ACTUAL ATI Med-Surg Proctored Exam Test Bank 2026 | Medical-
Surgical Nursing, NCLEX Preparation | Multiple Choice Questions
and Answers with Verified Rationales With Complete Solutions.
SECTION 1: CARDIOVASCULAR DISORDERS
Question 1
A nurse is caring for a client with heart failure who is receiving digoxin (Lanoxin) 0.25 mg
daily. Which of the following findings indicates digoxin toxicity?
A) Heart rate of 62 bpm
B) Blood pressure of 118/76 mmHg
C) Nausea and yellow-tinged vision
D) Urine output of 50 mL/hour
Correct Answer: C) Nausea and yellow-tinged vision
Rationale:
Classic signs of digoxin toxicity include gastrointestinal symptoms (nausea, vomiting,
anorexia) and visual disturbances including yellow-green halos or blurred vision. Other
signs include bradycardia, cardiac dysrhythmias, and confusion. The therapeutic range is
narrow (0.8-2.0 ng/mL), and toxicity risk increases with hypokalemia, renal impairment,
and advanced age .
Distractor Analysis:
,• A) HR 62 bpm: Normal heart rate; digoxin is typically held if heart rate is below 60 bpm
• B) BP 118/76 mmHg: Normal blood pressure; digoxin toxicity does not directly cause
hypotension
• D) Urine output 50 mL/hr: Normal urine output; not indicative of digoxin toxicity
High-Yield Tip: Remember "Nausea, vomiting, anorexia, and yellow halos" as the classic
signs. Hypokalemia increases the risk of digoxin toxicity, so always check potassium
levels before administration.
Question 2
A nurse is assessing a client with heart failure. Which finding indicates worsening of the
client's condition?
A) Weight loss of 1 lb in 2 days
B) Increased urine output
C) Weight gain of 3 lbs in 2 days
D) Decreased edema in lower extremities
Correct Answer: C) Weight gain of 3 lbs in 2 days
Rationale:
Rapid weight gain in heart failure indicates fluid retention, reflecting worsening cardiac
function. The heart is unable to effectively pump blood forward, leading to fluid backup
and edema. A weight gain of 1-2 lb/day or 3+ lb/week is a warning sign of fluid overload.
Daily weights are the most sensitive indicator of fluid retention .
Distractor Analysis:
• A) Weight loss of 1 lb in 2 days: Indicates improvement or diuresis
• B) Increased urine output: Indicates effective diuresis and improvement
,• D) Decreased edema: Indicates improvement in fluid status
High-Yield Tip: Daily weight is more reliable than edema assessment or lung
auscultation for detecting early fluid overload. Instruct clients to weigh themselves at the
same time each day using the same scale.
Question 3
A client with a myocardial infarction is given nitroglycerin. What is the primary
therapeutic effect of this medication?
A) Increases preload
B) Decreases myocardial oxygen demand
C) Increases cardiac output
D) Increases platelet aggregation
Correct Answer: B) Decreases myocardial oxygen demand
Rationale:
Nitroglycerin is a nitrate that dilates veins, reducing venous return (preload). This
decreases ventricular wall tension, reducing the heart's workload and myocardial oxygen
consumption. This vasodilation effect is the primary mechanism for relieving anginal
chest pain in myocardial infarction .
Distractor Analysis:
• A) Increases preload: Nitroglycerin actually decreases preload through venous dilation
• C) Increases cardiac output: Nitroglycerin may initially reduce cardiac output due to
decreased preload
• D) Increases platelet aggregation: Nitroglycerin does not affect platelet function;
aspirin is used for antiplatelet effects
, High-Yield Tip: Nitroglycerin works primarily on veins at lower doses and arteries at
higher doses. Sublingual administration provides rapid onset (1-3 minutes) for acute
angina relief.
Question 4
A client is prescribed furosemide (Lasix) for heart failure. Which laboratory value should
the nurse monitor most closely?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
Correct Answer: B) Serum potassium
Rationale:
Furosemide is a loop diuretic that inhibits sodium and chloride reabsorption in the
ascending loop of Henle, causing significant potassium loss. Hypokalemia is a common
adverse effect and increases the risk of digoxin toxicity and cardiac dysrhythmias.
Monitor serum potassium closely and replace as needed .
Distractor Analysis:
• A) Serum sodium: Hyponatremia can occur but is less common and less immediately
dangerous
• C) Serum calcium: Furosemide may cause slight calcium loss but potassium is more
critical
• D) Serum magnesium: Magnesium loss can occur but is not the primary concern
Surgical Nursing, NCLEX Preparation | Multiple Choice Questions
and Answers with Verified Rationales With Complete Solutions.
SECTION 1: CARDIOVASCULAR DISORDERS
Question 1
A nurse is caring for a client with heart failure who is receiving digoxin (Lanoxin) 0.25 mg
daily. Which of the following findings indicates digoxin toxicity?
A) Heart rate of 62 bpm
B) Blood pressure of 118/76 mmHg
C) Nausea and yellow-tinged vision
D) Urine output of 50 mL/hour
Correct Answer: C) Nausea and yellow-tinged vision
Rationale:
Classic signs of digoxin toxicity include gastrointestinal symptoms (nausea, vomiting,
anorexia) and visual disturbances including yellow-green halos or blurred vision. Other
signs include bradycardia, cardiac dysrhythmias, and confusion. The therapeutic range is
narrow (0.8-2.0 ng/mL), and toxicity risk increases with hypokalemia, renal impairment,
and advanced age .
Distractor Analysis:
,• A) HR 62 bpm: Normal heart rate; digoxin is typically held if heart rate is below 60 bpm
• B) BP 118/76 mmHg: Normal blood pressure; digoxin toxicity does not directly cause
hypotension
• D) Urine output 50 mL/hr: Normal urine output; not indicative of digoxin toxicity
High-Yield Tip: Remember "Nausea, vomiting, anorexia, and yellow halos" as the classic
signs. Hypokalemia increases the risk of digoxin toxicity, so always check potassium
levels before administration.
Question 2
A nurse is assessing a client with heart failure. Which finding indicates worsening of the
client's condition?
A) Weight loss of 1 lb in 2 days
B) Increased urine output
C) Weight gain of 3 lbs in 2 days
D) Decreased edema in lower extremities
Correct Answer: C) Weight gain of 3 lbs in 2 days
Rationale:
Rapid weight gain in heart failure indicates fluid retention, reflecting worsening cardiac
function. The heart is unable to effectively pump blood forward, leading to fluid backup
and edema. A weight gain of 1-2 lb/day or 3+ lb/week is a warning sign of fluid overload.
Daily weights are the most sensitive indicator of fluid retention .
Distractor Analysis:
• A) Weight loss of 1 lb in 2 days: Indicates improvement or diuresis
• B) Increased urine output: Indicates effective diuresis and improvement
,• D) Decreased edema: Indicates improvement in fluid status
High-Yield Tip: Daily weight is more reliable than edema assessment or lung
auscultation for detecting early fluid overload. Instruct clients to weigh themselves at the
same time each day using the same scale.
Question 3
A client with a myocardial infarction is given nitroglycerin. What is the primary
therapeutic effect of this medication?
A) Increases preload
B) Decreases myocardial oxygen demand
C) Increases cardiac output
D) Increases platelet aggregation
Correct Answer: B) Decreases myocardial oxygen demand
Rationale:
Nitroglycerin is a nitrate that dilates veins, reducing venous return (preload). This
decreases ventricular wall tension, reducing the heart's workload and myocardial oxygen
consumption. This vasodilation effect is the primary mechanism for relieving anginal
chest pain in myocardial infarction .
Distractor Analysis:
• A) Increases preload: Nitroglycerin actually decreases preload through venous dilation
• C) Increases cardiac output: Nitroglycerin may initially reduce cardiac output due to
decreased preload
• D) Increases platelet aggregation: Nitroglycerin does not affect platelet function;
aspirin is used for antiplatelet effects
, High-Yield Tip: Nitroglycerin works primarily on veins at lower doses and arteries at
higher doses. Sublingual administration provides rapid onset (1-3 minutes) for acute
angina relief.
Question 4
A client is prescribed furosemide (Lasix) for heart failure. Which laboratory value should
the nurse monitor most closely?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
Correct Answer: B) Serum potassium
Rationale:
Furosemide is a loop diuretic that inhibits sodium and chloride reabsorption in the
ascending loop of Henle, causing significant potassium loss. Hypokalemia is a common
adverse effect and increases the risk of digoxin toxicity and cardiac dysrhythmias.
Monitor serum potassium closely and replace as needed .
Distractor Analysis:
• A) Serum sodium: Hyponatremia can occur but is less common and less immediately
dangerous
• C) Serum calcium: Furosemide may cause slight calcium loss but potassium is more
critical
• D) Serum magnesium: Magnesium loss can occur but is not the primary concern
