ATI MED-SURG PROCTORED EXAM
PRACTICE QUESTIONS & ANSWERS
Question 1
A 68-year-old client with acute myocardial infarction (AMI) is experiencing chest pain radiating
to the left arm. Which assessment finding is most indicative of cardiogenic shock?
A) Blood pressure of 140/90 mmHg with heart rate of 78 bpm
B) Urine output of 20 mL/hour with cool, clammy skin
C) Respiratory rate of 16 breaths/minute with clear lung sounds
D) Troponin level elevated at 2.5 ng/mL with normal lactate
Answer
Answer: B
Rationale
Cardiogenic shock occurs when the heart fails to pump adequate blood volume to perfuse vital organs.
Clinical manifestations include decreased urine output, cool and clammy skin from peripheral
vasoconstriction, altered mental status, and metabolic acidosis. Option B demonstrates the classic
compensatory response of the body attempting to maintain perfusion to vital organs by shunting blood
away from peripheral tissues.
Question 2
A 55-year-old client is admitted with acute decompensated heart failure. The nurse administers
furosemide IV. Which finding indicates the medication is having the intended therapeutic
effect?
A) Increased blood pressure by 20 mmHg systolic
B) Decreased respiratory rate from 28 to 18 breaths/minute
C) Increased serum sodium level from 138 to 142 mEq/L
D) Increased heart rate from 88 to 110 bpm
Answer
Answer: B
Rationale
,Furosemide is a loop diuretic used to reduce fluid overload in heart failure. In acute decompensated
heart failure with pulmonary edema, the elevated respiratory rate results from fluid in the alveoli
reducing gas exchange. As furosemide removes excess fluid, pulmonary edema decreases,
oxygenation improves, and respiratory rate normalizes.
Question 3
A 72-year-old client with chronic atrial fibrillation is prescribed warfarin. The client asks why
they need this medication. Which nursing response best explains the purpose?
A) To convert atrial fibrillation to normal sinus rhythm
B) To slow the ventricular response rate
C) To prevent blood clot formation and reduce stroke risk
D) To increase cardiac contractility
Answer
Answer: C
Rationale
Warfarin is an anticoagulant that prevents blood clot formation. In atrial fibrillation, blood can pool in
the atria and form clots that can travel to the brain, causing a stroke. Warfarin reduces this risk.
Question 4
A client with heart failure is prescribed furosemide. Which of the following is the primary
expected outcome of this medication?
A) Increase cardiac contractility and heart rate
B) Decrease fluid volume and reduce fluid accumulation in tissues
C) Prevent blood clot formation in the coronary arteries
D) Dilate the coronary arteries to improve blood flow
Answer
Answer: B
Rationale
Furosemide is a loop diuretic that works by inhibiting sodium and chloride reabsorption in the
ascending loop of Henle. By promoting diuresis, it decreases overall fluid volume in the body, reduces
pulmonary edema, and decreases peripheral edema commonly seen in heart failure.
2
,Question 5
A client is admitted with acute myocardial infarction (MI) and is experiencing chest pain. Which
nursing intervention is the priority in the immediate phase?
A) Encourage the client to ambulate to promote circulation
B) Administer oxygen and place the client on continuous cardiac monitoring
C) Educate the client about dietary restrictions and fluid intake
D) Assist the client in performing deep breathing exercises only
Answer
Answer: B
Rationale
During acute MI, the priority is to increase oxygen supply to the myocardium and monitor for potentially
life-threatening arrhythmias. Supplemental oxygen improves oxygenation to damaged cardiac tissue.
Continuous cardiac monitoring allows early detection of dysrhythmias.
Question 6
A client with hypertension is started on lisinopril, an ACE inhibitor. Which side effect should
the nurse instruct the client to report immediately?
A) Dry cough and mild dizziness
B) Difficulty breathing or swelling of the face and lips
C) Increased appetite and mild weight gain
D) Constipation and decreased urination
Answer
Answer: B
Rationale
These symptoms indicate angioedema, a potentially life-threatening allergic reaction to ACE inhibitors.
Angioedema can involve the throat and airway, compromising breathing. This is a medical emergency
requiring immediate discontinuation of the medication.
Question 7
3
, A 68-year-old patient is scheduled for an elective total knee replacement. During the
preoperative assessment, the nurse notes the patient takes warfarin 5 mg daily for atrial
fibrillation. Which action by the nurse is most appropriate?
A) Hold the warfarin on the morning of surgery and administer vitamin K as ordered
B) Continue the warfarin through the morning of surgery to prevent stroke
C) Hold the warfarin 5 days prior to surgery per the surgeon's protocol and document the last dose
taken
D) Switch the patient to aspirin 81 mg daily until the day of surgery
Answer
Answer: C
Rationale
Warfarin has a long half-life and requires approximately 5 days to clear from the system, so holding it
before surgery reduces bleeding risk during the procedure. The nurse's role is to verify the last dose,
document it, and communicate with the surgical team.
Question 8
During the immediate postoperative period, a patient who had abdominal surgery reports
severe pain at the incision site rated 9/10. The nurse notes the patient is guarding the abdomen
and has shallow respirations. Which nursing intervention takes priority?
A) Encourage the patient to use the incentive spirometer every hour
B) Administer the prescribed PRN opioid analgesic and reassess in 30 minutes
C) Apply a warm compress to the incision site to promote comfort
D) Reposition the patient to a side-lying position to reduce tension on the incision
Answer
Answer: B
Rationale
Uncontrolled postoperative pain leads to shallow breathing, which increases the risk of atelectasis and
pneumonia. Pain management is a priority in the immediate post-op period so the patient can
participate effectively in deep breathing, coughing, and mobilization.
Question 9
4
PRACTICE QUESTIONS & ANSWERS
Question 1
A 68-year-old client with acute myocardial infarction (AMI) is experiencing chest pain radiating
to the left arm. Which assessment finding is most indicative of cardiogenic shock?
A) Blood pressure of 140/90 mmHg with heart rate of 78 bpm
B) Urine output of 20 mL/hour with cool, clammy skin
C) Respiratory rate of 16 breaths/minute with clear lung sounds
D) Troponin level elevated at 2.5 ng/mL with normal lactate
Answer
Answer: B
Rationale
Cardiogenic shock occurs when the heart fails to pump adequate blood volume to perfuse vital organs.
Clinical manifestations include decreased urine output, cool and clammy skin from peripheral
vasoconstriction, altered mental status, and metabolic acidosis. Option B demonstrates the classic
compensatory response of the body attempting to maintain perfusion to vital organs by shunting blood
away from peripheral tissues.
Question 2
A 55-year-old client is admitted with acute decompensated heart failure. The nurse administers
furosemide IV. Which finding indicates the medication is having the intended therapeutic
effect?
A) Increased blood pressure by 20 mmHg systolic
B) Decreased respiratory rate from 28 to 18 breaths/minute
C) Increased serum sodium level from 138 to 142 mEq/L
D) Increased heart rate from 88 to 110 bpm
Answer
Answer: B
Rationale
,Furosemide is a loop diuretic used to reduce fluid overload in heart failure. In acute decompensated
heart failure with pulmonary edema, the elevated respiratory rate results from fluid in the alveoli
reducing gas exchange. As furosemide removes excess fluid, pulmonary edema decreases,
oxygenation improves, and respiratory rate normalizes.
Question 3
A 72-year-old client with chronic atrial fibrillation is prescribed warfarin. The client asks why
they need this medication. Which nursing response best explains the purpose?
A) To convert atrial fibrillation to normal sinus rhythm
B) To slow the ventricular response rate
C) To prevent blood clot formation and reduce stroke risk
D) To increase cardiac contractility
Answer
Answer: C
Rationale
Warfarin is an anticoagulant that prevents blood clot formation. In atrial fibrillation, blood can pool in
the atria and form clots that can travel to the brain, causing a stroke. Warfarin reduces this risk.
Question 4
A client with heart failure is prescribed furosemide. Which of the following is the primary
expected outcome of this medication?
A) Increase cardiac contractility and heart rate
B) Decrease fluid volume and reduce fluid accumulation in tissues
C) Prevent blood clot formation in the coronary arteries
D) Dilate the coronary arteries to improve blood flow
Answer
Answer: B
Rationale
Furosemide is a loop diuretic that works by inhibiting sodium and chloride reabsorption in the
ascending loop of Henle. By promoting diuresis, it decreases overall fluid volume in the body, reduces
pulmonary edema, and decreases peripheral edema commonly seen in heart failure.
2
,Question 5
A client is admitted with acute myocardial infarction (MI) and is experiencing chest pain. Which
nursing intervention is the priority in the immediate phase?
A) Encourage the client to ambulate to promote circulation
B) Administer oxygen and place the client on continuous cardiac monitoring
C) Educate the client about dietary restrictions and fluid intake
D) Assist the client in performing deep breathing exercises only
Answer
Answer: B
Rationale
During acute MI, the priority is to increase oxygen supply to the myocardium and monitor for potentially
life-threatening arrhythmias. Supplemental oxygen improves oxygenation to damaged cardiac tissue.
Continuous cardiac monitoring allows early detection of dysrhythmias.
Question 6
A client with hypertension is started on lisinopril, an ACE inhibitor. Which side effect should
the nurse instruct the client to report immediately?
A) Dry cough and mild dizziness
B) Difficulty breathing or swelling of the face and lips
C) Increased appetite and mild weight gain
D) Constipation and decreased urination
Answer
Answer: B
Rationale
These symptoms indicate angioedema, a potentially life-threatening allergic reaction to ACE inhibitors.
Angioedema can involve the throat and airway, compromising breathing. This is a medical emergency
requiring immediate discontinuation of the medication.
Question 7
3
, A 68-year-old patient is scheduled for an elective total knee replacement. During the
preoperative assessment, the nurse notes the patient takes warfarin 5 mg daily for atrial
fibrillation. Which action by the nurse is most appropriate?
A) Hold the warfarin on the morning of surgery and administer vitamin K as ordered
B) Continue the warfarin through the morning of surgery to prevent stroke
C) Hold the warfarin 5 days prior to surgery per the surgeon's protocol and document the last dose
taken
D) Switch the patient to aspirin 81 mg daily until the day of surgery
Answer
Answer: C
Rationale
Warfarin has a long half-life and requires approximately 5 days to clear from the system, so holding it
before surgery reduces bleeding risk during the procedure. The nurse's role is to verify the last dose,
document it, and communicate with the surgical team.
Question 8
During the immediate postoperative period, a patient who had abdominal surgery reports
severe pain at the incision site rated 9/10. The nurse notes the patient is guarding the abdomen
and has shallow respirations. Which nursing intervention takes priority?
A) Encourage the patient to use the incentive spirometer every hour
B) Administer the prescribed PRN opioid analgesic and reassess in 30 minutes
C) Apply a warm compress to the incision site to promote comfort
D) Reposition the patient to a side-lying position to reduce tension on the incision
Answer
Answer: B
Rationale
Uncontrolled postoperative pain leads to shallow breathing, which increases the risk of atelectasis and
pneumonia. Pain management is a priority in the immediate post-op period so the patient can
participate effectively in deep breathing, coughing, and mobilization.
Question 9
4
