1
The Ultimate ATI RN Medical-Surgical
Proctored Exam Prep: 100 High-Yield
Questions with Rationales
Cardiovascular & Hematologic Disorders
1. A nurse is assessing a client who is 24 hours post-cardiac catheterization via the femoral artery.
Which finding requires immediate intervention?
A. A hematoma at the insertion site
B. A palpable pulse distal to the insertion site
C. The client reports a pain level of 3 on a 0-10 scale
D. The insertion site is dry and intact
Answer: A. A hematoma can indicate bleeding and possible arterial occlusion. While a distal pulse is
a good sign, a hematoma indicates a complication requiring prompt action.
2. A client receiving IV heparin has an aPTT of 90 seconds. The normal range is 25-35 seconds.
What is the nurse's priority action?
A. Continue the heparin at the current rate.
B. Notify the healthcare provider.
C. Administer protamine sulfate.
D. Hold the heparin dose for one hour.
Answer: B. An aPTT of 90 seconds indicates a significant risk of bleeding. The nurse should notify the
provider for a dose adjustment.
3. A client is prescribed digoxin. Which of the following findings indicates potential digoxin
toxicity? (Select all that apply)
A. Visual disturbances (yellow halos)
B. Bradycardia
C. Nausea and vomiting
D. Hypertension
E. Confusion
Answer: A, B, C, E. Digoxin toxicity is characterized by GI upset (nausea, vomiting), bradycardia,
visual changes (yellow-green halos), and confusion.
4. A client who had a thyroidectomy 12 hours ago reports a feeling of tingling and numbness
around the mouth. Which laboratory value should the nurse anticipate?
A. Elevated serum calcium
B. Decreased serum calcium
C. Elevated serum potassium
D. Decreased serum sodium
Answer: B. This client is displaying signs of hypocalcemia (tingling, numbness), which can occur if the
parathyroid glands are damaged or removed during a thyroidectomy.
, 2
5. A client with a history of atrial fibrillation is prescribed warfarin. Which of the following
statements indicates the client understands the medication teaching?
A. "I will take an antacid if I develop a stomachache."
B. "I should use a soft-bristled toothbrush."
C. "I can continue taking my daily aspirin for my arthritis."
D. "I will increase my intake of leafy green vegetables."
Answer: B. Soft-bristled toothbrushes are recommended to prevent gum bleeding, a major risk of
warfarin therapy.
6. A client receiving a blood transfusion begins to experience chills, fever, and severe lower back
pain. What is the nurse's first action?
A. Notify the provider.
B. Slow the transfusion rate.
C. Stop the transfusion.
D. Administer an antihistamine.
Answer: C. These symptoms are classic signs of an acute hemolytic transfusion reaction. The priority
is to stop the transfusion to prevent further harm.
7. A client who is prescribed an ACE inhibitor for hypertension should be taught to avoid which
supplement?
A. Potassium chloride
B. Calcium carbonate
C. Magnesium sulfate
D. Sodium chloride
Answer: A. ACE inhibitors can cause potassium retention, so clients should be taught to avoid
potassium supplements and salt substitutes containing potassium.
8. A nurse is assessing a client with heart failure. Which finding indicates fluid overload?
A. Crackles in the lungs
B. Decreased blood pressure
C. Thready pulse
D. Flat neck veins
Answer: A. Crackles (or rales) in the lungs are a classic sign of pulmonary congestion due to fluid
overload in heart failure.
9. A client with a history of DVT is prescribed enoxaparin. The client asks, "Why can't I just take
the warfarin pills I had before?" Which response by the nurse is correct?
A. "Enoxaparin is much stronger than warfarin."
B. "Enoxaparin has a faster onset and is used for immediate prevention of clots."
C. "Enoxaparin doesn't have the side effect of bleeding."
D. "Warfarin is no longer effective for DVT prophylaxis."
Answer: B. Enoxaparin is a low-molecular-weight heparin (LMWH) used for rapid anticoagulation,
while warfarin takes several days to become therapeutic.
10. A client is prescribed furosemide for heart failure. The nurse should monitor for which
potential electrolyte imbalance?
A. Hyperkalemia
, 3
B. Hypokalemia
C. Hypernatremia
D. Hypermagnesemia
Answer: B. Furosemide is a loop diuretic that causes the excretion of potassium, leading to
hypokalemia.
Respiratory Disorders
11. A client with COPD has an oxygen saturation of 84% on room air. Which oxygen delivery device
is most appropriate to initiate?
A. Non-rebreather mask at 15 L/min
B. Simple face mask at 6 L/min
C. Venturi mask at 28% FiO2
D. Nasal cannula at 4 L/min
Answer: C. For clients with COPD who rely on a hypoxic drive to breathe, the Venturi mask is
preferred as it delivers the most precise and controlled oxygen concentration, minimizing the risk of
suppressing their respiratory drive.
12. A client with asthma is receiving a nebulized albuterol treatment. Upon reassessment, the
nurse notes that wheezing is no longer audible and the client is now drowsy with retractions.
What is the nurse's priority action?
A. Document the improvement in the client's breath sounds.
B. Continue to monitor the client's respiratory status.
C. Prepare for emergency intubation and notify the provider.
D. Administer a dose of an oral corticosteroid.
Answer: C. The "silent chest" with retractions and drowsiness indicates severe respiratory muscle
fatigue and impending respiratory failure. Immediate intubation is necessary.
13. A nurse is caring for a client on a mechanical ventilator when the low-pressure alarm sounds.
What is the most likely cause of this alarm?
A. Biting the endotracheal tube
B. Kink in the ventilator circuit
C. Disconnection of the ventilator tubing
D. A build-up of secretions
Answer: C. Low-pressure alarms indicate a decrease in pressure, usually caused by a leak or
disconnection in the system. Biting, kinks, or secretions would cause a high-pressure alarm.
14. A client with a pneumothorax has a chest tube attached to a wet-suction drainage system. The
nurse observes continuous, vigorous bubbling in the water-seal chamber. What is the correct
interpretation?
A. The suction is working effectively.
B. The lung has fully re-expanded.
C. There is an air leak in the system.
D. This is a normal finding.
Answer: C. Continuous bubbling in the water-seal chamber indicates an air leak in the chest tube
system or from the lung/pleural space, which requires investigation.
The Ultimate ATI RN Medical-Surgical
Proctored Exam Prep: 100 High-Yield
Questions with Rationales
Cardiovascular & Hematologic Disorders
1. A nurse is assessing a client who is 24 hours post-cardiac catheterization via the femoral artery.
Which finding requires immediate intervention?
A. A hematoma at the insertion site
B. A palpable pulse distal to the insertion site
C. The client reports a pain level of 3 on a 0-10 scale
D. The insertion site is dry and intact
Answer: A. A hematoma can indicate bleeding and possible arterial occlusion. While a distal pulse is
a good sign, a hematoma indicates a complication requiring prompt action.
2. A client receiving IV heparin has an aPTT of 90 seconds. The normal range is 25-35 seconds.
What is the nurse's priority action?
A. Continue the heparin at the current rate.
B. Notify the healthcare provider.
C. Administer protamine sulfate.
D. Hold the heparin dose for one hour.
Answer: B. An aPTT of 90 seconds indicates a significant risk of bleeding. The nurse should notify the
provider for a dose adjustment.
3. A client is prescribed digoxin. Which of the following findings indicates potential digoxin
toxicity? (Select all that apply)
A. Visual disturbances (yellow halos)
B. Bradycardia
C. Nausea and vomiting
D. Hypertension
E. Confusion
Answer: A, B, C, E. Digoxin toxicity is characterized by GI upset (nausea, vomiting), bradycardia,
visual changes (yellow-green halos), and confusion.
4. A client who had a thyroidectomy 12 hours ago reports a feeling of tingling and numbness
around the mouth. Which laboratory value should the nurse anticipate?
A. Elevated serum calcium
B. Decreased serum calcium
C. Elevated serum potassium
D. Decreased serum sodium
Answer: B. This client is displaying signs of hypocalcemia (tingling, numbness), which can occur if the
parathyroid glands are damaged or removed during a thyroidectomy.
, 2
5. A client with a history of atrial fibrillation is prescribed warfarin. Which of the following
statements indicates the client understands the medication teaching?
A. "I will take an antacid if I develop a stomachache."
B. "I should use a soft-bristled toothbrush."
C. "I can continue taking my daily aspirin for my arthritis."
D. "I will increase my intake of leafy green vegetables."
Answer: B. Soft-bristled toothbrushes are recommended to prevent gum bleeding, a major risk of
warfarin therapy.
6. A client receiving a blood transfusion begins to experience chills, fever, and severe lower back
pain. What is the nurse's first action?
A. Notify the provider.
B. Slow the transfusion rate.
C. Stop the transfusion.
D. Administer an antihistamine.
Answer: C. These symptoms are classic signs of an acute hemolytic transfusion reaction. The priority
is to stop the transfusion to prevent further harm.
7. A client who is prescribed an ACE inhibitor for hypertension should be taught to avoid which
supplement?
A. Potassium chloride
B. Calcium carbonate
C. Magnesium sulfate
D. Sodium chloride
Answer: A. ACE inhibitors can cause potassium retention, so clients should be taught to avoid
potassium supplements and salt substitutes containing potassium.
8. A nurse is assessing a client with heart failure. Which finding indicates fluid overload?
A. Crackles in the lungs
B. Decreased blood pressure
C. Thready pulse
D. Flat neck veins
Answer: A. Crackles (or rales) in the lungs are a classic sign of pulmonary congestion due to fluid
overload in heart failure.
9. A client with a history of DVT is prescribed enoxaparin. The client asks, "Why can't I just take
the warfarin pills I had before?" Which response by the nurse is correct?
A. "Enoxaparin is much stronger than warfarin."
B. "Enoxaparin has a faster onset and is used for immediate prevention of clots."
C. "Enoxaparin doesn't have the side effect of bleeding."
D. "Warfarin is no longer effective for DVT prophylaxis."
Answer: B. Enoxaparin is a low-molecular-weight heparin (LMWH) used for rapid anticoagulation,
while warfarin takes several days to become therapeutic.
10. A client is prescribed furosemide for heart failure. The nurse should monitor for which
potential electrolyte imbalance?
A. Hyperkalemia
, 3
B. Hypokalemia
C. Hypernatremia
D. Hypermagnesemia
Answer: B. Furosemide is a loop diuretic that causes the excretion of potassium, leading to
hypokalemia.
Respiratory Disorders
11. A client with COPD has an oxygen saturation of 84% on room air. Which oxygen delivery device
is most appropriate to initiate?
A. Non-rebreather mask at 15 L/min
B. Simple face mask at 6 L/min
C. Venturi mask at 28% FiO2
D. Nasal cannula at 4 L/min
Answer: C. For clients with COPD who rely on a hypoxic drive to breathe, the Venturi mask is
preferred as it delivers the most precise and controlled oxygen concentration, minimizing the risk of
suppressing their respiratory drive.
12. A client with asthma is receiving a nebulized albuterol treatment. Upon reassessment, the
nurse notes that wheezing is no longer audible and the client is now drowsy with retractions.
What is the nurse's priority action?
A. Document the improvement in the client's breath sounds.
B. Continue to monitor the client's respiratory status.
C. Prepare for emergency intubation and notify the provider.
D. Administer a dose of an oral corticosteroid.
Answer: C. The "silent chest" with retractions and drowsiness indicates severe respiratory muscle
fatigue and impending respiratory failure. Immediate intubation is necessary.
13. A nurse is caring for a client on a mechanical ventilator when the low-pressure alarm sounds.
What is the most likely cause of this alarm?
A. Biting the endotracheal tube
B. Kink in the ventilator circuit
C. Disconnection of the ventilator tubing
D. A build-up of secretions
Answer: C. Low-pressure alarms indicate a decrease in pressure, usually caused by a leak or
disconnection in the system. Biting, kinks, or secretions would cause a high-pressure alarm.
14. A client with a pneumothorax has a chest tube attached to a wet-suction drainage system. The
nurse observes continuous, vigorous bubbling in the water-seal chamber. What is the correct
interpretation?
A. The suction is working effectively.
B. The lung has fully re-expanded.
C. There is an air leak in the system.
D. This is a normal finding.
Answer: C. Continuous bubbling in the water-seal chamber indicates an air leak in the chest tube
system or from the lung/pleural space, which requires investigation.
