ATI RN Adult Medical Surgical 2026
Proctored Exam- Questions with
Rationales - The Ultimate Last-Minute
Prep Guide
### SECTION 1: CARDIOVASCULAR & HEMATOLOGIC DISORDERS
(Questions 1-30)
**1. A client with heart failure has crackles in all lung fields, jugular
venous distention, and 3+ pitting edema. Which medication should the
nurse expect to administer first?**
A) Digoxin
B) Furosemide
C) Enalapril
D) Carvedilol
**Answer: B) Furosemide**
,**Rationale:** Furosemide (loop diuretic) reduces preload by
promoting diuresis, relieving pulmonary congestion and edema. It is
first-line for acute decompensated heart failure with fluid overload .
The client's crackles, JVD, and edema indicate significant fluid volume
overload requiring immediate diuresis.
---
**2. A client with atrial fibrillation is prescribed warfarin. Which
laboratory test should the nurse monitor to evaluate therapeutic
effect?**
A) aPTT
B) INR
C) Platelet count
D) Bleeding time
**Answer: B) INR**
**Rationale:** Warfarin anticoagulation is monitored by the INR
(International Normalized Ratio). For atrial fibrillation, the target INR is
typically 2-3. aPTT monitors heparin therapy, not warfarin .
,---
**3. A client with chest pain is admitted with suspected acute coronary
syndrome (ACS). Which serum cardiac marker is most specific for
myocardial necrosis?**
A) CK-MB
B) Myoglobin
C) Troponin I or T
D) C-reactive protein
**Answer: C) Troponin I or T**
**Rationale:** Troponin is the most specific and sensitive marker for
myocardial necrosis; elevated troponin indicates MI. CK-MB is less
specific, myoglobin is not cardiac-specific, and CRP is an inflammatory
marker .
---
**4. A client receiving warfarin has an INR of 4.5. What should the
nurse anticipate?**
A) Administering a higher dose of warfarin
, B) Holding the warfarin and possibly giving vitamin K
C) Continuing the current dose
D) Administering protamine sulfate
**Answer: B) Holding the warfarin and possibly giving vitamin K**
**Rationale:** Therapeutic INR for most conditions is 2-3. An INR of 4.5
is elevated and increases bleeding risk; hold warfarin and possibly give
Vitamin K (reversal agent). Protamine sulfate is for heparin reversal .
---
**5. A client with heart failure is prescribed spironolactone. The client's
potassium level is 5.8 mEq/L. What is the nurse's priority action?**
A) Administer the medication as ordered
B) Hold the medication and notify the provider
C) Give the medication with a potassium supplement
D) Double the dose for faster effect
**Answer: B) Hold the medication and notify the provider**
Proctored Exam- Questions with
Rationales - The Ultimate Last-Minute
Prep Guide
### SECTION 1: CARDIOVASCULAR & HEMATOLOGIC DISORDERS
(Questions 1-30)
**1. A client with heart failure has crackles in all lung fields, jugular
venous distention, and 3+ pitting edema. Which medication should the
nurse expect to administer first?**
A) Digoxin
B) Furosemide
C) Enalapril
D) Carvedilol
**Answer: B) Furosemide**
,**Rationale:** Furosemide (loop diuretic) reduces preload by
promoting diuresis, relieving pulmonary congestion and edema. It is
first-line for acute decompensated heart failure with fluid overload .
The client's crackles, JVD, and edema indicate significant fluid volume
overload requiring immediate diuresis.
---
**2. A client with atrial fibrillation is prescribed warfarin. Which
laboratory test should the nurse monitor to evaluate therapeutic
effect?**
A) aPTT
B) INR
C) Platelet count
D) Bleeding time
**Answer: B) INR**
**Rationale:** Warfarin anticoagulation is monitored by the INR
(International Normalized Ratio). For atrial fibrillation, the target INR is
typically 2-3. aPTT monitors heparin therapy, not warfarin .
,---
**3. A client with chest pain is admitted with suspected acute coronary
syndrome (ACS). Which serum cardiac marker is most specific for
myocardial necrosis?**
A) CK-MB
B) Myoglobin
C) Troponin I or T
D) C-reactive protein
**Answer: C) Troponin I or T**
**Rationale:** Troponin is the most specific and sensitive marker for
myocardial necrosis; elevated troponin indicates MI. CK-MB is less
specific, myoglobin is not cardiac-specific, and CRP is an inflammatory
marker .
---
**4. A client receiving warfarin has an INR of 4.5. What should the
nurse anticipate?**
A) Administering a higher dose of warfarin
, B) Holding the warfarin and possibly giving vitamin K
C) Continuing the current dose
D) Administering protamine sulfate
**Answer: B) Holding the warfarin and possibly giving vitamin K**
**Rationale:** Therapeutic INR for most conditions is 2-3. An INR of 4.5
is elevated and increases bleeding risk; hold warfarin and possibly give
Vitamin K (reversal agent). Protamine sulfate is for heparin reversal .
---
**5. A client with heart failure is prescribed spironolactone. The client's
potassium level is 5.8 mEq/L. What is the nurse's priority action?**
A) Administer the medication as ordered
B) Hold the medication and notify the provider
C) Give the medication with a potassium supplement
D) Double the dose for faster effect
**Answer: B) Hold the medication and notify the provider**
