ATI CAPSTONE MED SURG ASSESSEMENT 1 AND 2 - 100
Questions and Answers Already Graded A+ Premium Exam
Tested And Verified
Subject Area Medical-Surgical Nursing
Description This exam assesses advanced knowledge in medical-surgical nursing, covering
complex pathophysiology, evidence-based interventions, and critical
decision-making for adult patients with acute and chronic conditions. It integrates
pharmacology, diagnostics, and nursing management across multiple body
systems.
Expected Grade A+
Total Questions 100
Duration 3 hours
Learning Outcomes 1. Analyze complex pathophysiological processes to prioritize nursing
interventions.
2. Integrate pharmacological principles with patient-specific factors to optimize
outcomes.
3. Interpret diagnostic data to guide clinical decision-making in acute care
settings.
4. Evaluate evidence-based practices for managing multisystem complications.
5. Apply safety and quality standards in high-acuity medical-surgical nursing.
Accreditation Complies with AACN and CCNE standards for baccalaureate nursing education.
Page 1
,1. A patient with end-stage liver disease develops asterixis and confusion. Serum
ammonia is 180 mcg/dL. Which intervention is most likely to reduce ammonia
production?
A. Administer lactulose orally or via nasogastric tube
B. Start intravenous albumin infusion
C. Give furosemide to promote diuresis
D. Initiate broad-spectrum antibiotics
Answer: A. Administer lactulose orally or via nasogastric tube
Lactulose acidifies the colon, trapping ammonium ions and reducing absorption. It also
promotes excretion via osmotic diarrhea. Albumin and diuretics do not directly reduce
ammonia production. Antibiotics (e.g., rifaximin) reduce gut bacteria but are
second-line; lactulose is first-line.
2. In a patient with acute respiratory distress syndrome (ARDS) on
volume-controlled ventilation, plateau pressure rises to 32 cm H2O and PaO2/FiO2
ratio drops to 150. Which ventilator adjustment is most appropriate?
A. Increase positive end-expiratory pressure (PEEP) to 15 cm H2O
B. Increase tidal volume to 8 mL/kg predicted body weight
C. Switch to pressure-controlled ventilation with peak pressure 35 cm H2O
D. Decrease respiratory rate to 10 breaths/min
Answer: A. Increase positive end-expiratory pressure (PEEP) to 15 cm H2O
High plateau pressure indicates overdistension; increasing PEEP can recruit alveoli
and improve oxygenation without raising plateau pressure if done cautiously.
Increasing tidal volume would worsen barotrauma. Pressure control may not lower
plateau pressure. Decreasing rate could worsen ventilation.
Page 2
,3. A patient receiving vancomycin for MRSA pneumonia has a trough level of 25
mcg/mL and serum creatinine rising from 0.8 to 1.5 mg/dL over 48 hours. What is
the priority action?
A. Discontinue vancomycin and start daptomycin
B. Reduce vancomycin dose and interval based on renal function
C. Continue current dose and monitor renal function daily
D. Administer intravenous fluids and sodium bicarbonate
Answer: B. Reduce vancomycin dose and interval based on renal function
Vancomycin trough >20 mcg/mL increases nephrotoxicity risk. With rising creatinine,
dose adjustment is necessary. Daptomycin is inactivated by pulmonary surfactant and
not effective for pneumonia. Fluids and bicarbonate do not address drug toxicity.
Continuing same dose risks further renal injury.
4. A patient with diabetic ketoacidosis has serum potassium 3.2 mEq/L after two
hours of insulin infusion. Which intervention is indicated?
A. Hold insulin until potassium is >3.5 mEq/L
B. Continue insulin and infuse potassium chloride 20 mEq/h
C. Decrease insulin infusion rate by 50%
D. Administer potassium-sparing diuretic
Answer: B. Continue insulin and infuse potassium chloride 20 mEq/h
Insulin drives potassium into cells, causing hypokalemia. Potassium replacement is
needed to prevent dysrhythmias; insulin should continue to correct acidosis. Holding
insulin would worsen DKA. Decreasing rate does not address hypokalemia.
Potassium-sparing diuretic would be harmful.
Page 3
, 5. A patient with acute pancreatitis develops sudden dyspnea, oxygen saturation
88% on room air, and a new pleural effusion on chest X-ray. Which complication is
most likely?
A. Acute respiratory distress syndrome (ARDS)
B. Pulmonary embolism
C. Pancreatic pseudocyst rupture
D. Spontaneous pneumothorax
Answer: A. Acute respiratory distress syndrome (ARDS)
ARDS is a common complication of severe pancreatitis due to systemic inflammation. It
presents with hypoxemia, dyspnea, and bilateral infiltrates/effusion. Pulmonary
embolism would not typically cause pleural effusion. Pseudocyst rupture causes
peritonitis, not respiratory symptoms. Pneumothorax would show air, not effusion.
6. A patient with chronic kidney disease (GFR 25 mL/min) is prescribed
spironolactone for heart failure. Which laboratory value requires immediate
intervention before administration?
A. Serum potassium 5.6 mEq/L
B. Serum sodium 132 mEq/L
C. Serum magnesium 2.0 mg/dL
D. Serum calcium 9.0 mg/dL
Answer: A. Serum potassium 5.6 mEq/L
Spironolactone is a potassium-sparing diuretic; in CKD with GFR <30, hyperkalemia
risk is high. Potassium >5.0 mEq/L contraindicates use. Hyponatremia,
hypomagnesemia, and hypocalcemia are not absolute contraindications but require
monitoring.
Page 4
Questions and Answers Already Graded A+ Premium Exam
Tested And Verified
Subject Area Medical-Surgical Nursing
Description This exam assesses advanced knowledge in medical-surgical nursing, covering
complex pathophysiology, evidence-based interventions, and critical
decision-making for adult patients with acute and chronic conditions. It integrates
pharmacology, diagnostics, and nursing management across multiple body
systems.
Expected Grade A+
Total Questions 100
Duration 3 hours
Learning Outcomes 1. Analyze complex pathophysiological processes to prioritize nursing
interventions.
2. Integrate pharmacological principles with patient-specific factors to optimize
outcomes.
3. Interpret diagnostic data to guide clinical decision-making in acute care
settings.
4. Evaluate evidence-based practices for managing multisystem complications.
5. Apply safety and quality standards in high-acuity medical-surgical nursing.
Accreditation Complies with AACN and CCNE standards for baccalaureate nursing education.
Page 1
,1. A patient with end-stage liver disease develops asterixis and confusion. Serum
ammonia is 180 mcg/dL. Which intervention is most likely to reduce ammonia
production?
A. Administer lactulose orally or via nasogastric tube
B. Start intravenous albumin infusion
C. Give furosemide to promote diuresis
D. Initiate broad-spectrum antibiotics
Answer: A. Administer lactulose orally or via nasogastric tube
Lactulose acidifies the colon, trapping ammonium ions and reducing absorption. It also
promotes excretion via osmotic diarrhea. Albumin and diuretics do not directly reduce
ammonia production. Antibiotics (e.g., rifaximin) reduce gut bacteria but are
second-line; lactulose is first-line.
2. In a patient with acute respiratory distress syndrome (ARDS) on
volume-controlled ventilation, plateau pressure rises to 32 cm H2O and PaO2/FiO2
ratio drops to 150. Which ventilator adjustment is most appropriate?
A. Increase positive end-expiratory pressure (PEEP) to 15 cm H2O
B. Increase tidal volume to 8 mL/kg predicted body weight
C. Switch to pressure-controlled ventilation with peak pressure 35 cm H2O
D. Decrease respiratory rate to 10 breaths/min
Answer: A. Increase positive end-expiratory pressure (PEEP) to 15 cm H2O
High plateau pressure indicates overdistension; increasing PEEP can recruit alveoli
and improve oxygenation without raising plateau pressure if done cautiously.
Increasing tidal volume would worsen barotrauma. Pressure control may not lower
plateau pressure. Decreasing rate could worsen ventilation.
Page 2
,3. A patient receiving vancomycin for MRSA pneumonia has a trough level of 25
mcg/mL and serum creatinine rising from 0.8 to 1.5 mg/dL over 48 hours. What is
the priority action?
A. Discontinue vancomycin and start daptomycin
B. Reduce vancomycin dose and interval based on renal function
C. Continue current dose and monitor renal function daily
D. Administer intravenous fluids and sodium bicarbonate
Answer: B. Reduce vancomycin dose and interval based on renal function
Vancomycin trough >20 mcg/mL increases nephrotoxicity risk. With rising creatinine,
dose adjustment is necessary. Daptomycin is inactivated by pulmonary surfactant and
not effective for pneumonia. Fluids and bicarbonate do not address drug toxicity.
Continuing same dose risks further renal injury.
4. A patient with diabetic ketoacidosis has serum potassium 3.2 mEq/L after two
hours of insulin infusion. Which intervention is indicated?
A. Hold insulin until potassium is >3.5 mEq/L
B. Continue insulin and infuse potassium chloride 20 mEq/h
C. Decrease insulin infusion rate by 50%
D. Administer potassium-sparing diuretic
Answer: B. Continue insulin and infuse potassium chloride 20 mEq/h
Insulin drives potassium into cells, causing hypokalemia. Potassium replacement is
needed to prevent dysrhythmias; insulin should continue to correct acidosis. Holding
insulin would worsen DKA. Decreasing rate does not address hypokalemia.
Potassium-sparing diuretic would be harmful.
Page 3
, 5. A patient with acute pancreatitis develops sudden dyspnea, oxygen saturation
88% on room air, and a new pleural effusion on chest X-ray. Which complication is
most likely?
A. Acute respiratory distress syndrome (ARDS)
B. Pulmonary embolism
C. Pancreatic pseudocyst rupture
D. Spontaneous pneumothorax
Answer: A. Acute respiratory distress syndrome (ARDS)
ARDS is a common complication of severe pancreatitis due to systemic inflammation. It
presents with hypoxemia, dyspnea, and bilateral infiltrates/effusion. Pulmonary
embolism would not typically cause pleural effusion. Pseudocyst rupture causes
peritonitis, not respiratory symptoms. Pneumothorax would show air, not effusion.
6. A patient with chronic kidney disease (GFR 25 mL/min) is prescribed
spironolactone for heart failure. Which laboratory value requires immediate
intervention before administration?
A. Serum potassium 5.6 mEq/L
B. Serum sodium 132 mEq/L
C. Serum magnesium 2.0 mg/dL
D. Serum calcium 9.0 mg/dL
Answer: A. Serum potassium 5.6 mEq/L
Spironolactone is a potassium-sparing diuretic; in CKD with GFR <30, hyperkalemia
risk is high. Potassium >5.0 mEq/L contraindicates use. Hyponatremia,
hypomagnesemia, and hypocalcemia are not absolute contraindications but require
monitoring.
Page 4
