ATI Med‑Surg 2 Exam (Latest 2025/2026 Update) 200 Practice
Questions – Complete & Verified Answers with Detailed
Rationales
1. A nurse is caring for a client experiencing chest pain unrelieved by rest. Which action should the nurse
take first?
A) Obtain a 12‑lead ECG
B) Check troponin levels
C) Administer morphine
D) Start a heparin infusion
Answer: A
Rationale: The priority is to obtain an ECG immediately to identify ischemia or myocardial infarction.
Pain unrelieved by rest suggests possible acute coronary syndrome. While troponin, morphine, and
heparin are important, the ECG provides rapid diagnostic information that guides further treatment.
2. A client with heart failure reports increased shortness of breath and a 3‑lb (1.4 kg) weight gain in 24 h.
Which finding indicates worsening heart failure?
A) Bounding pulses
B) Crackles in lung bases
C) BP 130/90 mmHg
D) HR 88/min
Answer: B
Rationale: Pulmonary crackles reflect fluid overload from a heart failure exacerbation. Weight gain,
especially 2–3 lb in 24 h, combined with increased SOB and crackles are classic signs of worsening HF.
Bounding pulses are not specific, and the vital signs are not overtly abnormal.
3. A client receiving IV furosemide develops muscle weakness. Which laboratory value should the nurse
check?
,A) Hemoglobin
B) Sodium
C) Potassium
D) Chloride
Answer: C
Rationale: Loop diuretics such as furosemide cause potassium loss, leading to hypokalemia. Muscle
weakness is a hallmark sign of hypokalemia. The nurse should check the potassium level immediately
and notify the provider if it is below the normal range.
4. A client with atrial fibrillation is starting warfarin. Which statement indicates understanding of the
medication?
A) “I will increase green leafy vegetables in my diet.”
B) “I need to avoid acetaminophen.”
C) “I will keep my diet consistent each week.”
D) “I do not need blood tests.”
Answer: C
Rationale: Consistent vitamin K intake from foods such as green leafy vegetables helps keep the INR
stable. Maintaining a consistent diet and adhering to regular INR monitoring are essential for safe
warfarin therapy. Avoiding acetaminophen is not necessary (though excessive use should be avoided),
and INR testing is required.
5. A nurse notes ST‑segment depression on the ECG. The client is most likely experiencing which
condition?
A) Ventricular fibrillation
B) Acute STEMI
C) Myocardial ischemia
D) Pericarditis
Answer: C
,Rationale: ST‑segment depression indicates myocardial ischemia (inadequate oxygen supply).
ST‑elevation suggests injury (STEMI). Ventricular fibrillation is a chaotic rhythm, and pericarditis typically
shows diffuse ST‑elevation with PR depression.
6. A client with pericarditis has pulsus paradoxus. This finding suggests which complication?
A) Cardiogenic shock
B) Cardiac tamponade
C) Right‑sided heart failure
D) Myocardial infarction
Answer: B
Rationale: Pulsus paradoxus (exaggerated decrease in systolic blood pressure during inspiration) is a
hallmark sign of cardiac tamponade. It can also occur with constrictive pericarditis. Pulsus paradoxus is
not typical of cardiogenic shock, right‑sided heart failure, or an uncomplicated MI.
7. A nurse is preparing to administer nitroglycerin. Which assessment is the priority before giving the
medication?
A) Pain score
B) Heart rate
C) Blood pressure
D) Oxygen saturation
Answer: C
Rationale: Nitroglycerin is a potent vasodilator that can cause significant hypotension. The nurse must
check the blood pressure before administration to ensure it is not already low (usually withhold if
systolic BP <90 mmHg). Pain score, heart rate, and oxygen saturation are important, but safety requires
BP assessment first.
8. A client with left‑sided heart failure is at increased risk for which complication?
A) Peripheral edema
B) Jugular venous distention
C) Pulmonary congestion
, D) Weight loss
Answer: C
Rationale: Left‑sided heart failure causes fluid to back up into the lungs, leading to pulmonary
congestion (crackles, dyspnea, orthopnea). Peripheral edema and jugular venous distention are
characteristic of right‑sided heart failure. Weight loss is not a feature of fluid overload.
9. A client with infective endocarditis reports new‑onset flank pain. The nurse should suspect which
problem?
A) Kidney infection
B) Emboli to renal arteries
C) Hydronephrosis
D) Dehydration
Answer: B
Rationale: Infective endocarditis can cause septic emboli that travel to various organs, including the
kidneys. Flank pain may indicate renal infarction or abscess. Pyelonephritis (kidney infection) is possible,
but embolization is a common complication of endocarditis.
10. A nurse is caring for a client with sudden onset of chest pain and shortness of breath. The client’s
oxygen saturation is 88% on room air. What is the priority nursing action?
A) Apply oxygen and assess vital signs
B) Obtain a 12‑lead ECG
C) Administer aspirin
D) Draw cardiac enzymes
Answer: A
Rationale: The priority is to administer supplemental oxygen to correct hypoxemia. After applying
oxygen, the nurse should assess vital signs and perform further diagnostic testing. Airway and breathing
always come first (ABCs).
Questions – Complete & Verified Answers with Detailed
Rationales
1. A nurse is caring for a client experiencing chest pain unrelieved by rest. Which action should the nurse
take first?
A) Obtain a 12‑lead ECG
B) Check troponin levels
C) Administer morphine
D) Start a heparin infusion
Answer: A
Rationale: The priority is to obtain an ECG immediately to identify ischemia or myocardial infarction.
Pain unrelieved by rest suggests possible acute coronary syndrome. While troponin, morphine, and
heparin are important, the ECG provides rapid diagnostic information that guides further treatment.
2. A client with heart failure reports increased shortness of breath and a 3‑lb (1.4 kg) weight gain in 24 h.
Which finding indicates worsening heart failure?
A) Bounding pulses
B) Crackles in lung bases
C) BP 130/90 mmHg
D) HR 88/min
Answer: B
Rationale: Pulmonary crackles reflect fluid overload from a heart failure exacerbation. Weight gain,
especially 2–3 lb in 24 h, combined with increased SOB and crackles are classic signs of worsening HF.
Bounding pulses are not specific, and the vital signs are not overtly abnormal.
3. A client receiving IV furosemide develops muscle weakness. Which laboratory value should the nurse
check?
,A) Hemoglobin
B) Sodium
C) Potassium
D) Chloride
Answer: C
Rationale: Loop diuretics such as furosemide cause potassium loss, leading to hypokalemia. Muscle
weakness is a hallmark sign of hypokalemia. The nurse should check the potassium level immediately
and notify the provider if it is below the normal range.
4. A client with atrial fibrillation is starting warfarin. Which statement indicates understanding of the
medication?
A) “I will increase green leafy vegetables in my diet.”
B) “I need to avoid acetaminophen.”
C) “I will keep my diet consistent each week.”
D) “I do not need blood tests.”
Answer: C
Rationale: Consistent vitamin K intake from foods such as green leafy vegetables helps keep the INR
stable. Maintaining a consistent diet and adhering to regular INR monitoring are essential for safe
warfarin therapy. Avoiding acetaminophen is not necessary (though excessive use should be avoided),
and INR testing is required.
5. A nurse notes ST‑segment depression on the ECG. The client is most likely experiencing which
condition?
A) Ventricular fibrillation
B) Acute STEMI
C) Myocardial ischemia
D) Pericarditis
Answer: C
,Rationale: ST‑segment depression indicates myocardial ischemia (inadequate oxygen supply).
ST‑elevation suggests injury (STEMI). Ventricular fibrillation is a chaotic rhythm, and pericarditis typically
shows diffuse ST‑elevation with PR depression.
6. A client with pericarditis has pulsus paradoxus. This finding suggests which complication?
A) Cardiogenic shock
B) Cardiac tamponade
C) Right‑sided heart failure
D) Myocardial infarction
Answer: B
Rationale: Pulsus paradoxus (exaggerated decrease in systolic blood pressure during inspiration) is a
hallmark sign of cardiac tamponade. It can also occur with constrictive pericarditis. Pulsus paradoxus is
not typical of cardiogenic shock, right‑sided heart failure, or an uncomplicated MI.
7. A nurse is preparing to administer nitroglycerin. Which assessment is the priority before giving the
medication?
A) Pain score
B) Heart rate
C) Blood pressure
D) Oxygen saturation
Answer: C
Rationale: Nitroglycerin is a potent vasodilator that can cause significant hypotension. The nurse must
check the blood pressure before administration to ensure it is not already low (usually withhold if
systolic BP <90 mmHg). Pain score, heart rate, and oxygen saturation are important, but safety requires
BP assessment first.
8. A client with left‑sided heart failure is at increased risk for which complication?
A) Peripheral edema
B) Jugular venous distention
C) Pulmonary congestion
, D) Weight loss
Answer: C
Rationale: Left‑sided heart failure causes fluid to back up into the lungs, leading to pulmonary
congestion (crackles, dyspnea, orthopnea). Peripheral edema and jugular venous distention are
characteristic of right‑sided heart failure. Weight loss is not a feature of fluid overload.
9. A client with infective endocarditis reports new‑onset flank pain. The nurse should suspect which
problem?
A) Kidney infection
B) Emboli to renal arteries
C) Hydronephrosis
D) Dehydration
Answer: B
Rationale: Infective endocarditis can cause septic emboli that travel to various organs, including the
kidneys. Flank pain may indicate renal infarction or abscess. Pyelonephritis (kidney infection) is possible,
but embolization is a common complication of endocarditis.
10. A nurse is caring for a client with sudden onset of chest pain and shortness of breath. The client’s
oxygen saturation is 88% on room air. What is the priority nursing action?
A) Apply oxygen and assess vital signs
B) Obtain a 12‑lead ECG
C) Administer aspirin
D) Draw cardiac enzymes
Answer: A
Rationale: The priority is to administer supplemental oxygen to correct hypoxemia. After applying
oxygen, the nurse should assess vital signs and perform further diagnostic testing. Airway and breathing
always come first (ABCs).
