RN Adult Medical Surgical Proctored Exam 2023 B
/ATI RN Adult Medical Surgical Proctored Exam
2023 B: LATEST-2026, A COMPLETE DOCUMENT
FOR EXAM
SECTION I: CARDIOVASCULAR (Questions 1–18)
1. A client with heart failure has a new prescription for furosemide 40 mg IV push.
Which assessment finding should the nurse report to the provider before
administering the medication?
A. Blood pressure 148/86 mm Hg
B. Potassium 2.9 mEq/L
C. Heart rate 96/min
D. Weight gain of 1 kg since admission
Correct answer: B
Rationale: Loop diuretics such as furosemide cause potassium loss. A
potassium of 2.9 mEq/L is critically low and increases the risk of dysrhythmias; the
provider should be notified before giving a drug that will lower it further. BP
148/86 and HR 96 are not contraindications, and weight gain supports the need
for diuresis.
2. A nurse is caring for a client who is 6 hours postoperative following a coronary
artery bypass graft (CABG). Which finding requires immediate intervention?
A. Temperature 37.8°C (100°F)
B. Chest tube drainage of 150 mL in the last hour
C. Serum potassium 4.2 mEq/L
D. Incisional pain rated 5/10
, Correct answer: B
Rationale: Chest tube drainage greater than 100–150 mL/hr after cardiac
surgery may indicate hemorrhage or cardiac tamponade and requires immediate
notification of the surgeon. Low-grade fever is common postoperatively,
potassium is normal, and incisional pain is expected.
3. A client is admitted with an acute myocardial infarction. Which laboratory value
is the most specific indicator of myocardial damage?
A. Myoglobin
B. Troponin I
C. CK-MB
D. LDH
Correct answer: B
Rationale: Troponin I is highly specific to cardiac muscle and rises within 3–4
hours of injury, remaining elevated for 7–10 days. Myoglobin rises early but is not
cardiac-specific. CK-MB is cardiac-specific but less so than troponin. LDH is
nonspecific and outdated for this purpose.
4. A nurse is teaching a client who has a new diagnosis of atrial fibrillation and a
prescription for warfarin. Which statement by the client indicates understanding?
A. "I will increase my intake of green leafy vegetables."
B. "I will use a soft toothbrush and electric razor."
C. "I can take aspirin for headaches without asking."
D. "I will stop the medication once my heart rhythm is normal."
Correct answer: B
Rationale: Warfarin increases bleeding risk, so bleeding precautions such as a
soft toothbrush and electric razor are appropriate. Green leafy vegetables contain
vitamin K, which antagonizes warfarin and should be kept consistent—not
,increased. Aspirin compounds increase bleeding risk. Warfarin is continued long-
term for AFib, not stopped when rhythm converts.
5. A client with infective endocarditis is receiving IV gentamicin. Which finding
should the nurse report immediately?
A. Trough level of 1 mcg/mL
B. Serum creatinine increase from 0.9 to 1.8 mg/dL
C. Temperature 38.1°C (100.6°F)
D. Heart murmur
Correct answer: B
Rationale: Gentamicin is nephrotoxic and ototoxic. A doubling of serum
creatinine indicates acute kidney injury and requires immediate provider
notification. A trough of 1 mcg/mL is within therapeutic range. Fever and murmur
are expected with endocarditis.
6. A nurse is assessing a client with peripheral arterial disease (PAD). Which
finding is expected?
A. Dependent rubor and cool, shiny skin
B. Warm, edematous extremities
C. Brown pigmentation at the ankles
D. Pain relieved by elevating the legs
Correct answer: A
Rationale: PAD causes decreased arterial perfusion, resulting in cool, shiny,
hairless skin, dependent rubor, and pain worsened by elevation (relieved by
dependency). Warm edema and brown ankle pigmentation are characteristic of
venous insufficiency, and venous pain is relieved by elevation.
, 7. A client's cardiac monitor shows ventricular tachycardia and the client is
unresponsive with no pulse. Which action should the nurse take first?
A. Administer amiodarone IV push
B. Begin CPR and defibrillate
C. Perform a 12-lead ECG
D. Administer epinephrine 1 mg IV push
Correct answer: B
Rationale: Pulseless ventricular tachycardia is a shockable rhythm; the priority
is immediate CPR and defibrillation. Amiodarone and epinephrine are given after
rhythm checks during ACLS but do not precede defibrillation. A 12-lead ECG is not
obtained during cardiac arrest.
8. A nurse is caring for a client following a cardiac catheterization via the right
femoral artery. Which finding requires immediate follow-up?
A. Small bruise at the puncture site
B. Right pedal pulse 1+ versus 2+ on the left
C. Client reports needing to urinate
D. Groin discomfort rated 2/10
Correct answer: B
Rationale: A diminished pedal pulse on the catheterized side suggests arterial
occlusion or hematoma formation and requires immediate assessment and
provider notification. A small bruise and mild discomfort are expected. Urinary
urgency may relate to contrast/diuresis but is not the priority.
9. A nurse is teaching a client about a low-sodium diet for hypertension. Which
food should the client be instructed to limit?
A. Fresh apples
B. Canned soup
/ATI RN Adult Medical Surgical Proctored Exam
2023 B: LATEST-2026, A COMPLETE DOCUMENT
FOR EXAM
SECTION I: CARDIOVASCULAR (Questions 1–18)
1. A client with heart failure has a new prescription for furosemide 40 mg IV push.
Which assessment finding should the nurse report to the provider before
administering the medication?
A. Blood pressure 148/86 mm Hg
B. Potassium 2.9 mEq/L
C. Heart rate 96/min
D. Weight gain of 1 kg since admission
Correct answer: B
Rationale: Loop diuretics such as furosemide cause potassium loss. A
potassium of 2.9 mEq/L is critically low and increases the risk of dysrhythmias; the
provider should be notified before giving a drug that will lower it further. BP
148/86 and HR 96 are not contraindications, and weight gain supports the need
for diuresis.
2. A nurse is caring for a client who is 6 hours postoperative following a coronary
artery bypass graft (CABG). Which finding requires immediate intervention?
A. Temperature 37.8°C (100°F)
B. Chest tube drainage of 150 mL in the last hour
C. Serum potassium 4.2 mEq/L
D. Incisional pain rated 5/10
, Correct answer: B
Rationale: Chest tube drainage greater than 100–150 mL/hr after cardiac
surgery may indicate hemorrhage or cardiac tamponade and requires immediate
notification of the surgeon. Low-grade fever is common postoperatively,
potassium is normal, and incisional pain is expected.
3. A client is admitted with an acute myocardial infarction. Which laboratory value
is the most specific indicator of myocardial damage?
A. Myoglobin
B. Troponin I
C. CK-MB
D. LDH
Correct answer: B
Rationale: Troponin I is highly specific to cardiac muscle and rises within 3–4
hours of injury, remaining elevated for 7–10 days. Myoglobin rises early but is not
cardiac-specific. CK-MB is cardiac-specific but less so than troponin. LDH is
nonspecific and outdated for this purpose.
4. A nurse is teaching a client who has a new diagnosis of atrial fibrillation and a
prescription for warfarin. Which statement by the client indicates understanding?
A. "I will increase my intake of green leafy vegetables."
B. "I will use a soft toothbrush and electric razor."
C. "I can take aspirin for headaches without asking."
D. "I will stop the medication once my heart rhythm is normal."
Correct answer: B
Rationale: Warfarin increases bleeding risk, so bleeding precautions such as a
soft toothbrush and electric razor are appropriate. Green leafy vegetables contain
vitamin K, which antagonizes warfarin and should be kept consistent—not
,increased. Aspirin compounds increase bleeding risk. Warfarin is continued long-
term for AFib, not stopped when rhythm converts.
5. A client with infective endocarditis is receiving IV gentamicin. Which finding
should the nurse report immediately?
A. Trough level of 1 mcg/mL
B. Serum creatinine increase from 0.9 to 1.8 mg/dL
C. Temperature 38.1°C (100.6°F)
D. Heart murmur
Correct answer: B
Rationale: Gentamicin is nephrotoxic and ototoxic. A doubling of serum
creatinine indicates acute kidney injury and requires immediate provider
notification. A trough of 1 mcg/mL is within therapeutic range. Fever and murmur
are expected with endocarditis.
6. A nurse is assessing a client with peripheral arterial disease (PAD). Which
finding is expected?
A. Dependent rubor and cool, shiny skin
B. Warm, edematous extremities
C. Brown pigmentation at the ankles
D. Pain relieved by elevating the legs
Correct answer: A
Rationale: PAD causes decreased arterial perfusion, resulting in cool, shiny,
hairless skin, dependent rubor, and pain worsened by elevation (relieved by
dependency). Warm edema and brown ankle pigmentation are characteristic of
venous insufficiency, and venous pain is relieved by elevation.
, 7. A client's cardiac monitor shows ventricular tachycardia and the client is
unresponsive with no pulse. Which action should the nurse take first?
A. Administer amiodarone IV push
B. Begin CPR and defibrillate
C. Perform a 12-lead ECG
D. Administer epinephrine 1 mg IV push
Correct answer: B
Rationale: Pulseless ventricular tachycardia is a shockable rhythm; the priority
is immediate CPR and defibrillation. Amiodarone and epinephrine are given after
rhythm checks during ACLS but do not precede defibrillation. A 12-lead ECG is not
obtained during cardiac arrest.
8. A nurse is caring for a client following a cardiac catheterization via the right
femoral artery. Which finding requires immediate follow-up?
A. Small bruise at the puncture site
B. Right pedal pulse 1+ versus 2+ on the left
C. Client reports needing to urinate
D. Groin discomfort rated 2/10
Correct answer: B
Rationale: A diminished pedal pulse on the catheterized side suggests arterial
occlusion or hematoma formation and requires immediate assessment and
provider notification. A small bruise and mild discomfort are expected. Urinary
urgency may relate to contrast/diuresis but is not the priority.
9. A nurse is teaching a client about a low-sodium diet for hypertension. Which
food should the client be instructed to limit?
A. Fresh apples
B. Canned soup
