ATI RN Adult Medical-Surgical Proctored Exam 2026/2027 – ACTUAL-
Style Practice Questions & Answers, ATI Adult Medical-Surgical Nursing
Content Mastery Review, Cardiovascular Disorders, Respiratory
Diseases, Neurological Conditions, Fluid and Electrolyte Imbalances, Acid-
Base Balance, Renal and Urinary Disorders, Endocrine Conditions,
Gastrointestinal Disorders, Hematology, Infection Control, Immune
Disorders, Musculoskeletal Conditions, Perioperative Nursing,
Pharmacology, Clinical Judgment & Detailed Rationales
Question 1: A nurse is caring for a client who has heart failure and is
receiving furosemide. Which of the following findings indicates a
therapeutic response to the medication?
A. Weight loss of 1 kg in 24 hours
B. Urine output of 20 mL/hr
C. Development of crackles in lung bases
D. Heart rate increase from 80 to 110 bpm
CORRECT ANSWER: A. Weight loss of 1 kg in 24 hours
Rationale: Furosemide is a loop diuretic that reduces fluid volume excess
in heart failure by promoting diuresis. A therapeutic response is
demonstrated by weight loss of approximately 0.5 to 1 kg per day, indicating
mobilization of excess fluid. Urine output of 20 mL/hr is below the
minimum acceptable rate of 30 mL/hr and suggests inadequate diuresis or
renal compromise. Development of crackles indicates worsening
pulmonary congestion, and tachycardia may reflect fluid overload or
worsening cardiac function, both of which indicate an inadequate
therapeutic response.
Question 2: A nurse is assessing a client who has acute
decompensated heart failure. Which of the following findings requires
immediate intervention?
A. Bilateral crackles in lung bases
B. Oxygen saturation of 94% on 2 L nasal cannula
C. Pink frothy sputum with severe dyspnea
D. Weight gain of 1 kg since admission
CORRECT ANSWER: C. Pink frothy sputum with severe dyspnea
,Rationale: Pink frothy sputum accompanied by severe dyspnea indicates
acute pulmonary edema, a life-threatening emergency requiring immediate
intervention to prevent respiratory failure. Bilateral crackles are an
expected finding in fluid overload but do not indicate imminent
decompensation requiring the same urgency. An oxygen saturation of 94%
on 2 L is acceptable, and a 1 kg weight gain requires monitoring but does
not constitute an immediate emergency.
Question 3: A nurse is preparing to administer digoxin to a client who
has heart failure. Which of the following assessment findings should
cause the nurse to withhold the medication?
A. Apical pulse of 58 beats per minute
B. Blood pressure of 118/76 mm Hg
C. Respiratory rate of 18 breaths per minute
D. Serum potassium of 4.2 mEq/L
CORRECT ANSWER: A. Apical pulse of 58 beats per minute
Rationale: Digoxin should be withheld if the adult apical pulse is below 60
beats per minute, as bradycardia may indicate digoxin toxicity. Blood
pressure, respiratory rate, and potassium level within normal limits do not
require withholding the medication. The nurse should hold the digoxin,
document the finding, and notify the provider.
Question 4: A client who has chronic heart failure reports muscle
weakness and cramps. Which laboratory value requires immediate
attention?
A. Sodium 140 mEq/L
B. Potassium 2.8 mEq/L
C. Calcium 9.2 mg/dL
D. Magnesium 2.0 mg/dL
CORRECT ANSWER: B. Potassium 2.8 mEq/L
Rationale: Muscle weakness and cramps are classic manifestations of
hypokalemia, which is a common adverse effect of loop diuretics such as
furosemide. A potassium level of 2.8 mEq/L is critically low (normal range:
3.5–5.0 mEq/L) and places the client at risk for cardiac dysrhythmias.
Sodium, calcium, and magnesium values within normal limits do not
explain the client's symptoms or require immediate intervention.
,Question 5: A nurse is teaching a client who has a new prescription for
sublingual nitroglycerin. Which of the following statements by the
client indicates understanding of the teaching?
A. "I will take the medication while sitting or lying down."
B. "I should take up to five tablets before seeking emergency care."
C. "I will stop taking the medication if I develop a headache."
D. "I can keep the medication for two years before replacing it."
CORRECT ANSWER: A. "I will take the medication while sitting or lying
down."
Rationale: Sublingual nitroglycerin causes vasodilation and can lead to
hypotension and syncope. Clients should sit or lie down when taking the
medication to reduce the risk of falls. The client should take no more than
three tablets, five minutes apart, and seek emergency care if chest pain
persists. Headache is an expected side effect that can be managed with
acetaminophen and does not require discontinuing the medication.
Sublingual nitroglycerin has a shelf life of approximately six months after
the bottle is opened.
Question 6: A nurse is assessing a client who has peripheral arterial
disease (PAD). Which of the following findings should the nurse
expect?
A. Dependent rubor with elevation pallor
B. Warm, swollen extremities with pitting edema
C. Bounding pedal pulses bilaterally
D. Improved pain with leg elevation
CORRECT ANSWER: A. Dependent rubor with elevation pallor
Rationale: Peripheral arterial disease results from impaired arterial blood
flow to the extremities. Classic findings include dependent rubor (redness
when the extremity is lowered) and pallor when the extremity is elevated,
due to inadequate perfusion. PAD also presents with cool extremities,
diminished or absent pedal pulses, and pain that worsens with elevation
and improves with dependency. Warm, swollen extremities with edema
and bounding pulses are characteristic of venous insufficiency, not arterial
disease.
, Question 7: A nurse is caring for a client who has a new prescription for
warfarin for atrial fibrillation. Which laboratory value indicates a
therapeutic response?
A. INR of 1.2
B. INR of 2.5
C. aPTT of 35 seconds
D. Platelet count of 150,000/mm³
CORRECT ANSWER: B. INR of 2.5
Rationale: For a client with atrial fibrillation receiving warfarin, the
therapeutic INR range is 2.0 to 3.0. An INR of 2.5 indicates adequate
anticoagulation to prevent thromboembolic events such as stroke. An INR
of 1.2 is subtherapeutic and does not provide adequate anticoagulation.
aPTT is used to monitor heparin therapy, not warfarin. Platelet count
assesses clotting capacity but does not measure warfarin's therapeutic
effect.
Question 8: A nurse is assessing a client who is receiving a blood
transfusion and develops chills, fever, and flank pain. Which action
should the nurse take first?
A. Slow the transfusion rate
B. Administer acetaminophen
C. Stop the transfusion immediately
D. Notify the provider
CORRECT ANSWER: C. Stop the transfusion immediately
Rationale: Chills, fever, and flank pain are manifestations of an acute
hemolytic transfusion reaction, which is life-threatening. The first and most
critical action is to stop the transfusion immediately to prevent further
administration of incompatible blood products. The nurse should then
maintain IV access with normal saline, notify the provider, and monitor the
client closely. Slowing the transfusion is unsafe, as it allows continued
administration of incompatible blood.
Question 9: A nurse is caring for a client who has a chest tube following
a thoracotomy. Which finding indicates a need for immediate
intervention?
Style Practice Questions & Answers, ATI Adult Medical-Surgical Nursing
Content Mastery Review, Cardiovascular Disorders, Respiratory
Diseases, Neurological Conditions, Fluid and Electrolyte Imbalances, Acid-
Base Balance, Renal and Urinary Disorders, Endocrine Conditions,
Gastrointestinal Disorders, Hematology, Infection Control, Immune
Disorders, Musculoskeletal Conditions, Perioperative Nursing,
Pharmacology, Clinical Judgment & Detailed Rationales
Question 1: A nurse is caring for a client who has heart failure and is
receiving furosemide. Which of the following findings indicates a
therapeutic response to the medication?
A. Weight loss of 1 kg in 24 hours
B. Urine output of 20 mL/hr
C. Development of crackles in lung bases
D. Heart rate increase from 80 to 110 bpm
CORRECT ANSWER: A. Weight loss of 1 kg in 24 hours
Rationale: Furosemide is a loop diuretic that reduces fluid volume excess
in heart failure by promoting diuresis. A therapeutic response is
demonstrated by weight loss of approximately 0.5 to 1 kg per day, indicating
mobilization of excess fluid. Urine output of 20 mL/hr is below the
minimum acceptable rate of 30 mL/hr and suggests inadequate diuresis or
renal compromise. Development of crackles indicates worsening
pulmonary congestion, and tachycardia may reflect fluid overload or
worsening cardiac function, both of which indicate an inadequate
therapeutic response.
Question 2: A nurse is assessing a client who has acute
decompensated heart failure. Which of the following findings requires
immediate intervention?
A. Bilateral crackles in lung bases
B. Oxygen saturation of 94% on 2 L nasal cannula
C. Pink frothy sputum with severe dyspnea
D. Weight gain of 1 kg since admission
CORRECT ANSWER: C. Pink frothy sputum with severe dyspnea
,Rationale: Pink frothy sputum accompanied by severe dyspnea indicates
acute pulmonary edema, a life-threatening emergency requiring immediate
intervention to prevent respiratory failure. Bilateral crackles are an
expected finding in fluid overload but do not indicate imminent
decompensation requiring the same urgency. An oxygen saturation of 94%
on 2 L is acceptable, and a 1 kg weight gain requires monitoring but does
not constitute an immediate emergency.
Question 3: A nurse is preparing to administer digoxin to a client who
has heart failure. Which of the following assessment findings should
cause the nurse to withhold the medication?
A. Apical pulse of 58 beats per minute
B. Blood pressure of 118/76 mm Hg
C. Respiratory rate of 18 breaths per minute
D. Serum potassium of 4.2 mEq/L
CORRECT ANSWER: A. Apical pulse of 58 beats per minute
Rationale: Digoxin should be withheld if the adult apical pulse is below 60
beats per minute, as bradycardia may indicate digoxin toxicity. Blood
pressure, respiratory rate, and potassium level within normal limits do not
require withholding the medication. The nurse should hold the digoxin,
document the finding, and notify the provider.
Question 4: A client who has chronic heart failure reports muscle
weakness and cramps. Which laboratory value requires immediate
attention?
A. Sodium 140 mEq/L
B. Potassium 2.8 mEq/L
C. Calcium 9.2 mg/dL
D. Magnesium 2.0 mg/dL
CORRECT ANSWER: B. Potassium 2.8 mEq/L
Rationale: Muscle weakness and cramps are classic manifestations of
hypokalemia, which is a common adverse effect of loop diuretics such as
furosemide. A potassium level of 2.8 mEq/L is critically low (normal range:
3.5–5.0 mEq/L) and places the client at risk for cardiac dysrhythmias.
Sodium, calcium, and magnesium values within normal limits do not
explain the client's symptoms or require immediate intervention.
,Question 5: A nurse is teaching a client who has a new prescription for
sublingual nitroglycerin. Which of the following statements by the
client indicates understanding of the teaching?
A. "I will take the medication while sitting or lying down."
B. "I should take up to five tablets before seeking emergency care."
C. "I will stop taking the medication if I develop a headache."
D. "I can keep the medication for two years before replacing it."
CORRECT ANSWER: A. "I will take the medication while sitting or lying
down."
Rationale: Sublingual nitroglycerin causes vasodilation and can lead to
hypotension and syncope. Clients should sit or lie down when taking the
medication to reduce the risk of falls. The client should take no more than
three tablets, five minutes apart, and seek emergency care if chest pain
persists. Headache is an expected side effect that can be managed with
acetaminophen and does not require discontinuing the medication.
Sublingual nitroglycerin has a shelf life of approximately six months after
the bottle is opened.
Question 6: A nurse is assessing a client who has peripheral arterial
disease (PAD). Which of the following findings should the nurse
expect?
A. Dependent rubor with elevation pallor
B. Warm, swollen extremities with pitting edema
C. Bounding pedal pulses bilaterally
D. Improved pain with leg elevation
CORRECT ANSWER: A. Dependent rubor with elevation pallor
Rationale: Peripheral arterial disease results from impaired arterial blood
flow to the extremities. Classic findings include dependent rubor (redness
when the extremity is lowered) and pallor when the extremity is elevated,
due to inadequate perfusion. PAD also presents with cool extremities,
diminished or absent pedal pulses, and pain that worsens with elevation
and improves with dependency. Warm, swollen extremities with edema
and bounding pulses are characteristic of venous insufficiency, not arterial
disease.
, Question 7: A nurse is caring for a client who has a new prescription for
warfarin for atrial fibrillation. Which laboratory value indicates a
therapeutic response?
A. INR of 1.2
B. INR of 2.5
C. aPTT of 35 seconds
D. Platelet count of 150,000/mm³
CORRECT ANSWER: B. INR of 2.5
Rationale: For a client with atrial fibrillation receiving warfarin, the
therapeutic INR range is 2.0 to 3.0. An INR of 2.5 indicates adequate
anticoagulation to prevent thromboembolic events such as stroke. An INR
of 1.2 is subtherapeutic and does not provide adequate anticoagulation.
aPTT is used to monitor heparin therapy, not warfarin. Platelet count
assesses clotting capacity but does not measure warfarin's therapeutic
effect.
Question 8: A nurse is assessing a client who is receiving a blood
transfusion and develops chills, fever, and flank pain. Which action
should the nurse take first?
A. Slow the transfusion rate
B. Administer acetaminophen
C. Stop the transfusion immediately
D. Notify the provider
CORRECT ANSWER: C. Stop the transfusion immediately
Rationale: Chills, fever, and flank pain are manifestations of an acute
hemolytic transfusion reaction, which is life-threatening. The first and most
critical action is to stop the transfusion immediately to prevent further
administration of incompatible blood products. The nurse should then
maintain IV access with normal saline, notify the provider, and monitor the
client closely. Slowing the transfusion is unsafe, as it allows continued
administration of incompatible blood.
Question 9: A nurse is caring for a client who has a chest tube following
a thoracotomy. Which finding indicates a need for immediate
intervention?
