Ultimate ATI RN Med Surg Retake 2 Exam Prep: Actual Practice Questions with Detailed Rationales to Help You Pass on Your First Attempt

Ultimate ATI RN Med Surg Retake 2 Exam Prep: Actual
Practice Questions with Detailed Rationales to Help
You Pass on Your First Attempt



SECTION 1: CARDIOVASCULAR SYSTEM (Questions 1-20)


1. A nurse is caring for a client with heart failure who has gained 2 kg (4.4 lbs) in 24

hours. Which assessment finding is the priority?


 A) Blood pressure 138/88 mmHg

 B) Heart rate 92 bpm

 C) Jugular venous distention

 D) Crackles auscultated halfway up the lung fields


Answer: D. Crackles halfway up the lung fields indicate pulmonary edema, a life-

threatening complication requiring immediate intervention. While JVD, tachycardia, and

elevated BP are also concerning, crackles indicate fluid in the lungs that can compromise

gas exchange.


2. A client with heart failure is prescribed digoxin. Which finding indicates digoxin

toxicity?

, A) Heart rate of 68 bpm

 B) Serum potassium of 3.8 mEq/L

 C) Yellow-green halos around visual fields

 D) Blood pressure of 120/78 mmHg


Answer: C. Yellow-green halos (xanthopsia) is a classic sign of digoxin toxicity. Other signs

include nausea, vomiting, anorexia, and bradycardia. Digoxin toxicity is more likely with

hypokalemia (K+ < 3.5 mEq/L).


3. A nurse is providing discharge teaching to a client with angina. Which statement

indicates a need for further teaching?


 A) "I should stop taking my nitroglycerin if I develop a headache."

 B) "I will take my nitroglycerin as prescribed."

 C) "I should sit down when I take my nitroglycerin."

 D) "I will call 911 if my chest pain is not relieved after taking nitroglycerin."


Answer: A. Headache is a common side effect of nitroglycerin and does not indicate the

client should stop taking it. The client should be taught to expect headaches and manage

them with OTC pain relievers.

, 4. A nurse is admitting a client who reports chest pain and has been placed on a

telemetry monitor. Which of the following should the nurse analyze to determine

whether the client is experiencing a myocardial infarction?


 A) PR interval

 B) QRS duration

 C) T wave

 D) ST segment


Answer: D. ST segment elevation indicates myocardial infarction. ST segment depression

indicates ischemia.


5. A client with heart failure is prescribed furosemide. Which laboratory value should

the nurse monitor closely?


 A) Serum sodium

 B) Serum potassium

 C) Serum calcium

 D) Serum magnesium


Answer: B. Furosemide is a loop diuretic that can cause hypokalemia. The nurse should

monitor potassium levels and encourage potassium-rich foods.

, 6. A nurse is assessing a client who has just returned from cardiac catheterization via

the femoral artery. Which finding requires immediate action?


 A) Pulse rate 76 bpm

 B) Blood pressure 118/72 mmHg

 C) Pallor and coolness of the affected extremity

 D) Small amount of serous drainage at the insertion site


Answer: C. Pallor and coolness of the affected extremity indicate arterial occlusion, a

medical emergency. The nurse should assess for pulses, color, warmth, and sensation.


7. A client is prescribed warfarin after a mechanical heart valve replacement. Which

laboratory value should the nurse monitor?


 A) Platelet count

 B) PT/INR

 C) PTT

 D) Hemoglobin


Answer: B. Warfarin is monitored using PT (prothrombin time) and INR (international

normalized ratio). Therapeutic INR for mechanical valves is typically 2.5-3.5.


8. A nurse is caring for a client with hypertension who is prescribed lisinopril. Which

side effect should the nurse monitor for?