ATI NUR 265 Study Guide | Practice Questions &
Verified Answers with Rationales | Advanced
Medical-Surgical Nursing Review | Latest
2026/2027 Update | Graded A+
SECTION 1: CARDIOVASCULAR SYSTEM (Q1–15)
Q1. A client with heart failure is prescribed furosemide. Which assessment finding requires
immediate intervention?
A. Potassium 3.1 mEq/L
B. Urine output of 60 mL/hr
C. Weight loss of 1 kg in 24 hours
D. Blood pressure 118/72 mm Hg
Correct Answer: A
Rationale: Furosemide is a loop diuretic that causes potassium loss. A potassium of 3.1
mEq/L is below normal (3.5–5.0) and places the client at risk for dysrhythmias, especially with
concurrent digoxin use. The other findings are expected or acceptable.
Q2. Which client is at highest risk for developing infective endocarditis?
A. A client with a urinary tract infection
B. A client who injects IV drugs
C. A client with iron-deficiency anemia
D. A client with gastroesophageal reflux disease
Correct Answer: B
Rationale: IV drug use introduces bacteria directly into the bloodstream, and the right-sided
heart valves (tricuspid/pulmonic) are most commonly affected. The other conditions do not
predispose to endocarditis.
Q3. A client is admitted with an acute myocardial infarction. Which laboratory value is most
specific for myocardial damage?
,A. CK-MB
B. Troponin I
C. Myoglobin
D. LDH
Correct Answer: B
Rationale: Troponin I is highly specific to cardiac muscle and rises within 3–6 hours, peaking
at 10–24 hours. CK-MB is cardiac-specific but less sensitive. Myoglobin rises early but is not
specific. LDH is nonspecific.
Q4. A client with atrial fibrillation is prescribed warfarin. Which instruction should the nurse
include? (SATA)
A. "Increase your intake of green leafy vegetables."
B. "Use an electric razor to shave."
C. "Report any black or tarry stools."
D. "Take aspirin for headaches without concern."
E. "Keep all INR monitoring appointments."
Correct Answers: B, C, E
Rationale: Warfarin increases bleeding risk, so using an electric razor and reporting GI
bleeding are essential. INR monitoring ensures therapeutic anticoagulation. Vitamin K–rich
foods (green leafy vegetables) should be kept consistent, not increased. Aspirin increases
bleeding risk and should be avoided unless prescribed.
Q5. A client with an abdominal aortic aneurysm reports sudden, severe back pain. What is the
priority action?
A. Administer prescribed antihypertensive.
B. Assess blood pressure and heart rate.
C. Prepare the client for emergency surgery.
D. Document the finding and reassess in 15 minutes.
Correct Answer: B
Rationale: Sudden severe back pain may indicate aneurysm rupture. The priority is a rapid
assessment of vital signs to detect hypovolemic shock (hypotension, tachycardia), then
emergency intervention. Assessment precedes intervention.
,Q6. Which finding indicates a client with heart failure is experiencing digoxin toxicity?
A. Heart rate 58 beats/min
B. Blood pressure 138/86 mm Hg
C. Visual disturbances with yellow halos
D. Weight gain of 0.5 kg
Correct Answer: C
Rationale: Visual disturbances (yellow/green halos, blurred vision) are classic signs of
digoxin toxicity. Bradycardia may occur but a rate of 58 alone is not definitive. The other findings
are not toxicity indicators.
Q7. A client is started on captopril. Which side effect should the nurse monitor for?
A. Dry, persistent cough
B. Hyperkalemia
C. Hypotension
D. All of the above
Correct Answer: D
Rationale: ACE inhibitors such as captopril can cause a dry cough (bradykinin accumulation),
hyperkalemia (decreased aldosterone), and first-dose hypotension. All require monitoring.
Q8. A client with a new pacemaker asks about precautions. Which statement indicates a need
for further teaching?
A. "I will avoid leaning over a running microwave."
B. "I can use my cell phone on the opposite ear from the pacemaker."
C. "I can have an MRI anytime without telling anyone."
D. "I will carry a pacemaker identification card."
Correct Answer: C
Rationale: MRI may be contraindicated unless the pacemaker is MRI-conditional; the client
must always inform providers. Cell phone and microwave precautions are appropriate. Carrying
an ID card is correct.
, Q9. A client develops pulseless ventricular tachycardia. What is the priority intervention?
A. Administer amiodarone IV push
B. Begin CPR and defibrillate
C. Perform synchronized cardioversion
D. Give epinephrine IV
Correct Answer: B
Rationale: Pulseless VT is a shockable rhythm. Per ACLS, immediate high-quality CPR and
defibrillation are the priority. Amiodarone and epinephrine are given after defibrillation
attempts. Synchronized cardioversion is for clients with a pulse.
Q10. Which assessment finding is most concerning in a client with pericarditis?
A. Pericardial friction rub
B. Chest pain relieved by leaning forward
C. Muffled heart sounds with hypotension and JVD
D. Low-grade fever
Correct Answer: C
Rationale: Muffled heart sounds, hypotension, and JVD (Beck's triad) indicate cardiac
tamponade, a life-threatening emergency requiring pericardiocentesis. The other findings are
expected in pericarditis.
Q11. A client is prescribed atorvastatin. Which teaching point is most important?
A. "Take this medication in the morning."
B. "Report muscle pain or weakness immediately."
C. "Increase grapefruit juice intake."
D. "Stop the medication when cholesterol normalizes."
Correct Answer: B
Rationale: Statins can cause myopathy/rhabdomyolysis, signaled by muscle pain or
weakness. Statins are typically taken in the evening. Grapefruit juice increases statin levels and
should be avoided. Therapy is lifelong.
Q12. Which client is at greatest risk for a deep vein thrombosis?
Verified Answers with Rationales | Advanced
Medical-Surgical Nursing Review | Latest
2026/2027 Update | Graded A+
SECTION 1: CARDIOVASCULAR SYSTEM (Q1–15)
Q1. A client with heart failure is prescribed furosemide. Which assessment finding requires
immediate intervention?
A. Potassium 3.1 mEq/L
B. Urine output of 60 mL/hr
C. Weight loss of 1 kg in 24 hours
D. Blood pressure 118/72 mm Hg
Correct Answer: A
Rationale: Furosemide is a loop diuretic that causes potassium loss. A potassium of 3.1
mEq/L is below normal (3.5–5.0) and places the client at risk for dysrhythmias, especially with
concurrent digoxin use. The other findings are expected or acceptable.
Q2. Which client is at highest risk for developing infective endocarditis?
A. A client with a urinary tract infection
B. A client who injects IV drugs
C. A client with iron-deficiency anemia
D. A client with gastroesophageal reflux disease
Correct Answer: B
Rationale: IV drug use introduces bacteria directly into the bloodstream, and the right-sided
heart valves (tricuspid/pulmonic) are most commonly affected. The other conditions do not
predispose to endocarditis.
Q3. A client is admitted with an acute myocardial infarction. Which laboratory value is most
specific for myocardial damage?
,A. CK-MB
B. Troponin I
C. Myoglobin
D. LDH
Correct Answer: B
Rationale: Troponin I is highly specific to cardiac muscle and rises within 3–6 hours, peaking
at 10–24 hours. CK-MB is cardiac-specific but less sensitive. Myoglobin rises early but is not
specific. LDH is nonspecific.
Q4. A client with atrial fibrillation is prescribed warfarin. Which instruction should the nurse
include? (SATA)
A. "Increase your intake of green leafy vegetables."
B. "Use an electric razor to shave."
C. "Report any black or tarry stools."
D. "Take aspirin for headaches without concern."
E. "Keep all INR monitoring appointments."
Correct Answers: B, C, E
Rationale: Warfarin increases bleeding risk, so using an electric razor and reporting GI
bleeding are essential. INR monitoring ensures therapeutic anticoagulation. Vitamin K–rich
foods (green leafy vegetables) should be kept consistent, not increased. Aspirin increases
bleeding risk and should be avoided unless prescribed.
Q5. A client with an abdominal aortic aneurysm reports sudden, severe back pain. What is the
priority action?
A. Administer prescribed antihypertensive.
B. Assess blood pressure and heart rate.
C. Prepare the client for emergency surgery.
D. Document the finding and reassess in 15 minutes.
Correct Answer: B
Rationale: Sudden severe back pain may indicate aneurysm rupture. The priority is a rapid
assessment of vital signs to detect hypovolemic shock (hypotension, tachycardia), then
emergency intervention. Assessment precedes intervention.
,Q6. Which finding indicates a client with heart failure is experiencing digoxin toxicity?
A. Heart rate 58 beats/min
B. Blood pressure 138/86 mm Hg
C. Visual disturbances with yellow halos
D. Weight gain of 0.5 kg
Correct Answer: C
Rationale: Visual disturbances (yellow/green halos, blurred vision) are classic signs of
digoxin toxicity. Bradycardia may occur but a rate of 58 alone is not definitive. The other findings
are not toxicity indicators.
Q7. A client is started on captopril. Which side effect should the nurse monitor for?
A. Dry, persistent cough
B. Hyperkalemia
C. Hypotension
D. All of the above
Correct Answer: D
Rationale: ACE inhibitors such as captopril can cause a dry cough (bradykinin accumulation),
hyperkalemia (decreased aldosterone), and first-dose hypotension. All require monitoring.
Q8. A client with a new pacemaker asks about precautions. Which statement indicates a need
for further teaching?
A. "I will avoid leaning over a running microwave."
B. "I can use my cell phone on the opposite ear from the pacemaker."
C. "I can have an MRI anytime without telling anyone."
D. "I will carry a pacemaker identification card."
Correct Answer: C
Rationale: MRI may be contraindicated unless the pacemaker is MRI-conditional; the client
must always inform providers. Cell phone and microwave precautions are appropriate. Carrying
an ID card is correct.
, Q9. A client develops pulseless ventricular tachycardia. What is the priority intervention?
A. Administer amiodarone IV push
B. Begin CPR and defibrillate
C. Perform synchronized cardioversion
D. Give epinephrine IV
Correct Answer: B
Rationale: Pulseless VT is a shockable rhythm. Per ACLS, immediate high-quality CPR and
defibrillation are the priority. Amiodarone and epinephrine are given after defibrillation
attempts. Synchronized cardioversion is for clients with a pulse.
Q10. Which assessment finding is most concerning in a client with pericarditis?
A. Pericardial friction rub
B. Chest pain relieved by leaning forward
C. Muffled heart sounds with hypotension and JVD
D. Low-grade fever
Correct Answer: C
Rationale: Muffled heart sounds, hypotension, and JVD (Beck's triad) indicate cardiac
tamponade, a life-threatening emergency requiring pericardiocentesis. The other findings are
expected in pericarditis.
Q11. A client is prescribed atorvastatin. Which teaching point is most important?
A. "Take this medication in the morning."
B. "Report muscle pain or weakness immediately."
C. "Increase grapefruit juice intake."
D. "Stop the medication when cholesterol normalizes."
Correct Answer: B
Rationale: Statins can cause myopathy/rhabdomyolysis, signaled by muscle pain or
weakness. Statins are typically taken in the evening. Grapefruit juice increases statin levels and
should be avoided. Therapy is lifelong.
Q12. Which client is at greatest risk for a deep vein thrombosis?
