ATI PN Adult Medical Surgical 2023 Proctored Exam Study
Guide and Practice Test
Comprehensive 150-Question Multiple-Choice Practice Exam
SECTION 1: Cardiovascular Disorders (Questions 1-20)
1. A nurse is assessing a client with heart failure who has been prescribed furosemide. Which finding
indicates the medication is effective?
A) Decreased blood pressure
B) Increased urinary output
C) Presence of crackles in lung bases
D) Jugular vein distention
Correct Answer: B) Increased urinary output
Rationale: Furosemide is a loop diuretic that reduces fluid volume overload by increasing urine output.
Expected therapeutic effects include decreased peripheral edema, reduced crackles, and diminished
jugular vein distention. Increased urinary output directly indicates the medication is working to remove
excess fluid.
2. A client with hypertension is prescribed lisinopril. Which adverse effect should the nurse instruct
the client to report immediately?
A) Dry cough
B) Dizziness
C) Angioedema
D) Headache
Correct Answer: C) Angioedema
Rationale: Angioedema (swelling of the lips, tongue, throat, or face) is a serious, potentially life-
threatening adverse effect of ACE inhibitors like lisinopril and requires immediate medical attention.
Dry cough is a common but non-life-threatening side effect.
3. A nurse is caring for a client following a cardiac catheterization via the femoral artery. Which
finding requires immediate intervention?
,A) Blood pressure 118/76 mm Hg
B) Small amount of blood at insertion site
C) Cool, pale right foot with diminished pulse
D) Heart rate 88 bpm
Correct Answer: C) Cool, pale right foot with diminished pulse
Rationale: Cool, pale extremity with diminished pulse indicates arterial insufficiency or possible
thrombosis at the catheter insertion site, which is a medical emergency. The other findings are within
expected parameters.
4. A client with peripheral artery disease (PAD) reports leg pain when walking. Which instruction
should the nurse provide?
A) "Rest with legs elevated above heart level"
B) "Walk until pain occurs, then rest until it subsides"
C) "Apply heat packs to painful areas"
D) "Limit walking to avoid pain"
Correct Answer: B) "Walk until pain occurs, then rest until it subsides"
Rationale: A structured walking program helps develop collateral circulation. Clients should walk until
claudication pain occurs, rest until it subsides, then resume walking. Legs should be kept in a
dependent position to promote blood flow.
5. A nurse is assessing a client with deep vein thrombosis (DVT) who is receiving heparin therapy.
Which laboratory value indicates the therapy is therapeutic?
A) aPTT 1.5 to 2.5 times the control
B) INR 2.0 to 3.0
C) Platelet count 150,000/mm³
D) Hemoglobin 12 g/dL
Correct Answer: A) aPTT 1.5 to 2.5 times the control
Rationale: For heparin therapy, the therapeutic range is an aPTT of 1.5 to 2.5 times the normal control
value. INR is monitored for warfarin therapy. Platelet count and hemoglobin are not direct indicators
of heparin therapeutic effect.
6. A client with angina is prescribed sublingual nitroglycerin. Which instruction should the nurse
include in teaching?
,A) "Swallow the tablet with a full glass of water"
B) "Take one tablet every 15 minutes for up to three doses"
C) "Call 911 if pain is not relieved after one tablet"
D) "Store the tablets in the refrigerator"
Correct Answer: C) "Call 911 if pain is not relieved after one tablet"
Rationale: Clients should take one nitroglycerin tablet sublingually every 5 minutes for up to three
doses. If pain is not relieved after the first tablet, the client should call 911 immediately. Tablets should
be stored in a dark, dry place, not refrigerated.
7. A nurse is caring for a client with acute myocardial infarction. Which of the following findings
should the nurse report to the provider immediately?
A) Chest pain rated 6 on a 0-10 scale
B) Heart rate of 92 bpm
C) Blood pressure 100/60 mm Hg
D) New onset of dyspnea and crackles
Correct Answer: D) New onset of dyspnea and crackles
Rationale: New onset dyspnea and crackles indicate pulmonary edema, a life-threatening complication
of acute myocardial infarction requiring immediate intervention. While chest pain, tachycardia, and
hypotension are also concerning, pulmonary edema indicates acute heart failure and requires
emergent treatment.
8. A client is recovering from coronary artery bypass graft (CABG) surgery. Which assessment
finding requires immediate notification of the provider?
A) Temperature 99.8°F (37.7°C)
B) Serosanguineous drainage on dressing
C) Widening mediastinum on chest x-ray
D) Heart rate 88 bpm
Correct Answer: C) Widening mediastinum on chest x-ray
Rationale: A widening mediastinum on chest x-ray is a sign of potential bleeding or cardiac
tamponade following CABG surgery and requires immediate intervention. Low-grade fever and
serosanguineous drainage are expected postoperatively.
9. A nurse is providing discharge teaching to a client with heart failure. Which statement by the
client indicates understanding of dietary restrictions?
, A) "I can use salt substitutes freely"
B) "I should limit my fluid intake to 3 liters per day"
C) "I will weigh myself daily and report a gain of 2 pounds in one day"
D) "I can eat canned soups as long as I drain the liquid"
Correct Answer: C) "I will weigh myself daily and report a gain of 2 pounds in one day"
Rationale: Daily weight monitoring is essential for clients with heart failure. A weight gain of 2 pounds
in one day or 5 pounds in one week indicates fluid retention and should be reported. Salt substitutes
should be used cautiously due to potassium content.
10. Which electrocardiogram (ECG) finding is most characteristic of acute myocardial ischemia?
A) Prolonged PR interval
B) ST-segment elevation
C) Widened QRS complex
D) Flat T waves
Correct Answer: B) ST-segment elevation
Rationale: ST-segment elevation is a classic ECG finding indicating acute myocardial injury and
transmural ischemia. This requires immediate intervention to restore coronary blood flow.
11. A nurse is preparing a client for a cardiac stress test. Which medication should the nurse expect
to hold prior to the test?
A) Furosemide
B) Metoprolol
C) Potassium chloride
D) Acetaminophen
Correct Answer: B) Metoprolol
Rationale: Beta-blockers such as metoprolol should be held before a cardiac stress test because they
blunt the heart rate response to exercise, potentially causing false-negative results. The provider
should be consulted for specific instructions.
12. A client with atrial fibrillation is prescribed warfarin. Which laboratory value should the nurse
monitor to evaluate therapeutic effect?
A) aPTT
B) INR
Guide and Practice Test
Comprehensive 150-Question Multiple-Choice Practice Exam
SECTION 1: Cardiovascular Disorders (Questions 1-20)
1. A nurse is assessing a client with heart failure who has been prescribed furosemide. Which finding
indicates the medication is effective?
A) Decreased blood pressure
B) Increased urinary output
C) Presence of crackles in lung bases
D) Jugular vein distention
Correct Answer: B) Increased urinary output
Rationale: Furosemide is a loop diuretic that reduces fluid volume overload by increasing urine output.
Expected therapeutic effects include decreased peripheral edema, reduced crackles, and diminished
jugular vein distention. Increased urinary output directly indicates the medication is working to remove
excess fluid.
2. A client with hypertension is prescribed lisinopril. Which adverse effect should the nurse instruct
the client to report immediately?
A) Dry cough
B) Dizziness
C) Angioedema
D) Headache
Correct Answer: C) Angioedema
Rationale: Angioedema (swelling of the lips, tongue, throat, or face) is a serious, potentially life-
threatening adverse effect of ACE inhibitors like lisinopril and requires immediate medical attention.
Dry cough is a common but non-life-threatening side effect.
3. A nurse is caring for a client following a cardiac catheterization via the femoral artery. Which
finding requires immediate intervention?
,A) Blood pressure 118/76 mm Hg
B) Small amount of blood at insertion site
C) Cool, pale right foot with diminished pulse
D) Heart rate 88 bpm
Correct Answer: C) Cool, pale right foot with diminished pulse
Rationale: Cool, pale extremity with diminished pulse indicates arterial insufficiency or possible
thrombosis at the catheter insertion site, which is a medical emergency. The other findings are within
expected parameters.
4. A client with peripheral artery disease (PAD) reports leg pain when walking. Which instruction
should the nurse provide?
A) "Rest with legs elevated above heart level"
B) "Walk until pain occurs, then rest until it subsides"
C) "Apply heat packs to painful areas"
D) "Limit walking to avoid pain"
Correct Answer: B) "Walk until pain occurs, then rest until it subsides"
Rationale: A structured walking program helps develop collateral circulation. Clients should walk until
claudication pain occurs, rest until it subsides, then resume walking. Legs should be kept in a
dependent position to promote blood flow.
5. A nurse is assessing a client with deep vein thrombosis (DVT) who is receiving heparin therapy.
Which laboratory value indicates the therapy is therapeutic?
A) aPTT 1.5 to 2.5 times the control
B) INR 2.0 to 3.0
C) Platelet count 150,000/mm³
D) Hemoglobin 12 g/dL
Correct Answer: A) aPTT 1.5 to 2.5 times the control
Rationale: For heparin therapy, the therapeutic range is an aPTT of 1.5 to 2.5 times the normal control
value. INR is monitored for warfarin therapy. Platelet count and hemoglobin are not direct indicators
of heparin therapeutic effect.
6. A client with angina is prescribed sublingual nitroglycerin. Which instruction should the nurse
include in teaching?
,A) "Swallow the tablet with a full glass of water"
B) "Take one tablet every 15 minutes for up to three doses"
C) "Call 911 if pain is not relieved after one tablet"
D) "Store the tablets in the refrigerator"
Correct Answer: C) "Call 911 if pain is not relieved after one tablet"
Rationale: Clients should take one nitroglycerin tablet sublingually every 5 minutes for up to three
doses. If pain is not relieved after the first tablet, the client should call 911 immediately. Tablets should
be stored in a dark, dry place, not refrigerated.
7. A nurse is caring for a client with acute myocardial infarction. Which of the following findings
should the nurse report to the provider immediately?
A) Chest pain rated 6 on a 0-10 scale
B) Heart rate of 92 bpm
C) Blood pressure 100/60 mm Hg
D) New onset of dyspnea and crackles
Correct Answer: D) New onset of dyspnea and crackles
Rationale: New onset dyspnea and crackles indicate pulmonary edema, a life-threatening complication
of acute myocardial infarction requiring immediate intervention. While chest pain, tachycardia, and
hypotension are also concerning, pulmonary edema indicates acute heart failure and requires
emergent treatment.
8. A client is recovering from coronary artery bypass graft (CABG) surgery. Which assessment
finding requires immediate notification of the provider?
A) Temperature 99.8°F (37.7°C)
B) Serosanguineous drainage on dressing
C) Widening mediastinum on chest x-ray
D) Heart rate 88 bpm
Correct Answer: C) Widening mediastinum on chest x-ray
Rationale: A widening mediastinum on chest x-ray is a sign of potential bleeding or cardiac
tamponade following CABG surgery and requires immediate intervention. Low-grade fever and
serosanguineous drainage are expected postoperatively.
9. A nurse is providing discharge teaching to a client with heart failure. Which statement by the
client indicates understanding of dietary restrictions?
, A) "I can use salt substitutes freely"
B) "I should limit my fluid intake to 3 liters per day"
C) "I will weigh myself daily and report a gain of 2 pounds in one day"
D) "I can eat canned soups as long as I drain the liquid"
Correct Answer: C) "I will weigh myself daily and report a gain of 2 pounds in one day"
Rationale: Daily weight monitoring is essential for clients with heart failure. A weight gain of 2 pounds
in one day or 5 pounds in one week indicates fluid retention and should be reported. Salt substitutes
should be used cautiously due to potassium content.
10. Which electrocardiogram (ECG) finding is most characteristic of acute myocardial ischemia?
A) Prolonged PR interval
B) ST-segment elevation
C) Widened QRS complex
D) Flat T waves
Correct Answer: B) ST-segment elevation
Rationale: ST-segment elevation is a classic ECG finding indicating acute myocardial injury and
transmural ischemia. This requires immediate intervention to restore coronary blood flow.
11. A nurse is preparing a client for a cardiac stress test. Which medication should the nurse expect
to hold prior to the test?
A) Furosemide
B) Metoprolol
C) Potassium chloride
D) Acetaminophen
Correct Answer: B) Metoprolol
Rationale: Beta-blockers such as metoprolol should be held before a cardiac stress test because they
blunt the heart rate response to exercise, potentially causing false-negative results. The provider
should be consulted for specific instructions.
12. A client with atrial fibrillation is prescribed warfarin. Which laboratory value should the nurse
monitor to evaluate therapeutic effect?
A) aPTT
B) INR
