Virtual ATI: Priority- Setting Frameworks |Telemetry
Latest Update |A Comprehensive Sample of 650+
Multichoice Practice Questions Covering Full Scope of the
Topic| Each Question Includes the Correct Answer with a
Clinical Explanation| Guaranteed Pass
Table of Contents
Unit Chapters Question Range
Unit 1: Foundations of Medical-Surgical Nursing 1–5 1–80
Unit 2: Cardiovascular System & Telemetry 6–12 81–210
Unit 3: Respiratory System 13–17 211–290
Unit 4: Neurological System 18–22 291–360
Unit 5: Gastrointestinal System 23–27 361–430
Unit 6: Renal & Genitourinary System 28–31 431–490
Unit 7: Endocrine System 32–35 491–540
Unit 8: Musculoskeletal & Integumentary Systems 36–39 541–580
Unit 9: Critical Care Nursing 40–45 581–650
,Unit 1: Foundations of Medical-Surgical Nursing (Questions
1–80)
1. A nurse is preparing to receive a handoff report using the SBAR format.
Which component of SBAR involves stating the patient's current vital signs
and assessment findings?
A. Situation
B. Background
C. Assessment
D. Recommendation
Correct Answer: C
Rationale: In the SBAR communication framework, "Assessment" is the
component where the nurse provides objective data including current vital signs,
physical assessment findings, and laboratory results that support the clinical
picture. "Situation" states the immediate concern, "Background" provides relevant
history, and "Recommendation" suggests what action is needed. This structured
approach reduces communication errors during handoffs.
DIF: Understand
KEY: Communication, SBAR
MSC: Safe and Effective Care Environment
NOT: This question tests knowledge of standardized handoff communication
protocols.
2. During a shift assessment, a nurse notes that a patient has developed new-
onset confusion and agitation. Which action should the nurse take FIRST?
A. Administer a prescribed PRN sedative
B. Apply restraints to prevent injury
C. Assess for hypoxia and hypoglycemia
D. Document the finding and continue monitoring
Correct Answer: C
Rationale: New-onset confusion in a hospitalized patient is a medical emergency
until proven otherwise. The nurse's first priority is to assess for common reversible
,causes, particularly hypoxia and hypoglycemia, which can present as acute mental
status changes. Only after ruling out these life-threatening causes should the nurse
consider other interventions such as medications or restraints.
DIF: Apply
KEY: Assessment, Altered Mental Status
MSC: Physiological Integrity
NOT: This question emphasizes the nursing priority of assessment before
intervention.
3. A nurse is reviewing a patient's medication administration record and notes
an order for "Heparin 5,000 units SUBQ Q8H." What is the primary purpose
of this medication at this dose?
A. To treat existing deep vein thrombosis
B. To prevent venous thromboembolism
C. To dissolve pulmonary emboli
D. To manage atrial fibrillation
Correct Answer: B
Rationale: Low-dose unfractionated heparin (5,000 units subcutaneously every 8–
12 hours) is prescribed for VTE prophylaxis in hospitalized patients at risk for clot
formation. Treatment doses of heparin for existing DVT or PE are much higher
(typically 80 units/kg bolus followed by 18 units/kg/hour infusion). Heparin does
not dissolve existing clots; it prevents extension and new clot formation.
DIF: Understand
KEY: Pharmacology, Anticoagulation
MSC: Pharmacological and Parenteral Therapies
NOT: This question differentiates between prophylactic and therapeutic
heparin dosing.
4. A nurse is caring for a patient with a new tracheostomy. Which assessment
finding requires IMMEDIATE intervention?
A. Thin, white secretions suctioned from the tracheostomy
, B. A small amount of serosanguineous drainage at the stoma site
C. Audible gurgling sounds with each breath
D. The patient is able to speak with the cuff deflated
Correct Answer: C
Rationale: Audible gurgling with respirations indicates secretions or fluid
accumulation in the airway that requires immediate suctioning to maintain a patent
airway. Thin white secretions are normal. Serosanguineous drainage at a new
tracheostomy site is expected initially. Speaking with the cuff deflated is an
expected finding when the cuff is down.
DIF: Apply
KEY: Airway Management, Tracheostomy Care
MSC: Physiological Integrity
NOT: This question tests prioritization of airway emergencies.
5. A nurse is preparing to administer packed red blood cells to a patient with a
hemoglobin of 6.8 g/dL. Which action should the nurse take FIRST?
A. Obtain the patient's vital signs
B. Verify the blood product with another nurse
C. Prime the blood tubing with normal saline
D. Administer the blood over 4 hours
Correct Answer: B
Rationale: Before initiating any blood transfusion, the nurse must verify the blood
product with another qualified staff member using a two-person verification
process. This critical safety step confirms the patient's identity, blood type, unit
number, and expiration date. Vital signs should be obtained before transfusion, but
verification is the first action in the transfusion process.
DIF: Apply
KEY: Blood Transfusion, Safety
MSC: Safe and Effective Care Environment
NOT: This question emphasizes the critical safety check required before
transfusion.
Latest Update |A Comprehensive Sample of 650+
Multichoice Practice Questions Covering Full Scope of the
Topic| Each Question Includes the Correct Answer with a
Clinical Explanation| Guaranteed Pass
Table of Contents
Unit Chapters Question Range
Unit 1: Foundations of Medical-Surgical Nursing 1–5 1–80
Unit 2: Cardiovascular System & Telemetry 6–12 81–210
Unit 3: Respiratory System 13–17 211–290
Unit 4: Neurological System 18–22 291–360
Unit 5: Gastrointestinal System 23–27 361–430
Unit 6: Renal & Genitourinary System 28–31 431–490
Unit 7: Endocrine System 32–35 491–540
Unit 8: Musculoskeletal & Integumentary Systems 36–39 541–580
Unit 9: Critical Care Nursing 40–45 581–650
,Unit 1: Foundations of Medical-Surgical Nursing (Questions
1–80)
1. A nurse is preparing to receive a handoff report using the SBAR format.
Which component of SBAR involves stating the patient's current vital signs
and assessment findings?
A. Situation
B. Background
C. Assessment
D. Recommendation
Correct Answer: C
Rationale: In the SBAR communication framework, "Assessment" is the
component where the nurse provides objective data including current vital signs,
physical assessment findings, and laboratory results that support the clinical
picture. "Situation" states the immediate concern, "Background" provides relevant
history, and "Recommendation" suggests what action is needed. This structured
approach reduces communication errors during handoffs.
DIF: Understand
KEY: Communication, SBAR
MSC: Safe and Effective Care Environment
NOT: This question tests knowledge of standardized handoff communication
protocols.
2. During a shift assessment, a nurse notes that a patient has developed new-
onset confusion and agitation. Which action should the nurse take FIRST?
A. Administer a prescribed PRN sedative
B. Apply restraints to prevent injury
C. Assess for hypoxia and hypoglycemia
D. Document the finding and continue monitoring
Correct Answer: C
Rationale: New-onset confusion in a hospitalized patient is a medical emergency
until proven otherwise. The nurse's first priority is to assess for common reversible
,causes, particularly hypoxia and hypoglycemia, which can present as acute mental
status changes. Only after ruling out these life-threatening causes should the nurse
consider other interventions such as medications or restraints.
DIF: Apply
KEY: Assessment, Altered Mental Status
MSC: Physiological Integrity
NOT: This question emphasizes the nursing priority of assessment before
intervention.
3. A nurse is reviewing a patient's medication administration record and notes
an order for "Heparin 5,000 units SUBQ Q8H." What is the primary purpose
of this medication at this dose?
A. To treat existing deep vein thrombosis
B. To prevent venous thromboembolism
C. To dissolve pulmonary emboli
D. To manage atrial fibrillation
Correct Answer: B
Rationale: Low-dose unfractionated heparin (5,000 units subcutaneously every 8–
12 hours) is prescribed for VTE prophylaxis in hospitalized patients at risk for clot
formation. Treatment doses of heparin for existing DVT or PE are much higher
(typically 80 units/kg bolus followed by 18 units/kg/hour infusion). Heparin does
not dissolve existing clots; it prevents extension and new clot formation.
DIF: Understand
KEY: Pharmacology, Anticoagulation
MSC: Pharmacological and Parenteral Therapies
NOT: This question differentiates between prophylactic and therapeutic
heparin dosing.
4. A nurse is caring for a patient with a new tracheostomy. Which assessment
finding requires IMMEDIATE intervention?
A. Thin, white secretions suctioned from the tracheostomy
, B. A small amount of serosanguineous drainage at the stoma site
C. Audible gurgling sounds with each breath
D. The patient is able to speak with the cuff deflated
Correct Answer: C
Rationale: Audible gurgling with respirations indicates secretions or fluid
accumulation in the airway that requires immediate suctioning to maintain a patent
airway. Thin white secretions are normal. Serosanguineous drainage at a new
tracheostomy site is expected initially. Speaking with the cuff deflated is an
expected finding when the cuff is down.
DIF: Apply
KEY: Airway Management, Tracheostomy Care
MSC: Physiological Integrity
NOT: This question tests prioritization of airway emergencies.
5. A nurse is preparing to administer packed red blood cells to a patient with a
hemoglobin of 6.8 g/dL. Which action should the nurse take FIRST?
A. Obtain the patient's vital signs
B. Verify the blood product with another nurse
C. Prime the blood tubing with normal saline
D. Administer the blood over 4 hours
Correct Answer: B
Rationale: Before initiating any blood transfusion, the nurse must verify the blood
product with another qualified staff member using a two-person verification
process. This critical safety step confirms the patient's identity, blood type, unit
number, and expiration date. Vital signs should be obtained before transfusion, but
verification is the first action in the transfusion process.
DIF: Apply
KEY: Blood Transfusion, Safety
MSC: Safe and Effective Care Environment
NOT: This question emphasizes the critical safety check required before
transfusion.
