ATI MEDICAL-SURGICAL PROCTORED EXAM 2023 NGN
Multiple-Choice Questions with Answers & Rationales 3
VERSIONS
Question 1:
A nurse is assessing a client with heart failure who reports dyspnea, orthopnea, and a
weight gain of 5 lb in 2 days. Which action should the nurse take first?
A) Administer furosemide IV
B) Place the client in high-Fowler's position
C) Obtain a stat chest x-ray
D) Auscultate breath sounds
Correct Answer: B) Place the client in high-Fowler's position
Rationale: High-Fowler's position reduces venous return and improves ventilation, which is
the immediate priority before other interventions. Airway and breathing always come first
in patient care. The other actions are important but secondary to positioning for optimal
breathing.
Question 2:
A client with atrial fibrillation is prescribed warfarin. The INR is 4.5. Which action should
the nurse take?
A) Administer the next dose as scheduled
B) Hold the dose and notify the provider
C) Administer vitamin K 10 mg IM
D) Increase the warfarin dose
Correct Answer: B) Hold the dose and notify the provider
Rationale: INR 4.5 is above the therapeutic range (2-3); the dose should be held and the
provider notified. Vitamin K may be ordered for significantly elevated INR with active
bleeding, but holding the dose and notification is the first step.
,Question 3:
A nurse is caring for a client with heart failure who has developed crackles in the lungs
and peripheral edema. Which medication should the nurse expect to administer?
A) Digoxin
B) Furosemide
C) Metoprolol
D) Spironolactone
Correct Answer: B) Furosemide
Rationale: Furosemide is a loop diuretic that reduces fluid overload by promoting excretion
of sodium and water. It is first-line treatment for pulmonary edema and peripheral edema
in heart failure. Digoxin improves contractility but does not address fluid overload directly.
Question 4:
A client with hypertension is prescribed lisinopril. Which finding requires immediate
intervention?
A) Dry cough
B) Serum potassium 5.8 mEq/L
C) Headache
D) Dizziness upon standing
Correct Answer: B) Serum potassium 5.8 mEq/L
Rationale: Hyperkalemia (K >5.5) can cause life-threatening arrhythmias; the provider
should be notified. Dry cough is a common side effect of ACE inhibitors but not
immediately life-threatening. Dizziness may indicate hypotension but is less urgent than
hyperkalemia.
Question 5:
A client with unstable angina is admitted to the telemetry unit. The nurse should
prioritize which assessment?
,A) Pain level
B) Oxygen saturation
C) Blood pressure
D) ECG rhythm
Correct Answer: D) ECG rhythm
Rationale: Continuous ECG monitoring is critical to detect ischemia or arrhythmias in
unstable angina. While pain, oxygen saturation, and blood pressure are important, rhythm
monitoring is the priority to detect life-threatening dysrhythmias.
Question 6:
A client is receiving a continuous heparin infusion. Which laboratory value should the
nurse monitor?
A) aPTT
B) PT/INR
C) Platelet count
D) Hemoglobin
Correct Answer: A) aPTT (Activated Partial Thromboplastin Time)
Rationale: aPTT is the standard test used to monitor heparin therapy. The therapeutic goal
is typically 1.5-2.5 times the normal aPTT. PT/INR is used for warfarin monitoring, platelet
count monitors for heparin-induced thrombocytopenia, and hemoglobin monitors for
bleeding.
Question 7:
A nurse is assessing a client who has just returned from cardiac catheterization via the
femoral artery. Which finding requires immediate intervention?
A) Blood pressure 110/70 mm Hg
B) Pulse rate 88/min
C) Bleeding at the insertion site
D) Urine output 60 mL/hr
, Correct Answer: C) Bleeding at the insertion site
Rationale: Bleeding at the insertion site requires immediate intervention to prevent
hematoma formation or hemorrhage. Vital signs and urine output are within normal
limits and do not require immediate action.
Question 8:
After cardiac catheterization via the femoral artery, which interventions are appropriate?
(Select all that apply)
A) Monitor the insertion site for bleeding or hematoma
B) Assess distal pulses (dorsalis pedis, posterior tibial)
C) Keep the affected leg straight and immobile
D) Ambulate the patient immediately after the procedure
E) Monitor vital signs every 15 minutes for the first hour
Correct Answer: A, B, C, E
Rationale: After femoral artery catheterization, the patient must remain flat with the
affected leg straight to prevent bleeding. The site is monitored for bleeding/hematoma;
distal pulses are assessed to detect arterial occlusion. Ambulation is contraindicated
immediately post-procedure. Vital signs should be monitored frequently per protocol.
Question 9:
A client reports chest pain rated 7/10 radiating to the left arm, with nausea, diaphoresis,
and shortness of breath. What is the nurse's priority action?
A) Administer prescribed antiemetic for nausea
B) Apply oxygen at 2 L/min per nasal cannula
C) Obtain a stat 12-lead ECG
D) Prepare the client for an echocardiogram
Correct Answer: C) Obtain a stat 12-lead ECG
Multiple-Choice Questions with Answers & Rationales 3
VERSIONS
Question 1:
A nurse is assessing a client with heart failure who reports dyspnea, orthopnea, and a
weight gain of 5 lb in 2 days. Which action should the nurse take first?
A) Administer furosemide IV
B) Place the client in high-Fowler's position
C) Obtain a stat chest x-ray
D) Auscultate breath sounds
Correct Answer: B) Place the client in high-Fowler's position
Rationale: High-Fowler's position reduces venous return and improves ventilation, which is
the immediate priority before other interventions. Airway and breathing always come first
in patient care. The other actions are important but secondary to positioning for optimal
breathing.
Question 2:
A client with atrial fibrillation is prescribed warfarin. The INR is 4.5. Which action should
the nurse take?
A) Administer the next dose as scheduled
B) Hold the dose and notify the provider
C) Administer vitamin K 10 mg IM
D) Increase the warfarin dose
Correct Answer: B) Hold the dose and notify the provider
Rationale: INR 4.5 is above the therapeutic range (2-3); the dose should be held and the
provider notified. Vitamin K may be ordered for significantly elevated INR with active
bleeding, but holding the dose and notification is the first step.
,Question 3:
A nurse is caring for a client with heart failure who has developed crackles in the lungs
and peripheral edema. Which medication should the nurse expect to administer?
A) Digoxin
B) Furosemide
C) Metoprolol
D) Spironolactone
Correct Answer: B) Furosemide
Rationale: Furosemide is a loop diuretic that reduces fluid overload by promoting excretion
of sodium and water. It is first-line treatment for pulmonary edema and peripheral edema
in heart failure. Digoxin improves contractility but does not address fluid overload directly.
Question 4:
A client with hypertension is prescribed lisinopril. Which finding requires immediate
intervention?
A) Dry cough
B) Serum potassium 5.8 mEq/L
C) Headache
D) Dizziness upon standing
Correct Answer: B) Serum potassium 5.8 mEq/L
Rationale: Hyperkalemia (K >5.5) can cause life-threatening arrhythmias; the provider
should be notified. Dry cough is a common side effect of ACE inhibitors but not
immediately life-threatening. Dizziness may indicate hypotension but is less urgent than
hyperkalemia.
Question 5:
A client with unstable angina is admitted to the telemetry unit. The nurse should
prioritize which assessment?
,A) Pain level
B) Oxygen saturation
C) Blood pressure
D) ECG rhythm
Correct Answer: D) ECG rhythm
Rationale: Continuous ECG monitoring is critical to detect ischemia or arrhythmias in
unstable angina. While pain, oxygen saturation, and blood pressure are important, rhythm
monitoring is the priority to detect life-threatening dysrhythmias.
Question 6:
A client is receiving a continuous heparin infusion. Which laboratory value should the
nurse monitor?
A) aPTT
B) PT/INR
C) Platelet count
D) Hemoglobin
Correct Answer: A) aPTT (Activated Partial Thromboplastin Time)
Rationale: aPTT is the standard test used to monitor heparin therapy. The therapeutic goal
is typically 1.5-2.5 times the normal aPTT. PT/INR is used for warfarin monitoring, platelet
count monitors for heparin-induced thrombocytopenia, and hemoglobin monitors for
bleeding.
Question 7:
A nurse is assessing a client who has just returned from cardiac catheterization via the
femoral artery. Which finding requires immediate intervention?
A) Blood pressure 110/70 mm Hg
B) Pulse rate 88/min
C) Bleeding at the insertion site
D) Urine output 60 mL/hr
, Correct Answer: C) Bleeding at the insertion site
Rationale: Bleeding at the insertion site requires immediate intervention to prevent
hematoma formation or hemorrhage. Vital signs and urine output are within normal
limits and do not require immediate action.
Question 8:
After cardiac catheterization via the femoral artery, which interventions are appropriate?
(Select all that apply)
A) Monitor the insertion site for bleeding or hematoma
B) Assess distal pulses (dorsalis pedis, posterior tibial)
C) Keep the affected leg straight and immobile
D) Ambulate the patient immediately after the procedure
E) Monitor vital signs every 15 minutes for the first hour
Correct Answer: A, B, C, E
Rationale: After femoral artery catheterization, the patient must remain flat with the
affected leg straight to prevent bleeding. The site is monitored for bleeding/hematoma;
distal pulses are assessed to detect arterial occlusion. Ambulation is contraindicated
immediately post-procedure. Vital signs should be monitored frequently per protocol.
Question 9:
A client reports chest pain rated 7/10 radiating to the left arm, with nausea, diaphoresis,
and shortness of breath. What is the nurse's priority action?
A) Administer prescribed antiemetic for nausea
B) Apply oxygen at 2 L/min per nasal cannula
C) Obtain a stat 12-lead ECG
D) Prepare the client for an echocardiogram
Correct Answer: C) Obtain a stat 12-lead ECG
