ATI RN Adult Medical Surgical Nursing
2026 Proctored Exam | 130 Most Likely Questions & Answers
2026 Updated
Name: Date: Score: ______ / 130
________________________ ________________________
Instructions: Read each question carefully. Select the best answer (A, B, C, or D).
The correct answer and a brief rationale are provided after each question for study
purposes.
1. A nurse is assessing a client who has heart failure. Which of the following
findings should the nurse expect?
A. Weight loss of 2 kg in 48 hours
B. Bilateral crackles in the lungs
C. Bradycardia with a rate of 50/min
D. Warm, flushed skin
Answer: B
Rationale: Bilateral crackles indicate pulmonary congestion secondary to fluid
retention from heart failure. Weight gain (not loss), tachycardia, and cool, pale skin
are also expected findings.
2. A nurse is providing discharge teaching to a client who has heart failure. Which
of the following instructions should the nurse include?
A. Limit fluid intake to 3 L per day
B. Weigh yourself daily and report a gain of 1 kg in 24 hours
C. Eat a high-sodium diet to prevent hyponatremia
D. Exercise vigorously for 60 minutes daily
Answer: B
Rationale: Daily weight monitoring is essential for detecting fluid retention early. A
weight gain of 1 to 1.5 kg in 24 hours indicates fluid retention and should be
reported. Fluid is typically limited to 1.5 to 2 L per day.
1
,3. A nurse is caring for a client who is receiving IV furosemide for heart failure.
Which of the following findings should the nurse monitor for as an adverse effect of
this medication?
A. Hyperkalemia B. Hypokalemia
C. Hypernatremia D. Hypocalcemia
Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium loss through
increased urinary excretion. Hypokalemia can lead to cardiac dysrhythmias and
should be closely monitored.
4. A nurse is assessing a client who has aortic stenosis. Which of the following
findings should the nurse expect?
A. A systolic murmur heard at the right sternal border
B. A diastolic murmur heard at the left sternal border
C. A holosystolic murmur at the apex
D. A decrescendo diastolic murmur at the left sternal border
Answer: A
Rationale: Aortic stenosis produces a systolic ejection murmur best heard at the
right second intercostal space (right sternal border). The murmur is caused by
turbulent blood flow across the narrowed valve.
5. A nurse is caring for a client who has left-sided heart failure. Which of the
following manifestations should the nurse expect?
A. Jugular venous distention B. Hepatomegaly
C. Dependent edema D. Dyspnea on exertion
Answer: D
Rationale: Left-sided heart failure causes pulmonary congestion, leading to
dyspnea on exertion, orthopnea, and crackles. Jugular venous distention,
hepatomegaly, and dependent edema are signs of right-sided heart failure.
2
,6. A nurse is reviewing the laboratory results of a client who has chronic heart
failure and is receiving digoxin. Which of the following results should the nurse
report to the provider immediately?
A. Potassium 3.2 mEq/L B. Sodium 140 mEq/L
C. Calcium 9.2 mg/dL D. Magnesium 2.0 mg/dL
Answer: A
Rationale: Hypokalemia (potassium below 3.5 mEq/L) increases the risk of digoxin
toxicity because potassium competes with digoxin at cardiac binding sites. This
finding should be reported immediately.
7. A nurse is teaching a client who has a new prescription for warfarin. Which of
the following statements by the client indicates an understanding of the teaching?
A. I will eat large amounts of green leafy vegetables daily.
B. I will have my blood tested regularly to check the INR.
C. I will take ibuprofen for headaches or minor pain.
D. I will double my dose if I miss one.
Answer: B
Rationale: Regular INR monitoring is essential for clients on warfarin to ensure
therapeutic anticoagulation and prevent bleeding or thrombosis. Green leafy
vegetables contain vitamin K, which antagonizes warfarin, and should be consumed
consistently, not in excess.
8. A nurse is assessing a client following a myocardial infarction. Which of the
following laboratory findings indicates myocardial tissue damage?
A. Elevated troponin I B. Decreased BNP
C. Elevated creatinine D. Decreased hemoglobin
Answer: A
Rationale: Troponin I is a cardiac-specific biomarker that rises within 3 to 4 hours
of myocardial injury and remains elevated for up to 14 days. It is the most sensitive
and specific indicator of myocardial damage.
3
, 9. A nurse is providing teaching to a client who has hypertension. Which of the
following dietary modifications should the nurse recommend?
A. Increase intake of processed foods
B. Limit sodium intake to 2,000 mg per day
C. Increase potassium supplementation without physician approval
D. Consume a high-fat diet
Answer: B
Rationale: The recommended sodium limit for adults with hypertension is 1,500 to
2,000 mg per day. Reducing sodium intake helps lower blood pressure by
decreasing fluid retention and vascular resistance.
10. A nurse is caring for a client who has a deep vein thrombosis (DVT) and is
receiving heparin therapy. Which of the following laboratory values should the
nurse monitor?
A. Prothrombin time (PT)
B. Activated partial thromboplastin time (aPTT)
C. International normalized ratio (INR)
D. Platelet count only
Answer: B
Rationale: aPTT is used to monitor heparin therapy and should be maintained at
1.5 to 2.5 times the control value. PT/INR is used to monitor warfarin therapy, not
heparin.
11. A nurse is caring for a client who has peripheral arterial disease. Which of the
following manifestations should the nurse expect?
A. Edema in the lower extremities
B. Pain that worsens with leg elevation and improves with dependency
C. Warm, pink feet with strong pulses
D. Thickened, brittle toenails
Answer: B
Rationale: Peripheral arterial disease causes ischemic pain that worsens with
elevation (decreased arterial flow) and improves with dependency (increased
4
2026 Proctored Exam | 130 Most Likely Questions & Answers
2026 Updated
Name: Date: Score: ______ / 130
________________________ ________________________
Instructions: Read each question carefully. Select the best answer (A, B, C, or D).
The correct answer and a brief rationale are provided after each question for study
purposes.
1. A nurse is assessing a client who has heart failure. Which of the following
findings should the nurse expect?
A. Weight loss of 2 kg in 48 hours
B. Bilateral crackles in the lungs
C. Bradycardia with a rate of 50/min
D. Warm, flushed skin
Answer: B
Rationale: Bilateral crackles indicate pulmonary congestion secondary to fluid
retention from heart failure. Weight gain (not loss), tachycardia, and cool, pale skin
are also expected findings.
2. A nurse is providing discharge teaching to a client who has heart failure. Which
of the following instructions should the nurse include?
A. Limit fluid intake to 3 L per day
B. Weigh yourself daily and report a gain of 1 kg in 24 hours
C. Eat a high-sodium diet to prevent hyponatremia
D. Exercise vigorously for 60 minutes daily
Answer: B
Rationale: Daily weight monitoring is essential for detecting fluid retention early. A
weight gain of 1 to 1.5 kg in 24 hours indicates fluid retention and should be
reported. Fluid is typically limited to 1.5 to 2 L per day.
1
,3. A nurse is caring for a client who is receiving IV furosemide for heart failure.
Which of the following findings should the nurse monitor for as an adverse effect of
this medication?
A. Hyperkalemia B. Hypokalemia
C. Hypernatremia D. Hypocalcemia
Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium loss through
increased urinary excretion. Hypokalemia can lead to cardiac dysrhythmias and
should be closely monitored.
4. A nurse is assessing a client who has aortic stenosis. Which of the following
findings should the nurse expect?
A. A systolic murmur heard at the right sternal border
B. A diastolic murmur heard at the left sternal border
C. A holosystolic murmur at the apex
D. A decrescendo diastolic murmur at the left sternal border
Answer: A
Rationale: Aortic stenosis produces a systolic ejection murmur best heard at the
right second intercostal space (right sternal border). The murmur is caused by
turbulent blood flow across the narrowed valve.
5. A nurse is caring for a client who has left-sided heart failure. Which of the
following manifestations should the nurse expect?
A. Jugular venous distention B. Hepatomegaly
C. Dependent edema D. Dyspnea on exertion
Answer: D
Rationale: Left-sided heart failure causes pulmonary congestion, leading to
dyspnea on exertion, orthopnea, and crackles. Jugular venous distention,
hepatomegaly, and dependent edema are signs of right-sided heart failure.
2
,6. A nurse is reviewing the laboratory results of a client who has chronic heart
failure and is receiving digoxin. Which of the following results should the nurse
report to the provider immediately?
A. Potassium 3.2 mEq/L B. Sodium 140 mEq/L
C. Calcium 9.2 mg/dL D. Magnesium 2.0 mg/dL
Answer: A
Rationale: Hypokalemia (potassium below 3.5 mEq/L) increases the risk of digoxin
toxicity because potassium competes with digoxin at cardiac binding sites. This
finding should be reported immediately.
7. A nurse is teaching a client who has a new prescription for warfarin. Which of
the following statements by the client indicates an understanding of the teaching?
A. I will eat large amounts of green leafy vegetables daily.
B. I will have my blood tested regularly to check the INR.
C. I will take ibuprofen for headaches or minor pain.
D. I will double my dose if I miss one.
Answer: B
Rationale: Regular INR monitoring is essential for clients on warfarin to ensure
therapeutic anticoagulation and prevent bleeding or thrombosis. Green leafy
vegetables contain vitamin K, which antagonizes warfarin, and should be consumed
consistently, not in excess.
8. A nurse is assessing a client following a myocardial infarction. Which of the
following laboratory findings indicates myocardial tissue damage?
A. Elevated troponin I B. Decreased BNP
C. Elevated creatinine D. Decreased hemoglobin
Answer: A
Rationale: Troponin I is a cardiac-specific biomarker that rises within 3 to 4 hours
of myocardial injury and remains elevated for up to 14 days. It is the most sensitive
and specific indicator of myocardial damage.
3
, 9. A nurse is providing teaching to a client who has hypertension. Which of the
following dietary modifications should the nurse recommend?
A. Increase intake of processed foods
B. Limit sodium intake to 2,000 mg per day
C. Increase potassium supplementation without physician approval
D. Consume a high-fat diet
Answer: B
Rationale: The recommended sodium limit for adults with hypertension is 1,500 to
2,000 mg per day. Reducing sodium intake helps lower blood pressure by
decreasing fluid retention and vascular resistance.
10. A nurse is caring for a client who has a deep vein thrombosis (DVT) and is
receiving heparin therapy. Which of the following laboratory values should the
nurse monitor?
A. Prothrombin time (PT)
B. Activated partial thromboplastin time (aPTT)
C. International normalized ratio (INR)
D. Platelet count only
Answer: B
Rationale: aPTT is used to monitor heparin therapy and should be maintained at
1.5 to 2.5 times the control value. PT/INR is used to monitor warfarin therapy, not
heparin.
11. A nurse is caring for a client who has peripheral arterial disease. Which of the
following manifestations should the nurse expect?
A. Edema in the lower extremities
B. Pain that worsens with leg elevation and improves with dependency
C. Warm, pink feet with strong pulses
D. Thickened, brittle toenails
Answer: B
Rationale: Peripheral arterial disease causes ischemic pain that worsens with
elevation (decreased arterial flow) and improves with dependency (increased
4
