RN VATI Adult Medical Surgical
Assessment Exam QUESTIONS AND
ANSWERS ALREADY GRADED A+. 100%
Verified Solutions | Updated Per Latest
Guidelines | Graded A+
Question 1
A client with heart failure is prescribed furosemide (Lasix). Which assessment
finding indicates the medication is having the desired therapeutic effect? Select all
that apply.
A) Decreased shortness of breath
B) Weight loss of 2 kg in 24 hours
C) Increased jugular venous distension
D) Decreased peripheral edema
E) Increased crackles in lung bases
Correct Answers: A, B, D
Rationales>..: Furosemide is a loop diuretic that reduces fluid volume overload.
Desired effects include decreased dyspnea (A), weight loss from fluid loss (B), and
decreased peripheral edema (D). JVD (C) and crackles (E) indicate fluid overload
and would decrease, not increase, with effective therapy.
,Question 2
A client is receiving heparin therapy for a deep vein thrombosis. Which laboratory
values should the nurse monitor? Select all that apply.
A) aPTT
B) PT/INR
C) Platelet count
D) Hemoglobin
E) Hematocrit
Correct Answers: A, C, D, E
Rationales>..: Heparin therapy requires monitoring of aPTT (A) to assess
therapeutic effect (1.5-2.5 times control). Platelet count (C) should be monitored
for heparin-induced thrombocytopenia (HIT). Hemoglobin (D) and hematocrit (E)
should be monitored for bleeding. PT/INR (B) is used to monitor warfarin therapy,
not heparin.
Question 3
A client is 2 days post-myocardial infarction. Which findings require immediate
notification of the healthcare provider? Select all that apply.
A) Chest pain rated 6 on a 0-10 scale
B) Heart rate of 52 bpm
C) Oxygen saturation of 91%
D) Blood pressure of 140/90 mmHg
E) New onset of dysrhythmias
Correct Answers: A, B, C, E
,Rationales>..: Chest pain (A) may indicate recurrent ischemia or infarction.
Bradycardia (B) and dysrhythmias (E) may indicate heart block or other
complications. Hypoxia (C) requires intervention. BP of 140/90 (D) is elevated but
not immediately life-threatening.
Question 4
A client with atrial fibrillation is prescribed warfarin. Which statements indicate the
client understands the medication teaching? Select all that apply.
A) "I will avoid eating large amounts of leafy green vegetables."
B) "I will take my medication at the same time each day."
C) "I will report any bleeding or bruising to my provider."
D) "I will check my INR regularly as ordered."
E) "I can stop taking the medication when my heart rhythm is normal."
Correct Answers: A, B, C, D
Rationales>..: Clients on warfarin should maintain consistent vitamin K intake
(avoid large amounts of leafy greens - A), take medication consistently (B), report
bleeding (C), and monitor INR (D). Warfarin should not be stopped without provider
guidance (E).
Question 5
A client with angina is prescribed nitroglycerin sublingually. Which instructions
should the nurse provide? Select all that apply.
, A) Take one tablet at the onset of chest pain
B) Repeat every 5 minutes up to 3 doses
C) Call 911 if pain is not relieved after 3 doses
D) Store tablets in a light-resistant container
E) Replace tablets every 3 months
Correct Answers: A, B, C, D, E
Rationales>..: Nitroglycerin should be taken at onset of pain (A), repeated every 5
minutes up to 3 doses (B), and emergency services called if no relief after 3 doses
(C). Tablets should be stored in light-resistant containers (D) and replaced every 3-
6 months (E).
SECTION 2: RESPIRATORY SYSTEM
Question 6
A client with COPD has an oxygen saturation of 88% on room air. Which actions
should the nurse take? Select all that apply.
A) Administer oxygen via nasal cannula at 2 L/min
B) Maintain SpO₂ target of 88-92%
C) Administer oxygen via non-rebreather mask
D) Monitor for signs of CO₂ retention
E) Assess respiratory rate and depth
Correct Answers: A, B, D, E
Rationales>..: COPD clients should receive controlled oxygen (A) to maintain SpO₂
88-92% (B) to avoid suppressing the hypoxic drive. Monitoring for CO₂ retention (D)
Assessment Exam QUESTIONS AND
ANSWERS ALREADY GRADED A+. 100%
Verified Solutions | Updated Per Latest
Guidelines | Graded A+
Question 1
A client with heart failure is prescribed furosemide (Lasix). Which assessment
finding indicates the medication is having the desired therapeutic effect? Select all
that apply.
A) Decreased shortness of breath
B) Weight loss of 2 kg in 24 hours
C) Increased jugular venous distension
D) Decreased peripheral edema
E) Increased crackles in lung bases
Correct Answers: A, B, D
Rationales>..: Furosemide is a loop diuretic that reduces fluid volume overload.
Desired effects include decreased dyspnea (A), weight loss from fluid loss (B), and
decreased peripheral edema (D). JVD (C) and crackles (E) indicate fluid overload
and would decrease, not increase, with effective therapy.
,Question 2
A client is receiving heparin therapy for a deep vein thrombosis. Which laboratory
values should the nurse monitor? Select all that apply.
A) aPTT
B) PT/INR
C) Platelet count
D) Hemoglobin
E) Hematocrit
Correct Answers: A, C, D, E
Rationales>..: Heparin therapy requires monitoring of aPTT (A) to assess
therapeutic effect (1.5-2.5 times control). Platelet count (C) should be monitored
for heparin-induced thrombocytopenia (HIT). Hemoglobin (D) and hematocrit (E)
should be monitored for bleeding. PT/INR (B) is used to monitor warfarin therapy,
not heparin.
Question 3
A client is 2 days post-myocardial infarction. Which findings require immediate
notification of the healthcare provider? Select all that apply.
A) Chest pain rated 6 on a 0-10 scale
B) Heart rate of 52 bpm
C) Oxygen saturation of 91%
D) Blood pressure of 140/90 mmHg
E) New onset of dysrhythmias
Correct Answers: A, B, C, E
,Rationales>..: Chest pain (A) may indicate recurrent ischemia or infarction.
Bradycardia (B) and dysrhythmias (E) may indicate heart block or other
complications. Hypoxia (C) requires intervention. BP of 140/90 (D) is elevated but
not immediately life-threatening.
Question 4
A client with atrial fibrillation is prescribed warfarin. Which statements indicate the
client understands the medication teaching? Select all that apply.
A) "I will avoid eating large amounts of leafy green vegetables."
B) "I will take my medication at the same time each day."
C) "I will report any bleeding or bruising to my provider."
D) "I will check my INR regularly as ordered."
E) "I can stop taking the medication when my heart rhythm is normal."
Correct Answers: A, B, C, D
Rationales>..: Clients on warfarin should maintain consistent vitamin K intake
(avoid large amounts of leafy greens - A), take medication consistently (B), report
bleeding (C), and monitor INR (D). Warfarin should not be stopped without provider
guidance (E).
Question 5
A client with angina is prescribed nitroglycerin sublingually. Which instructions
should the nurse provide? Select all that apply.
, A) Take one tablet at the onset of chest pain
B) Repeat every 5 minutes up to 3 doses
C) Call 911 if pain is not relieved after 3 doses
D) Store tablets in a light-resistant container
E) Replace tablets every 3 months
Correct Answers: A, B, C, D, E
Rationales>..: Nitroglycerin should be taken at onset of pain (A), repeated every 5
minutes up to 3 doses (B), and emergency services called if no relief after 3 doses
(C). Tablets should be stored in light-resistant containers (D) and replaced every 3-
6 months (E).
SECTION 2: RESPIRATORY SYSTEM
Question 6
A client with COPD has an oxygen saturation of 88% on room air. Which actions
should the nurse take? Select all that apply.
A) Administer oxygen via nasal cannula at 2 L/min
B) Maintain SpO₂ target of 88-92%
C) Administer oxygen via non-rebreather mask
D) Monitor for signs of CO₂ retention
E) Assess respiratory rate and depth
Correct Answers: A, B, D, E
Rationales>..: COPD clients should receive controlled oxygen (A) to maintain SpO₂
88-92% (B) to avoid suppressing the hypoxic drive. Monitoring for CO₂ retention (D)
