ATI Advanced Medical-Surgical Proctored Exam
Questions with Correct Answers
(verifiedanswers) plus Rationales 2026 Q&A
instant download pdf
Question 1 — Acute Heart Failure
A nurse is caring for a client who has acute decompensated
heart failure. Which finding requires the nurse's priority
intervention?
A. 2+ bilateral ankle edema
B. Weight gain of 1 kg over 3 days
C. Orthopnea when lying flat
D. Pink, frothy sputum with severe dyspnea
Correct answer: D. Pink, frothy sputum with severe dyspnea
Rationale: Pink, frothy sputum accompanied by severe dyspnea
is a classic indication of acute pulmonary edema, which can
rapidly compromise oxygenation and become life-threatening.
The immediate priority is to support airway and breathing and
rapidly improve oxygenation while implementing prescribed
emergency interventions. Peripheral edema, weight gain, and
orthopnea indicate worsening fluid retention, but pink frothy
,sputum with severe respiratory distress represents a more
immediate threat to life.
Question 2 — Myocardial Infarction
A client reports crushing substernal chest pain that radiates to
the left arm and jaw and is accompanied by diaphoresis and
nausea. Which action should the nurse take first?
A. Obtain a 12-lead ECG
B. Administer an antacid
C. Encourage the client to ambulate
D. Place the client in a supine position
Correct answer: A. Obtain a 12-lead ECG
Rationale: A 12-lead ECG should be obtained rapidly when acute
coronary syndrome is suspected because it can identify ST-
segment elevation or other ischemic changes and guide urgent
treatment. The client should remain at rest rather than
ambulate. Antacids are inappropriate when the symptom
pattern strongly suggests myocardial ischemia. Positioning
should promote comfort and oxygenation, commonly with the
head of the bed elevated rather than placing the client flat.
Question 3 — Atrial Fibrillation
,A client with atrial fibrillation is receiving warfarin. Which
laboratory value is most important for the nurse to monitor?
A. Serum potassium
B. INR
C. Serum sodium
D. Troponin
Correct answer: B. INR
Rationale: Warfarin therapy is monitored using the
international normalized ratio (INR). The INR helps determine
whether anticoagulation is within the prescribed therapeutic
range and helps reduce the risk of both thromboembolism and
excessive bleeding. Potassium is important for clients receiving
certain cardiac medications, but it does not directly measure the
effect of warfarin. Troponin evaluates myocardial injury rather
than anticoagulant effectiveness.
Question 4 — Cardiogenic Shock
A client develops hypotension, cool clammy skin, oliguria, and
altered mental status after an extensive myocardial infarction.
Which condition should the nurse suspect?
A. Cardiogenic shock
B. Neurogenic shock
, C. Septic shock
D. Hypovolemic shock
Correct answer: A. Cardiogenic shock
Rationale: Cardiogenic shock occurs when the heart cannot
pump enough blood to maintain adequate tissue perfusion.
Following a major myocardial infarction, extensive myocardial
damage can markedly decrease cardiac output. Hypotension,
cool clammy skin, reduced urine output, and altered mental
status reflect inadequate systemic perfusion. Hypovolemic shock
results primarily from loss of circulating volume, while septic
shock is associated with severe infection and vasodilation.
Question 5 — Hypertension
A client with severe hypertension reports a sudden severe
headache, blurred vision, and confusion. Which action is the
nurse's priority?
A. Recheck the blood pressure in 4 hr
B. Encourage oral fluids
C. Notify the provider immediately
D. Ask the client to walk in the hallway
Correct answer: C. Notify the provider immediately
Rationale: Severe hypertension accompanied by neurological
changes can indicate hypertensive emergency with possible
Questions with Correct Answers
(verifiedanswers) plus Rationales 2026 Q&A
instant download pdf
Question 1 — Acute Heart Failure
A nurse is caring for a client who has acute decompensated
heart failure. Which finding requires the nurse's priority
intervention?
A. 2+ bilateral ankle edema
B. Weight gain of 1 kg over 3 days
C. Orthopnea when lying flat
D. Pink, frothy sputum with severe dyspnea
Correct answer: D. Pink, frothy sputum with severe dyspnea
Rationale: Pink, frothy sputum accompanied by severe dyspnea
is a classic indication of acute pulmonary edema, which can
rapidly compromise oxygenation and become life-threatening.
The immediate priority is to support airway and breathing and
rapidly improve oxygenation while implementing prescribed
emergency interventions. Peripheral edema, weight gain, and
orthopnea indicate worsening fluid retention, but pink frothy
,sputum with severe respiratory distress represents a more
immediate threat to life.
Question 2 — Myocardial Infarction
A client reports crushing substernal chest pain that radiates to
the left arm and jaw and is accompanied by diaphoresis and
nausea. Which action should the nurse take first?
A. Obtain a 12-lead ECG
B. Administer an antacid
C. Encourage the client to ambulate
D. Place the client in a supine position
Correct answer: A. Obtain a 12-lead ECG
Rationale: A 12-lead ECG should be obtained rapidly when acute
coronary syndrome is suspected because it can identify ST-
segment elevation or other ischemic changes and guide urgent
treatment. The client should remain at rest rather than
ambulate. Antacids are inappropriate when the symptom
pattern strongly suggests myocardial ischemia. Positioning
should promote comfort and oxygenation, commonly with the
head of the bed elevated rather than placing the client flat.
Question 3 — Atrial Fibrillation
,A client with atrial fibrillation is receiving warfarin. Which
laboratory value is most important for the nurse to monitor?
A. Serum potassium
B. INR
C. Serum sodium
D. Troponin
Correct answer: B. INR
Rationale: Warfarin therapy is monitored using the
international normalized ratio (INR). The INR helps determine
whether anticoagulation is within the prescribed therapeutic
range and helps reduce the risk of both thromboembolism and
excessive bleeding. Potassium is important for clients receiving
certain cardiac medications, but it does not directly measure the
effect of warfarin. Troponin evaluates myocardial injury rather
than anticoagulant effectiveness.
Question 4 — Cardiogenic Shock
A client develops hypotension, cool clammy skin, oliguria, and
altered mental status after an extensive myocardial infarction.
Which condition should the nurse suspect?
A. Cardiogenic shock
B. Neurogenic shock
, C. Septic shock
D. Hypovolemic shock
Correct answer: A. Cardiogenic shock
Rationale: Cardiogenic shock occurs when the heart cannot
pump enough blood to maintain adequate tissue perfusion.
Following a major myocardial infarction, extensive myocardial
damage can markedly decrease cardiac output. Hypotension,
cool clammy skin, reduced urine output, and altered mental
status reflect inadequate systemic perfusion. Hypovolemic shock
results primarily from loss of circulating volume, while septic
shock is associated with severe infection and vasodilation.
Question 5 — Hypertension
A client with severe hypertension reports a sudden severe
headache, blurred vision, and confusion. Which action is the
nurse's priority?
A. Recheck the blood pressure in 4 hr
B. Encourage oral fluids
C. Notify the provider immediately
D. Ask the client to walk in the hallway
Correct answer: C. Notify the provider immediately
Rationale: Severe hypertension accompanied by neurological
changes can indicate hypertensive emergency with possible
