ATI Adult Medical Surgical Practice Assessment
A 2026–2027 Complete Study Guide with Med-
Surg Practice Questions and Rationales
SECTION 1: CARDIOVASCULAR DISORDERS
Question 1:
A nurse is assessing a client with heart failure who is receiving digoxin. Which of the
following findings indicates digoxin toxicity?
A) Heart rate of 72 beats per minute
B) Anorexia, nausea, and blurred yellow vision
C) Blood pressure of 120/80 mmHg
D) Potassium level of 4.0 mEq/L
Correct Answer: B) Anorexia, nausea, and blurred yellow vision
Rationale: Digoxin toxicity causes gastrointestinal symptoms (anorexia, nausea, vomiting,
abdominal pain), visual changes (yellow-green halos, blurred vision, photophobia), and
cardiac dysrhythmias (bradycardia, heart block, ventricular dysrhythmias). Hypokalemia
increases the risk of digoxin toxicity. A potassium level of 4.0 mEq/L is within normal range
(3.5-5.0 mEq/L) and would not be a concern. A heart rate of 72 is normal and does not
indicate toxicity.
Question 2:
A nurse is assessing a client who is 12 hours post-cardiac catheterization via the right
femoral artery. Which of the following findings requires immediate intervention?
A) Blood pressure 128/74 mm Hg
B) Heart rate 86/min
C) A small amount of bloody drainage on the dressing
D) A palpable, hard lump at the catheter insertion site
Correct Answer: D) A palpable, hard lump at the catheter insertion site
Rationale: A palpable, hard lump (hematoma) at the catheter insertion site indicates active
bleeding into the tissue, which can lead to compromised circulation to the limb and
,significant blood loss. The nurse should immediately assess the site, apply pressure, and
notify the provider. A small amount of bloody drainage is expected, and stable vital signs
are reassuring.
Question 3:
A client with heart failure has an ejection fraction of 30%. Which clinical finding correlates
with this?
A) Bounding peripheral pulses
B) Pulmonary crackles
C) Jugular vein distention
D) Hypertension
Correct Answer: B) Pulmonary crackles
Rationale: An ejection fraction of 30% indicates significant left ventricular dysfunction. With
reduced cardiac output, blood backs up into the pulmonary circulation, causing pulmonary
congestion and crackles on auscultation. Jugular vein distention is more indicative of right-
sided heart failure.
Question 4:
A nurse is caring for a client with acute myocardial infarction who reports chest pain. Which
medication should the nurse administer first?
A) Morphine sulfate
B) Nitroglycerin sublingual
C) Aspirin
D) Oxygen
Correct Answer: C) Aspirin
Rationale: Aspirin should be administered immediately upon suspicion of MI because it
reduces mortality by inhibiting platelet aggregation and preventing further clot formation.
While oxygen, nitroglycerin, and morphine are also part of the MONA protocol, aspirin is the
priority initial intervention.
,Question 5:
A client with heart failure has crackles in the lungs and peripheral edema. The nurse should
anticipate which intervention?
A) Administer diuretics
B) Restrict fluids and sodium
C) Administer oxygen
D) All of the above
Correct Answer: D) All of the above
Rationale: Crackles and edema indicate fluid volume overload. Diuretics promote fluid
excretion, fluid and sodium restriction reduces fluid retention, and oxygen improves
oxygenation. All interventions are appropriate for managing acute heart failure exacerbation.
Question 6:
A client with angina pectoris reports chest pain that occurs with exertion and resolves with
rest and nitroglycerin. The nurse should document this as which type of angina?
A) Unstable angina
B) Variant angina
C) Stable angina
D) Prinzmetal's angina
Correct Answer: C) Stable angina
Rationale: Stable angina is characterized by chest pain that occurs predictably with
exertion or stress and is relieved by rest or nitroglycerin. Unstable angina occurs at rest or
with minimal exertion and is not relieved by rest. Variant (Prinzmetal's) angina occurs at rest
due to coronary artery spasm.
Question 7:
A nurse is assessing a client with left-sided heart failure. Which finding is most indicative of
this condition?
A) Peripheral edema
B) Jugular vein distention
C) Crackles in the lung bases
D) Hepatomegaly
, Correct Answer: C) Crackles in the lung bases
Rationale: Left-sided heart failure causes blood to back up into the pulmonary circulation,
leading to pulmonary congestion and crackles. Peripheral edema, jugular vein distention,
and hepatomegaly are signs of right-sided heart failure.
Question 8:
A client is prescribed warfarin for atrial fibrillation. Which laboratory value should the nurse
monitor to evaluate therapeutic effectiveness?
A) aPTT
B) INR
C) Platelet count
D) Serum potassium
Correct Answer: B) INR
Rationale: Warfarin is monitored using the International Normalized Ratio (INR). The
therapeutic INR for atrial fibrillation is typically 2.0-3.0. aPTT is used to monitor heparin
therapy. Platelet count monitors for thrombocytopenia, and potassium monitoring is not
specific to warfarin therapy.
Question 9:
A client with peripheral arterial disease (PAD) reports leg pain when walking that is relieved
by rest. The nurse should document this as:
A) Rest pain
B) Intermittent claudication
C) Venous insufficiency
D) Neuropathic pain
Correct Answer: B) Intermittent claudication
Rationale: Intermittent claudication is pain in the legs (typically calves) that occurs with
exercise and is relieved by rest. It is caused by inadequate blood flow to the muscles during
activity due to peripheral arterial disease. Rest pain indicates severe arterial insufficiency.
A 2026–2027 Complete Study Guide with Med-
Surg Practice Questions and Rationales
SECTION 1: CARDIOVASCULAR DISORDERS
Question 1:
A nurse is assessing a client with heart failure who is receiving digoxin. Which of the
following findings indicates digoxin toxicity?
A) Heart rate of 72 beats per minute
B) Anorexia, nausea, and blurred yellow vision
C) Blood pressure of 120/80 mmHg
D) Potassium level of 4.0 mEq/L
Correct Answer: B) Anorexia, nausea, and blurred yellow vision
Rationale: Digoxin toxicity causes gastrointestinal symptoms (anorexia, nausea, vomiting,
abdominal pain), visual changes (yellow-green halos, blurred vision, photophobia), and
cardiac dysrhythmias (bradycardia, heart block, ventricular dysrhythmias). Hypokalemia
increases the risk of digoxin toxicity. A potassium level of 4.0 mEq/L is within normal range
(3.5-5.0 mEq/L) and would not be a concern. A heart rate of 72 is normal and does not
indicate toxicity.
Question 2:
A nurse is assessing a client who is 12 hours post-cardiac catheterization via the right
femoral artery. Which of the following findings requires immediate intervention?
A) Blood pressure 128/74 mm Hg
B) Heart rate 86/min
C) A small amount of bloody drainage on the dressing
D) A palpable, hard lump at the catheter insertion site
Correct Answer: D) A palpable, hard lump at the catheter insertion site
Rationale: A palpable, hard lump (hematoma) at the catheter insertion site indicates active
bleeding into the tissue, which can lead to compromised circulation to the limb and
,significant blood loss. The nurse should immediately assess the site, apply pressure, and
notify the provider. A small amount of bloody drainage is expected, and stable vital signs
are reassuring.
Question 3:
A client with heart failure has an ejection fraction of 30%. Which clinical finding correlates
with this?
A) Bounding peripheral pulses
B) Pulmonary crackles
C) Jugular vein distention
D) Hypertension
Correct Answer: B) Pulmonary crackles
Rationale: An ejection fraction of 30% indicates significant left ventricular dysfunction. With
reduced cardiac output, blood backs up into the pulmonary circulation, causing pulmonary
congestion and crackles on auscultation. Jugular vein distention is more indicative of right-
sided heart failure.
Question 4:
A nurse is caring for a client with acute myocardial infarction who reports chest pain. Which
medication should the nurse administer first?
A) Morphine sulfate
B) Nitroglycerin sublingual
C) Aspirin
D) Oxygen
Correct Answer: C) Aspirin
Rationale: Aspirin should be administered immediately upon suspicion of MI because it
reduces mortality by inhibiting platelet aggregation and preventing further clot formation.
While oxygen, nitroglycerin, and morphine are also part of the MONA protocol, aspirin is the
priority initial intervention.
,Question 5:
A client with heart failure has crackles in the lungs and peripheral edema. The nurse should
anticipate which intervention?
A) Administer diuretics
B) Restrict fluids and sodium
C) Administer oxygen
D) All of the above
Correct Answer: D) All of the above
Rationale: Crackles and edema indicate fluid volume overload. Diuretics promote fluid
excretion, fluid and sodium restriction reduces fluid retention, and oxygen improves
oxygenation. All interventions are appropriate for managing acute heart failure exacerbation.
Question 6:
A client with angina pectoris reports chest pain that occurs with exertion and resolves with
rest and nitroglycerin. The nurse should document this as which type of angina?
A) Unstable angina
B) Variant angina
C) Stable angina
D) Prinzmetal's angina
Correct Answer: C) Stable angina
Rationale: Stable angina is characterized by chest pain that occurs predictably with
exertion or stress and is relieved by rest or nitroglycerin. Unstable angina occurs at rest or
with minimal exertion and is not relieved by rest. Variant (Prinzmetal's) angina occurs at rest
due to coronary artery spasm.
Question 7:
A nurse is assessing a client with left-sided heart failure. Which finding is most indicative of
this condition?
A) Peripheral edema
B) Jugular vein distention
C) Crackles in the lung bases
D) Hepatomegaly
, Correct Answer: C) Crackles in the lung bases
Rationale: Left-sided heart failure causes blood to back up into the pulmonary circulation,
leading to pulmonary congestion and crackles. Peripheral edema, jugular vein distention,
and hepatomegaly are signs of right-sided heart failure.
Question 8:
A client is prescribed warfarin for atrial fibrillation. Which laboratory value should the nurse
monitor to evaluate therapeutic effectiveness?
A) aPTT
B) INR
C) Platelet count
D) Serum potassium
Correct Answer: B) INR
Rationale: Warfarin is monitored using the International Normalized Ratio (INR). The
therapeutic INR for atrial fibrillation is typically 2.0-3.0. aPTT is used to monitor heparin
therapy. Platelet count monitors for thrombocytopenia, and potassium monitoring is not
specific to warfarin therapy.
Question 9:
A client with peripheral arterial disease (PAD) reports leg pain when walking that is relieved
by rest. The nurse should document this as:
A) Rest pain
B) Intermittent claudication
C) Venous insufficiency
D) Neuropathic pain
Correct Answer: B) Intermittent claudication
Rationale: Intermittent claudication is pain in the legs (typically calves) that occurs with
exercise and is relieved by rest. It is caused by inadequate blood flow to the muscles during
activity due to peripheral arterial disease. Rest pain indicates severe arterial insufficiency.
