ATI RN ADULT MEDICAL-SURGICAL
PROCTORED EXAM PRACTICE WITH
ORIGINAL QUESTIONS AND VERIFIED
ANSWERS, PLUS EXPLAINED
RATIONALES/EXPERT VERIFIED FOR
GUARANTEED 100% PASS 2026/LATEST
UPDATE/INSTANT DOWNLOAD PDF
Question 1
A nurse is caring for a client who was admitted with acute
decompensated heart failure. The client reports increasing dyspnea and
is unable to lie flat. Assessment findings include bilateral crackles
extending halfway up the posterior lung fields, oxygen saturation of 86%
on room air, respiratory rate of 30/min, blood pressure of 168/94 mm
Hg, and 3+ bilateral lower-extremity edema. Which action should the
nurse take first?
A. Administer the prescribed IV furosemide
B. Place the client in high-Fowler's position
C. Restrict the client's oral fluid intake
D. Obtain the client's daily body weight
Answer: B. Place the client in high-Fowler's position
Rationale: High-Fowler's positioning is the immediate priority
because it improves lung expansion and decreases venous return,
helping reduce pulmonary congestion and work of breathing. The
client's hypoxemia and severe dyspnea indicate impaired oxygenation
requiring immediate intervention. IV furosemide is also appropriate,
but positioning should occur immediately while additional
interventions are prepared. Fluid restriction and daily weight are
1
,important management measures but do not address the client's
immediate respiratory compromise.
Question 2
A client with atrial fibrillation is prescribed digoxin. Before
administering the medication, the nurse obtains an apical heart rate of
48/min. The client also reports nausea and seeing yellow-green halos
around lights. Which action should the nurse take?
A. Administer the medication because atrial fibrillation requires rate
control
B. Hold the medication and notify the provider
C. Administer the medication with food
D. Recheck the heart rate after ambulation
Answer: B. Hold the medication and notify the provider
Rationale: Bradycardia, nausea, and visual disturbances are classic
manifestations of digoxin toxicity. The nurse should withhold digoxin
and notify the provider. Hypokalemia increases the risk of digoxin
toxicity, so the nurse should anticipate checking the client's potassium
level and other relevant laboratory values. Administering the
medication despite significant bradycardia could worsen the
dysrhythmia.
Question 3
A client receiving an unfractionated heparin infusion for an acute deep-
vein thrombosis has an aPTT of 118 seconds. The facility's therapeutic
range for the infusion is 60 to 80 seconds. Which action should the nurse
anticipate?
2
,A. Increase the heparin infusion rate
B. Continue the infusion at the current rate
C. Hold or reduce the infusion according to protocol
D. Administer vitamin K
Answer: C. Hold or reduce the infusion according to protocol
Rationale: An aPTT of 118 seconds is above the prescribed therapeutic
range and indicates excessive anticoagulation. The nurse should
follow the facility's heparin protocol, which commonly requires
temporarily holding or reducing the infusion. Vitamin K reverses
warfarin rather than unfractionated heparin. Increasing the infusion
would increase the risk of serious bleeding.
Question 4
A client receiving a blood transfusion develops chills, fever, low back
pain, and anxiety 15 minutes after the transfusion begins. Which action
should the nurse take first?
A. Slow the transfusion rate
B. Stop the transfusion
C. Administer acetaminophen
D. Obtain another unit of blood
Answer: B. Stop the transfusion
Rationale: The client's acute fever, chills, back pain, and anxiety
suggest an acute hemolytic transfusion reaction. The nurse should
immediately stop the transfusion to prevent additional exposure to the
incompatible blood. The nurse should maintain IV access with
appropriate normal saline tubing according to facility policy, notify the
provider and blood bank, monitor vital signs, and follow the
transfusion-reaction protocol. Slowing the transfusion is unsafe
because continued exposure can worsen the reaction.
3
, Question 5
A nurse is caring for a client who has chronic obstructive pulmonary
disease and is receiving oxygen at 2 L/min by nasal cannula. Which
finding requires the nurse's immediate attention?
A. Oxygen saturation of 91%
B. Barrel-shaped chest
C. New-onset drowsiness and confusion
D. Productive cough with clear sputum
Answer: C. New-onset drowsiness and confusion
Rationale: New drowsiness and confusion can indicate worsening
carbon dioxide retention and respiratory failure in a client with
COPD. The nurse should immediately assess respiratory status,
including respiratory rate, depth, breath sounds, oxygenation, and
mental status, and notify the provider or rapid response team if
deterioration is present. An oxygen saturation around 88% to 92%
may be an appropriate target for some clients with COPD, depending
on the prescribed goal.
Question 6
A client with asthma develops severe wheezing after exposure to an
environmental allergen. After several minutes, the nurse notices that the
wheezing has suddenly disappeared. The client is increasingly restless
and has difficulty speaking. Which interpretation is most appropriate?
A. The bronchospasm has resolved
B. The client is experiencing improved ventilation
C. The absence of wheezing may indicate critically reduced airflow
D. The client is developing pulmonary edema
4
PROCTORED EXAM PRACTICE WITH
ORIGINAL QUESTIONS AND VERIFIED
ANSWERS, PLUS EXPLAINED
RATIONALES/EXPERT VERIFIED FOR
GUARANTEED 100% PASS 2026/LATEST
UPDATE/INSTANT DOWNLOAD PDF
Question 1
A nurse is caring for a client who was admitted with acute
decompensated heart failure. The client reports increasing dyspnea and
is unable to lie flat. Assessment findings include bilateral crackles
extending halfway up the posterior lung fields, oxygen saturation of 86%
on room air, respiratory rate of 30/min, blood pressure of 168/94 mm
Hg, and 3+ bilateral lower-extremity edema. Which action should the
nurse take first?
A. Administer the prescribed IV furosemide
B. Place the client in high-Fowler's position
C. Restrict the client's oral fluid intake
D. Obtain the client's daily body weight
Answer: B. Place the client in high-Fowler's position
Rationale: High-Fowler's positioning is the immediate priority
because it improves lung expansion and decreases venous return,
helping reduce pulmonary congestion and work of breathing. The
client's hypoxemia and severe dyspnea indicate impaired oxygenation
requiring immediate intervention. IV furosemide is also appropriate,
but positioning should occur immediately while additional
interventions are prepared. Fluid restriction and daily weight are
1
,important management measures but do not address the client's
immediate respiratory compromise.
Question 2
A client with atrial fibrillation is prescribed digoxin. Before
administering the medication, the nurse obtains an apical heart rate of
48/min. The client also reports nausea and seeing yellow-green halos
around lights. Which action should the nurse take?
A. Administer the medication because atrial fibrillation requires rate
control
B. Hold the medication and notify the provider
C. Administer the medication with food
D. Recheck the heart rate after ambulation
Answer: B. Hold the medication and notify the provider
Rationale: Bradycardia, nausea, and visual disturbances are classic
manifestations of digoxin toxicity. The nurse should withhold digoxin
and notify the provider. Hypokalemia increases the risk of digoxin
toxicity, so the nurse should anticipate checking the client's potassium
level and other relevant laboratory values. Administering the
medication despite significant bradycardia could worsen the
dysrhythmia.
Question 3
A client receiving an unfractionated heparin infusion for an acute deep-
vein thrombosis has an aPTT of 118 seconds. The facility's therapeutic
range for the infusion is 60 to 80 seconds. Which action should the nurse
anticipate?
2
,A. Increase the heparin infusion rate
B. Continue the infusion at the current rate
C. Hold or reduce the infusion according to protocol
D. Administer vitamin K
Answer: C. Hold or reduce the infusion according to protocol
Rationale: An aPTT of 118 seconds is above the prescribed therapeutic
range and indicates excessive anticoagulation. The nurse should
follow the facility's heparin protocol, which commonly requires
temporarily holding or reducing the infusion. Vitamin K reverses
warfarin rather than unfractionated heparin. Increasing the infusion
would increase the risk of serious bleeding.
Question 4
A client receiving a blood transfusion develops chills, fever, low back
pain, and anxiety 15 minutes after the transfusion begins. Which action
should the nurse take first?
A. Slow the transfusion rate
B. Stop the transfusion
C. Administer acetaminophen
D. Obtain another unit of blood
Answer: B. Stop the transfusion
Rationale: The client's acute fever, chills, back pain, and anxiety
suggest an acute hemolytic transfusion reaction. The nurse should
immediately stop the transfusion to prevent additional exposure to the
incompatible blood. The nurse should maintain IV access with
appropriate normal saline tubing according to facility policy, notify the
provider and blood bank, monitor vital signs, and follow the
transfusion-reaction protocol. Slowing the transfusion is unsafe
because continued exposure can worsen the reaction.
3
, Question 5
A nurse is caring for a client who has chronic obstructive pulmonary
disease and is receiving oxygen at 2 L/min by nasal cannula. Which
finding requires the nurse's immediate attention?
A. Oxygen saturation of 91%
B. Barrel-shaped chest
C. New-onset drowsiness and confusion
D. Productive cough with clear sputum
Answer: C. New-onset drowsiness and confusion
Rationale: New drowsiness and confusion can indicate worsening
carbon dioxide retention and respiratory failure in a client with
COPD. The nurse should immediately assess respiratory status,
including respiratory rate, depth, breath sounds, oxygenation, and
mental status, and notify the provider or rapid response team if
deterioration is present. An oxygen saturation around 88% to 92%
may be an appropriate target for some clients with COPD, depending
on the prescribed goal.
Question 6
A client with asthma develops severe wheezing after exposure to an
environmental allergen. After several minutes, the nurse notices that the
wheezing has suddenly disappeared. The client is increasingly restless
and has difficulty speaking. Which interpretation is most appropriate?
A. The bronchospasm has resolved
B. The client is experiencing improved ventilation
C. The absence of wheezing may indicate critically reduced airflow
D. The client is developing pulmonary edema
4
