RN VATI Adult Medical-Surgical 2026 |
Verified Questions and Answers with
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1. A nurse is assessing a client who has left-sided heart failure. Which
of the following findings should the nurse expect?
• A) Jugular venous distention
• B) Peripheral edema
• C) Crackles in the lung bases
• D) Hepatomegaly
Correct ,Answer: C) Crackles in the lung bases
Rationale: Left-sided heart failure causes fluid backup into the pulmonary
circulation, leading to pulmonary congestion, crackles, dyspnea, and
orthopnea. Jugular venous distention, peripheral edema, and hepatomegaly
are signs of right-sided heart failure.
2. A nurse is caring for a client who has acute kidney injury and a
potassium level of 6.5 mEq/L. Which of the following actions should
the nurse take first?
, • A) Administer sodium polystyrene sulfonate (Kayexalate)
• B) Obtain a stat ECG
• C) Prepare the client for hemodialysis
• D) Restrict dietary potassium
Correct ,Answer: B) Obtain a stat ECG
Rationale: A potassium level of 6.5 mEq/L is dangerously elevated
(hyperkalemia) and places the client at risk for fatal cardiac arrhythmias. The
priority is to assess cardiac status with an ECG. Kayexalate, dietary
restriction, and hemodialysis are interventions, but the immediate priority is
cardiac monitoring.
3. A nurse is assessing a client who has pericarditis. Which of the
following findings is most consistent with this diagnosis?
• A) Chest pain that worsens when lying flat
• B) Chest pain that improves with deep inspiration
• C) Substernal chest pain that radiates to the left arm
• D) Chest pain that is relieved by nitroglycerin
Correct ,Answer: A) Chest pain that worsens when lying flat
Rationale: Pericarditis causes inflammation of the pericardial sac. Pain is
typically sharp, pleuritic, and worsens when lying flat or with inspiration. It
improves when sitting up and leaning forward (relieves pressure on the
pericardium).
,4. A nurse is monitoring a client who has an acute myocardial
infarction (MI). Which of the following complications should the nurse
anticipate within the first 24 hours?
• A) Cardiac tamponade
• B) Ventricular arrhythmias
• C) Pericarditis
• D) Heart failure
Correct ,Answer: B) Ventricular arrhythmias
Rationale: Within the first 24 hours following an acute MI, the most
common and life-threatening complication is ventricular arrhythmias (e.g.,
ventricular tachycardia, ventricular fibrillation) due to myocardial irritability
from ischemia and reperfusion injury.
5. A nurse is caring for a client who has a new diagnosis of
hypertension. Which of the following lifestyle modifications should
the nurse recommend?
• A) Increase sodium intake to 3,000 mg/day
• B) Limit alcohol consumption to 2 drinks per day for men
• C) Decrease physical activity to reduce cardiac workload
• D) Reduce dietary fat to less than 10% of total calories
Correct ,Answer: B) Limit alcohol consumption to 2 drinks per day for
men
Rationale: Lifestyle modifications for hypertension include limiting alcohol
to ≤2 drinks/day for men and ≤1 drink/day for women, reducing sodium to
<2,300 mg/day, engaging in regular aerobic exercise, and maintaining a
healthy weight. Decreasing physical activity is incorrect.
, 6. A nurse is caring for a client who has an abdominal aortic aneurysm
(AAA). Which of the following findings indicates possible rupture of
the aneurysm?
• A) Severe back pain and hypotension
• B) Hypertension and tachycardia
• C) Bilateral lower extremity edema
• D) Abdominal pain that improves with eating
Correct ,Answer: A) Severe back pain and hypotension
Rationale: A rupturing AAA presents with sudden, severe back or abdominal
pain, hypotension, tachycardia, and signs of hypovolemic shock. This is a
medical emergency requiring immediate surgical intervention.
7. A nurse is assessing a client who has peripheral arterial disease
(PAD). Which of the following findings should the nurse expect?
• A) Bilateral lower extremity edema
• B) Cool, pale extremities with diminished pulses
• C) Warm, erythematous extremities
• D) Visible varicose veins
Correct ,Answer: B) Cool, pale extremities with diminished pulses
Rationale: PAD results from atherosclerosis causing narrowed peripheral
arteries. Findings include cool, pale extremities, diminished or absent
pulses, hair loss on the legs, and painful ulcers on the toes or feet. Edema
and warmth are more consistent with venous insufficiency.
Verified Questions and Answers with
Detailed Rationales | Complete
Comprehensive Review | 100%
Guaranteed Pass | NCLEX-RN® & ATI
Predictor Exam Prep PDF
1. A nurse is assessing a client who has left-sided heart failure. Which
of the following findings should the nurse expect?
• A) Jugular venous distention
• B) Peripheral edema
• C) Crackles in the lung bases
• D) Hepatomegaly
Correct ,Answer: C) Crackles in the lung bases
Rationale: Left-sided heart failure causes fluid backup into the pulmonary
circulation, leading to pulmonary congestion, crackles, dyspnea, and
orthopnea. Jugular venous distention, peripheral edema, and hepatomegaly
are signs of right-sided heart failure.
2. A nurse is caring for a client who has acute kidney injury and a
potassium level of 6.5 mEq/L. Which of the following actions should
the nurse take first?
, • A) Administer sodium polystyrene sulfonate (Kayexalate)
• B) Obtain a stat ECG
• C) Prepare the client for hemodialysis
• D) Restrict dietary potassium
Correct ,Answer: B) Obtain a stat ECG
Rationale: A potassium level of 6.5 mEq/L is dangerously elevated
(hyperkalemia) and places the client at risk for fatal cardiac arrhythmias. The
priority is to assess cardiac status with an ECG. Kayexalate, dietary
restriction, and hemodialysis are interventions, but the immediate priority is
cardiac monitoring.
3. A nurse is assessing a client who has pericarditis. Which of the
following findings is most consistent with this diagnosis?
• A) Chest pain that worsens when lying flat
• B) Chest pain that improves with deep inspiration
• C) Substernal chest pain that radiates to the left arm
• D) Chest pain that is relieved by nitroglycerin
Correct ,Answer: A) Chest pain that worsens when lying flat
Rationale: Pericarditis causes inflammation of the pericardial sac. Pain is
typically sharp, pleuritic, and worsens when lying flat or with inspiration. It
improves when sitting up and leaning forward (relieves pressure on the
pericardium).
,4. A nurse is monitoring a client who has an acute myocardial
infarction (MI). Which of the following complications should the nurse
anticipate within the first 24 hours?
• A) Cardiac tamponade
• B) Ventricular arrhythmias
• C) Pericarditis
• D) Heart failure
Correct ,Answer: B) Ventricular arrhythmias
Rationale: Within the first 24 hours following an acute MI, the most
common and life-threatening complication is ventricular arrhythmias (e.g.,
ventricular tachycardia, ventricular fibrillation) due to myocardial irritability
from ischemia and reperfusion injury.
5. A nurse is caring for a client who has a new diagnosis of
hypertension. Which of the following lifestyle modifications should
the nurse recommend?
• A) Increase sodium intake to 3,000 mg/day
• B) Limit alcohol consumption to 2 drinks per day for men
• C) Decrease physical activity to reduce cardiac workload
• D) Reduce dietary fat to less than 10% of total calories
Correct ,Answer: B) Limit alcohol consumption to 2 drinks per day for
men
Rationale: Lifestyle modifications for hypertension include limiting alcohol
to ≤2 drinks/day for men and ≤1 drink/day for women, reducing sodium to
<2,300 mg/day, engaging in regular aerobic exercise, and maintaining a
healthy weight. Decreasing physical activity is incorrect.
, 6. A nurse is caring for a client who has an abdominal aortic aneurysm
(AAA). Which of the following findings indicates possible rupture of
the aneurysm?
• A) Severe back pain and hypotension
• B) Hypertension and tachycardia
• C) Bilateral lower extremity edema
• D) Abdominal pain that improves with eating
Correct ,Answer: A) Severe back pain and hypotension
Rationale: A rupturing AAA presents with sudden, severe back or abdominal
pain, hypotension, tachycardia, and signs of hypovolemic shock. This is a
medical emergency requiring immediate surgical intervention.
7. A nurse is assessing a client who has peripheral arterial disease
(PAD). Which of the following findings should the nurse expect?
• A) Bilateral lower extremity edema
• B) Cool, pale extremities with diminished pulses
• C) Warm, erythematous extremities
• D) Visible varicose veins
Correct ,Answer: B) Cool, pale extremities with diminished pulses
Rationale: PAD results from atherosclerosis causing narrowed peripheral
arteries. Findings include cool, pale extremities, diminished or absent
pulses, hair loss on the legs, and painful ulcers on the toes or feet. Edema
and warmth are more consistent with venous insufficiency.
