/L) and
indicates hypokalemia. This can cause muscle cramps, weakness, and life-threatening
cardiac dysrhythmias. Immediate intervention is required to correct the hypokalemia. The
other values are within normal limits .
5. A nurse is assessing a client with heart failure. Which finding indicates the medication
furosemide is effective?
A) Decreased blood pressure
B) Weight loss of 2 kg in 24 hours
C) Increased heart rate
D) Presence of crackles in lung bases
, Correct Answer: B
Rationale: Weight loss is the most reliable indicator of fluid loss in heart failure. Each
kilogram (2.2 lb) of weight loss represents approximately 1 liter of fluid loss. Effective
diuresis should result in decreased peripheral edema, improved breath sounds, and
reduced dyspnea. Crackles should decrease, not increase .
6. A client with heart failure has a prescription for digoxin. Which finding indicates digoxin
toxicity?
A) Heart rate of 72 bpm
B) Nausea and yellow vision
C) Blood pressure of 140/90 mm Hg
D) Dry cough
Correct Answer: B
Rationale: Classic signs of digoxin toxicity include gastrointestinal symptoms (nausea,
vomiting, anorexia) and visual disturbances (yellow or green halos, blurred vision).
Bradycardia is also a sign of digoxin toxicity, but a heart rate of 72 bpm is normal. A dry
cough is associated with ACE inhibitors, not digoxin .
7. A client with heart failure and atrial fibrillation is prescribed warfarin (Coumadin). Which
laboratory value should the nurse monitor to evaluate therapeutic effect?
A) aPTT
B) Platelet count
C) INR
