ATI PN Adult Medical Surgical
(Med-Surg) 2026 Proctored Exam –
Retake 1 200 Practice Questions with
Answers & Detailed Rationales
Section 1: Cardiovascular Disorders (Questions 1-40)
Question 1
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
Answer: A) Potassium 3.2 mEq/L
Rationale: Hypokalemia (potassium < 3.5 mEq/L) significantly increases
the risk of digoxin toxicity, which can precipitate life-threatening
dysrhythmias. Furosemide is a loop diuretic that causes potassium loss
through the kidneys. The nurse should monitor potassium levels closely
and notify the provider if hypokalemia is detected. Sodium, calcium, and
magnesium levels are within normal limits in this scenario.
Question 2
A client with heart failure has gained 2 kg (4.4 lb) in 2 days. What is the
nurse's priority action?
,A) Encourage ambulation
B) Restrict fluids
C) Notify the provider
D) Administer potassium
Answer: C) Notify the provider
Rationale: Rapid weight gain indicates fluid overload and possible heart
failure exacerbation. A weight gain of 1 kg (2.2 lb) in 24 hours suggests
approximately 1 liter of fluid retention. The provider should be notified
immediately for possible medication adjustment (e.g., increasing diuretic
dose) to prevent further decompensation.
Question 3
A client who is 2 hours post-cardiac catheterization via the femoral artery
has an expanding hematoma at the insertion site. Which action should the
nurse take first?
A) Apply ice to the site
B) Apply firm pressure 1-2 cm above the insertion site
C) Notify the provider
D) Assess the client's vital signs
Answer: B) Apply firm pressure 1-2 cm above the insertion site
Rationale: An expanding hematoma indicates active bleeding at the arterial
puncture site, which can lead to significant blood loss, hypovolemic shock,
and limb ischemia. The immediate priority is to apply firm pressure 1-2 cm
above the insertion site to control the bleeding. After applying pressure, the
nurse should then notify the provider and monitor vital signs.
Question 4
A client with atrial fibrillation has a PT/INR of 4.5 (therapeutic range:
,2.0-3.0). There is no active bleeding. What should the nurse do?
A) Administer the next warfarin dose as ordered
B) Hold the next dose and notify the provider
C) Administer vitamin K immediately
D) Increase the next warfarin dose
Answer: B) Hold the next dose and notify the provider
Rationale: An INR of 4.5 is supratherapeutic and significantly increases the
risk of bleeding complications. The nurse should hold the next dose of
warfarin and notify the provider for further instructions. Vitamin K
administration is typically reserved for active bleeding or an INR > 10.0.
Continuing the warfarin at the same dose would increase the risk of
bleeding; increasing the dose would be unsafe.
Question 5
A client with new-onset atrial fibrillation has a heart rate of 140 bpm and
blood pressure 100/60 mmHg. The nurse should prepare for which
intervention?
A) Synchronized electrical cardioversion
B) Defibrillation
C) Pacemaker insertion
D) Adenosine administration
Answer: A) Synchronized electrical cardioversion
Rationale: Synchronized cardioversion is indicated for unstable atrial
fibrillation with a rapid ventricular response causing hemodynamic
compromise. The hypotension (100/60 mmHg) indicates instability. The
shock is synchronized with the QRS complex to avoid the R-on-T
phenomenon. Defibrillation is used for pulseless rhythms. Pacemakers are
for bradyarrhythmias. Adenosine is used for regular supraventricular
tachycardia.
, Question 6
A client is receiving IV heparin for a deep vein thrombosis (DVT). Which
laboratory test is used to monitor heparin therapy?
A) PT/INR
B) aPTT
C) Platelet count
D) Hemoglobin A1c
Answer: B) aPTT
Rationale: Activated partial thromboplastin time (aPTT) is the laboratory
test used to monitor unfractionated heparin therapy. The therapeutic range
is typically 1.5 to 2.5 times the control value. PT/INR monitors warfarin
therapy. Platelet count monitors for heparin-induced thrombocytopenia
(HIT). Hemoglobin A1c monitors diabetes control.
Question 7
A nurse is assessing a client with deep vein thrombosis (DVT). Which
finding is expected?
A) Cool, pale extremity
B) Bilateral edema
C) Warm, swollen calf with tenderness
D) Decreased heart rate
Answer: C) Warm, swollen calf with tenderness
Rationale: Classic signs of DVT include unilateral calf swelling, warmth,
erythema, and tenderness. A cool, pale extremity suggests arterial
insufficiency. Bilateral edema suggests systemic causes such as heart
failure or kidney disease. Tachycardia, not bradycardia, may occur if a
pulmonary embolism develops.
(Med-Surg) 2026 Proctored Exam –
Retake 1 200 Practice Questions with
Answers & Detailed Rationales
Section 1: Cardiovascular Disorders (Questions 1-40)
Question 1
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
Answer: A) Potassium 3.2 mEq/L
Rationale: Hypokalemia (potassium < 3.5 mEq/L) significantly increases
the risk of digoxin toxicity, which can precipitate life-threatening
dysrhythmias. Furosemide is a loop diuretic that causes potassium loss
through the kidneys. The nurse should monitor potassium levels closely
and notify the provider if hypokalemia is detected. Sodium, calcium, and
magnesium levels are within normal limits in this scenario.
Question 2
A client with heart failure has gained 2 kg (4.4 lb) in 2 days. What is the
nurse's priority action?
,A) Encourage ambulation
B) Restrict fluids
C) Notify the provider
D) Administer potassium
Answer: C) Notify the provider
Rationale: Rapid weight gain indicates fluid overload and possible heart
failure exacerbation. A weight gain of 1 kg (2.2 lb) in 24 hours suggests
approximately 1 liter of fluid retention. The provider should be notified
immediately for possible medication adjustment (e.g., increasing diuretic
dose) to prevent further decompensation.
Question 3
A client who is 2 hours post-cardiac catheterization via the femoral artery
has an expanding hematoma at the insertion site. Which action should the
nurse take first?
A) Apply ice to the site
B) Apply firm pressure 1-2 cm above the insertion site
C) Notify the provider
D) Assess the client's vital signs
Answer: B) Apply firm pressure 1-2 cm above the insertion site
Rationale: An expanding hematoma indicates active bleeding at the arterial
puncture site, which can lead to significant blood loss, hypovolemic shock,
and limb ischemia. The immediate priority is to apply firm pressure 1-2 cm
above the insertion site to control the bleeding. After applying pressure, the
nurse should then notify the provider and monitor vital signs.
Question 4
A client with atrial fibrillation has a PT/INR of 4.5 (therapeutic range:
,2.0-3.0). There is no active bleeding. What should the nurse do?
A) Administer the next warfarin dose as ordered
B) Hold the next dose and notify the provider
C) Administer vitamin K immediately
D) Increase the next warfarin dose
Answer: B) Hold the next dose and notify the provider
Rationale: An INR of 4.5 is supratherapeutic and significantly increases the
risk of bleeding complications. The nurse should hold the next dose of
warfarin and notify the provider for further instructions. Vitamin K
administration is typically reserved for active bleeding or an INR > 10.0.
Continuing the warfarin at the same dose would increase the risk of
bleeding; increasing the dose would be unsafe.
Question 5
A client with new-onset atrial fibrillation has a heart rate of 140 bpm and
blood pressure 100/60 mmHg. The nurse should prepare for which
intervention?
A) Synchronized electrical cardioversion
B) Defibrillation
C) Pacemaker insertion
D) Adenosine administration
Answer: A) Synchronized electrical cardioversion
Rationale: Synchronized cardioversion is indicated for unstable atrial
fibrillation with a rapid ventricular response causing hemodynamic
compromise. The hypotension (100/60 mmHg) indicates instability. The
shock is synchronized with the QRS complex to avoid the R-on-T
phenomenon. Defibrillation is used for pulseless rhythms. Pacemakers are
for bradyarrhythmias. Adenosine is used for regular supraventricular
tachycardia.
, Question 6
A client is receiving IV heparin for a deep vein thrombosis (DVT). Which
laboratory test is used to monitor heparin therapy?
A) PT/INR
B) aPTT
C) Platelet count
D) Hemoglobin A1c
Answer: B) aPTT
Rationale: Activated partial thromboplastin time (aPTT) is the laboratory
test used to monitor unfractionated heparin therapy. The therapeutic range
is typically 1.5 to 2.5 times the control value. PT/INR monitors warfarin
therapy. Platelet count monitors for heparin-induced thrombocytopenia
(HIT). Hemoglobin A1c monitors diabetes control.
Question 7
A nurse is assessing a client with deep vein thrombosis (DVT). Which
finding is expected?
A) Cool, pale extremity
B) Bilateral edema
C) Warm, swollen calf with tenderness
D) Decreased heart rate
Answer: C) Warm, swollen calf with tenderness
Rationale: Classic signs of DVT include unilateral calf swelling, warmth,
erythema, and tenderness. A cool, pale extremity suggests arterial
insufficiency. Bilateral edema suggests systemic causes such as heart
failure or kidney disease. Tachycardia, not bradycardia, may occur if a
pulmonary embolism develops.
