ATI Med Surg Proctored Exam Question
Bank / Practice Questions (New, 2020)
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–20)
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
Rationale: Chest pain in acute MI indicates ongoing myocardial ischemia and is life-
threatening. Administering prescribed nitroglycerin addresses the ischemia by dilating coronary
arteries and reducing preload. Documentation is important but does not treat the patient. Food
intake is irrelevant and potentially harmful during acute MI. Family notification is secondary to
immediate patient stabilization .
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
Rationale: Sacubitril-valsartan is an ARNI (angiotensin receptor-neprilysin inhibitor) that
reduces mortality and heart failure hospitalizations in patients with reduced ejection fraction.
Amlodipine does not improve outcomes in HFrEF. Digoxin reduces hospitalizations but does not
improve survival. Hydralazine alone is not as effective as the combination with isosorbide
dinitrate in certain populations .
,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
Rationale: 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 is indicated for unstable patients. Amiodarone may be used but is
not typically first-line for rate control. A pacemaker is not indicated for atrial fibrillation .
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
Rationale: Acute pericarditis typically causes diffuse ST elevation across multiple leads due
to inflammation of the pericardial sac. ST depression with troponin elevation suggests non-ST
elevation MI. Pathologic Q waves indicate prior infarction. Prolonged PR interval may be seen in
first-degree heart block, not specifically pericarditis .
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
Rationale: Hydrochlorothiazide is a thiazide diuretic that causes potassium loss, leading to
,hypokalemia. While sodium, calcium, and magnesium can also be affected, potassium is the
most critical electrolyte to monitor due to the risk of cardiac dysrhythmias.
6. 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
Rationale: Thick, red-colored urine following TURP indicates significant bleeding and
possible clot formation, which can obstruct the urinary catheter and lead to bladder distention
or hemorrhage. This requires immediate provider notification. Emesis may be related to
anesthesia. Low-grade fever is common postoperatively. Pain level of 4 is manageable with
prescribed analgesics .
7. A nurse is providing discharge teaching to a client who has a new prescription for sublingual
nitroglycerin. Which statement indicates understanding?
A) "I can keep my medications for 1 year before replacing it."
B) "I should discontinue this medication if I develop a headache."
C) "I can take up to five tablets in 15 minutes before seeking medical attention."
D) "I should call 911 if chest pain is not relieved after one tablet."
Correct Answer: D
Rationale: The client should call 911 if chest pain persists after one sublingual nitroglycerin
tablet (or per current guidelines, after taking up to three tablets over 15 minutes if prescribed).
Nitroglycerin tablets expire after 6 months once opened. Headache is a common side effect that
indicates the medication is working and should not prompt discontinuation. Taking five tablets
in 15 minutes exceeds recommended dosing .
8. A nurse is monitoring a client receiving a blood transfusion. Which of the following
symptoms indicates a hemolytic reaction?
A) Bradycardia
B) Urticaria and itching
, C) Distended neck veins
D) Low back pain and hypotension
Correct Answer: D
Rationale: Low back pain, hypotension, and fever are classic signs of an acute hemolytic
transfusion reaction due to ABO incompatibility. Bradycardia is not typical. Urticaria and itching
indicate a mild allergic reaction. Distended neck veins suggest fluid overload .
9. A client has a chest tube connected to a water-seal drainage system. Which finding requires
immediate intervention?
A) Tidaling in the water-seal chamber
B) Continuous bubbling in the water-seal chamber
C) Intermittent bubbling in the suction control chamber
D) 50 mL of serosanguineous drainage in 1 hour
Correct Answer: B
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak in the
system, which requires immediate troubleshooting. Tidaling is an expected finding with
respiration. Intermittent bubbling in the suction control chamber is normal. Drainage of 50
mL/hr is within acceptable limits .
10. A nurse is caring for a client who had an excision of a malignant pituitary tumor. Which
findings should the nurse document that indicate the client is developing syndrome of
inappropriate antidiuretic hormone (SIADH)?
A) Hypernatremia and periorbital edema
B) Muscle spasticity and hypertension
C) Weight gain with low serum sodium
D) Increased urinary output and thirst
Correct Answer: C
Rationale: SIADH most frequently occurs when cancer cells manufacture and release ADH,
which is manifested by water retention causing weight gain and hyponatremia. Other
manifestations include oliguria, weakness, anorexia, nausea, vomiting, personality changes,
seizures, decrease in reflexes, and coma. Hypernatremia, increased urinary output, and thirst
are findings of diabetes insipidus, not SIADH .
Bank / Practice Questions (New, 2020)
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–20)
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
Rationale: Chest pain in acute MI indicates ongoing myocardial ischemia and is life-
threatening. Administering prescribed nitroglycerin addresses the ischemia by dilating coronary
arteries and reducing preload. Documentation is important but does not treat the patient. Food
intake is irrelevant and potentially harmful during acute MI. Family notification is secondary to
immediate patient stabilization .
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
Rationale: Sacubitril-valsartan is an ARNI (angiotensin receptor-neprilysin inhibitor) that
reduces mortality and heart failure hospitalizations in patients with reduced ejection fraction.
Amlodipine does not improve outcomes in HFrEF. Digoxin reduces hospitalizations but does not
improve survival. Hydralazine alone is not as effective as the combination with isosorbide
dinitrate in certain populations .
,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
Rationale: 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 is indicated for unstable patients. Amiodarone may be used but is
not typically first-line for rate control. A pacemaker is not indicated for atrial fibrillation .
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
Rationale: Acute pericarditis typically causes diffuse ST elevation across multiple leads due
to inflammation of the pericardial sac. ST depression with troponin elevation suggests non-ST
elevation MI. Pathologic Q waves indicate prior infarction. Prolonged PR interval may be seen in
first-degree heart block, not specifically pericarditis .
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
Rationale: Hydrochlorothiazide is a thiazide diuretic that causes potassium loss, leading to
,hypokalemia. While sodium, calcium, and magnesium can also be affected, potassium is the
most critical electrolyte to monitor due to the risk of cardiac dysrhythmias.
6. 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
Rationale: Thick, red-colored urine following TURP indicates significant bleeding and
possible clot formation, which can obstruct the urinary catheter and lead to bladder distention
or hemorrhage. This requires immediate provider notification. Emesis may be related to
anesthesia. Low-grade fever is common postoperatively. Pain level of 4 is manageable with
prescribed analgesics .
7. A nurse is providing discharge teaching to a client who has a new prescription for sublingual
nitroglycerin. Which statement indicates understanding?
A) "I can keep my medications for 1 year before replacing it."
B) "I should discontinue this medication if I develop a headache."
C) "I can take up to five tablets in 15 minutes before seeking medical attention."
D) "I should call 911 if chest pain is not relieved after one tablet."
Correct Answer: D
Rationale: The client should call 911 if chest pain persists after one sublingual nitroglycerin
tablet (or per current guidelines, after taking up to three tablets over 15 minutes if prescribed).
Nitroglycerin tablets expire after 6 months once opened. Headache is a common side effect that
indicates the medication is working and should not prompt discontinuation. Taking five tablets
in 15 minutes exceeds recommended dosing .
8. A nurse is monitoring a client receiving a blood transfusion. Which of the following
symptoms indicates a hemolytic reaction?
A) Bradycardia
B) Urticaria and itching
, C) Distended neck veins
D) Low back pain and hypotension
Correct Answer: D
Rationale: Low back pain, hypotension, and fever are classic signs of an acute hemolytic
transfusion reaction due to ABO incompatibility. Bradycardia is not typical. Urticaria and itching
indicate a mild allergic reaction. Distended neck veins suggest fluid overload .
9. A client has a chest tube connected to a water-seal drainage system. Which finding requires
immediate intervention?
A) Tidaling in the water-seal chamber
B) Continuous bubbling in the water-seal chamber
C) Intermittent bubbling in the suction control chamber
D) 50 mL of serosanguineous drainage in 1 hour
Correct Answer: B
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak in the
system, which requires immediate troubleshooting. Tidaling is an expected finding with
respiration. Intermittent bubbling in the suction control chamber is normal. Drainage of 50
mL/hr is within acceptable limits .
10. A nurse is caring for a client who had an excision of a malignant pituitary tumor. Which
findings should the nurse document that indicate the client is developing syndrome of
inappropriate antidiuretic hormone (SIADH)?
A) Hypernatremia and periorbital edema
B) Muscle spasticity and hypertension
C) Weight gain with low serum sodium
D) Increased urinary output and thirst
Correct Answer: C
Rationale: SIADH most frequently occurs when cancer cells manufacture and release ADH,
which is manifested by water retention causing weight gain and hyponatremia. Other
manifestations include oliguria, weakness, anorexia, nausea, vomiting, personality changes,
seizures, decrease in reflexes, and coma. Hypernatremia, increased urinary output, and thirst
are findings of diabetes insipidus, not SIADH .
