ATI RN Adult Medical-Surgical Proctored Exam
- 100 Practice Questions with Rationales
Cardiovascular Disorders
Question 1: A nurse is assessing a client with heart failure who has gained 2.2 kg (5 lb) in the
past 24 hours. Which finding should the nurse report to the provider?
A) Blood pressure 138/86 mm Hg
B) Crackles in the lung bases
C) Peripheral pulse 2+
D) Urine output 60 mL/hr
Answer: B
Rationale: A weight gain of 2.2 kg in 24 hours indicates fluid retention. Crackles in the lung
bases suggest pulmonary congestion, a sign of worsening heart failure that requires immediate
intervention. Urine output of 60 mL/hr is within normal limits (>30 mL/hr).
Question 2: A client is receiving IV heparin and has a platelet count of 80,000/mm³. What
should the nurse do?
A) Continue therapy and monitor labs
B) Hold heparin and notify the provider
C) Increase the heparin dose
D) Administer vitamin K
Answer: B
Rationale: Thrombocytopenia (platelet count <100,000/mm³) may indicate heparin-induced
thrombocytopenia (HIT), a serious complication. Heparin should be held and the provider
notified immediately.
Question 3: A client with angina is prescribed nitroglycerin sublingual. Which instruction should
the nurse include?
A) "Take one tablet every 15 minutes for up to 3 doses."
B) "Place the tablet under your tongue and allow it to dissolve."
C) "Swallow the tablet with a full glass of water."
D) "Chew the tablet for faster absorption."
Answer: B
,Rationale: Sublingual nitroglycerin is placed under the tongue and allowed to dissolve. It should
not be swallowed or chewed. The standard regimen is one tablet every 5 minutes for up to 3
doses.
Question 4: A client on digoxin reports nausea, vomiting, and a heart rate of 45 bpm. What
action should the nurse take?
A) Administer digoxin as ordered
B) Hold the medication and notify the provider
C) Encourage fluids and monitor
D) Check potassium level and give potassium supplement
Answer: B
Rationale: Nausea, vomiting, and bradycardia are classic signs of digoxin toxicity. The nurse
should hold the dose and notify the provider.
Question 5: Which laboratory value is most specific for myocardial necrosis following an MI?
A) Creatine kinase (CK)
B) Troponin I
C) Myoglobin
D) C-reactive protein (CRP)
Answer: B
Rationale: Troponin I is the most specific and sensitive cardiac marker for myocardial necrosis. It
rises 3-4 hours after an MI and remains elevated for up to 14 days.
Respiratory Disorders
Question 6: A nurse is assessing a client with COPD. Which finding indicates an exacerbation?
A) Oxygen saturation 94% on room air
B) Increased anteroposterior chest diameter
C) Use of accessory muscles and pursed-lip breathing
D) Respiratory rate 18 breaths per minute
Answer: C
Rationale: Use of accessory muscles and pursed-lip breathing indicate increased work of
breathing and are signs of an acute exacerbation. The other findings are either normal or
chronic changes.
,Question 7: A client receiving vancomycin reports itching and redness on the upper chest during
infusion. Vital signs are stable. What should the nurse do?
A) Stop the infusion immediately and notify the provider
B) Slow the infusion rate and monitor closely
C) Administer diphenhydramine and continue at the same rate
D) Document the reaction and continue infusion
Answer: B
Rationale: Red Man Syndrome is related to rapid vancomycin infusion; slowing the rate typically
reduces symptoms.
Renal/Electrolyte Disorders
Question 8: Which manifestations indicate hypokalemia? (Select all that apply)
A) Muscle weakness
B) Constipation
C) Tented T waves on ECG
D) Hypotension
E) Polyuria
Answer: A, B, D, E
Rationale: Hypokalemia causes muscle weakness, decreased GI motility (constipation),
hypotension, and polyuria (nephrogenic diabetes insipidus). Tented T waves are a sign of
hyperkalemia.
Question 9: A client with heart failure is prescribed furosemide (Lasix). Which electrolyte
imbalance should the nurse monitor most closely?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypocalcemia
Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia is a
common adverse effect and can increase the risk of digoxin toxicity and cardiac dysrhythmias.
, GI/Hepatic Disorders
Question 10: What foods should a client with cholecystitis be taught to eliminate from their
diet?
A) Fresh fruits
B) Whole grains
C) Fried eggs
D) Lean meats
Answer: C
Rationale: Clients with cholecystitis should avoid high-fat foods that stimulate gallbladder
contraction, including fried eggs and other fried foods.
Prioritization/Delegation
Question 11: A nurse is caring for four clients. Which client should the nurse assess first?
A) A client with COPD and SpO₂ of 89% on 2L nasal cannula
B) A client who is 2 hours post-operative from a thoracotomy and reports sudden shortness of
breath
C) A client with heart failure and 3+ pitting edema
D) A client with new-onset confusion and bounding pulse
Answer: B
Rationale: The client post-thoracotomy with sudden shortness of breath is at highest risk for
life-threatening complications like pulmonary embolism or pneumothorax. Using the ABC
(Airway, Breathing, Circulation) framework, breathing difficulties take precedence.
Pharmacology
Question 12: A client prescribed warfarin states, "I can take ibuprofen for my headaches."
Which response is correct?
A) "That is fine, but take it with food."
B) "Ibuprofen can increase bleeding risk; use acetaminophen instead."
C) "Only take ibuprofen if your headache is severe."
D) "Ibuprofen is the preferred pain reliever with warfarin."
Answer: B
- 100 Practice Questions with Rationales
Cardiovascular Disorders
Question 1: A nurse is assessing a client with heart failure who has gained 2.2 kg (5 lb) in the
past 24 hours. Which finding should the nurse report to the provider?
A) Blood pressure 138/86 mm Hg
B) Crackles in the lung bases
C) Peripheral pulse 2+
D) Urine output 60 mL/hr
Answer: B
Rationale: A weight gain of 2.2 kg in 24 hours indicates fluid retention. Crackles in the lung
bases suggest pulmonary congestion, a sign of worsening heart failure that requires immediate
intervention. Urine output of 60 mL/hr is within normal limits (>30 mL/hr).
Question 2: A client is receiving IV heparin and has a platelet count of 80,000/mm³. What
should the nurse do?
A) Continue therapy and monitor labs
B) Hold heparin and notify the provider
C) Increase the heparin dose
D) Administer vitamin K
Answer: B
Rationale: Thrombocytopenia (platelet count <100,000/mm³) may indicate heparin-induced
thrombocytopenia (HIT), a serious complication. Heparin should be held and the provider
notified immediately.
Question 3: A client with angina is prescribed nitroglycerin sublingual. Which instruction should
the nurse include?
A) "Take one tablet every 15 minutes for up to 3 doses."
B) "Place the tablet under your tongue and allow it to dissolve."
C) "Swallow the tablet with a full glass of water."
D) "Chew the tablet for faster absorption."
Answer: B
,Rationale: Sublingual nitroglycerin is placed under the tongue and allowed to dissolve. It should
not be swallowed or chewed. The standard regimen is one tablet every 5 minutes for up to 3
doses.
Question 4: A client on digoxin reports nausea, vomiting, and a heart rate of 45 bpm. What
action should the nurse take?
A) Administer digoxin as ordered
B) Hold the medication and notify the provider
C) Encourage fluids and monitor
D) Check potassium level and give potassium supplement
Answer: B
Rationale: Nausea, vomiting, and bradycardia are classic signs of digoxin toxicity. The nurse
should hold the dose and notify the provider.
Question 5: Which laboratory value is most specific for myocardial necrosis following an MI?
A) Creatine kinase (CK)
B) Troponin I
C) Myoglobin
D) C-reactive protein (CRP)
Answer: B
Rationale: Troponin I is the most specific and sensitive cardiac marker for myocardial necrosis. It
rises 3-4 hours after an MI and remains elevated for up to 14 days.
Respiratory Disorders
Question 6: A nurse is assessing a client with COPD. Which finding indicates an exacerbation?
A) Oxygen saturation 94% on room air
B) Increased anteroposterior chest diameter
C) Use of accessory muscles and pursed-lip breathing
D) Respiratory rate 18 breaths per minute
Answer: C
Rationale: Use of accessory muscles and pursed-lip breathing indicate increased work of
breathing and are signs of an acute exacerbation. The other findings are either normal or
chronic changes.
,Question 7: A client receiving vancomycin reports itching and redness on the upper chest during
infusion. Vital signs are stable. What should the nurse do?
A) Stop the infusion immediately and notify the provider
B) Slow the infusion rate and monitor closely
C) Administer diphenhydramine and continue at the same rate
D) Document the reaction and continue infusion
Answer: B
Rationale: Red Man Syndrome is related to rapid vancomycin infusion; slowing the rate typically
reduces symptoms.
Renal/Electrolyte Disorders
Question 8: Which manifestations indicate hypokalemia? (Select all that apply)
A) Muscle weakness
B) Constipation
C) Tented T waves on ECG
D) Hypotension
E) Polyuria
Answer: A, B, D, E
Rationale: Hypokalemia causes muscle weakness, decreased GI motility (constipation),
hypotension, and polyuria (nephrogenic diabetes insipidus). Tented T waves are a sign of
hyperkalemia.
Question 9: A client with heart failure is prescribed furosemide (Lasix). Which electrolyte
imbalance should the nurse monitor most closely?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypocalcemia
Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia is a
common adverse effect and can increase the risk of digoxin toxicity and cardiac dysrhythmias.
, GI/Hepatic Disorders
Question 10: What foods should a client with cholecystitis be taught to eliminate from their
diet?
A) Fresh fruits
B) Whole grains
C) Fried eggs
D) Lean meats
Answer: C
Rationale: Clients with cholecystitis should avoid high-fat foods that stimulate gallbladder
contraction, including fried eggs and other fried foods.
Prioritization/Delegation
Question 11: A nurse is caring for four clients. Which client should the nurse assess first?
A) A client with COPD and SpO₂ of 89% on 2L nasal cannula
B) A client who is 2 hours post-operative from a thoracotomy and reports sudden shortness of
breath
C) A client with heart failure and 3+ pitting edema
D) A client with new-onset confusion and bounding pulse
Answer: B
Rationale: The client post-thoracotomy with sudden shortness of breath is at highest risk for
life-threatening complications like pulmonary embolism or pneumothorax. Using the ABC
(Airway, Breathing, Circulation) framework, breathing difficulties take precedence.
Pharmacology
Question 12: A client prescribed warfarin states, "I can take ibuprofen for my headaches."
Which response is correct?
A) "That is fine, but take it with food."
B) "Ibuprofen can increase bleeding risk; use acetaminophen instead."
C) "Only take ibuprofen if your headache is severe."
D) "Ibuprofen is the preferred pain reliever with warfarin."
Answer: B
