ATI Med-Surg Proctored Exam Questions 1-
160 with Answers and Rationales
DOMAIN 1: CARDIOVASCULAR & HEMATOLOGIC DISORDERS (Questions 1-30)
Question 1
A nurse is assessing a client who is 12 hours post-cardiac catheterization via the
femoral artery. The nurse notes the client's right foot is pale, cool to the touch,
and the client reports numbness. Which action should the nurse take FIRST?
A. Apply warm blankets to the right foot
B. Elevate the head of the bed to 45 degrees
C. Assess the right femoral pulse
D. Document the findings as normal
Correct Answer: C. Assess the right femoral pulse
Rationale: Pale, cool, and numb extremity post-catheterization suggests arterial
occlusion or thrombus formation. Assessing the femoral pulse checks for
perfusion—this is the priority action. Warm blankets treat symptoms but delay
emergent intervention. Elevating the HOB does not restore arterial flow. These
findings are abnormal (potential limb ischemia) and require immediate action, not
just documentation.
Question 2
A nurse is monitoring a client receiving a blood transfusion. Which finding
indicates a hemolytic transfusion reaction?
A. Hypertension and bradycardia
B. Low back pain and tachycardia
,C. Flushed skin and fever
D. Hypothermia and urticaria
Correct Answer: B. Low back pain and tachycardia
Rationale: Low back pain (from kidney stress), tachycardia, hypotension, and
hemoglobinuria are hallmark signs of an acute hemolytic reaction due to RBC
destruction. Hemolytic reactions usually cause hypotension, not hypertension.
Flushed skin/fever can occur in febrile reactions, but back pain is specific to
hemolysis. Urticaria is an allergic reaction; hypothermia is not typical for
immediate hemolysis.
Question 3
A nurse is teaching a client with heart failure about fluid restriction. Which
statement indicates understanding?
A. "I will count my coffee as part of my daily fluids"
B. "Ice chips don't count toward my daily total"
C. "I should drink most of my fluids at dinner"
D. "Thickened liquids are free and don't count"
Correct Answer: A. "I will count my coffee as part of my daily fluids"
Rationale: All liquids at room temperature (coffee, water, juice, ice cream) AND ice
chips count toward fluid restrictions (ice chips typically count as half volume). Ice
chips melt into water, so they absolutely count. Fluids should be spread out to
prevent overloading the heart at one time. Thickened liquids are still liquids.
Question 4
A client is prescribed warfarin (Coumadin). Which lab value indicates therapeutic
effectiveness?
A. aPTT of 60 seconds
B. INR of 2.5
C. Platelet count of 150,000
D. Bleeding time of 8 minutes
Correct Answer: B. INR of 2.5
,*Rationale: Warfarin affects the extrinsic pathway. A therapeutic INR for most
conditions (like a-fib or DVT) is 2.0-3.0. aPTT monitors heparin, not warfarin.
Platelet count monitors bleeding risk but not warfarin efficacy. Bleeding time
measures platelet function, not warfarin levels.*
Question 5
A nurse is caring for a client with a deep vein thrombosis (DVT) who is on a
heparin drip. Which finding requires immediate intervention?
A. aPTT of 80 seconds (control 30 seconds)
B. Platelet count drop from 250,000 to 100,000
C. Client reports headache and visual changes
D. Presence of pedal edema
Correct Answer: C. Client reports headache and visual changes
*Rationale: Headache + visual changes on heparin could indicate adrenal
hemorrhage (rare but fatal) or heparin-induced thrombocytopenia (HIT) with
thrombosis. aPTT of 80 seconds is therapeutic (1.5-2.5x control). Platelet drop is a
concern for HIT, but neurological symptoms are a higher priority immediately.
Edema is expected with DVT.*
Question 6
A client with hypertension is started on hydrochlorothiazide. The nurse should
include which food to prevent an adverse effect?
A. Apples
B. Brown rice
C. Bananas
D. Chicken breast
Correct Answer: C. Bananas
Rationale: Thiazide diuretics cause potassium loss (hypokalemia). Bananas are
high in potassium to prevent arrhythmias. Apples are low in potassium. Rice does
not replace potassium significantly. Chicken is for protein, not potassium
replacement.
, Question 7
A nurse is caring for a client with a newly placed arteriovenous (AV) fistula in the
left arm. Which action should the nurse take?
A. Obtain blood pressure from the left arm
B. Palpate for a thrill over the fistula site
C. Administer IV fluids via a large catheter in the left hand
D. Elevate the left arm above heart level
Correct Answer: B. Palpate for a thrill over the fistula site
Rationale: A palpable "thrill" and audible "bruit" indicate patency and blood flow.
Absence indicates clotting. Never take BP on the fistula arm (risk of
clotting/damage). No sticks (IVs/blood draws) on the fistula arm. The arm should
not be constricted; no pressure is the main issue.
Question 8
A client with chronic kidney disease (CKD) has a hemoglobin level of 8.0 g/dL. The
provider orders epoetin alfa (Epogen). The nurse knows this medication is given
to:
A. Prevent iron deficiency
B. Stimulate RBC production
C. Increase white blood cell count
D. Treat metabolic acidosis
Correct Answer: B. Stimulate RBC production
Rationale: Epogen is synthetic erythropoietin. CKD patients lack natural
erythropoietin, leading to anemia. This stimulates bone marrow to make RBCs. It
doesn't prevent iron deficiency; iron is usually given with it. Colony-stimulating
factors (e.g., Neupogen) increase WBCs. Bicarb is used for acidosis.
Question 9
A nurse is teaching a client with thrombocytopenia. Which statement by the client
indicates a need for further teaching?
A. "I will use a soft-bristled toothbrush"
B. "I will blow my nose gently if it is stuffy"
160 with Answers and Rationales
DOMAIN 1: CARDIOVASCULAR & HEMATOLOGIC DISORDERS (Questions 1-30)
Question 1
A nurse is assessing a client who is 12 hours post-cardiac catheterization via the
femoral artery. The nurse notes the client's right foot is pale, cool to the touch,
and the client reports numbness. Which action should the nurse take FIRST?
A. Apply warm blankets to the right foot
B. Elevate the head of the bed to 45 degrees
C. Assess the right femoral pulse
D. Document the findings as normal
Correct Answer: C. Assess the right femoral pulse
Rationale: Pale, cool, and numb extremity post-catheterization suggests arterial
occlusion or thrombus formation. Assessing the femoral pulse checks for
perfusion—this is the priority action. Warm blankets treat symptoms but delay
emergent intervention. Elevating the HOB does not restore arterial flow. These
findings are abnormal (potential limb ischemia) and require immediate action, not
just documentation.
Question 2
A nurse is monitoring a client receiving a blood transfusion. Which finding
indicates a hemolytic transfusion reaction?
A. Hypertension and bradycardia
B. Low back pain and tachycardia
,C. Flushed skin and fever
D. Hypothermia and urticaria
Correct Answer: B. Low back pain and tachycardia
Rationale: Low back pain (from kidney stress), tachycardia, hypotension, and
hemoglobinuria are hallmark signs of an acute hemolytic reaction due to RBC
destruction. Hemolytic reactions usually cause hypotension, not hypertension.
Flushed skin/fever can occur in febrile reactions, but back pain is specific to
hemolysis. Urticaria is an allergic reaction; hypothermia is not typical for
immediate hemolysis.
Question 3
A nurse is teaching a client with heart failure about fluid restriction. Which
statement indicates understanding?
A. "I will count my coffee as part of my daily fluids"
B. "Ice chips don't count toward my daily total"
C. "I should drink most of my fluids at dinner"
D. "Thickened liquids are free and don't count"
Correct Answer: A. "I will count my coffee as part of my daily fluids"
Rationale: All liquids at room temperature (coffee, water, juice, ice cream) AND ice
chips count toward fluid restrictions (ice chips typically count as half volume). Ice
chips melt into water, so they absolutely count. Fluids should be spread out to
prevent overloading the heart at one time. Thickened liquids are still liquids.
Question 4
A client is prescribed warfarin (Coumadin). Which lab value indicates therapeutic
effectiveness?
A. aPTT of 60 seconds
B. INR of 2.5
C. Platelet count of 150,000
D. Bleeding time of 8 minutes
Correct Answer: B. INR of 2.5
,*Rationale: Warfarin affects the extrinsic pathway. A therapeutic INR for most
conditions (like a-fib or DVT) is 2.0-3.0. aPTT monitors heparin, not warfarin.
Platelet count monitors bleeding risk but not warfarin efficacy. Bleeding time
measures platelet function, not warfarin levels.*
Question 5
A nurse is caring for a client with a deep vein thrombosis (DVT) who is on a
heparin drip. Which finding requires immediate intervention?
A. aPTT of 80 seconds (control 30 seconds)
B. Platelet count drop from 250,000 to 100,000
C. Client reports headache and visual changes
D. Presence of pedal edema
Correct Answer: C. Client reports headache and visual changes
*Rationale: Headache + visual changes on heparin could indicate adrenal
hemorrhage (rare but fatal) or heparin-induced thrombocytopenia (HIT) with
thrombosis. aPTT of 80 seconds is therapeutic (1.5-2.5x control). Platelet drop is a
concern for HIT, but neurological symptoms are a higher priority immediately.
Edema is expected with DVT.*
Question 6
A client with hypertension is started on hydrochlorothiazide. The nurse should
include which food to prevent an adverse effect?
A. Apples
B. Brown rice
C. Bananas
D. Chicken breast
Correct Answer: C. Bananas
Rationale: Thiazide diuretics cause potassium loss (hypokalemia). Bananas are
high in potassium to prevent arrhythmias. Apples are low in potassium. Rice does
not replace potassium significantly. Chicken is for protein, not potassium
replacement.
, Question 7
A nurse is caring for a client with a newly placed arteriovenous (AV) fistula in the
left arm. Which action should the nurse take?
A. Obtain blood pressure from the left arm
B. Palpate for a thrill over the fistula site
C. Administer IV fluids via a large catheter in the left hand
D. Elevate the left arm above heart level
Correct Answer: B. Palpate for a thrill over the fistula site
Rationale: A palpable "thrill" and audible "bruit" indicate patency and blood flow.
Absence indicates clotting. Never take BP on the fistula arm (risk of
clotting/damage). No sticks (IVs/blood draws) on the fistula arm. The arm should
not be constricted; no pressure is the main issue.
Question 8
A client with chronic kidney disease (CKD) has a hemoglobin level of 8.0 g/dL. The
provider orders epoetin alfa (Epogen). The nurse knows this medication is given
to:
A. Prevent iron deficiency
B. Stimulate RBC production
C. Increase white blood cell count
D. Treat metabolic acidosis
Correct Answer: B. Stimulate RBC production
Rationale: Epogen is synthetic erythropoietin. CKD patients lack natural
erythropoietin, leading to anemia. This stimulates bone marrow to make RBCs. It
doesn't prevent iron deficiency; iron is usually given with it. Colony-stimulating
factors (e.g., Neupogen) increase WBCs. Bicarb is used for acidosis.
Question 9
A nurse is teaching a client with thrombocytopenia. Which statement by the client
indicates a need for further teaching?
A. "I will use a soft-bristled toothbrush"
B. "I will blow my nose gently if it is stuffy"
