ATI Med-Surg 2 Exam 2 – 2026 Verified Version | Complete Exam
Questions & Answers with Rationales (Latest Update)
Question 1
A nurse is caring for a client who has acute pulmonary edema. Which position
should the nurse place the client in?
A. Supine
B. Trendelenburg
C. High-Fowler’s
D. Prone
Correct Answer: C. High-Fowler’s
Rationale: High-Fowler’s position promotes maximum lung expansion and
decreases venous return to the heart, which can reduce pulmonary vascular
congestion. A client with acute pulmonary edema commonly presents with
severe dyspnea, crackles, hypoxemia, and anxiety. Positioning is an immediate
supportive intervention while additional treatment is initiated.
Question 2
A client with heart failure reports increasing shortness of breath and has
gained 2.5 kg (5.5 lb) over several days. Which finding should the nurse
recognize as indicating fluid retention?
A. Decreased jugular venous pressure
B. Bilateral dependent edema
C. Dry mucous membranes
D. Decreased blood pressure with weight loss
Correct Answer: B. Bilateral dependent edema
Rationale: Rapid weight gain in heart failure is commonly caused by sodium
and water retention. Increased venous pressure can cause dependent edema,
while pulmonary congestion may produce dyspnea and crackles. Daily weight
is an important indicator of changes in fluid status.
pg. 1
,Question 3
A nurse is assessing a client who has left-sided heart failure. Which finding is
most characteristic?
A. Ascites
B. Hepatomegaly
C. Pulmonary crackles
D. Dependent peripheral edema only
Correct Answer: C. Pulmonary crackles
Rationale: Left-sided heart failure causes blood to back up into the
pulmonary circulation. Increased pulmonary capillary pressure causes fluid to
move into the interstitial tissue and alveoli, producing pulmonary congestion,
crackles, dyspnea, and potentially pulmonary edema. Right-sided failure more
commonly produces systemic venous congestion such as peripheral edema,
ascites, and hepatomegaly.
Question 4
A client taking furosemide for heart failure should be monitored closely for
which electrolyte imbalance?
A. Hyperkalemia
B. Hypokalemia
C. Hypermagnesemia
D. Hypernatremia
Correct Answer: B. Hypokalemia
Rationale: Furosemide is a loop diuretic that increases urinary excretion of
sodium, chloride, potassium, and water. Hypokalemia can cause muscle
weakness, fatigue, and potentially dangerous cardiac dysrhythmias.
Potassium levels should therefore be monitored during therapy.
pg. 2
,Question 5
A client taking digoxin reports nausea, poor appetite, and seeing yellow halos
around lights. Which complication should the nurse suspect?
A. Digoxin toxicity
B. Hyperglycemia
C. Pulmonary embolism
D. Hypertensive crisis
Correct Answer: A. Digoxin toxicity
Rationale: Gastrointestinal symptoms and visual disturbances such as yellow
or blurred vision are classic manifestations of digoxin toxicity. Bradycardia
and various cardiac dysrhythmias can also occur. Hypokalemia increases the
risk of digoxin toxicity because potassium and digoxin interact at the sodium-
potassium ATPase pump.
Question 6
Before administering digoxin to an adult client, which assessment is the
priority?
A. Respiratory depth
B. Apical heart rate
C. Bowel sounds
D. Pupillary response
Correct Answer: B. Apical heart rate
Rationale: Digoxin slows conduction through the atrioventricular node and
can produce bradycardia. The nurse should assess the apical pulse before
administration and follow the prescribed parameters for withholding the
medication. A significantly low heart rate may indicate that the medication
should not be administered.
Question 7
pg. 3
, A client develops sudden dyspnea, pleuritic chest pain, tachycardia, and
anxiety following prolonged immobility. Which condition should the nurse
suspect?
A. Pulmonary embolism
B. Stable angina
C. Chronic bronchitis
D. Pleural effusion
Correct Answer: A. Pulmonary embolism
Rationale: A pulmonary embolism occurs when a thrombus, usually
originating from a deep vein in the lower extremity, travels to the pulmonary
circulation. Sudden dyspnea, pleuritic chest pain, tachycardia, hypoxemia, and
anxiety are common manifestations. It is a potentially life-threatening
emergency.
Question 8
A client is suspected of having a pulmonary embolism. Which action should
the nurse take first?
A. Encourage ambulation
B. Apply oxygen as prescribed and assess respiratory status
C. Massage the affected leg
D. Place the client flat in bed
Correct Answer: B. Apply oxygen as prescribed and assess respiratory
status
Rationale: A pulmonary embolism can rapidly impair oxygenation. The
immediate priority is to support airway and breathing, including oxygen
administration when indicated and continuous assessment of respiratory and
cardiovascular status. The nurse should not massage a potentially thrombosed
extremity because this could theoretically dislodge thrombotic material.
Question 9
pg. 4
Questions & Answers with Rationales (Latest Update)
Question 1
A nurse is caring for a client who has acute pulmonary edema. Which position
should the nurse place the client in?
A. Supine
B. Trendelenburg
C. High-Fowler’s
D. Prone
Correct Answer: C. High-Fowler’s
Rationale: High-Fowler’s position promotes maximum lung expansion and
decreases venous return to the heart, which can reduce pulmonary vascular
congestion. A client with acute pulmonary edema commonly presents with
severe dyspnea, crackles, hypoxemia, and anxiety. Positioning is an immediate
supportive intervention while additional treatment is initiated.
Question 2
A client with heart failure reports increasing shortness of breath and has
gained 2.5 kg (5.5 lb) over several days. Which finding should the nurse
recognize as indicating fluid retention?
A. Decreased jugular venous pressure
B. Bilateral dependent edema
C. Dry mucous membranes
D. Decreased blood pressure with weight loss
Correct Answer: B. Bilateral dependent edema
Rationale: Rapid weight gain in heart failure is commonly caused by sodium
and water retention. Increased venous pressure can cause dependent edema,
while pulmonary congestion may produce dyspnea and crackles. Daily weight
is an important indicator of changes in fluid status.
pg. 1
,Question 3
A nurse is assessing a client who has left-sided heart failure. Which finding is
most characteristic?
A. Ascites
B. Hepatomegaly
C. Pulmonary crackles
D. Dependent peripheral edema only
Correct Answer: C. Pulmonary crackles
Rationale: Left-sided heart failure causes blood to back up into the
pulmonary circulation. Increased pulmonary capillary pressure causes fluid to
move into the interstitial tissue and alveoli, producing pulmonary congestion,
crackles, dyspnea, and potentially pulmonary edema. Right-sided failure more
commonly produces systemic venous congestion such as peripheral edema,
ascites, and hepatomegaly.
Question 4
A client taking furosemide for heart failure should be monitored closely for
which electrolyte imbalance?
A. Hyperkalemia
B. Hypokalemia
C. Hypermagnesemia
D. Hypernatremia
Correct Answer: B. Hypokalemia
Rationale: Furosemide is a loop diuretic that increases urinary excretion of
sodium, chloride, potassium, and water. Hypokalemia can cause muscle
weakness, fatigue, and potentially dangerous cardiac dysrhythmias.
Potassium levels should therefore be monitored during therapy.
pg. 2
,Question 5
A client taking digoxin reports nausea, poor appetite, and seeing yellow halos
around lights. Which complication should the nurse suspect?
A. Digoxin toxicity
B. Hyperglycemia
C. Pulmonary embolism
D. Hypertensive crisis
Correct Answer: A. Digoxin toxicity
Rationale: Gastrointestinal symptoms and visual disturbances such as yellow
or blurred vision are classic manifestations of digoxin toxicity. Bradycardia
and various cardiac dysrhythmias can also occur. Hypokalemia increases the
risk of digoxin toxicity because potassium and digoxin interact at the sodium-
potassium ATPase pump.
Question 6
Before administering digoxin to an adult client, which assessment is the
priority?
A. Respiratory depth
B. Apical heart rate
C. Bowel sounds
D. Pupillary response
Correct Answer: B. Apical heart rate
Rationale: Digoxin slows conduction through the atrioventricular node and
can produce bradycardia. The nurse should assess the apical pulse before
administration and follow the prescribed parameters for withholding the
medication. A significantly low heart rate may indicate that the medication
should not be administered.
Question 7
pg. 3
, A client develops sudden dyspnea, pleuritic chest pain, tachycardia, and
anxiety following prolonged immobility. Which condition should the nurse
suspect?
A. Pulmonary embolism
B. Stable angina
C. Chronic bronchitis
D. Pleural effusion
Correct Answer: A. Pulmonary embolism
Rationale: A pulmonary embolism occurs when a thrombus, usually
originating from a deep vein in the lower extremity, travels to the pulmonary
circulation. Sudden dyspnea, pleuritic chest pain, tachycardia, hypoxemia, and
anxiety are common manifestations. It is a potentially life-threatening
emergency.
Question 8
A client is suspected of having a pulmonary embolism. Which action should
the nurse take first?
A. Encourage ambulation
B. Apply oxygen as prescribed and assess respiratory status
C. Massage the affected leg
D. Place the client flat in bed
Correct Answer: B. Apply oxygen as prescribed and assess respiratory
status
Rationale: A pulmonary embolism can rapidly impair oxygenation. The
immediate priority is to support airway and breathing, including oxygen
administration when indicated and continuous assessment of respiratory and
cardiovascular status. The nurse should not massage a potentially thrombosed
extremity because this could theoretically dislodge thrombotic material.
Question 9
pg. 4
