ATI RN ADULT MEDICAL-SURGICAL PROCTORED EXAM
2026/2027 | 300 VERIFIED QUESTIONS & DETAILED
RATIONALES | COMPREHENSIVE STUDY GUIDE
1. A nurse is providing discharge teaching to a client with a new prescription for
sublingual nitroglycerin. Which client statement indicates understanding?
A) "I can keep my medication for 1 year before replacing it"
B) "I should lie down when I take this medication"
C) "I should discontinue this medication if I develop a headache"
D) "I can take up to five tablets in 15 minutes before seeking attention"
Answer: B) "I should lie down when I take this medication"
Rationale: Clients should lie down when taking sublingual nitroglycerin to prevent
dizziness and hypotension from vasodilation. Nitroglycerin should be replaced every 6
months, headaches are an expected side effect, and the protocol is one tablet every 5
minutes for up to 3 tablets.
2. A nurse is caring for a client receiving a blood transfusion. The nurse observes
bounding peripheral pulses, hypertension, and distended jugular veins. Which
medication should the nurse anticipate administering?
A) Acetaminophen
B) Furosemide
C) Diphenhydramine
D) Pantoprazole
Answer: B) Furosemide
Rationale: These findings indicate circulatory overload (fluid volume excess). Furosemide
(Lasix) is a diuretic that reduces preload and fluid volume. Acetaminophen treats fever,
diphenhydramine treats allergic reactions, and pantoprazole is a proton pump inhibitor.
,3. A nurse is caring for a client with hypervolemia. Which assessment finding is
expected?
A) Weight loss
B) Increased urine output
C) Weight gain
D) Decreased blood pressure
Answer: C) Weight gain
Rationale: Hypervolemia (fluid volume excess) results in weight gain, edema, distended
neck veins, crackles in the lungs, and elevated blood pressure. Weight loss and decreased
urine output are associated with hypovolemia.
4. A nurse is auscultating heart sounds and hears a high-pitched, blowing sound at
the apex during systole. This finding is consistent with:
A) Mitral stenosis
B) Aortic regurgitation
C) Mitral regurgitation
D) Aortic stenosis
Answer: C) Mitral regurgitation
Rationale: Mitral regurgitation produces a high-pitched, blowing holosystolic murmur best
heard at the apex. Mitral stenosis is a diastolic rumble. Aortic stenosis is a systolic ejection
murmur at the right upper sternal border. Aortic regurgitation is a diastolic murmur.
5. A client with hypertension is prescribed lisinopril. Which side effect should the
client report immediately?
A) Dry cough
B) Swelling of the face and lips
C) Dizziness when standing
D) Increased urination
Answer: B) Swelling of the face and lips
,Rationale: Angioedema (swelling of the face, lips, tongue, or throat) is a serious adverse
effect of ACE inhibitors that requires immediate medical attention. Dry cough is a
common but not life-threatening side effect. Dizziness is expected with initial dosing.
6. A client with heart failure is on a low-sodium diet. Which food choice indicates
understanding?
A) Canned vegetable soup
B) Grilled chicken with fresh herbs
C) Salted pretzels
D) Processed cheese sandwich
Answer: B) Grilled chicken with fresh herbs
Rationale: Fresh, unprocessed foods like grilled chicken with herbs are low in sodium.
Canned soups, salted snacks, and processed cheeses are high in sodium and should be
avoided.
7. A client presents with chest pain, diaphoresis, and nausea. ECG shows ST-
segment elevation in leads V1-V4. Which coronary artery is most likely occluded?
A) Right coronary artery
B) Left anterior descending (LAD)
C) Left circumflex artery
D) Posterior descending artery
Answer: B) Left anterior descending (LAD)
Rationale: ST elevation in V1-V4 indicates an anterior wall MI, which is supplied by the
LAD artery. Right coronary artery occlusion causes inferior MI (II, III, aVF). Circumflex
causes lateral MI (I, aVL, V5-V6).
8. A nurse is assessing a client with pericarditis. Which finding is classic for this
condition?
, A) Pain relieved by leaning forward
B) Pain worsened by sitting upright
C) Pain relieved by lying flat
D) Pain that radiates to the right arm
Answer: A) Pain relieved by leaning forward
Rationale: Pericardial pain is typically sharp, pleuritic, and worsens with lying flat or
inspiration. Leaning forward relieves pressure on the pericardial sac and reduces pain.
9. A client with cardiogenic shock has a pulmonary artery catheter. Cardiac output
is 2.5 L/min and PCWP is 22 mmHg. Which intervention is most appropriate?
A) Administer IV fluids rapidly
B) Administer a vasopressor like dobutamine
C) Place the client in Trendelenburg position
D) Administer a diuretic
Answer: B) Administer a vasopressor like dobutamine
Rationale: Low cardiac output (normal 4-8 L/min) with high PCWP (normal 4-12 mmHg)
indicates pump failure with fluid backup. Inotropic support like dobutamine improves
contractility. Fluids would worsen PCWP.
10. What medication and electrical management are used for atrial fibrillation?
A) Amiodarone, adenosine, verapamil - synchronized cardioversion
B) Lidocaine, epinephrine - defibrillation
C) Atropine - pacemaker insertion
D) Dobutamine - synchronized cardioversion
Answer: A) Amiodarone, adenosine, verapamil - synchronized cardioversion
Rationale: Atrial fibrillation is managed with rate control (amiodarone, verapamil) and
synchronized cardioversion for unstable patients. Defibrillation is for pulseless rhythms.
11. What assessment finding indicates fluid volume overload?
2026/2027 | 300 VERIFIED QUESTIONS & DETAILED
RATIONALES | COMPREHENSIVE STUDY GUIDE
1. A nurse is providing discharge teaching to a client with a new prescription for
sublingual nitroglycerin. Which client statement indicates understanding?
A) "I can keep my medication for 1 year before replacing it"
B) "I should lie down when I take this medication"
C) "I should discontinue this medication if I develop a headache"
D) "I can take up to five tablets in 15 minutes before seeking attention"
Answer: B) "I should lie down when I take this medication"
Rationale: Clients should lie down when taking sublingual nitroglycerin to prevent
dizziness and hypotension from vasodilation. Nitroglycerin should be replaced every 6
months, headaches are an expected side effect, and the protocol is one tablet every 5
minutes for up to 3 tablets.
2. A nurse is caring for a client receiving a blood transfusion. The nurse observes
bounding peripheral pulses, hypertension, and distended jugular veins. Which
medication should the nurse anticipate administering?
A) Acetaminophen
B) Furosemide
C) Diphenhydramine
D) Pantoprazole
Answer: B) Furosemide
Rationale: These findings indicate circulatory overload (fluid volume excess). Furosemide
(Lasix) is a diuretic that reduces preload and fluid volume. Acetaminophen treats fever,
diphenhydramine treats allergic reactions, and pantoprazole is a proton pump inhibitor.
,3. A nurse is caring for a client with hypervolemia. Which assessment finding is
expected?
A) Weight loss
B) Increased urine output
C) Weight gain
D) Decreased blood pressure
Answer: C) Weight gain
Rationale: Hypervolemia (fluid volume excess) results in weight gain, edema, distended
neck veins, crackles in the lungs, and elevated blood pressure. Weight loss and decreased
urine output are associated with hypovolemia.
4. A nurse is auscultating heart sounds and hears a high-pitched, blowing sound at
the apex during systole. This finding is consistent with:
A) Mitral stenosis
B) Aortic regurgitation
C) Mitral regurgitation
D) Aortic stenosis
Answer: C) Mitral regurgitation
Rationale: Mitral regurgitation produces a high-pitched, blowing holosystolic murmur best
heard at the apex. Mitral stenosis is a diastolic rumble. Aortic stenosis is a systolic ejection
murmur at the right upper sternal border. Aortic regurgitation is a diastolic murmur.
5. A client with hypertension is prescribed lisinopril. Which side effect should the
client report immediately?
A) Dry cough
B) Swelling of the face and lips
C) Dizziness when standing
D) Increased urination
Answer: B) Swelling of the face and lips
,Rationale: Angioedema (swelling of the face, lips, tongue, or throat) is a serious adverse
effect of ACE inhibitors that requires immediate medical attention. Dry cough is a
common but not life-threatening side effect. Dizziness is expected with initial dosing.
6. A client with heart failure is on a low-sodium diet. Which food choice indicates
understanding?
A) Canned vegetable soup
B) Grilled chicken with fresh herbs
C) Salted pretzels
D) Processed cheese sandwich
Answer: B) Grilled chicken with fresh herbs
Rationale: Fresh, unprocessed foods like grilled chicken with herbs are low in sodium.
Canned soups, salted snacks, and processed cheeses are high in sodium and should be
avoided.
7. A client presents with chest pain, diaphoresis, and nausea. ECG shows ST-
segment elevation in leads V1-V4. Which coronary artery is most likely occluded?
A) Right coronary artery
B) Left anterior descending (LAD)
C) Left circumflex artery
D) Posterior descending artery
Answer: B) Left anterior descending (LAD)
Rationale: ST elevation in V1-V4 indicates an anterior wall MI, which is supplied by the
LAD artery. Right coronary artery occlusion causes inferior MI (II, III, aVF). Circumflex
causes lateral MI (I, aVL, V5-V6).
8. A nurse is assessing a client with pericarditis. Which finding is classic for this
condition?
, A) Pain relieved by leaning forward
B) Pain worsened by sitting upright
C) Pain relieved by lying flat
D) Pain that radiates to the right arm
Answer: A) Pain relieved by leaning forward
Rationale: Pericardial pain is typically sharp, pleuritic, and worsens with lying flat or
inspiration. Leaning forward relieves pressure on the pericardial sac and reduces pain.
9. A client with cardiogenic shock has a pulmonary artery catheter. Cardiac output
is 2.5 L/min and PCWP is 22 mmHg. Which intervention is most appropriate?
A) Administer IV fluids rapidly
B) Administer a vasopressor like dobutamine
C) Place the client in Trendelenburg position
D) Administer a diuretic
Answer: B) Administer a vasopressor like dobutamine
Rationale: Low cardiac output (normal 4-8 L/min) with high PCWP (normal 4-12 mmHg)
indicates pump failure with fluid backup. Inotropic support like dobutamine improves
contractility. Fluids would worsen PCWP.
10. What medication and electrical management are used for atrial fibrillation?
A) Amiodarone, adenosine, verapamil - synchronized cardioversion
B) Lidocaine, epinephrine - defibrillation
C) Atropine - pacemaker insertion
D) Dobutamine - synchronized cardioversion
Answer: A) Amiodarone, adenosine, verapamil - synchronized cardioversion
Rationale: Atrial fibrillation is managed with rate control (amiodarone, verapamil) and
synchronized cardioversion for unstable patients. Defibrillation is for pulseless rhythms.
11. What assessment finding indicates fluid volume overload?
