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ATI Medical-Surgical Nursing
Proctored Exam | Advanced/Hard
Difficulty | Graded A+
1. A client with chronic heart failure is prescribed furosemide and digoxin. Which assessment
finding is most indicative of digoxin toxicity?
A. Hypertension and bradycardia
B. Visual disturbances and nausea
C. Hyperkalemia and muscle cramps
D. Tachycardia and dry cough
☑ Correct Answer: B
☑ Explanation: Digoxin toxicity classically presents with GI symptoms (nausea, vomiting,
anorexia) and neurologic/visual disturbances (halos, blurred vision, yellow-green vision).
Bradycardia (not tachycardia) and hypokalemia are associated with toxicity. A dry cough is a
side effect of ACE inhibitors, not digoxin.
,2
2. A client is admitted with syndrome of inappropriate antidiuretic hormone (SIADH). Which
serum laboratory value requires immediate nursing intervention?
A. Serum sodium of 118 mEq/L
B. Serum potassium of 5.2 mEq/L
C. Serum calcium of 10.5 mg/dL
D. Serum glucose of 150 mg/dL
☑ Correct Answer: A
☑ Explanation: In SIADH, there is excessive water retention leading to dilutional
hyponatremia. A sodium level of 118 mEq/L is severely low and can cause neurologic symptoms
such as seizures, coma, and respiratory arrest. The other values are mildly elevated but not as
immediately life-threatening.
3. A nurse is caring for a client with a chest tube connected to a closed-chest drainage system.
Which finding indicates a possible air leak?
A. Continuous bubbling in the water seal chamber
B. Intermittent bubbling in the suction control chamber
C. Tidaling in the water seal chamber
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D. Constant bubbling in the suction control chamber
☑ Correct Answer: A
☑ Explanation: Continuous bubbling in the water seal chamber indicates an air leak in the
system. Intermittent bubbling is normal and indicates the evacuation of air from the pleural
space. Tidaling is normal respiratory fluctuation.
4. A client with cirrhosis is exhibiting asterixis. What is the priority nursing action?
A. Administer a lactulose enema as prescribed
B. Assess the client's serum albumin level
C. Increase protein in the client's diet
D. Place the client in a supine position
☑ Correct Answer: A
☑ Explanation: Asterixis (liver flap) is a sign of hepatic encephalopathy due to elevated
ammonia levels. Lactulose is administered to reduce serum ammonia by promoting its excretion
in the stool. Decreasing protein intake (not increasing) is typically part of the management.
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5. A client is receiving IV heparin for a deep vein thrombosis. The aPTT is 110 seconds. Which
action should the nurse take first?
A. Administer protamine sulfate
B. Stop the heparin infusion
C. Notify the healthcare provider
D. Decrease the infusion rate
☑ Correct Answer: B
☑ Explanation: The therapeutic aPTT for heparin is typically 1.5 to 2.5 times the normal
control (usually 60-80 seconds). An aPTT of 110 seconds is dangerously high, placing the client
at risk for hemorrhage. The priority action is to stop the infusion to prevent further
anticoagulation.
6. A client in diabetic ketoacidosis (DKA) has an initial serum potassium of 3.2 mEq/L. The
nurse is preparing to administer IV fluids and insulin. Which action is most appropriate?
A. Administer IV potassium replacement before starting the insulin infusion
B. Start the insulin infusion and monitor the potassium closely
C. Administer sodium bicarbonate to correct the acidosis first
ATI Medical-Surgical Nursing
Proctored Exam | Advanced/Hard
Difficulty | Graded A+
1. A client with chronic heart failure is prescribed furosemide and digoxin. Which assessment
finding is most indicative of digoxin toxicity?
A. Hypertension and bradycardia
B. Visual disturbances and nausea
C. Hyperkalemia and muscle cramps
D. Tachycardia and dry cough
☑ Correct Answer: B
☑ Explanation: Digoxin toxicity classically presents with GI symptoms (nausea, vomiting,
anorexia) and neurologic/visual disturbances (halos, blurred vision, yellow-green vision).
Bradycardia (not tachycardia) and hypokalemia are associated with toxicity. A dry cough is a
side effect of ACE inhibitors, not digoxin.
,2
2. A client is admitted with syndrome of inappropriate antidiuretic hormone (SIADH). Which
serum laboratory value requires immediate nursing intervention?
A. Serum sodium of 118 mEq/L
B. Serum potassium of 5.2 mEq/L
C. Serum calcium of 10.5 mg/dL
D. Serum glucose of 150 mg/dL
☑ Correct Answer: A
☑ Explanation: In SIADH, there is excessive water retention leading to dilutional
hyponatremia. A sodium level of 118 mEq/L is severely low and can cause neurologic symptoms
such as seizures, coma, and respiratory arrest. The other values are mildly elevated but not as
immediately life-threatening.
3. A nurse is caring for a client with a chest tube connected to a closed-chest drainage system.
Which finding indicates a possible air leak?
A. Continuous bubbling in the water seal chamber
B. Intermittent bubbling in the suction control chamber
C. Tidaling in the water seal chamber
,3
D. Constant bubbling in the suction control chamber
☑ Correct Answer: A
☑ Explanation: Continuous bubbling in the water seal chamber indicates an air leak in the
system. Intermittent bubbling is normal and indicates the evacuation of air from the pleural
space. Tidaling is normal respiratory fluctuation.
4. A client with cirrhosis is exhibiting asterixis. What is the priority nursing action?
A. Administer a lactulose enema as prescribed
B. Assess the client's serum albumin level
C. Increase protein in the client's diet
D. Place the client in a supine position
☑ Correct Answer: A
☑ Explanation: Asterixis (liver flap) is a sign of hepatic encephalopathy due to elevated
ammonia levels. Lactulose is administered to reduce serum ammonia by promoting its excretion
in the stool. Decreasing protein intake (not increasing) is typically part of the management.
, 4
5. A client is receiving IV heparin for a deep vein thrombosis. The aPTT is 110 seconds. Which
action should the nurse take first?
A. Administer protamine sulfate
B. Stop the heparin infusion
C. Notify the healthcare provider
D. Decrease the infusion rate
☑ Correct Answer: B
☑ Explanation: The therapeutic aPTT for heparin is typically 1.5 to 2.5 times the normal
control (usually 60-80 seconds). An aPTT of 110 seconds is dangerously high, placing the client
at risk for hemorrhage. The priority action is to stop the infusion to prevent further
anticoagulation.
6. A client in diabetic ketoacidosis (DKA) has an initial serum potassium of 3.2 mEq/L. The
nurse is preparing to administer IV fluids and insulin. Which action is most appropriate?
A. Administer IV potassium replacement before starting the insulin infusion
B. Start the insulin infusion and monitor the potassium closely
C. Administer sodium bicarbonate to correct the acidosis first
