ATI QUESTIONS 231 (COMPLETE) ATI/RN/ATI RN
TARGETED MEDICAL SURGICAL CARDIOVASCULAR,
RESPIRATORY, PERIOPERATIVE/ PREOPERATIVE, FLUID,
ELECTROLYTE, ACID-BASE, NEUROSENSORY,
MUSCULOSKELETAL, GASTROINTESTINAL, ENDOCRINE
AND IMMUNE: QUESTIONS AND ANSWERS
1. A 68-year-old man with chronic heart failure reports sudden worsening
dyspnea, cough producing frothy sputum, and anxiety. Vital signs: T 37.2°C,
HR 120, RR 28, BP 160/96, SpO₂ 86% on room air. Which action should the
nurse take first?
A. Administer IV morphine per order.
B. Place the client in high-fowler's position and give oxygen.
C. Start IV furosemide 40 mg push.
D. Obtain a stat portable chest x-ray.
Answer: B. Rationale: Airway/oxygenation is first priority in acute
pulmonary edema; high-fowler's + oxygen improves ventilation and gas
exchange immediately. (Medications follow after initial support.)
2. A client in sinus tachycardia (HR 130) is anxious and diaphoretic. Which
assessment finding best indicates that the tachycardia is hemodynamically
significant?
A. Bounding peripheral pulses.
B. Urine output 50 mL/hr.
C. Altered mental status and hypotension.
D. Complaints of palpitations.
Answer: C. Rationale: Altered mental status and hypotension show reduced
perfusion and hemodynamic compromise requiring urgent intervention.
,3. A nurse reviews morning labs for a client taking warfarin (coumadin).
Which lab result requires immediate notification of the provider?
A. INR 1.5
B. INR 2.8
C. INR 4.2
D. Platelet count 200,000/mm³
Answer: C. Rationale: INR >4.0 increases bleeding risk; provider should be
notified to consider dose adjustment or reversal.
4. After a myocardial infarction, a client is started on a beta-blocker. The nurse
teaches the client to report which immediate symptom?
A. Dry cough.
B. Weight gain of 2 lb in one day.
C. Worsening shortness of breath and wheezing.
D. Constipation.
Answer: C. Rationale: Beta-blockers may worsen bronchospasm in reactive
airway disease — acute worsening dyspnea/wheezing is concerning.
5. A client with peripheral arterial disease (PAD) asks which symptom most
commonly indicates critical limb ischemia. The nurse responds:
A. Intermittent claudication only when walking uphill.
B. Rest pain and nonhealing foot ulcer.
C. Bilateral ankle edema.
D. Varicose veins and leg heaviness.
Answer: B. Rationale: Rest pain and nonhealing ulcers indicate severe
arterial insufficiency and need urgent vascular evaluation.
6. Which finding best differentiates pericarditis from myocardial infarction
(MI)?
, A. Chest pain that improves when leaning forward.
B. Elevated troponin I.
C. ST elevation on ECG.
D. Hypotension.
Answer: A. Rationale: Chest pain that improves when leaning forward is
classic for pericarditis; MI pain typically not position dependent.
7. A client with a new left ventricular assist device (LVAD) has a continuous
pump. Which nursing assessment is most important?
A. Palpate for a peripheral pulse every 4 hours.
B. Measure BP with Doppler and monitor mean arterial pressure.
C. Check for bowel sounds.
D. Take orthostatic vital signs hourly.
Answer: B. Rationale: With continuous-flow LVADs, BP by standard cuff
can be inaccurate; use Doppler to obtain MAP (target often 60–90 mmHg).
8. A client on IV nitroprusside for hypertensive emergency becomes agitated
and tachycardic and has metabolic acidosis. What toxicity is the nurse most
concerned about?
A. Cyanide toxicity.
B. Digoxin toxicity.
C. Hemolytic anemia.
D. Acute renal failure.
Answer: A. Rationale: Nitroprusside can produce cyanide; signs include
agitation, tachycardia, metabolic acidosis, and altered mental status.
, 9. A client with COPD has chronic hypercapnia. Which arterial blood gas
pattern would you expect at baseline?
A. pH 7.50, PaCO₂ 30 mmHg, HCO₃⁻ 28 mEq/L
B. pH 7.38, PaCO₂ 55 mmHg, HCO₃⁻ 34 mEq/L
C. pH 7.25, PaCO₂ 70 mmHg, HCO₃⁻ 22 mEq/L
D. pH 7.60, PaCO₂ 20 mmHg, HCO₃⁻ 24 mEq/L
Answer: B. Rationale: Chronic respiratory acidosis with metabolic
compensation: elevated PaCO₂ with near-normal pH and increased HCO₃⁻.
10. A client develops sudden pleuritic chest pain and tachycardia after a long
flight. The nurse suspects pulmonary embolism (PE). Which is the most
appropriate immediate nursing action?
A. Administer subcutaneous heparin.
B. Prepare for emergent chest CT with contrast.
C. Elevate the client's legs.
D. Give high-flow oxygen and notify provider.
Answer: D. Rationale: Support airway and oxygenation first; notify
provider for further diagnostics/intervention (CT, anticoagulation).
11. A client has ARDS and is receiving mechanical ventilation with low tidal
volume strategy. Which ventilator setting supports lung protective
ventilation?
A. Tidal volume 10 mL/kg predicted body weight.
B. Tidal volume 6 mL/kg predicted body weight.
C. High FiO₂ 100% only strategy.
D. Zero PEEP to increase minute ventilation.
Answer: B. Rationale: Low tidal volume (~6 mL/kg predicted body weight)
reduces ventilator-induced lung injury in ARDS.
TARGETED MEDICAL SURGICAL CARDIOVASCULAR,
RESPIRATORY, PERIOPERATIVE/ PREOPERATIVE, FLUID,
ELECTROLYTE, ACID-BASE, NEUROSENSORY,
MUSCULOSKELETAL, GASTROINTESTINAL, ENDOCRINE
AND IMMUNE: QUESTIONS AND ANSWERS
1. A 68-year-old man with chronic heart failure reports sudden worsening
dyspnea, cough producing frothy sputum, and anxiety. Vital signs: T 37.2°C,
HR 120, RR 28, BP 160/96, SpO₂ 86% on room air. Which action should the
nurse take first?
A. Administer IV morphine per order.
B. Place the client in high-fowler's position and give oxygen.
C. Start IV furosemide 40 mg push.
D. Obtain a stat portable chest x-ray.
Answer: B. Rationale: Airway/oxygenation is first priority in acute
pulmonary edema; high-fowler's + oxygen improves ventilation and gas
exchange immediately. (Medications follow after initial support.)
2. A client in sinus tachycardia (HR 130) is anxious and diaphoretic. Which
assessment finding best indicates that the tachycardia is hemodynamically
significant?
A. Bounding peripheral pulses.
B. Urine output 50 mL/hr.
C. Altered mental status and hypotension.
D. Complaints of palpitations.
Answer: C. Rationale: Altered mental status and hypotension show reduced
perfusion and hemodynamic compromise requiring urgent intervention.
,3. A nurse reviews morning labs for a client taking warfarin (coumadin).
Which lab result requires immediate notification of the provider?
A. INR 1.5
B. INR 2.8
C. INR 4.2
D. Platelet count 200,000/mm³
Answer: C. Rationale: INR >4.0 increases bleeding risk; provider should be
notified to consider dose adjustment or reversal.
4. After a myocardial infarction, a client is started on a beta-blocker. The nurse
teaches the client to report which immediate symptom?
A. Dry cough.
B. Weight gain of 2 lb in one day.
C. Worsening shortness of breath and wheezing.
D. Constipation.
Answer: C. Rationale: Beta-blockers may worsen bronchospasm in reactive
airway disease — acute worsening dyspnea/wheezing is concerning.
5. A client with peripheral arterial disease (PAD) asks which symptom most
commonly indicates critical limb ischemia. The nurse responds:
A. Intermittent claudication only when walking uphill.
B. Rest pain and nonhealing foot ulcer.
C. Bilateral ankle edema.
D. Varicose veins and leg heaviness.
Answer: B. Rationale: Rest pain and nonhealing ulcers indicate severe
arterial insufficiency and need urgent vascular evaluation.
6. Which finding best differentiates pericarditis from myocardial infarction
(MI)?
, A. Chest pain that improves when leaning forward.
B. Elevated troponin I.
C. ST elevation on ECG.
D. Hypotension.
Answer: A. Rationale: Chest pain that improves when leaning forward is
classic for pericarditis; MI pain typically not position dependent.
7. A client with a new left ventricular assist device (LVAD) has a continuous
pump. Which nursing assessment is most important?
A. Palpate for a peripheral pulse every 4 hours.
B. Measure BP with Doppler and monitor mean arterial pressure.
C. Check for bowel sounds.
D. Take orthostatic vital signs hourly.
Answer: B. Rationale: With continuous-flow LVADs, BP by standard cuff
can be inaccurate; use Doppler to obtain MAP (target often 60–90 mmHg).
8. A client on IV nitroprusside for hypertensive emergency becomes agitated
and tachycardic and has metabolic acidosis. What toxicity is the nurse most
concerned about?
A. Cyanide toxicity.
B. Digoxin toxicity.
C. Hemolytic anemia.
D. Acute renal failure.
Answer: A. Rationale: Nitroprusside can produce cyanide; signs include
agitation, tachycardia, metabolic acidosis, and altered mental status.
, 9. A client with COPD has chronic hypercapnia. Which arterial blood gas
pattern would you expect at baseline?
A. pH 7.50, PaCO₂ 30 mmHg, HCO₃⁻ 28 mEq/L
B. pH 7.38, PaCO₂ 55 mmHg, HCO₃⁻ 34 mEq/L
C. pH 7.25, PaCO₂ 70 mmHg, HCO₃⁻ 22 mEq/L
D. pH 7.60, PaCO₂ 20 mmHg, HCO₃⁻ 24 mEq/L
Answer: B. Rationale: Chronic respiratory acidosis with metabolic
compensation: elevated PaCO₂ with near-normal pH and increased HCO₃⁻.
10. A client develops sudden pleuritic chest pain and tachycardia after a long
flight. The nurse suspects pulmonary embolism (PE). Which is the most
appropriate immediate nursing action?
A. Administer subcutaneous heparin.
B. Prepare for emergent chest CT with contrast.
C. Elevate the client's legs.
D. Give high-flow oxygen and notify provider.
Answer: D. Rationale: Support airway and oxygenation first; notify
provider for further diagnostics/intervention (CT, anticoagulation).
11. A client has ARDS and is receiving mechanical ventilation with low tidal
volume strategy. Which ventilator setting supports lung protective
ventilation?
A. Tidal volume 10 mL/kg predicted body weight.
B. Tidal volume 6 mL/kg predicted body weight.
C. High FiO₂ 100% only strategy.
D. Zero PEEP to increase minute ventilation.
Answer: B. Rationale: Low tidal volume (~6 mL/kg predicted body weight)
reduces ventilator-induced lung injury in ARDS.
