ATI RN ADULT MEDICAL SURGICAL
PROCTORED
Section 1: Cardiovascular System
Question 1
A nurse is caring for a client who has heart failure and is receiving furosemide. Which of the
following findings should the nurse identify as an adverse effect of this medication?
A. Hypertension
B. Hypokalemia
C. Hypernatremia
D. Bradycardia
Correct Answer: B. Hypokalemia
Rationale: Furosemide is a loop diuretic that inhibits sodium and chloride reabsorption in
the ascending loop of Henle, leading to increased urine output. This can cause significant
potassium loss, resulting in hypokalemia. Clients should be monitored for low potassium levels
(normal range 3.5–5.0 mEq/L) and may need potassium supplementation or a potassium-
sparing diuretic. Hypertension is treated by furosemide, not caused by it. Hypernatremia is not
a typical adverse effect; hyponatremia is more common. Bradycardia is not directly associated
with furosemide; tachycardia can occur with hypokalemia.
Question 2
A nurse is assessing a client who has an abdominal aortic aneurysm (AAA). Which of the
following findings is the priority to report to the provider?
A. A pulsating mass in the abdomen
B. Sudden onset of severe back pain
C. Blood pressure of 138/86 mm Hg
D. Diminished pedal pulses
Correct Answer: B. Sudden onset of severe back pain
Rationale: A sudden onset of severe back or abdominal pain in a client with an AAA may
indicate rupture or impending rupture, which is a life-threatening emergency requiring
,immediate intervention. A pulsating mass is a common finding with AAA but is not an acute
emergency. A BP of 138/86 mm Hg is mildly elevated but not immediately life-threatening.
Diminished pedal pulses can occur with AAA due to compromised circulation but do not
indicate imminent rupture. The priority is recognizing signs of rupture.
Question 3 (SATA)
A nurse is teaching a client who has a new prescription for warfarin. Which of the following
statements by the client indicates an understanding of the teaching? (Select all that apply.)
A. "I will use a soft toothbrush to brush my teeth."
B. "I will increase my intake of leafy green vegetables."
C. "I will avoid taking aspirin without talking to my provider."
D. "I will wear a medical alert bracelet."
E. "I will take this medication with a full glass of water every morning."
Correct Answers: A, C, D
Rationale:
• A is correct: Warfarin increases bleeding risk; a soft toothbrush reduces gum bleeding.
• B is incorrect: Leafy green vegetables are high in vitamin K, which antagonizes warfarin.
Intake should be consistent, not increased.
• C is correct: Aspirin increases bleeding risk when combined with warfarin.
• D is correct: A medical alert bracelet informs emergency personnel of anticoagulant
therapy.
• E is incorrect: While taking with water is fine, this statement does not demonstrate
specific understanding of warfarin safety. Warfarin is typically taken at the same time
daily, usually in the evening, but this is not the key teaching point.
Question 4
A nurse is caring for a client who has acute pericarditis. Which of the following findings should
the nurse expect?
A. Distended neck veins
B. Pericardial friction rub
,C. Muffled heart sounds
D. Pulsus paradoxus greater than 10 mm Hg
Correct Answer: B. Pericardial friction rub
Rationale: Acute pericarditis is inflammation of the pericardial sac. The classic finding is a
pericardial friction rub, a scratching, grating sound heard best at the left lower sternal border
with the client leaning forward. Distended neck veins, muffled heart sounds, and pulsus
paradoxus are classic findings of cardiac tamponade, a complication of pericarditis, not
pericarditis itself.
Question 5
A nurse is reviewing the laboratory results of a client who has heart failure and is taking digoxin.
Which of the following findings indicates a need for immediate intervention?
A. Potassium 3.2 mEq/L
B. Digoxin level 1.2 ng/mL
C. Sodium 138 mEq/L
D. BNP 200 pg/mL
Correct Answer: A. Potassium 3.2 mEq/L
Rationale: Hypokalemia increases the risk of digoxin toxicity. A potassium level of 3.2 mEq/L
is below the normal range (3.5–5.0 mEq/L) and places the client at risk for digoxin toxicity. The
therapeutic digoxin level is 0.5–2.0 ng/mL, so 1.2 ng/mL is therapeutic. Sodium 138 mEq/L is
within normal limits. BNP of 200 pg/mL is elevated but not immediately life-threatening; it
indicates heart failure but does not require immediate intervention as urgently as hypokalemia
in a client on digoxin.
Question 6
A nurse is caring for a client who is 24 hours postoperative following a coronary artery bypass
graft (CABG). Which of the following findings should the nurse report to the provider
immediately?
A. Temperature of 100.2°F (37.9°C)
B. Drainage of 150 mL from the chest tube in 8 hours
C. Sudden cessation of chest tube drainage
D. Incisional pain rated 4 on a scale of 0 to 10
, Correct Answer: C. Sudden cessation of chest tube drainage
Rationale: Sudden cessation of chest tube drainage after CABG may indicate a clot or
obstruction in the tube, which can lead to cardiac tamponade. This is a medical emergency. A
low-grade temperature is common postoperatively. Drainage of 150 mL over 8 hours is within
normal limits (typically report >100 mL/hr). Incisional pain rated 4/10 is expected and
manageable with analgesics.
Question 7 (SATA)
A nurse is caring for a client who has a new diagnosis of hypertension. Which of the following
dietary recommendations should the nurse include? (Select all that apply.)
A. Increase intake of potassium-rich foods
B. Limit sodium intake to less than 2,300 mg/day
C. Increase intake of saturated fats
D. Follow the DASH eating plan
E. Limit alcohol consumption to no more than 2 drinks per day for men
Correct Answers: A, B, D
Rationale:
• A is correct: Potassium helps lower blood pressure by promoting sodium excretion.
• B is correct: Limiting sodium to less than 2,300 mg/day (ideally 1,500 mg/day) helps
manage hypertension.
• C is incorrect: Saturated fats should be limited, not increased, to reduce cardiovascular
risk.
• D is correct: The DASH (Dietary Approaches to Stop Hypertension) plan is recommended
for managing hypertension.
• E is incorrect: For men, alcohol should be limited to no more than 2 drinks per day, but
this is a maximum, not a recommendation. The question asks for dietary
recommendations; alcohol limitation is part of lifestyle modification but the phrasing
"no more than 2 drinks" is accurate for men per guidelines. However, the best answers
are A, B, and D as they are directly dietary.
Question 8
PROCTORED
Section 1: Cardiovascular System
Question 1
A nurse is caring for a client who has heart failure and is receiving furosemide. Which of the
following findings should the nurse identify as an adverse effect of this medication?
A. Hypertension
B. Hypokalemia
C. Hypernatremia
D. Bradycardia
Correct Answer: B. Hypokalemia
Rationale: Furosemide is a loop diuretic that inhibits sodium and chloride reabsorption in
the ascending loop of Henle, leading to increased urine output. This can cause significant
potassium loss, resulting in hypokalemia. Clients should be monitored for low potassium levels
(normal range 3.5–5.0 mEq/L) and may need potassium supplementation or a potassium-
sparing diuretic. Hypertension is treated by furosemide, not caused by it. Hypernatremia is not
a typical adverse effect; hyponatremia is more common. Bradycardia is not directly associated
with furosemide; tachycardia can occur with hypokalemia.
Question 2
A nurse is assessing a client who has an abdominal aortic aneurysm (AAA). Which of the
following findings is the priority to report to the provider?
A. A pulsating mass in the abdomen
B. Sudden onset of severe back pain
C. Blood pressure of 138/86 mm Hg
D. Diminished pedal pulses
Correct Answer: B. Sudden onset of severe back pain
Rationale: A sudden onset of severe back or abdominal pain in a client with an AAA may
indicate rupture or impending rupture, which is a life-threatening emergency requiring
,immediate intervention. A pulsating mass is a common finding with AAA but is not an acute
emergency. A BP of 138/86 mm Hg is mildly elevated but not immediately life-threatening.
Diminished pedal pulses can occur with AAA due to compromised circulation but do not
indicate imminent rupture. The priority is recognizing signs of rupture.
Question 3 (SATA)
A nurse is teaching a client who has a new prescription for warfarin. Which of the following
statements by the client indicates an understanding of the teaching? (Select all that apply.)
A. "I will use a soft toothbrush to brush my teeth."
B. "I will increase my intake of leafy green vegetables."
C. "I will avoid taking aspirin without talking to my provider."
D. "I will wear a medical alert bracelet."
E. "I will take this medication with a full glass of water every morning."
Correct Answers: A, C, D
Rationale:
• A is correct: Warfarin increases bleeding risk; a soft toothbrush reduces gum bleeding.
• B is incorrect: Leafy green vegetables are high in vitamin K, which antagonizes warfarin.
Intake should be consistent, not increased.
• C is correct: Aspirin increases bleeding risk when combined with warfarin.
• D is correct: A medical alert bracelet informs emergency personnel of anticoagulant
therapy.
• E is incorrect: While taking with water is fine, this statement does not demonstrate
specific understanding of warfarin safety. Warfarin is typically taken at the same time
daily, usually in the evening, but this is not the key teaching point.
Question 4
A nurse is caring for a client who has acute pericarditis. Which of the following findings should
the nurse expect?
A. Distended neck veins
B. Pericardial friction rub
,C. Muffled heart sounds
D. Pulsus paradoxus greater than 10 mm Hg
Correct Answer: B. Pericardial friction rub
Rationale: Acute pericarditis is inflammation of the pericardial sac. The classic finding is a
pericardial friction rub, a scratching, grating sound heard best at the left lower sternal border
with the client leaning forward. Distended neck veins, muffled heart sounds, and pulsus
paradoxus are classic findings of cardiac tamponade, a complication of pericarditis, not
pericarditis itself.
Question 5
A nurse is reviewing the laboratory results of a client who has heart failure and is taking digoxin.
Which of the following findings indicates a need for immediate intervention?
A. Potassium 3.2 mEq/L
B. Digoxin level 1.2 ng/mL
C. Sodium 138 mEq/L
D. BNP 200 pg/mL
Correct Answer: A. Potassium 3.2 mEq/L
Rationale: Hypokalemia increases the risk of digoxin toxicity. A potassium level of 3.2 mEq/L
is below the normal range (3.5–5.0 mEq/L) and places the client at risk for digoxin toxicity. The
therapeutic digoxin level is 0.5–2.0 ng/mL, so 1.2 ng/mL is therapeutic. Sodium 138 mEq/L is
within normal limits. BNP of 200 pg/mL is elevated but not immediately life-threatening; it
indicates heart failure but does not require immediate intervention as urgently as hypokalemia
in a client on digoxin.
Question 6
A nurse is caring for a client who is 24 hours postoperative following a coronary artery bypass
graft (CABG). Which of the following findings should the nurse report to the provider
immediately?
A. Temperature of 100.2°F (37.9°C)
B. Drainage of 150 mL from the chest tube in 8 hours
C. Sudden cessation of chest tube drainage
D. Incisional pain rated 4 on a scale of 0 to 10
, Correct Answer: C. Sudden cessation of chest tube drainage
Rationale: Sudden cessation of chest tube drainage after CABG may indicate a clot or
obstruction in the tube, which can lead to cardiac tamponade. This is a medical emergency. A
low-grade temperature is common postoperatively. Drainage of 150 mL over 8 hours is within
normal limits (typically report >100 mL/hr). Incisional pain rated 4/10 is expected and
manageable with analgesics.
Question 7 (SATA)
A nurse is caring for a client who has a new diagnosis of hypertension. Which of the following
dietary recommendations should the nurse include? (Select all that apply.)
A. Increase intake of potassium-rich foods
B. Limit sodium intake to less than 2,300 mg/day
C. Increase intake of saturated fats
D. Follow the DASH eating plan
E. Limit alcohol consumption to no more than 2 drinks per day for men
Correct Answers: A, B, D
Rationale:
• A is correct: Potassium helps lower blood pressure by promoting sodium excretion.
• B is correct: Limiting sodium to less than 2,300 mg/day (ideally 1,500 mg/day) helps
manage hypertension.
• C is incorrect: Saturated fats should be limited, not increased, to reduce cardiovascular
risk.
• D is correct: The DASH (Dietary Approaches to Stop Hypertension) plan is recommended
for managing hypertension.
• E is incorrect: For men, alcohol should be limited to no more than 2 drinks per day, but
this is a maximum, not a recommendation. The question asks for dietary
recommendations; alcohol limitation is part of lifestyle modification but the phrasing
"no more than 2 drinks" is accurate for men per guidelines. However, the best answers
are A, B, and D as they are directly dietary.
Question 8
