ATI RN Adult Medical-Surgical (Med-
Surg) Advanced Practice Examination
Comprehensive 100-Question Test Bank with
Detailed Rationales
Cardiovascular System (Questions 1–20)
Question 1
A nurse is caring for a client with acute decompensated heart
failure who is receiving continuous IV infusion of nesiritide. Which
assessment finding requires immediate intervention?
A. Blood pressure 98/62 mm Hg
B. Heart rate 88/min and regular
C. Urine output 45 mL/hr
D. Mild headache
Correct Answer: A
Rationale: Nesiritide is a recombinant B-type natriuretic peptide
that causes vasodilation and can lead to significant hypotension. A
systolic blood pressure below 100 mm Hg or symptomatic
hypotension requires dose reduction or discontinuation. The other
findings are expected or acceptable during nesiritide therapy.
,Question 2
A client with unstable angina is scheduled for cardiac
catheterization. The nurse reviews the pre-procedure laboratory
results. Which finding is most concerning?
A. Serum creatinine 2.8 mg/dL
B. Hemoglobin 12.5 g/dL
C. Serum potassium 4.0 mEq/L
D. Platelet count 220,000/mm³
Correct Answer: A
Rationale: Contrast-induced nephropathy is a significant risk during
cardiac catheterization, particularly in clients with pre-existing renal
impairment. A creatinine of 2.8 mg/dL indicates significant renal
dysfunction and increases the risk of acute kidney injury from
contrast media. Pre-procedure hydration and nephroprotective
measures should be implemented.
Question 3
A nurse is assessing a client who is 6 hours post-percutaneous
coronary intervention (PCI) via the femoral artery. Which finding
indicates a potential complication requiring immediate notification
of the provider?
A. Pulse rate 76/min, regular
B. Left groin site with 3 cm ecchymosis
,C. Client reports feeling hungry
D. Right foot is pale and cool with weak dorsalis pedis pulse
Correct Answer: D
Rationale: Pale, cool extremity with diminished pulses distal to the
access site suggests arterial occlusion, thrombus formation, or
compromised circulation. This is a vascular emergency requiring
immediate intervention. Ecchymosis at the groin site is expected.
Hunger is not concerning. A heart rate of 76/min is normal.
Question 4
A client with chronic heart failure is prescribed carvedilol. Which
statement by the client indicates understanding of this medication?
A. "I should take this medication with food to prevent stomach
upset."
B. "I will monitor my weight daily and report any sudden increases."
C. "I can stop this medication if I feel dizzy or lightheaded."
D. "This medication will cure my heart failure over time."
Correct Answer: B
Rationale: Carvedilol is a beta-blocker used in heart failure
management. Daily weight monitoring is essential to detect fluid
retention, a sign of worsening heart failure. Abrupt discontinuation
of carvedilol can cause rebound tachycardia and worsening heart
failure. The medication manages symptoms and slows progression
but is not curative.
, Question 5
A nurse in the emergency department is assessing a client with
chest pain. Which finding is most indicative of an acute myocardial
infarction?
A. Pain that is relieved by rest
B. Pain that radiates to the left arm
C. ST-segment elevation on ECG
D. Pain described as sharp and stabbing
Correct Answer: C
Rationale: ST-segment elevation on ECG is a hallmark finding of
ST-elevation myocardial infarction (STEMI) and indicates transmural
ischemia. While radiation to the left arm is classic, it is not specific
to MI. Pain relieved by rest suggests stable angina. Sharp, stabbing
pain is more characteristic of pericarditis or musculoskeletal pain.
Question 6
A client with atrial fibrillation has been prescribed warfarin. The
nurse notes an INR of 4.2. Which action should the nurse take first?
A. Administer vitamin K as prescribed
B. Hold the next dose of warfarin
C. Notify the healthcare provider
D. Assess the client for signs of bleeding
Correct Answer: D
Surg) Advanced Practice Examination
Comprehensive 100-Question Test Bank with
Detailed Rationales
Cardiovascular System (Questions 1–20)
Question 1
A nurse is caring for a client with acute decompensated heart
failure who is receiving continuous IV infusion of nesiritide. Which
assessment finding requires immediate intervention?
A. Blood pressure 98/62 mm Hg
B. Heart rate 88/min and regular
C. Urine output 45 mL/hr
D. Mild headache
Correct Answer: A
Rationale: Nesiritide is a recombinant B-type natriuretic peptide
that causes vasodilation and can lead to significant hypotension. A
systolic blood pressure below 100 mm Hg or symptomatic
hypotension requires dose reduction or discontinuation. The other
findings are expected or acceptable during nesiritide therapy.
,Question 2
A client with unstable angina is scheduled for cardiac
catheterization. The nurse reviews the pre-procedure laboratory
results. Which finding is most concerning?
A. Serum creatinine 2.8 mg/dL
B. Hemoglobin 12.5 g/dL
C. Serum potassium 4.0 mEq/L
D. Platelet count 220,000/mm³
Correct Answer: A
Rationale: Contrast-induced nephropathy is a significant risk during
cardiac catheterization, particularly in clients with pre-existing renal
impairment. A creatinine of 2.8 mg/dL indicates significant renal
dysfunction and increases the risk of acute kidney injury from
contrast media. Pre-procedure hydration and nephroprotective
measures should be implemented.
Question 3
A nurse is assessing a client who is 6 hours post-percutaneous
coronary intervention (PCI) via the femoral artery. Which finding
indicates a potential complication requiring immediate notification
of the provider?
A. Pulse rate 76/min, regular
B. Left groin site with 3 cm ecchymosis
,C. Client reports feeling hungry
D. Right foot is pale and cool with weak dorsalis pedis pulse
Correct Answer: D
Rationale: Pale, cool extremity with diminished pulses distal to the
access site suggests arterial occlusion, thrombus formation, or
compromised circulation. This is a vascular emergency requiring
immediate intervention. Ecchymosis at the groin site is expected.
Hunger is not concerning. A heart rate of 76/min is normal.
Question 4
A client with chronic heart failure is prescribed carvedilol. Which
statement by the client indicates understanding of this medication?
A. "I should take this medication with food to prevent stomach
upset."
B. "I will monitor my weight daily and report any sudden increases."
C. "I can stop this medication if I feel dizzy or lightheaded."
D. "This medication will cure my heart failure over time."
Correct Answer: B
Rationale: Carvedilol is a beta-blocker used in heart failure
management. Daily weight monitoring is essential to detect fluid
retention, a sign of worsening heart failure. Abrupt discontinuation
of carvedilol can cause rebound tachycardia and worsening heart
failure. The medication manages symptoms and slows progression
but is not curative.
, Question 5
A nurse in the emergency department is assessing a client with
chest pain. Which finding is most indicative of an acute myocardial
infarction?
A. Pain that is relieved by rest
B. Pain that radiates to the left arm
C. ST-segment elevation on ECG
D. Pain described as sharp and stabbing
Correct Answer: C
Rationale: ST-segment elevation on ECG is a hallmark finding of
ST-elevation myocardial infarction (STEMI) and indicates transmural
ischemia. While radiation to the left arm is classic, it is not specific
to MI. Pain relieved by rest suggests stable angina. Sharp, stabbing
pain is more characteristic of pericarditis or musculoskeletal pain.
Question 6
A client with atrial fibrillation has been prescribed warfarin. The
nurse notes an INR of 4.2. Which action should the nurse take first?
A. Administer vitamin K as prescribed
B. Hold the next dose of warfarin
C. Notify the healthcare provider
D. Assess the client for signs of bleeding
Correct Answer: D
