ATI Adult Medical-Surgical
Practice Assessment A -
Version 2.0 well written one
year 2025 /2026 updated
graded A+ Comprehensive 150-Question
Practice Examination
Instructions
This comprehensive practice examination contains 150 multiple-choice questions designed to assess
knowledge and clinical judgment in adult medical-surgical nursing. Each question includes one correct
answer with a detailed rationale. Select the best answer for each question.
Cardiovascular Disorders (Questions 1-20)
1. A nurse is assessing a client with heart failure who reports sudden, severe dyspnea and
coughingup pink, frothy sputum. The nurse should identify these findings as indicating which
of the following complications?
A. Pulmonary embolism
B. Acute pulmonary edema
C. Cardiac tamponade
D. Pneumothorax
- detailed answer 100% correct:_B. Acute pulmonary edema
,Rationale: Pink, frothy sputum is a classic manifestation of acute pulmonary edema, a life-threatening
complication of left-sided heart failure where fluid accumulates in the alveoli. Pulmonary embolism
presents with sudden dyspnea and pleuritic chest pain but not pink frothy sputum. Cardiac
tamponade presents with muffled heart sounds, hypotension, and jugular venous distention.
Pneumothorax presents with sudden sharp chest pain and decreased breath sounds.
2. A client is prescribed digoxin for heart failure. Which of the following findings indicates
digoxintoxicity?
A. Heart rate 62 beats/min
B. Visual disturbances (yellow-green halos)
C. Blood pressure 138/86 mmHg
D. Serum digoxin level 1.2 ng/mL
- detailed answer 100% correct:_B. Visual disturbances (yellow-green halos)
Rationale: Visual disturbances such as yellow-green halos, blurred vision, and photophobia are classic
signs of digoxin toxicity. A normal digoxin therapeutic range is 0.8-2.0 ng/mL, so 1.2 ng/mL is within
therapeutic range. Bradycardia may occur with digoxin but a heart rate of 62 is not concerning. Blood
pressure is normal.
3. A nurse is caring for a client who has atrial fibrillation and is prescribed warfarin. The
client's INRis 4.5. Which of the following actions should the nurse take?
A. Administer the warfarin as prescribed
B. Hold the warfarin and notify the provider
C. Administer vitamin K immediately
D. Increase the warfarin dose
- detailed answer 100% correct:_B. Hold the warfarin and notify the provider
Rationale: The therapeutic INR range for atrial fibrillation is typically 2.0-3.0. An INR of 4.5 indicates
supratherapeutic anticoagulation and increased bleeding risk. The nurse should hold the medication
and notify the provider. Vitamin K may be ordered if bleeding occurs or if the INR is critically elevated,
but should not be administered without an order.
,4. A client with unstable angina is receiving continuous IV heparin therapy. Which
laboratory valueshould the nurse monitor to evaluate the effectiveness of therapy?
A. Prothrombin time (PT)
B. Activated partial thromboplastin time (aPTT)
C. International normalized ratio (INR)
D. Platelet count
- detailed answer 100% correct:_B. Activated partial thromboplastin time (aPTT)
Rationale: Heparin therapy is monitored using aPTT, with a therapeutic goal typically 1.5-2.5 times the
control value. PT and INR are used to monitor warfarin therapy. Platelet count is monitored to detect
heparin-induced thrombocytopenia but does not evaluate therapeutic effectiveness.
5. A nurse is assessing a client who has peripheral arterial disease (PAD). Which of the
followingfindings should the nurse expect?
A. Brownish discoloration of the lower legs
B. Thick, hardened skin on the lower legs
C. Cool, pale extremities with diminished pulses
D. Dependent edema and varicose veins
- detailed answer 100% correct:_C. Cool, pale extremities with diminished pulses
Rationale: PAD is characterized by reduced arterial blood flow, resulting in cool, pale extremities with
diminished or absent pulses. Brownish discoloration, thick hardened skin, dependent edema, and
varicose veins are associated with venous insufficiency, not arterial disease.
6. A client is 2 days post-myocardial infarction. Which of the following assessment findings
shouldthe nurse report to the provider immediately?
A. Heart rate 88 beats/min
B. Blood pressure 142/88 mmHg
C. Crackles auscultated in bilateral lung bases
D. Temperature 37.6°C
- detailed answer 100% correct:_C. Crackles auscultated in bilateral lung bases
, Rationale: Crackles in the lung bases indicate pulmonary congestion and may signal worsening heart
failure, a common complication following MI. This finding requires immediate notification of the
provider for potential intervention. The other findings are within normal limits or not immediately
concerning.
7. A client with heart failure is prescribed furosemide. Which of the following foods should
thenurse recommend to prevent hypokalemia?
A. Apples
B. Bananas
C. Carrots
D. Rice
- detailed answer 100% correct:_B. Bananas
Rationale: Furosemide causes potassium loss. Bananas are high in potassium and should be
recommended to help maintain potassium levels. Apples, carrots, and rice are not significant sources
of potassium.
8. A nurse is caring for a client who has a new diagnosis of hypertension. Which of the
followinglifestyle modifications should the nurse recommend?
A. Increase sodium intake to 3,000 mg/day
B. Engage in aerobic exercise 30 minutes most days
C. Limit alcohol consumption to 3 drinks per day
D. Decrease potassium intake
- detailed answer 100% correct:_B. Engage in aerobic exercise 30 minutes most days
Rationale: Regular aerobic exercise (at least 30 minutes most days) is recommended for hypertension
management. Sodium should be limited to <2,300 mg/day, alcohol should be limited to 1 drink/day
for women and 2 for men, and potassium intake should be increased, not decreased.
9. A client is receiving IV nitroglycerin for chest pain. Which of the following adverse effects
shouldthe nurse monitor for?
Practice Assessment A -
Version 2.0 well written one
year 2025 /2026 updated
graded A+ Comprehensive 150-Question
Practice Examination
Instructions
This comprehensive practice examination contains 150 multiple-choice questions designed to assess
knowledge and clinical judgment in adult medical-surgical nursing. Each question includes one correct
answer with a detailed rationale. Select the best answer for each question.
Cardiovascular Disorders (Questions 1-20)
1. A nurse is assessing a client with heart failure who reports sudden, severe dyspnea and
coughingup pink, frothy sputum. The nurse should identify these findings as indicating which
of the following complications?
A. Pulmonary embolism
B. Acute pulmonary edema
C. Cardiac tamponade
D. Pneumothorax
- detailed answer 100% correct:_B. Acute pulmonary edema
,Rationale: Pink, frothy sputum is a classic manifestation of acute pulmonary edema, a life-threatening
complication of left-sided heart failure where fluid accumulates in the alveoli. Pulmonary embolism
presents with sudden dyspnea and pleuritic chest pain but not pink frothy sputum. Cardiac
tamponade presents with muffled heart sounds, hypotension, and jugular venous distention.
Pneumothorax presents with sudden sharp chest pain and decreased breath sounds.
2. A client is prescribed digoxin for heart failure. Which of the following findings indicates
digoxintoxicity?
A. Heart rate 62 beats/min
B. Visual disturbances (yellow-green halos)
C. Blood pressure 138/86 mmHg
D. Serum digoxin level 1.2 ng/mL
- detailed answer 100% correct:_B. Visual disturbances (yellow-green halos)
Rationale: Visual disturbances such as yellow-green halos, blurred vision, and photophobia are classic
signs of digoxin toxicity. A normal digoxin therapeutic range is 0.8-2.0 ng/mL, so 1.2 ng/mL is within
therapeutic range. Bradycardia may occur with digoxin but a heart rate of 62 is not concerning. Blood
pressure is normal.
3. A nurse is caring for a client who has atrial fibrillation and is prescribed warfarin. The
client's INRis 4.5. Which of the following actions should the nurse take?
A. Administer the warfarin as prescribed
B. Hold the warfarin and notify the provider
C. Administer vitamin K immediately
D. Increase the warfarin dose
- detailed answer 100% correct:_B. Hold the warfarin and notify the provider
Rationale: The therapeutic INR range for atrial fibrillation is typically 2.0-3.0. An INR of 4.5 indicates
supratherapeutic anticoagulation and increased bleeding risk. The nurse should hold the medication
and notify the provider. Vitamin K may be ordered if bleeding occurs or if the INR is critically elevated,
but should not be administered without an order.
,4. A client with unstable angina is receiving continuous IV heparin therapy. Which
laboratory valueshould the nurse monitor to evaluate the effectiveness of therapy?
A. Prothrombin time (PT)
B. Activated partial thromboplastin time (aPTT)
C. International normalized ratio (INR)
D. Platelet count
- detailed answer 100% correct:_B. Activated partial thromboplastin time (aPTT)
Rationale: Heparin therapy is monitored using aPTT, with a therapeutic goal typically 1.5-2.5 times the
control value. PT and INR are used to monitor warfarin therapy. Platelet count is monitored to detect
heparin-induced thrombocytopenia but does not evaluate therapeutic effectiveness.
5. A nurse is assessing a client who has peripheral arterial disease (PAD). Which of the
followingfindings should the nurse expect?
A. Brownish discoloration of the lower legs
B. Thick, hardened skin on the lower legs
C. Cool, pale extremities with diminished pulses
D. Dependent edema and varicose veins
- detailed answer 100% correct:_C. Cool, pale extremities with diminished pulses
Rationale: PAD is characterized by reduced arterial blood flow, resulting in cool, pale extremities with
diminished or absent pulses. Brownish discoloration, thick hardened skin, dependent edema, and
varicose veins are associated with venous insufficiency, not arterial disease.
6. A client is 2 days post-myocardial infarction. Which of the following assessment findings
shouldthe nurse report to the provider immediately?
A. Heart rate 88 beats/min
B. Blood pressure 142/88 mmHg
C. Crackles auscultated in bilateral lung bases
D. Temperature 37.6°C
- detailed answer 100% correct:_C. Crackles auscultated in bilateral lung bases
, Rationale: Crackles in the lung bases indicate pulmonary congestion and may signal worsening heart
failure, a common complication following MI. This finding requires immediate notification of the
provider for potential intervention. The other findings are within normal limits or not immediately
concerning.
7. A client with heart failure is prescribed furosemide. Which of the following foods should
thenurse recommend to prevent hypokalemia?
A. Apples
B. Bananas
C. Carrots
D. Rice
- detailed answer 100% correct:_B. Bananas
Rationale: Furosemide causes potassium loss. Bananas are high in potassium and should be
recommended to help maintain potassium levels. Apples, carrots, and rice are not significant sources
of potassium.
8. A nurse is caring for a client who has a new diagnosis of hypertension. Which of the
followinglifestyle modifications should the nurse recommend?
A. Increase sodium intake to 3,000 mg/day
B. Engage in aerobic exercise 30 minutes most days
C. Limit alcohol consumption to 3 drinks per day
D. Decrease potassium intake
- detailed answer 100% correct:_B. Engage in aerobic exercise 30 minutes most days
Rationale: Regular aerobic exercise (at least 30 minutes most days) is recommended for hypertension
management. Sodium should be limited to <2,300 mg/day, alcohol should be limited to 1 drink/day
for women and 2 for men, and potassium intake should be increased, not decreased.
9. A client is receiving IV nitroglycerin for chest pain. Which of the following adverse effects
shouldthe nurse monitor for?
