ATI Med Surg Proctored Exam
2020 (10 Versions)| Complete
Documents
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–18)
Question 1
A nurse is caring for a client with acute myocardial infarction who reports chest pain rated 8/10.
Which action should the nurse take FIRST?
A) Document the pain in the client's medical record
B) Administer prescribed nitroglycerin and reassess
C) Notify the client's family members
D) Offer the client a light snack
Correct Answer: B
Chest pain in acute myocardial infarction indicates ongoing myocardial ischemia and is life-
threatening. Administering prescribed nitroglycerin addresses the ischemia by dilating coronary
arteries and reducing preload. Documentation (A) is important but does not treat the patient.
Food intake (D) is irrelevant and potentially harmful during acute MI. Family notification (C) is
secondary to immediate patient stabilization.
Question 2
A client with heart failure has an ejection fraction of 25% and reports waking up breathless at
night, requiring three pillows to sleep comfortably. The nurse recognizes that adding which
medication would most effectively reduce hospitalization risk?
A) Amlodipine
B) Digoxin
C) Sacubitril-valsartan
D) Hydralazine alone
Correct Answer: C
Sacubitril-valsartan is an ARNI (angiotensin receptor-neprilysin inhibitor) that reduces
,mortality and heart failure hospitalizations in patients with reduced ejection fraction.
Amlodipine (A) does not improve outcomes in HFrEF. Digoxin (B) reduces hospitalizations but
does not improve survival. Hydralazine alone (D) is not as effective as the combination with
isosorbide dinitrate in certain populations.
Question 3
A client with new-onset atrial fibrillation has a ventricular rate of 156/min and is
hemodynamically stable with blood pressure 128/78 mm Hg. The client reports lightheadedness
and palpitations. Which intervention should the nurse anticipate?
A) Immediate synchronized cardioversion
B) Administration of intravenous amiodarone
C) Administration of intravenous diltiazem
D) Insertion of a temporary pacemaker
Correct Answer: C
In hemodynamically stable atrial fibrillation with rapid ventricular response, rate control
with a calcium channel blocker (diltiazem) or beta-blocker is indicated. Immediate synchronized
cardioversion (A) is indicated for unstable patients. Amiodarone (B) may be used but is not
typically first-line for rate control. A pacemaker (D) is not indicated for atrial fibrillation.
Question 4
A nurse is assessing a client with pericarditis. Which ECG finding is most consistent with this
diagnosis?
A) ST depression in leads V3 through V6
B) Diffuse ST elevation
C) Pathologic Q waves
D) Prolonged PR interval
Correct Answer: B
Acute pericarditis typically causes diffuse ST elevation across multiple leads due to
inflammation of the pericardial sac. ST depression (A) with troponin elevation suggests non-ST
elevation MI. Pathologic Q waves (C) indicate prior infarction. Prolonged PR interval (D) may be
seen in first-degree heart block, not specifically pericarditis.
,Question 5
A client with hypertension is prescribed hydrochlorothiazide. Which laboratory value should the
nurse monitor closely?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
Correct Answer: B
Hydrochlorothiazide is a thiazide diuretic that causes potassium loss, potentially leading to
hypokalemia. While sodium, calcium, and magnesium can be affected, potassium is the most
critical electrolyte to monitor due to risk of cardiac dysrhythmias.
Question 6
A nurse is assessing a client who has an abdominal aortic aneurysm. Which of the following
manifestations should the nurse expect?
A) Midsternal chest pain
B) Thrill
C) Pitting edema in lower extremities
D) Lower back discomfort
Correct Answer: D
Abdominal aortic aneurysm often presents with lower back discomfort due to pressure on
surrounding structures. Midsternal chest pain (A) suggests cardiac ischemia. A thrill (B) may be
palpated in arteriovenous fistulas. Pitting edema (C) is associated with heart failure or venous
insufficiency.
Question 7
A client with acute myocardial infarction is receiving alteplase (tPA). The nurse should monitor
for which adverse effect?
A) Hypoglycemia
B) Bleeding
C) Hypertension
D) Seizures
, Correct Answer: B
Alteplase is a thrombolytic agent that dissolves clots; the major adverse effect is bleeding,
including intracranial hemorrhage. Blood pressure must be strictly controlled to reduce bleeding
risk. Hypoglycemia (A) is not a direct effect. Hypertension (C) is a contraindication, not an
adverse effect. Seizures (D) can occur with stroke but are not directly caused by alteplase.
Question 8
A client with left-sided heart failure is admitted with worsening dyspnea and an SpO2 of 87% on
room air. The nurse auscultates crackles in all lung fields. Which action should the nurse take
FIRST?
A) Administer furosemide IV as prescribed
B) Place the client in high Fowler's position
C) Obtain an arterial blood gas
D) Apply a 100% non-rebreather mask
Correct Answer: B
Positioning the client in high Fowler's position reduces venous return and pulmonary
congestion, improving ventilation and oxygenation. This low-risk, high-priority action can be
done immediately. Oxygen (D) and diuretics (A) are also important but positioning should be
done first to maximize ventilation. ABG (C) is not the first action.
Question 9
A nurse is caring for a client who is 4 hr postoperative following a transurethral resection of the
prostate (TURP). Which of the following is the priority finding for the nurse to report to the
provider?
A) Emesis of 100 mL
B) Oral temperature of 37.5°C (99.5°F)
C) Thick, red-colored urine
D) Pain level of 4 on a 0 to 10 rating scale
Correct Answer: C
Thick, red-colored urine following TURP indicates significant bleeding with clot formation,
which can obstruct the urinary catheter and lead to bladder distention or hemorrhage. Emesis
(A) and mild temperature elevation (B) are less urgent. Pain level of 4 (D) is manageable with
prescribed analgesia.
2020 (10 Versions)| Complete
Documents
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–18)
Question 1
A nurse is caring for a client with acute myocardial infarction who reports chest pain rated 8/10.
Which action should the nurse take FIRST?
A) Document the pain in the client's medical record
B) Administer prescribed nitroglycerin and reassess
C) Notify the client's family members
D) Offer the client a light snack
Correct Answer: B
Chest pain in acute myocardial infarction indicates ongoing myocardial ischemia and is life-
threatening. Administering prescribed nitroglycerin addresses the ischemia by dilating coronary
arteries and reducing preload. Documentation (A) is important but does not treat the patient.
Food intake (D) is irrelevant and potentially harmful during acute MI. Family notification (C) is
secondary to immediate patient stabilization.
Question 2
A client with heart failure has an ejection fraction of 25% and reports waking up breathless at
night, requiring three pillows to sleep comfortably. The nurse recognizes that adding which
medication would most effectively reduce hospitalization risk?
A) Amlodipine
B) Digoxin
C) Sacubitril-valsartan
D) Hydralazine alone
Correct Answer: C
Sacubitril-valsartan is an ARNI (angiotensin receptor-neprilysin inhibitor) that reduces
,mortality and heart failure hospitalizations in patients with reduced ejection fraction.
Amlodipine (A) does not improve outcomes in HFrEF. Digoxin (B) reduces hospitalizations but
does not improve survival. Hydralazine alone (D) is not as effective as the combination with
isosorbide dinitrate in certain populations.
Question 3
A client with new-onset atrial fibrillation has a ventricular rate of 156/min and is
hemodynamically stable with blood pressure 128/78 mm Hg. The client reports lightheadedness
and palpitations. Which intervention should the nurse anticipate?
A) Immediate synchronized cardioversion
B) Administration of intravenous amiodarone
C) Administration of intravenous diltiazem
D) Insertion of a temporary pacemaker
Correct Answer: C
In hemodynamically stable atrial fibrillation with rapid ventricular response, rate control
with a calcium channel blocker (diltiazem) or beta-blocker is indicated. Immediate synchronized
cardioversion (A) is indicated for unstable patients. Amiodarone (B) may be used but is not
typically first-line for rate control. A pacemaker (D) is not indicated for atrial fibrillation.
Question 4
A nurse is assessing a client with pericarditis. Which ECG finding is most consistent with this
diagnosis?
A) ST depression in leads V3 through V6
B) Diffuse ST elevation
C) Pathologic Q waves
D) Prolonged PR interval
Correct Answer: B
Acute pericarditis typically causes diffuse ST elevation across multiple leads due to
inflammation of the pericardial sac. ST depression (A) with troponin elevation suggests non-ST
elevation MI. Pathologic Q waves (C) indicate prior infarction. Prolonged PR interval (D) may be
seen in first-degree heart block, not specifically pericarditis.
,Question 5
A client with hypertension is prescribed hydrochlorothiazide. Which laboratory value should the
nurse monitor closely?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
Correct Answer: B
Hydrochlorothiazide is a thiazide diuretic that causes potassium loss, potentially leading to
hypokalemia. While sodium, calcium, and magnesium can be affected, potassium is the most
critical electrolyte to monitor due to risk of cardiac dysrhythmias.
Question 6
A nurse is assessing a client who has an abdominal aortic aneurysm. Which of the following
manifestations should the nurse expect?
A) Midsternal chest pain
B) Thrill
C) Pitting edema in lower extremities
D) Lower back discomfort
Correct Answer: D
Abdominal aortic aneurysm often presents with lower back discomfort due to pressure on
surrounding structures. Midsternal chest pain (A) suggests cardiac ischemia. A thrill (B) may be
palpated in arteriovenous fistulas. Pitting edema (C) is associated with heart failure or venous
insufficiency.
Question 7
A client with acute myocardial infarction is receiving alteplase (tPA). The nurse should monitor
for which adverse effect?
A) Hypoglycemia
B) Bleeding
C) Hypertension
D) Seizures
, Correct Answer: B
Alteplase is a thrombolytic agent that dissolves clots; the major adverse effect is bleeding,
including intracranial hemorrhage. Blood pressure must be strictly controlled to reduce bleeding
risk. Hypoglycemia (A) is not a direct effect. Hypertension (C) is a contraindication, not an
adverse effect. Seizures (D) can occur with stroke but are not directly caused by alteplase.
Question 8
A client with left-sided heart failure is admitted with worsening dyspnea and an SpO2 of 87% on
room air. The nurse auscultates crackles in all lung fields. Which action should the nurse take
FIRST?
A) Administer furosemide IV as prescribed
B) Place the client in high Fowler's position
C) Obtain an arterial blood gas
D) Apply a 100% non-rebreather mask
Correct Answer: B
Positioning the client in high Fowler's position reduces venous return and pulmonary
congestion, improving ventilation and oxygenation. This low-risk, high-priority action can be
done immediately. Oxygen (D) and diuretics (A) are also important but positioning should be
done first to maximize ventilation. ABG (C) is not the first action.
Question 9
A nurse is caring for a client who is 4 hr postoperative following a transurethral resection of the
prostate (TURP). Which of the following is the priority finding for the nurse to report to the
provider?
A) Emesis of 100 mL
B) Oral temperature of 37.5°C (99.5°F)
C) Thick, red-colored urine
D) Pain level of 4 on a 0 to 10 rating scale
Correct Answer: C
Thick, red-colored urine following TURP indicates significant bleeding with clot formation,
which can obstruct the urinary catheter and lead to bladder distention or hemorrhage. Emesis
(A) and mild temperature elevation (B) are less urgent. Pain level of 4 (D) is manageable with
prescribed analgesia.
