ATI Level 2 Proctored Exam: RN
Adult Medical Surgical Nursing
Review Module, 14th Edition by ATI
Nursing Education - Comprehensive
Test Bank with Verified Questions and
Detailed Rationales
| Proficiency Level | Description |
| :--- | :--- |
| **Level 1** | Foundational knowledge; meets minimum expectations |
| **Level 2** | **Expected clinical proficiency** – Demonstrates sound clinical judgment and ability to
prioritize care |
,| **Level 3** | Exceptional performance; exceeds expectations |
## ✅ Part 1: Cardiovascular Disorders
**Q1. A nurse is caring for a client with heart failure who is receiving furosemide 80 mg IV push. Which
assessment finding indicates the medication is having the desired therapeutic effect?**
A) Heart rate increases from 72 to 88 bpm
B) Urine output of 500 mL within 2 hours
C) Blood pressure increases from 100/60 to 120/80 mm Hg
D) Serum potassium increases from 3.5 to 4.2 mEq/L
**Answer: B**
*Rationale: Furosemide is a loop diuretic that promotes rapid diuresis. Increased urine output indicates
the medication is reducing fluid volume overload, which is the desired therapeutic effect in heart failure.
Increased heart rate and blood pressure are not intended effects; potassium should be monitored as
furosemide can cause hypokalemia .*
**Q2. A client with an acute ischemic stroke arrives within 2 hours of symptom onset. CT shows no
hemorrhage. BP is 170/95 mm Hg. What is the priority intervention?**
A) Administer IV labetalol to lower BP below 140/90 mm Hg
B) Evaluate for alteplase (tPA) eligibility and administer if criteria are met
C) Start aspirin 325 mg and clopidogrel 75 mg
, D) Observe for 24 hours before initiating treatment
**Answer: B**
*Rationale: Alteplase (tPA) within 4.5 hours is the standard of care for acute ischemic stroke, provided
BP is <185/110 mm Hg. This client meets the BP criteria for tPA administration. The nurse should
prioritize evaluating tPA eligibility and administering it if criteria are met .*
**Q3. A client with a large anterior MI develops a new holosystolic murmur at the apex and acute
pulmonary edema. What is the most likely cause?**
A) Ventricular septal rupture
B) Papillary muscle rupture causing acute mitral regurgitation
C) Left ventricular free wall rupture
D) Aortic dissection
**Answer: B**
*Rationale: Infarction of the papillary muscle causes acute severe mitral regurgitation, which presents
with a new holosystolic murmur at the apex and acute pulmonary edema. This is a life-threatening
complication requiring immediate surgical intervention .*
**Q4. A nurse is admitting a client who reports chest pain and has been placed on a telemetry monitor.
Which of the following should the nurse analyze to determine whether the client is experiencing a
myocardial infarction?**
Adult Medical Surgical Nursing
Review Module, 14th Edition by ATI
Nursing Education - Comprehensive
Test Bank with Verified Questions and
Detailed Rationales
| Proficiency Level | Description |
| :--- | :--- |
| **Level 1** | Foundational knowledge; meets minimum expectations |
| **Level 2** | **Expected clinical proficiency** – Demonstrates sound clinical judgment and ability to
prioritize care |
,| **Level 3** | Exceptional performance; exceeds expectations |
## ✅ Part 1: Cardiovascular Disorders
**Q1. A nurse is caring for a client with heart failure who is receiving furosemide 80 mg IV push. Which
assessment finding indicates the medication is having the desired therapeutic effect?**
A) Heart rate increases from 72 to 88 bpm
B) Urine output of 500 mL within 2 hours
C) Blood pressure increases from 100/60 to 120/80 mm Hg
D) Serum potassium increases from 3.5 to 4.2 mEq/L
**Answer: B**
*Rationale: Furosemide is a loop diuretic that promotes rapid diuresis. Increased urine output indicates
the medication is reducing fluid volume overload, which is the desired therapeutic effect in heart failure.
Increased heart rate and blood pressure are not intended effects; potassium should be monitored as
furosemide can cause hypokalemia .*
**Q2. A client with an acute ischemic stroke arrives within 2 hours of symptom onset. CT shows no
hemorrhage. BP is 170/95 mm Hg. What is the priority intervention?**
A) Administer IV labetalol to lower BP below 140/90 mm Hg
B) Evaluate for alteplase (tPA) eligibility and administer if criteria are met
C) Start aspirin 325 mg and clopidogrel 75 mg
, D) Observe for 24 hours before initiating treatment
**Answer: B**
*Rationale: Alteplase (tPA) within 4.5 hours is the standard of care for acute ischemic stroke, provided
BP is <185/110 mm Hg. This client meets the BP criteria for tPA administration. The nurse should
prioritize evaluating tPA eligibility and administering it if criteria are met .*
**Q3. A client with a large anterior MI develops a new holosystolic murmur at the apex and acute
pulmonary edema. What is the most likely cause?**
A) Ventricular septal rupture
B) Papillary muscle rupture causing acute mitral regurgitation
C) Left ventricular free wall rupture
D) Aortic dissection
**Answer: B**
*Rationale: Infarction of the papillary muscle causes acute severe mitral regurgitation, which presents
with a new holosystolic murmur at the apex and acute pulmonary edema. This is a life-threatening
complication requiring immediate surgical intervention .*
**Q4. A nurse is admitting a client who reports chest pain and has been placed on a telemetry monitor.
Which of the following should the nurse analyze to determine whether the client is experiencing a
myocardial infarction?**
