ATI PN Adult Medical Surgical 2023 Advanced Clinical
Judgment & Complex Scenarios 150-Item Practice Exam
Instructions:
• Each question requires synthesis of pathophysiology, pharmacology, and nursing
priorities.
• Select the single best answer.
• Rationales are provided to deepen understanding of the "why" behind correct and
incorrect choices.
1. A client with acute decompensated heart failure (ADHF) is receiving a continuous IV
infusion of nitroglycerin and furosemide. The nurse notes the client's blood pressure drops
from 142/88 mmHg to 98/62 mmHg over 30 minutes. The client is asymptomatic and
mentating well. Which action should the nurse take FIRST?
A) Stop the nitroglycerin infusion immediately.
B) Administer a 500 mL normal saline fluid bolus.
C) Decrease the nitroglycerin infusion rate by half.
D) Place the client in Trendelenburg position.
Correct Answer: C) Decrease the nitroglycerin infusion rate by half.
Rationale: Nitroglycerin is a potent vasodilator; hypotension is a common dose-related effect. If
the client remains asymptomatic (no chest pain, no altered mental status), the safest approach
is to titrate (reduce) the rate to maintain a mean arterial pressure (MAP) > 65 mmHg. Stopping
it abruptly can cause rebound hypertension and coronary vasospasm. Fluid boluses are
contraindicated in ADHF due to fluid overload. Trendelenburg worsens respiratory mechanics
and intracranial pressure.
,2. A client is 6 hours post-percutaneous coronary intervention (PCI) via the right femoral
artery. The sheath has been removed, and a sandbag is in place. The nurse assesses a 4 cm
firm, non-pulsatile hematoma at the insertion site, with a pedal pulse of +2 and warm skin on
the right foot. What is the priority nursing action?
A) Mark the hematoma borders and measure q15 minutes.
B) Notify the provider immediately for surgical evacuation.
C) Apply a cold pack and increase the sandbag weight.
D) Release the sandbag to allow blood flow to the site.
Correct Answer: A) Mark the hematoma borders and measure q15 minutes.
,Rationale: A small, firm, non-expanding hematoma with intact distal perfusion (warm, +2 pulse)
is often managed conservatively with close monitoring. Marking the borders allows the nurse to
assess for rapid expansion, which would indicate active bleeding. Notifying the provider is
premature unless the hematoma is expanding or pulsatile. Increasing weight or applying cold
without an order is outside the standard protocol; cold packs can cause vasoconstriction but
require a provider order. Removing the sandbag defeats the purpose of achieving hemostasis.
3. The nurse is caring for a client with a diagnosis of pericarditis. Which finding would indicate
a life-threatening complication is developing?
A) A friction rub audible at the left sternal border.
B) Chest pain that worsens with inspiration and is relieved by leaning forward.
, C) Jugular venous distention, muffled heart tones, and narrowing pulse pressure.
D) Low-grade fever and generalized ST-segment elevation on ECG.
Correct Answer: C) Jugular venous distention, muffled heart tones, and narrowing pulse
pressure.
Rationale: This classic triad (Beck's triad) indicates cardiac tamponade, a medical emergency
caused by fluid accumulation in the pericardial sac compressing the heart. This impairs diastolic
filling, leading to decreased cardiac output. A friction rub and pleuritic pain relieved by leaning
forward are classic signs of pericarditis itself, not tamponade. Fever and diffuse ST-elevation are
expected inflammatory findings.
Judgment & Complex Scenarios 150-Item Practice Exam
Instructions:
• Each question requires synthesis of pathophysiology, pharmacology, and nursing
priorities.
• Select the single best answer.
• Rationales are provided to deepen understanding of the "why" behind correct and
incorrect choices.
1. A client with acute decompensated heart failure (ADHF) is receiving a continuous IV
infusion of nitroglycerin and furosemide. The nurse notes the client's blood pressure drops
from 142/88 mmHg to 98/62 mmHg over 30 minutes. The client is asymptomatic and
mentating well. Which action should the nurse take FIRST?
A) Stop the nitroglycerin infusion immediately.
B) Administer a 500 mL normal saline fluid bolus.
C) Decrease the nitroglycerin infusion rate by half.
D) Place the client in Trendelenburg position.
Correct Answer: C) Decrease the nitroglycerin infusion rate by half.
Rationale: Nitroglycerin is a potent vasodilator; hypotension is a common dose-related effect. If
the client remains asymptomatic (no chest pain, no altered mental status), the safest approach
is to titrate (reduce) the rate to maintain a mean arterial pressure (MAP) > 65 mmHg. Stopping
it abruptly can cause rebound hypertension and coronary vasospasm. Fluid boluses are
contraindicated in ADHF due to fluid overload. Trendelenburg worsens respiratory mechanics
and intracranial pressure.
,2. A client is 6 hours post-percutaneous coronary intervention (PCI) via the right femoral
artery. The sheath has been removed, and a sandbag is in place. The nurse assesses a 4 cm
firm, non-pulsatile hematoma at the insertion site, with a pedal pulse of +2 and warm skin on
the right foot. What is the priority nursing action?
A) Mark the hematoma borders and measure q15 minutes.
B) Notify the provider immediately for surgical evacuation.
C) Apply a cold pack and increase the sandbag weight.
D) Release the sandbag to allow blood flow to the site.
Correct Answer: A) Mark the hematoma borders and measure q15 minutes.
,Rationale: A small, firm, non-expanding hematoma with intact distal perfusion (warm, +2 pulse)
is often managed conservatively with close monitoring. Marking the borders allows the nurse to
assess for rapid expansion, which would indicate active bleeding. Notifying the provider is
premature unless the hematoma is expanding or pulsatile. Increasing weight or applying cold
without an order is outside the standard protocol; cold packs can cause vasoconstriction but
require a provider order. Removing the sandbag defeats the purpose of achieving hemostasis.
3. The nurse is caring for a client with a diagnosis of pericarditis. Which finding would indicate
a life-threatening complication is developing?
A) A friction rub audible at the left sternal border.
B) Chest pain that worsens with inspiration and is relieved by leaning forward.
, C) Jugular venous distention, muffled heart tones, and narrowing pulse pressure.
D) Low-grade fever and generalized ST-segment elevation on ECG.
Correct Answer: C) Jugular venous distention, muffled heart tones, and narrowing pulse
pressure.
Rationale: This classic triad (Beck's triad) indicates cardiac tamponade, a medical emergency
caused by fluid accumulation in the pericardial sac compressing the heart. This impairs diastolic
filling, leading to decreased cardiac output. A friction rub and pleuritic pain relieved by leaning
forward are classic signs of pericarditis itself, not tamponade. Fever and diffuse ST-elevation are
expected inflammatory findings.
