ATI PN MED SURG PROCTORED EXAM – 180 PRACTICE QUESTIONS WITH ANSWERS &
RATIONALES
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–30)
1. A nurse is caring for a client with left-sided heart failure. Which assessment finding should
the nurse expect?
A) Jugular vein distension
B) Peripheral pitting edema
C) Hepatomegaly
D) Crackles in the lung bases
E) Ascites
Correct Answer: D) Crackles in the lung bases
Rationale: Left-sided heart failure causes fluid to back up into the pulmonary circulation,
resulting in pulmonary congestion and crackles (rales) in the lung bases. Options A, B, C, and E
are manifestations of right-sided heart failure due to systemic venous congestion. Left-sided
heart failure also presents with dyspnea, orthopnea, paroxysmal nocturnal dyspnea, cough, and
fatigue.
2. A nurse is assessing a client who is experiencing a myocardial infarction. Which symptom is
most commonly reported?
A) Nausea and vomiting
B) Jaw pain
C) Crushing substernal chest pain
D) Epigastric pain
E) Back pain
Correct Answer: C) Crushing substernal chest pain
Rationale: The most common symptom of a myocardial infarction is crushing substernal chest
pain that may radiate to the left arm, jaw, or back. While nausea and vomiting, jaw pain,
epigastric pain, and back pain can occur, especially in women, the elderly, and diabetics, the
classic presentation is substernal chest pain. Women and diabetics may present with atypical
symptoms.
3. A nurse is caring for a client with peripheral artery disease (PAD). Which assessment finding
is expected?
A) Bilateral lower extremity edema
B) Warm, flushed skin on the lower extremities
C) Diminished dorsalis pedis pulses
,D) Brown discoloration of the lower legs
E) Varicose veins
Correct Answer: C) Diminished dorsalis pedis pulses
Rationale: Peripheral artery disease (PAD) is characterized by reduced arterial blood flow to the
extremities, leading to diminished or absent peripheral pulses, cool skin, pallor, and intermittent
claudication. Bilateral edema, warm flushed skin, brown discoloration, and varicose veins are
associated with venous insufficiency, not PAD.
4. A client with heart failure is receiving furosemide and digoxin. Which laboratory value
requires priority intervention?
A) Potassium 3.2 mEq/L
B) Sodium 138 mEq/L
C) Calcium 9.0 mg/dL
D) Magnesium 2.0 mEq/L
Correct Answer: A) Potassium 3.2 mEq/L
Rationale: Hypokalemia (potassium <3.5 mEq/L) increases the risk of digoxin toxicity because
digoxin binds to the same sites as potassium on the sodium-potassium pump. The nurse should
notify the provider and prepare to administer potassium supplementation. The other values are
within normal limits.
5. A nurse is caring for a client who has a newly inserted permanent pacemaker. Which of the
following findings should the nurse report to the provider?
A) The client experiences hiccups when sitting.
B) The client's pulse rate is 5/min faster than the preset pacemaker rate.
C) There is the presence of a pacing spike before the P-wave on the ECG rhythm strip.
D) The dressing over the insertion site is dry and intact.
Correct Answer: A) The client experiences hiccups when sitting.
Rationale: Hiccups in a client with a newly inserted pacemaker can indicate diaphragmatic
pacing, which may occur if the lead has perforated the ventricular wall or is irritating the
phrenic nerve. This requires prompt evaluation. A pulse rate slightly faster than the preset rate,
pacing spikes before P-waves (atrial pacing), and a dry intact dressing are expected findings.
6. A nurse is caring for a client who is 1 day postoperative following a hip arthroplasty. The
client exhibits hypotension, tachycardia, and tachypnea. The nurse should recognize that
these findings indicate which of the following complications?
A) Wound infection
B) Thrombophlebitis
,C) Pulmonary embolism
D) Paralytic ileus
Correct Answer: C) Pulmonary embolism
Rationale: Manifestations of a pulmonary embolism include hypotension, tachycardia, and
tachypnea. Wound infection typically presents with fever, inflammation, and foul-smelling
drainage. Thrombophlebitis involves inflammation of a blood vessel. Paralytic ileus is the
absence of bowel peristalsis. These findings do not indicate the other complications.
7. A nurse is reinforcing teaching with a client who has hypertension. Which of the following
statements by the client indicates an understanding of the teaching?
A) "I should check my blood pressure once a month."
B) "I can stop my medication when my blood pressure is normal."
C) "I should limit my sodium intake to less than 2,300 mg per day."
D) "I should avoid all physical activity."
Correct Answer: C) "I should limit my sodium intake to less than 2,300 mg per day."
Rationale: The Dietary Approaches to Stop Hypertension (DASH) diet recommends limiting
sodium intake to less than 2,300 mg per day (ideally 1,500 mg). Blood pressure should be
monitored regularly, not just monthly. Antihypertensive medications must be taken consistently
even when blood pressure is normal. Regular physical activity is encouraged.
8. A nurse is monitoring a client who is receiving a continuous heparin infusion. Which
laboratory value should the nurse monitor to evaluate the effectiveness of therapy?
A) Prothrombin time (PT)
B) International normalized ratio (INR)
C) Activated partial thromboplastin time (aPTT)
D) Platelet count
Correct Answer: C) Activated partial thromboplastin time (aPTT)
Rationale: Heparin therapy is monitored using the activated partial thromboplastin time (aPTT).
The therapeutic goal is typically 1.5 to 2.5 times the normal control value. PT and INR are used
to monitor warfarin therapy. Platelet count is monitored to detect heparin-induced
thrombocytopenia (HIT).
9. A nurse is caring for a client with angina pectoris. Which medication should the nurse
administer to relieve acute chest pain?
A) Aspirin
B) Nitroglycerin sublingual
C) Metoprolol
D) Lisinopril
, Correct Answer: B) Nitroglycerin sublingual
Rationale: Sublingual nitroglycerin is the first-line medication for acute angina pectoris because
it rapidly dilates coronary arteries and reduces myocardial oxygen demand. Aspirin is given to
prevent platelet aggregation. Metoprolol and lisinopril are used for long-term management.
10. A nurse is assessing a client with peripheral venous insufficiency. Which finding is most
characteristic?
A) Cool, pale extremities
B) Diminished pulses
C) Brownish discoloration of the lower legs
D) Intermittent claudication
Correct Answer: C) Brownish discoloration of the lower legs
Rationale: Chronic venous insufficiency leads to venous stasis and hemosiderin deposition,
causing brownish discoloration of the lower legs. Cool, pale extremities, diminished pulses, and
intermittent claudication are characteristic of arterial insufficiency.
11. A nurse is caring for a client following a cardiac catheterization via the femoral artery.
Which action should the nurse take?
A) Keep the affected leg flexed for 6 hours.
B) Apply a sandbag over the insertion site.
C) Encourage early ambulation.
D) Apply heat to the insertion site.
Correct Answer: B) Apply a sandbag over the insertion site.
Rationale: After a femoral artery catheterization, a sandbag or other pressure device is applied
over the insertion site to maintain pressure and promote hemostasis. The affected leg should be
kept straight, not flexed. Bed rest is usually required for several hours. Heat should not be
applied as it can increase bleeding risk.
12. A nurse is reinforcing teaching about warfarin with a client who has atrial fibrillation.
Which statement by the client indicates a need for further teaching?
A) "I will eat more green leafy vegetables."
B) "I will report any unusual bleeding."
C) "I will have my blood drawn regularly."
D) "I will avoid taking aspirin."
Correct Answer: A) "I will eat more green leafy vegetables."
Rationale: Green leafy vegetables are high in vitamin K, which antagonizes the effects of
warfarin. Clients taking warfarin should maintain a consistent intake of vitamin K-containing
RATIONALES
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–30)
1. A nurse is caring for a client with left-sided heart failure. Which assessment finding should
the nurse expect?
A) Jugular vein distension
B) Peripheral pitting edema
C) Hepatomegaly
D) Crackles in the lung bases
E) Ascites
Correct Answer: D) Crackles in the lung bases
Rationale: Left-sided heart failure causes fluid to back up into the pulmonary circulation,
resulting in pulmonary congestion and crackles (rales) in the lung bases. Options A, B, C, and E
are manifestations of right-sided heart failure due to systemic venous congestion. Left-sided
heart failure also presents with dyspnea, orthopnea, paroxysmal nocturnal dyspnea, cough, and
fatigue.
2. A nurse is assessing a client who is experiencing a myocardial infarction. Which symptom is
most commonly reported?
A) Nausea and vomiting
B) Jaw pain
C) Crushing substernal chest pain
D) Epigastric pain
E) Back pain
Correct Answer: C) Crushing substernal chest pain
Rationale: The most common symptom of a myocardial infarction is crushing substernal chest
pain that may radiate to the left arm, jaw, or back. While nausea and vomiting, jaw pain,
epigastric pain, and back pain can occur, especially in women, the elderly, and diabetics, the
classic presentation is substernal chest pain. Women and diabetics may present with atypical
symptoms.
3. A nurse is caring for a client with peripheral artery disease (PAD). Which assessment finding
is expected?
A) Bilateral lower extremity edema
B) Warm, flushed skin on the lower extremities
C) Diminished dorsalis pedis pulses
,D) Brown discoloration of the lower legs
E) Varicose veins
Correct Answer: C) Diminished dorsalis pedis pulses
Rationale: Peripheral artery disease (PAD) is characterized by reduced arterial blood flow to the
extremities, leading to diminished or absent peripheral pulses, cool skin, pallor, and intermittent
claudication. Bilateral edema, warm flushed skin, brown discoloration, and varicose veins are
associated with venous insufficiency, not PAD.
4. A client with heart failure is receiving furosemide and digoxin. Which laboratory value
requires priority intervention?
A) Potassium 3.2 mEq/L
B) Sodium 138 mEq/L
C) Calcium 9.0 mg/dL
D) Magnesium 2.0 mEq/L
Correct Answer: A) Potassium 3.2 mEq/L
Rationale: Hypokalemia (potassium <3.5 mEq/L) increases the risk of digoxin toxicity because
digoxin binds to the same sites as potassium on the sodium-potassium pump. The nurse should
notify the provider and prepare to administer potassium supplementation. The other values are
within normal limits.
5. A nurse is caring for a client who has a newly inserted permanent pacemaker. Which of the
following findings should the nurse report to the provider?
A) The client experiences hiccups when sitting.
B) The client's pulse rate is 5/min faster than the preset pacemaker rate.
C) There is the presence of a pacing spike before the P-wave on the ECG rhythm strip.
D) The dressing over the insertion site is dry and intact.
Correct Answer: A) The client experiences hiccups when sitting.
Rationale: Hiccups in a client with a newly inserted pacemaker can indicate diaphragmatic
pacing, which may occur if the lead has perforated the ventricular wall or is irritating the
phrenic nerve. This requires prompt evaluation. A pulse rate slightly faster than the preset rate,
pacing spikes before P-waves (atrial pacing), and a dry intact dressing are expected findings.
6. A nurse is caring for a client who is 1 day postoperative following a hip arthroplasty. The
client exhibits hypotension, tachycardia, and tachypnea. The nurse should recognize that
these findings indicate which of the following complications?
A) Wound infection
B) Thrombophlebitis
,C) Pulmonary embolism
D) Paralytic ileus
Correct Answer: C) Pulmonary embolism
Rationale: Manifestations of a pulmonary embolism include hypotension, tachycardia, and
tachypnea. Wound infection typically presents with fever, inflammation, and foul-smelling
drainage. Thrombophlebitis involves inflammation of a blood vessel. Paralytic ileus is the
absence of bowel peristalsis. These findings do not indicate the other complications.
7. A nurse is reinforcing teaching with a client who has hypertension. Which of the following
statements by the client indicates an understanding of the teaching?
A) "I should check my blood pressure once a month."
B) "I can stop my medication when my blood pressure is normal."
C) "I should limit my sodium intake to less than 2,300 mg per day."
D) "I should avoid all physical activity."
Correct Answer: C) "I should limit my sodium intake to less than 2,300 mg per day."
Rationale: The Dietary Approaches to Stop Hypertension (DASH) diet recommends limiting
sodium intake to less than 2,300 mg per day (ideally 1,500 mg). Blood pressure should be
monitored regularly, not just monthly. Antihypertensive medications must be taken consistently
even when blood pressure is normal. Regular physical activity is encouraged.
8. A nurse is monitoring a client who is receiving a continuous heparin infusion. Which
laboratory value should the nurse monitor to evaluate the effectiveness of therapy?
A) Prothrombin time (PT)
B) International normalized ratio (INR)
C) Activated partial thromboplastin time (aPTT)
D) Platelet count
Correct Answer: C) Activated partial thromboplastin time (aPTT)
Rationale: Heparin therapy is monitored using the activated partial thromboplastin time (aPTT).
The therapeutic goal is typically 1.5 to 2.5 times the normal control value. PT and INR are used
to monitor warfarin therapy. Platelet count is monitored to detect heparin-induced
thrombocytopenia (HIT).
9. A nurse is caring for a client with angina pectoris. Which medication should the nurse
administer to relieve acute chest pain?
A) Aspirin
B) Nitroglycerin sublingual
C) Metoprolol
D) Lisinopril
, Correct Answer: B) Nitroglycerin sublingual
Rationale: Sublingual nitroglycerin is the first-line medication for acute angina pectoris because
it rapidly dilates coronary arteries and reduces myocardial oxygen demand. Aspirin is given to
prevent platelet aggregation. Metoprolol and lisinopril are used for long-term management.
10. A nurse is assessing a client with peripheral venous insufficiency. Which finding is most
characteristic?
A) Cool, pale extremities
B) Diminished pulses
C) Brownish discoloration of the lower legs
D) Intermittent claudication
Correct Answer: C) Brownish discoloration of the lower legs
Rationale: Chronic venous insufficiency leads to venous stasis and hemosiderin deposition,
causing brownish discoloration of the lower legs. Cool, pale extremities, diminished pulses, and
intermittent claudication are characteristic of arterial insufficiency.
11. A nurse is caring for a client following a cardiac catheterization via the femoral artery.
Which action should the nurse take?
A) Keep the affected leg flexed for 6 hours.
B) Apply a sandbag over the insertion site.
C) Encourage early ambulation.
D) Apply heat to the insertion site.
Correct Answer: B) Apply a sandbag over the insertion site.
Rationale: After a femoral artery catheterization, a sandbag or other pressure device is applied
over the insertion site to maintain pressure and promote hemostasis. The affected leg should be
kept straight, not flexed. Bed rest is usually required for several hours. Heat should not be
applied as it can increase bleeding risk.
12. A nurse is reinforcing teaching about warfarin with a client who has atrial fibrillation.
Which statement by the client indicates a need for further teaching?
A) "I will eat more green leafy vegetables."
B) "I will report any unusual bleeding."
C) "I will have my blood drawn regularly."
D) "I will avoid taking aspirin."
Correct Answer: A) "I will eat more green leafy vegetables."
Rationale: Green leafy vegetables are high in vitamin K, which antagonizes the effects of
warfarin. Clients taking warfarin should maintain a consistent intake of vitamin K-containing
