, ATI Capstone Medical-Surgical Assessment
1 (2026) – Study Guide & Practice
Questions
Instructions: Choose the best answer for each question. Rationales are provided to reinforce
learning.
Section 1: Cardiovascular & Hematology (Questions 1-20)
1. A client with heart failure is prescribed furosemide. Which finding by the nurse indicates a
therapeutic effect?
A. Weight loss of 1 kg (2.2 lb) in 24 hours.
B. Increased urine specific gravity.
C. Relief of dyspnea and decreased crackles in lungs.
D. Serum potassium level of 5.2 mEq/L.
Answer: C. Relief of dyspnea and decreased crackles indicate reduced pulmonary congestion,
the primary therapeutic goal of loop diuretics in HF. Weight loss is expected but is a secondary
indicator. (A) is a typical 24-hour loss, but (C) directly addresses symptom relief. (B) indicates
concentrated urine, not a goal. (D) is hyperkalemia, an adverse effect, not therapeutic.
2. When administering IV heparin, the nurse should monitor for therapeutic effect by tracking
which laboratory value?
A. Prothrombin time (PT).
B. Activated partial thromboplastin time (aPTT).
C. International normalized ratio (INR).
D. Platelet count.
Answer: B. aPTT is the standard test for monitoring unfractionated heparin therapy. (A & C) are
for warfarin therapy. (D) is monitored for heparin-induced thrombocytopenia (HIT).
3. A client with an acute myocardial infarction (MI) is prescribed metoprolol. The nurse
understands this medication is given primarily to:
A. Reduce preload and chest pain.
B. Decrease heart rate and myocardial oxygen demand.
,C. Prevent ventricular dysrhythmias.
D. Dissolve the coronary thrombus.
Answer: B. Beta-blockers like metoprolol reduce heart rate, contractility, and blood pressure,
thereby reducing myocardial oxygen demand. (A) is more related to nitrates. (C) is a secondary
effect. (D) is the action of fibrinolytics.
4. The nurse assesses a client who has chronic arterial insufficiency. Which finding is most
expected?
A. Pitting edema of the lower extremities.
B. Brownish discoloration around the ankles.
C. Pallor on elevation and rubor on dependency.
D. Warm, dry skin with thickened nails.
Answer: C. Pallor on elevation (due to poor blood flow against gravity) and dependent rubor
(dusky red color when legs are down due to reactive hyperemia) are classic signs of arterial
disease. (A & B) are signs of venous insufficiency. (D) may be seen in chronic arterial disease but
is not the most classic sign.
5. A client with atrial fibrillation is scheduled for electrical cardioversion. The priority action
by the nurse is to:
A. Administer IV diazepam as prescribed.
B. Ensure that informed consent is on the chart.
C. Verify that the client has been NPO.
D. Confirm that anticoagulation has been adequate for 3-4 weeks.
Answer: D. The major risk of cardioversion (electrical or chemical) in afib is thromboembolism
from atrial stasis. Anticoagulation (typically for 3-4 weeks) is essential to prevent stroke. (A, B, C)
are important but are not the priority safety measure.
6. Which instruction is essential for a client discharged on warfarin?
A. "Use a soft-bristle toothbrush and an electric razor."
B. "Increase your intake of dark green, leafy vegetables."
C. "Take the medication on an empty stomach for best absorption."
D. "Report any joint pain or stiffness to your provider."
Answer: A. This prevents bleeding from minor trauma. (B) is incorrect; vitamin K in leafy greens
antagonizes warfarin and must be kept consistent, not increased. (C) is false; it can be taken
with or without food. (D) is more relevant for statins or antibiotic therapy.
7. A client with a hemoglobin of 6.8 g/dL is receiving 2 units of packed red blood cells (PRBCs).
During the transfusion, the client reports chills, low back pain, and anxiety. The nurse's first
action is to:
A. Slow the infusion rate and monitor vital signs.
, B. Stop the infusion immediately and keep the IV line open with normal saline.
C. Administer prescribed diphenhydramine.
D. Notify the blood bank and the provider.
Answer: B. These symptoms are indicative of a potential acute hemolytic transfusion reaction,
which is a medical emergency. The infusion must be stopped immediately to prevent further
hemolysis, and the IV line is kept patent with normal saline. Then, the nurse would follow
institutional protocol (notify, monitor vitals, etc.).
8. For a client with deep vein thrombosis (DVT) in the left leg, which nursing action is
contraindicated?
A. Encouraging oral fluid intake.
B. Applying warm, moist packs to the affected area.
C. Elevating the affected leg.
D. Massaging the calf.
Answer: D. Massaging the calf is absolutely contraindicated as it could dislodge the thrombus,
causing a pulmonary embolism. (B) may be used for comfort; (A & C) are appropriate
interventions.
9. The nurse is teaching a client about taking nitroglycerin sublingual tablets for angina.
Which statement by the client indicates understanding?
A. "I should take one tablet every 5 minutes until the pain is gone, up to 3 tablets."
B. "If I get a headache, I should stop taking the medication."
C. "I should store my tablets in the kitchen cabinet for easy access."
D. "If the tablet doesn't dissolve, I should swallow it with water."
Answer: A. This is the standard instruction for acute angina attacks. (B) is incorrect; a headache
is a common side effect and indicates vasodilation but is not a reason to stop. (C) is incorrect;
nitroglycerin is light- and moisture-sensitive and should be stored in its original dark glass
container. (D) is incorrect; it must dissolve sublingually for proper, rapid absorption.
10. A client with a permanent pacemaker is being discharged. Which instruction is most
important?
A. "You cannot use a microwave oven."
B. "Avoid magnetic resonance imaging (MRI)."
C. "Carry your pacemaker ID card at all times."
D. "You must limit all physical activity."
Answer: B. MRI uses strong magnetic fields that can interfere with or damage pacemaker
circuitry. It is generally contraindicated. (A) is an outdated precaution. (C) is important but not
the most critical safety instruction. (D) is false; activity is encouraged as tolerated.
1 (2026) – Study Guide & Practice
Questions
Instructions: Choose the best answer for each question. Rationales are provided to reinforce
learning.
Section 1: Cardiovascular & Hematology (Questions 1-20)
1. A client with heart failure is prescribed furosemide. Which finding by the nurse indicates a
therapeutic effect?
A. Weight loss of 1 kg (2.2 lb) in 24 hours.
B. Increased urine specific gravity.
C. Relief of dyspnea and decreased crackles in lungs.
D. Serum potassium level of 5.2 mEq/L.
Answer: C. Relief of dyspnea and decreased crackles indicate reduced pulmonary congestion,
the primary therapeutic goal of loop diuretics in HF. Weight loss is expected but is a secondary
indicator. (A) is a typical 24-hour loss, but (C) directly addresses symptom relief. (B) indicates
concentrated urine, not a goal. (D) is hyperkalemia, an adverse effect, not therapeutic.
2. When administering IV heparin, the nurse should monitor for therapeutic effect by tracking
which laboratory value?
A. Prothrombin time (PT).
B. Activated partial thromboplastin time (aPTT).
C. International normalized ratio (INR).
D. Platelet count.
Answer: B. aPTT is the standard test for monitoring unfractionated heparin therapy. (A & C) are
for warfarin therapy. (D) is monitored for heparin-induced thrombocytopenia (HIT).
3. A client with an acute myocardial infarction (MI) is prescribed metoprolol. The nurse
understands this medication is given primarily to:
A. Reduce preload and chest pain.
B. Decrease heart rate and myocardial oxygen demand.
,C. Prevent ventricular dysrhythmias.
D. Dissolve the coronary thrombus.
Answer: B. Beta-blockers like metoprolol reduce heart rate, contractility, and blood pressure,
thereby reducing myocardial oxygen demand. (A) is more related to nitrates. (C) is a secondary
effect. (D) is the action of fibrinolytics.
4. The nurse assesses a client who has chronic arterial insufficiency. Which finding is most
expected?
A. Pitting edema of the lower extremities.
B. Brownish discoloration around the ankles.
C. Pallor on elevation and rubor on dependency.
D. Warm, dry skin with thickened nails.
Answer: C. Pallor on elevation (due to poor blood flow against gravity) and dependent rubor
(dusky red color when legs are down due to reactive hyperemia) are classic signs of arterial
disease. (A & B) are signs of venous insufficiency. (D) may be seen in chronic arterial disease but
is not the most classic sign.
5. A client with atrial fibrillation is scheduled for electrical cardioversion. The priority action
by the nurse is to:
A. Administer IV diazepam as prescribed.
B. Ensure that informed consent is on the chart.
C. Verify that the client has been NPO.
D. Confirm that anticoagulation has been adequate for 3-4 weeks.
Answer: D. The major risk of cardioversion (electrical or chemical) in afib is thromboembolism
from atrial stasis. Anticoagulation (typically for 3-4 weeks) is essential to prevent stroke. (A, B, C)
are important but are not the priority safety measure.
6. Which instruction is essential for a client discharged on warfarin?
A. "Use a soft-bristle toothbrush and an electric razor."
B. "Increase your intake of dark green, leafy vegetables."
C. "Take the medication on an empty stomach for best absorption."
D. "Report any joint pain or stiffness to your provider."
Answer: A. This prevents bleeding from minor trauma. (B) is incorrect; vitamin K in leafy greens
antagonizes warfarin and must be kept consistent, not increased. (C) is false; it can be taken
with or without food. (D) is more relevant for statins or antibiotic therapy.
7. A client with a hemoglobin of 6.8 g/dL is receiving 2 units of packed red blood cells (PRBCs).
During the transfusion, the client reports chills, low back pain, and anxiety. The nurse's first
action is to:
A. Slow the infusion rate and monitor vital signs.
, B. Stop the infusion immediately and keep the IV line open with normal saline.
C. Administer prescribed diphenhydramine.
D. Notify the blood bank and the provider.
Answer: B. These symptoms are indicative of a potential acute hemolytic transfusion reaction,
which is a medical emergency. The infusion must be stopped immediately to prevent further
hemolysis, and the IV line is kept patent with normal saline. Then, the nurse would follow
institutional protocol (notify, monitor vitals, etc.).
8. For a client with deep vein thrombosis (DVT) in the left leg, which nursing action is
contraindicated?
A. Encouraging oral fluid intake.
B. Applying warm, moist packs to the affected area.
C. Elevating the affected leg.
D. Massaging the calf.
Answer: D. Massaging the calf is absolutely contraindicated as it could dislodge the thrombus,
causing a pulmonary embolism. (B) may be used for comfort; (A & C) are appropriate
interventions.
9. The nurse is teaching a client about taking nitroglycerin sublingual tablets for angina.
Which statement by the client indicates understanding?
A. "I should take one tablet every 5 minutes until the pain is gone, up to 3 tablets."
B. "If I get a headache, I should stop taking the medication."
C. "I should store my tablets in the kitchen cabinet for easy access."
D. "If the tablet doesn't dissolve, I should swallow it with water."
Answer: A. This is the standard instruction for acute angina attacks. (B) is incorrect; a headache
is a common side effect and indicates vasodilation but is not a reason to stop. (C) is incorrect;
nitroglycerin is light- and moisture-sensitive and should be stored in its original dark glass
container. (D) is incorrect; it must dissolve sublingually for proper, rapid absorption.
10. A client with a permanent pacemaker is being discharged. Which instruction is most
important?
A. "You cannot use a microwave oven."
B. "Avoid magnetic resonance imaging (MRI)."
C. "Carry your pacemaker ID card at all times."
D. "You must limit all physical activity."
Answer: B. MRI uses strong magnetic fields that can interfere with or damage pacemaker
circuitry. It is generally contraindicated. (A) is an outdated precaution. (C) is important but not
the most critical safety instruction. (D) is false; activity is encouraged as tolerated.
