, ATI RN MEDICAL SURGICAL PROCTORED
EXAM QUESTIONS AND ANSWERS WITH
RATIONALE 2026/2027
Section 1: Cardiovascular Disorders & Hemodynamic
Monitoring
Q1: A client is admitted with acute heart failure and
presents with severe dyspnea, pink frothy sputum, and
crackles bilaterally throughout all lung fields. Which initial
nursing action is priority?
A) Place the client in a high-Fowler's position with legs
dangling.
B) Encourage incentive spirometry to expand lung volume.
C) Administer oral beta-blockers as prescribed.
D) Prepare the client for immediate continuous ambulatory
peritoneal dialysis.
Correct Answer: A
Rationale: Acute decompensated heart failure with
pulmonary edema requires immediate measures to reduce
venous return (preload) to the heart. Placing the client in a
high-Fowler's position with legs dependent decreases
venous return from the lower extremities, lessening
pulmonary congestion and improving oxygenation.
,Q2: A client who had an insertion of a temporary pacemaker
via the right femoral vein is recovering in bed. Which
postoperative intervention is essential?
A) Assist the client to ambulate around the unit immediately
to prevent deep vein thrombosis.
B) Maintain the client on strict bed rest with the right leg
completely straight to prevent lead displacement.
C) Flex the right hip at a 90-degree angle every two hours.
D) Apply heavy sandbags directly over the femoral insertion
site permanently.
Correct Answer: B
Rationale: Following femoral vein or artery catheterization
and pacemaker lead placement, the extremity must remain
immobilized and straight to prevent bleeding, hematoma
formation, or dislodgement of the pacing wires.
Q3: Which laboratory result should the nurse monitor
closely for a client receiving intravenous furosemide (Lasix)
for severe fluid overload?
A) Serum sodium and potassium levels
B) Blood glucose levels
C) Direct bilirubin
D) Platelet count
Correct Answer: A
, Rationale: Furosemide is a potent loop diuretic that inhibits
sodium and chloride reabsorption in the ascending loop of
Henle, leading to significant excretion of water, sodium,
and potassium. Hypokalemia and hyponatremia are
common adverse effects requiring close monitoring.
Section 2: Respiratory Disorders & Mechanical Ventilation
Q1: A client is receiving mechanical ventilation via an
endotracheal tube. The low-pressure ventilator alarm
sounds. Which situation should the nurse investigate first?
A) A kink in the ventilator tubing
B) Disconnection or a leak in the ventilator circuit
C) Excessive mucus secretions in the airway
D) Client biting down on the endotracheal tube
Correct Answer: B
Rationale: A low-pressure alarm indicates a loss of pressure
within the circuit, which is typically caused by a
disconnection, cuff leak, or tubing detachment. High-
pressure alarms are triggered by obstructions, kinks,
secretions, or client biting.
Q2: A client diagnosed with chronic obstructive pulmonary
disease (COPD) is receiving oxygen via a nasal cannula at 4
L/min. The client becomes increasingly lethargic and
confused. What is the nurse's priority action?
EXAM QUESTIONS AND ANSWERS WITH
RATIONALE 2026/2027
Section 1: Cardiovascular Disorders & Hemodynamic
Monitoring
Q1: A client is admitted with acute heart failure and
presents with severe dyspnea, pink frothy sputum, and
crackles bilaterally throughout all lung fields. Which initial
nursing action is priority?
A) Place the client in a high-Fowler's position with legs
dangling.
B) Encourage incentive spirometry to expand lung volume.
C) Administer oral beta-blockers as prescribed.
D) Prepare the client for immediate continuous ambulatory
peritoneal dialysis.
Correct Answer: A
Rationale: Acute decompensated heart failure with
pulmonary edema requires immediate measures to reduce
venous return (preload) to the heart. Placing the client in a
high-Fowler's position with legs dependent decreases
venous return from the lower extremities, lessening
pulmonary congestion and improving oxygenation.
,Q2: A client who had an insertion of a temporary pacemaker
via the right femoral vein is recovering in bed. Which
postoperative intervention is essential?
A) Assist the client to ambulate around the unit immediately
to prevent deep vein thrombosis.
B) Maintain the client on strict bed rest with the right leg
completely straight to prevent lead displacement.
C) Flex the right hip at a 90-degree angle every two hours.
D) Apply heavy sandbags directly over the femoral insertion
site permanently.
Correct Answer: B
Rationale: Following femoral vein or artery catheterization
and pacemaker lead placement, the extremity must remain
immobilized and straight to prevent bleeding, hematoma
formation, or dislodgement of the pacing wires.
Q3: Which laboratory result should the nurse monitor
closely for a client receiving intravenous furosemide (Lasix)
for severe fluid overload?
A) Serum sodium and potassium levels
B) Blood glucose levels
C) Direct bilirubin
D) Platelet count
Correct Answer: A
, Rationale: Furosemide is a potent loop diuretic that inhibits
sodium and chloride reabsorption in the ascending loop of
Henle, leading to significant excretion of water, sodium,
and potassium. Hypokalemia and hyponatremia are
common adverse effects requiring close monitoring.
Section 2: Respiratory Disorders & Mechanical Ventilation
Q1: A client is receiving mechanical ventilation via an
endotracheal tube. The low-pressure ventilator alarm
sounds. Which situation should the nurse investigate first?
A) A kink in the ventilator tubing
B) Disconnection or a leak in the ventilator circuit
C) Excessive mucus secretions in the airway
D) Client biting down on the endotracheal tube
Correct Answer: B
Rationale: A low-pressure alarm indicates a loss of pressure
within the circuit, which is typically caused by a
disconnection, cuff leak, or tubing detachment. High-
pressure alarms are triggered by obstructions, kinks,
secretions, or client biting.
Q2: A client diagnosed with chronic obstructive pulmonary
disease (COPD) is receiving oxygen via a nasal cannula at 4
L/min. The client becomes increasingly lethargic and
confused. What is the nurse's priority action?
