ATI RN Adult Medical-Surgical Nursing – ATI Adult
Medical-Surgical Study Guide, Original Practice
Questions & Answers, ATI Med-Surg Exam
Preparation, Comprehensive Adult Health Nursing
Review, Cardiovascular, Respiratory, Neurological,
Gastrointestinal, Hepatic, Renal, Genitourinary,
Endocrine, Metabolic, Musculoskeletal, Immune &
Infectious Disorders, Perioperative Care,
Pharmacology, Laboratory Values, Prioritization,
Patient Safety & Clinical Judgment
Question 1: A nurse is caring for a client with heart failure who is receiving
intravenous furosemide. Which of the following assessment findings indicates
that the medication is having the desired therapeutic effect?
A. Increased jugular venous distension
B. Decreased peripheral edema
C. Increased blood pressure
D. Decreased serum potassium levels
CORRECT ANSWER: B. Decreased peripheral edema
Rationale: Furosemide is a loop diuretic used to reduce fluid volume overload in heart
failure. The desired therapeutic effect is the reduction of excess extracellular fluid, which
manifests as decreased peripheral edema, decreased pulmonary congestion, and
decreased jugular venous distension. A decrease in blood pressure is a side effect, not
the primary therapeutic goal, and hypokalemia is an adverse effect.
Question 2: A nurse is preparing to administer a blood transfusion to a client.
Which of the following actions is most important to prevent a transfusion
reaction?
A. Infuse the blood over 4 hours
B. Verify the client's identity and blood compatibility with another licensed nurse
C. Pre-medicate the client with diphenhydramine
D. Obtain baseline vital signs 30 minutes prior to the transfusion
CORRECT ANSWER: B. Verify the client's identity and blood compatibility with
another licensed nurse
Rationale: The most critical action to prevent a hemolytic transfusion reaction is the
verification of the client's identity and blood product compatibility. This is a two-nurse
verification process checking the client's name, date of birth, medical record number,
blood type, Rh factor, and unit number against the blood bag and the order. Baseline
vital signs are important but secondary to correct identification.
,Question 3: A client with chronic obstructive pulmonary disease (COPD) has
an arterial blood gas (ABG) result showing a pH of 7.30, PaCO2 of 58 mmHg,
and HCO3 of 26 mEq/L. The nurse should interpret this as which of the
following?
A. Uncompensated respiratory alkalosis
B. Partially compensated respiratory acidosis
C. Fully compensated respiratory acidosis
D. Uncompensated metabolic acidosis
CORRECT ANSWER: B. Partially compensated respiratory acidosis
Rationale: The pH is below 7.35, indicating acidosis. The PaCO2 is elevated above 45
mmHg, indicating a respiratory cause. The HCO3 is normal (22-26 mEq/L), but the pH
is not yet within the normal range, meaning renal compensation (increased HCO3) has
not yet fully corrected the acidosis. Therefore, it is a partially compensated respiratory
acidosis.
Question 4: A nurse is caring for a client who is 2 days post-operative
following a total hip arthroplasty. Which of the following actions should the
nurse implement to prevent venous thromboembolism?
A. Massage the client's lower extremities to stimulate circulation
B. Apply sequential compression devices (SCDs) when the client is in bed
C. Place a pillow under the client's knees to promote comfort
D. Instruct the client to avoid range-of-motion exercises until day 4
CORRECT ANSWER: B. Apply sequential compression devices (SCDs) when the
client is in bed
Rationale: SCDs are a mechanical prophylactic measure that promote venous return
from the lower extremities and are a standard intervention for preventing deep vein
thrombosis (DVT) in post-operative clients. Massaging the legs is contraindicated due to
the risk of dislodging a thrombus. Pillows under the knees can impair venous return by
compressing popliteal veins. Early mobilization and range-of-motion exercises are
encouraged, not delayed.
Question 5: A nurse is providing education to a client with type 2 diabetes
mellitus who is starting metformin. Which of the following instructions should
the nurse include?
A. "You may experience weight gain with this medication."
B. "This medication can increase your risk for hypoglycemia if you skip a meal."
,C. "Take this medication with food to decrease gastrointestinal upset."
D. "You should avoid drinking grapefruit juice while on this medication."
CORRECT ANSWER: C. "Take this medication with food to decrease
gastrointestinal upset."
Rationale: Metformin is a biguanide that commonly causes gastrointestinal side effects
such as nausea, diarrhea, and abdominal cramping. Taking it with food significantly
reduces these symptoms. Metformin does not typically cause weight gain or
hypoglycemia as a monotherapy, and it is not associated with grapefruit juice
interactions (which are more common with calcium channel blockers and statins).
Question 6: A client with acute pancreatitis is complaining of severe
abdominal pain. Which of the following positions does the nurse anticipate the
client will assume to best manage the pain?
A. Lying supine with legs extended
B. Lying on the left side with knees flexed
C. Sitting upright and leaning forward
D. Lying prone with a pillow under the abdomen
CORRECT ANSWER: C. Sitting upright and leaning forward
Rationale: The client with acute pancreatitis often experiences relief by sitting upright
and leaning forward (the fetal position with a forward bend). This position reduces
tension on the abdominal wall and may help decrease pain by allowing the stomach to
hang forward, relieving pressure on the inflamed pancreas. Supine and prone positions
often exacerbate the pain due to pressure on the retroperitoneal area.
Question 7: A nurse is assessing a client who has sustained a closed head
injury. Which of the following findings is an early indication of increased
intracranial pressure (ICP)?
A. Widening pulse pressure
B. Bradycardia
C. Ipsilateral pupil dilation
D. Restlessness and confusion
CORRECT ANSWER: D. Restlessness and confusion
Rationale: Early signs of increased ICP are related to cerebral hypoxia and
compression. These include changes in level of consciousness (LOC) such as
restlessness, confusion, and lethargy. Widening pulse pressure, bradycardia, and
irregular respirations (Cushing's triad) are late signs of increased ICP. Ipsilateral pupil
dilation is also a late and ominous sign indicating herniation.
, Question 8: A nurse is preparing to administer 40 mEq of potassium chloride
(KCl) in 100 mL of normal saline intravenously. Which of the following actions
is correct?
A. Administer the medication as a rapid IV push
B. Infuse the medication at a rate of 20 mEq/hr
C. Administer the medication via a peripheral IV line with a 22-gauge catheter
D. Check the client's blood glucose level before administration
CORRECT ANSWER: B. Infuse the medication at a rate of 20 mEq/hr
Rationale: The maximum safe rate for intravenous potassium administration through a
peripheral line is generally 10-20 mEq/hr. Administering potassium IV push is strictly
contraindicated due to the risk of fatal cardiac arrhythmias. A 22-gauge catheter is
acceptable, but the rate is the critical safety parameter. Blood glucose is not specifically
required before potassium administration.
Question 9: A client with end-stage renal disease (ESRD) is receiving
hemodialysis. Which of the following dietary restrictions is most important for
the nurse to reinforce?
A. Increased protein intake
B. Restricted fluid intake
C. High potassium foods such as bananas and oranges
D. High sodium foods to maintain blood pressure
CORRECT ANSWER: B. Restricted fluid intake
Rationale: Clients on hemodialysis are anuric or severely oliguric and cannot excrete
excess fluid. Fluid restriction is critical to prevent fluid overload, hypertension, and
pulmonary edema between dialysis sessions. Protein needs are often increased due to
losses during dialysis. Potassium and phosphorus are restricted, not sodium.
Question 10: A nurse is providing discharge teaching to a client who is
prescribed warfarin (Coumadin). Which of the following statements by the
client indicates a need for further teaching?
A. "I will need to have my blood drawn regularly to check my INR."
B. "I should use a soft-bristled toothbrush."
C. "I can take ibuprofen for my occasional headaches."
D. "I should avoid eating large amounts of leafy green vegetables."
CORRECT ANSWER: C. "I can take ibuprofen for my occasional headaches."
Rationale: Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that increases
the risk of gastrointestinal bleeding when taken with warfarin. Clients should avoid
NSAIDs and use alternative pain relief such as acetaminophen. Regular INR monitoring,
Medical-Surgical Study Guide, Original Practice
Questions & Answers, ATI Med-Surg Exam
Preparation, Comprehensive Adult Health Nursing
Review, Cardiovascular, Respiratory, Neurological,
Gastrointestinal, Hepatic, Renal, Genitourinary,
Endocrine, Metabolic, Musculoskeletal, Immune &
Infectious Disorders, Perioperative Care,
Pharmacology, Laboratory Values, Prioritization,
Patient Safety & Clinical Judgment
Question 1: A nurse is caring for a client with heart failure who is receiving
intravenous furosemide. Which of the following assessment findings indicates
that the medication is having the desired therapeutic effect?
A. Increased jugular venous distension
B. Decreased peripheral edema
C. Increased blood pressure
D. Decreased serum potassium levels
CORRECT ANSWER: B. Decreased peripheral edema
Rationale: Furosemide is a loop diuretic used to reduce fluid volume overload in heart
failure. The desired therapeutic effect is the reduction of excess extracellular fluid, which
manifests as decreased peripheral edema, decreased pulmonary congestion, and
decreased jugular venous distension. A decrease in blood pressure is a side effect, not
the primary therapeutic goal, and hypokalemia is an adverse effect.
Question 2: A nurse is preparing to administer a blood transfusion to a client.
Which of the following actions is most important to prevent a transfusion
reaction?
A. Infuse the blood over 4 hours
B. Verify the client's identity and blood compatibility with another licensed nurse
C. Pre-medicate the client with diphenhydramine
D. Obtain baseline vital signs 30 minutes prior to the transfusion
CORRECT ANSWER: B. Verify the client's identity and blood compatibility with
another licensed nurse
Rationale: The most critical action to prevent a hemolytic transfusion reaction is the
verification of the client's identity and blood product compatibility. This is a two-nurse
verification process checking the client's name, date of birth, medical record number,
blood type, Rh factor, and unit number against the blood bag and the order. Baseline
vital signs are important but secondary to correct identification.
,Question 3: A client with chronic obstructive pulmonary disease (COPD) has
an arterial blood gas (ABG) result showing a pH of 7.30, PaCO2 of 58 mmHg,
and HCO3 of 26 mEq/L. The nurse should interpret this as which of the
following?
A. Uncompensated respiratory alkalosis
B. Partially compensated respiratory acidosis
C. Fully compensated respiratory acidosis
D. Uncompensated metabolic acidosis
CORRECT ANSWER: B. Partially compensated respiratory acidosis
Rationale: The pH is below 7.35, indicating acidosis. The PaCO2 is elevated above 45
mmHg, indicating a respiratory cause. The HCO3 is normal (22-26 mEq/L), but the pH
is not yet within the normal range, meaning renal compensation (increased HCO3) has
not yet fully corrected the acidosis. Therefore, it is a partially compensated respiratory
acidosis.
Question 4: A nurse is caring for a client who is 2 days post-operative
following a total hip arthroplasty. Which of the following actions should the
nurse implement to prevent venous thromboembolism?
A. Massage the client's lower extremities to stimulate circulation
B. Apply sequential compression devices (SCDs) when the client is in bed
C. Place a pillow under the client's knees to promote comfort
D. Instruct the client to avoid range-of-motion exercises until day 4
CORRECT ANSWER: B. Apply sequential compression devices (SCDs) when the
client is in bed
Rationale: SCDs are a mechanical prophylactic measure that promote venous return
from the lower extremities and are a standard intervention for preventing deep vein
thrombosis (DVT) in post-operative clients. Massaging the legs is contraindicated due to
the risk of dislodging a thrombus. Pillows under the knees can impair venous return by
compressing popliteal veins. Early mobilization and range-of-motion exercises are
encouraged, not delayed.
Question 5: A nurse is providing education to a client with type 2 diabetes
mellitus who is starting metformin. Which of the following instructions should
the nurse include?
A. "You may experience weight gain with this medication."
B. "This medication can increase your risk for hypoglycemia if you skip a meal."
,C. "Take this medication with food to decrease gastrointestinal upset."
D. "You should avoid drinking grapefruit juice while on this medication."
CORRECT ANSWER: C. "Take this medication with food to decrease
gastrointestinal upset."
Rationale: Metformin is a biguanide that commonly causes gastrointestinal side effects
such as nausea, diarrhea, and abdominal cramping. Taking it with food significantly
reduces these symptoms. Metformin does not typically cause weight gain or
hypoglycemia as a monotherapy, and it is not associated with grapefruit juice
interactions (which are more common with calcium channel blockers and statins).
Question 6: A client with acute pancreatitis is complaining of severe
abdominal pain. Which of the following positions does the nurse anticipate the
client will assume to best manage the pain?
A. Lying supine with legs extended
B. Lying on the left side with knees flexed
C. Sitting upright and leaning forward
D. Lying prone with a pillow under the abdomen
CORRECT ANSWER: C. Sitting upright and leaning forward
Rationale: The client with acute pancreatitis often experiences relief by sitting upright
and leaning forward (the fetal position with a forward bend). This position reduces
tension on the abdominal wall and may help decrease pain by allowing the stomach to
hang forward, relieving pressure on the inflamed pancreas. Supine and prone positions
often exacerbate the pain due to pressure on the retroperitoneal area.
Question 7: A nurse is assessing a client who has sustained a closed head
injury. Which of the following findings is an early indication of increased
intracranial pressure (ICP)?
A. Widening pulse pressure
B. Bradycardia
C. Ipsilateral pupil dilation
D. Restlessness and confusion
CORRECT ANSWER: D. Restlessness and confusion
Rationale: Early signs of increased ICP are related to cerebral hypoxia and
compression. These include changes in level of consciousness (LOC) such as
restlessness, confusion, and lethargy. Widening pulse pressure, bradycardia, and
irregular respirations (Cushing's triad) are late signs of increased ICP. Ipsilateral pupil
dilation is also a late and ominous sign indicating herniation.
, Question 8: A nurse is preparing to administer 40 mEq of potassium chloride
(KCl) in 100 mL of normal saline intravenously. Which of the following actions
is correct?
A. Administer the medication as a rapid IV push
B. Infuse the medication at a rate of 20 mEq/hr
C. Administer the medication via a peripheral IV line with a 22-gauge catheter
D. Check the client's blood glucose level before administration
CORRECT ANSWER: B. Infuse the medication at a rate of 20 mEq/hr
Rationale: The maximum safe rate for intravenous potassium administration through a
peripheral line is generally 10-20 mEq/hr. Administering potassium IV push is strictly
contraindicated due to the risk of fatal cardiac arrhythmias. A 22-gauge catheter is
acceptable, but the rate is the critical safety parameter. Blood glucose is not specifically
required before potassium administration.
Question 9: A client with end-stage renal disease (ESRD) is receiving
hemodialysis. Which of the following dietary restrictions is most important for
the nurse to reinforce?
A. Increased protein intake
B. Restricted fluid intake
C. High potassium foods such as bananas and oranges
D. High sodium foods to maintain blood pressure
CORRECT ANSWER: B. Restricted fluid intake
Rationale: Clients on hemodialysis are anuric or severely oliguric and cannot excrete
excess fluid. Fluid restriction is critical to prevent fluid overload, hypertension, and
pulmonary edema between dialysis sessions. Protein needs are often increased due to
losses during dialysis. Potassium and phosphorus are restricted, not sodium.
Question 10: A nurse is providing discharge teaching to a client who is
prescribed warfarin (Coumadin). Which of the following statements by the
client indicates a need for further teaching?
A. "I will need to have my blood drawn regularly to check my INR."
B. "I should use a soft-bristled toothbrush."
C. "I can take ibuprofen for my occasional headaches."
D. "I should avoid eating large amounts of leafy green vegetables."
CORRECT ANSWER: C. "I can take ibuprofen for my occasional headaches."
Rationale: Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that increases
the risk of gastrointestinal bleeding when taken with warfarin. Clients should avoid
NSAIDs and use alternative pain relief such as acetaminophen. Regular INR monitoring,
