ATI RN MED SURG PROCTORED RETAKE EXAM (Version 1, 2, &
3) – NGN‑Style Questions & Case Scenarios
BLOCK 1 – CARDIOVASCULAR DISORDERS (Questions 1–25)
Q1. A nurse is assessing a client with heart failure who has been prescribed digoxin. Which finding
indicates digoxin toxicity?
A) Heart rate 62 bpm and regular
B) Serum potassium 4.0 mEq/L
C) Visual disturbances (yellow‑green halos) and nausea
D) Blood pressure 130/80 mm Hg
Answer: C
Explanation: Digoxin toxicity presents with visual changes (yellow‑green halos, blurred vision), GI
symptoms (nausea, vomiting, anorexia), and cardiac dysrhythmias. Bradycardia may occur but not
always; normal potassium does not rule out toxicity.
Q2. A nurse is caring for a client with unstable angina. Which medication should the nurse expect to
administer to reduce the risk of myocardial infarction?
A) Aspirin 325 mg orally
B) Morphine sulfate IV
C) Nitroglycerin sublingual
D) Furosemide IV
Answer: A
Explanation: Aspirin inhibits platelet aggregation and reduces the risk of MI and death in unstable
angina. Morphine and nitroglycerin relieve pain but do not have the same long‑term antiplatelet effect.
Furosemide is for fluid overload.
Q3. A client with heart failure has an ejection fraction of 35%. Which medication is most likely to
improve survival?
,A) Carvedilol
B) Digoxin
C) Furosemide
D) Hydrochlorothiazide
Answer: A
Explanation: Beta‑blockers (carvedilol, metoprolol succinate) reduce mortality in heart failure with
reduced ejection fraction. Digoxin improves symptoms but not survival; diuretics manage fluid but do
not improve long‑term outcomes.
Q4. The nurse is assessing a client who underwent cardiac catheterization via the femoral artery. Which
finding requires immediate intervention?
A) Small hematoma at the insertion site
B) Pulse in the affected extremity is 2+ and equal to the other side
C) The client reports severe pain and pallor in the affected leg
D) Blood pressure 110/70 mm Hg
Answer: C
Explanation: Severe pain, pallor, paresthesia, pulselessness, or paralysis indicate arterial occlusion or
bleeding. This is a vascular emergency. Small hematoma and normal pulses are expected.
Q5. A client with hypertension is prescribed hydrochlorothiazide. Which laboratory value should the
nurse monitor?
A) Serum potassium
B) Serum sodium
C) Serum calcium
D) All of the above
Answer: D
Explanation: Thiazide diuretics can cause hypokalemia, hyponatremia, and hypercalcemia (because they
decrease calcium excretion). All electrolytes should be monitored.
,Q6. A nurse is providing discharge teaching to a client with a new diagnosis of heart failure. Which
statement indicates understanding?
A) “I will weigh myself weekly and report a gain of 3 lbs in a week.”
B) “I should limit my sodium intake to less than 2,000 mg per day.”
C) “I can stop taking my diuretic if I feel short of breath.”
D) “I should exercise vigorously every day.”
Answer: B
Explanation: Daily weights (not weekly) are recommended; a gain of 2‑3 lbs in 24 hours or 5 lbs in a
week should be reported. Symptom improvement does not mean stop diuretics. Moderate exercise is
encouraged, but vigorous may worsen symptoms.
Q7. A client with atrial fibrillation is prescribed warfarin. The nurse teaches the client to avoid which
food because it can decrease warfarin’s effectiveness?
A) Bananas
B) Green leafy vegetables (spinach, kale)
C) Dairy products
D) Red meat
Answer: B
Explanation: Green leafy vegetables are high in vitamin K, which antagonizes warfarin’s effect.
Consistent intake is fine, but large changes in intake can alter INR.
Q8. The nurse is assessing a client with pericarditis. Which finding is most characteristic?
A) Chest pain that worsens when lying flat and improves when leaning forward
B) Substernal chest pressure that radiates to the left arm
C) Dyspnea that improves with activity
D) Palpitations only with exercise
, Answer: A
Explanation: Pericarditis pain is often sharp, pleuritic, and worse when supine; sitting forward relieves it.
Angina radiates to the arm and is not positional.
Q9. A client with an implanted pacemaker asks about safety precautions. Which instruction should the
nurse include?
A) “You should avoid using a microwave oven.”
B) “You can undergo magnetic resonance imaging (MRI) without restriction.”
C) “Avoid close or prolonged contact with devices that have strong magnetic fields.”
D) “You should not use a cellular phone at all.”
Answer: C
Explanation: Modern pacemakers are shielded, but strong magnetic fields (large magnets, MRI, some
security scanners) can interfere. Microwaves are safe. MRI requires special precautions. Cellular phones
are safe if kept 6 inches away.
Q10. A client is admitted with acute decompensated heart failure. Which assessment finding is most
indicative of worsening pulmonary congestion?
A) Jugular venous distention
B) Peripheral edema 2+
C) Crackles in the lung bases
D) Hepatomegaly
Answer: C
Explanation: Crackles (rales) indicate pulmonary edema from left‑sided failure. JVD, peripheral edema,
and hepatomegaly are signs of right‑sided failure.
Q11. The nurse is caring for a client with infective endocarditis. Which assessment finding is consistent
with this diagnosis?
A) Splinter hemorrhages
B) Painless, nonpruritic rash on the trunk
3) – NGN‑Style Questions & Case Scenarios
BLOCK 1 – CARDIOVASCULAR DISORDERS (Questions 1–25)
Q1. A nurse is assessing a client with heart failure who has been prescribed digoxin. Which finding
indicates digoxin toxicity?
A) Heart rate 62 bpm and regular
B) Serum potassium 4.0 mEq/L
C) Visual disturbances (yellow‑green halos) and nausea
D) Blood pressure 130/80 mm Hg
Answer: C
Explanation: Digoxin toxicity presents with visual changes (yellow‑green halos, blurred vision), GI
symptoms (nausea, vomiting, anorexia), and cardiac dysrhythmias. Bradycardia may occur but not
always; normal potassium does not rule out toxicity.
Q2. A nurse is caring for a client with unstable angina. Which medication should the nurse expect to
administer to reduce the risk of myocardial infarction?
A) Aspirin 325 mg orally
B) Morphine sulfate IV
C) Nitroglycerin sublingual
D) Furosemide IV
Answer: A
Explanation: Aspirin inhibits platelet aggregation and reduces the risk of MI and death in unstable
angina. Morphine and nitroglycerin relieve pain but do not have the same long‑term antiplatelet effect.
Furosemide is for fluid overload.
Q3. A client with heart failure has an ejection fraction of 35%. Which medication is most likely to
improve survival?
,A) Carvedilol
B) Digoxin
C) Furosemide
D) Hydrochlorothiazide
Answer: A
Explanation: Beta‑blockers (carvedilol, metoprolol succinate) reduce mortality in heart failure with
reduced ejection fraction. Digoxin improves symptoms but not survival; diuretics manage fluid but do
not improve long‑term outcomes.
Q4. The nurse is assessing a client who underwent cardiac catheterization via the femoral artery. Which
finding requires immediate intervention?
A) Small hematoma at the insertion site
B) Pulse in the affected extremity is 2+ and equal to the other side
C) The client reports severe pain and pallor in the affected leg
D) Blood pressure 110/70 mm Hg
Answer: C
Explanation: Severe pain, pallor, paresthesia, pulselessness, or paralysis indicate arterial occlusion or
bleeding. This is a vascular emergency. Small hematoma and normal pulses are expected.
Q5. A client with hypertension is prescribed hydrochlorothiazide. Which laboratory value should the
nurse monitor?
A) Serum potassium
B) Serum sodium
C) Serum calcium
D) All of the above
Answer: D
Explanation: Thiazide diuretics can cause hypokalemia, hyponatremia, and hypercalcemia (because they
decrease calcium excretion). All electrolytes should be monitored.
,Q6. A nurse is providing discharge teaching to a client with a new diagnosis of heart failure. Which
statement indicates understanding?
A) “I will weigh myself weekly and report a gain of 3 lbs in a week.”
B) “I should limit my sodium intake to less than 2,000 mg per day.”
C) “I can stop taking my diuretic if I feel short of breath.”
D) “I should exercise vigorously every day.”
Answer: B
Explanation: Daily weights (not weekly) are recommended; a gain of 2‑3 lbs in 24 hours or 5 lbs in a
week should be reported. Symptom improvement does not mean stop diuretics. Moderate exercise is
encouraged, but vigorous may worsen symptoms.
Q7. A client with atrial fibrillation is prescribed warfarin. The nurse teaches the client to avoid which
food because it can decrease warfarin’s effectiveness?
A) Bananas
B) Green leafy vegetables (spinach, kale)
C) Dairy products
D) Red meat
Answer: B
Explanation: Green leafy vegetables are high in vitamin K, which antagonizes warfarin’s effect.
Consistent intake is fine, but large changes in intake can alter INR.
Q8. The nurse is assessing a client with pericarditis. Which finding is most characteristic?
A) Chest pain that worsens when lying flat and improves when leaning forward
B) Substernal chest pressure that radiates to the left arm
C) Dyspnea that improves with activity
D) Palpitations only with exercise
, Answer: A
Explanation: Pericarditis pain is often sharp, pleuritic, and worse when supine; sitting forward relieves it.
Angina radiates to the arm and is not positional.
Q9. A client with an implanted pacemaker asks about safety precautions. Which instruction should the
nurse include?
A) “You should avoid using a microwave oven.”
B) “You can undergo magnetic resonance imaging (MRI) without restriction.”
C) “Avoid close or prolonged contact with devices that have strong magnetic fields.”
D) “You should not use a cellular phone at all.”
Answer: C
Explanation: Modern pacemakers are shielded, but strong magnetic fields (large magnets, MRI, some
security scanners) can interfere. Microwaves are safe. MRI requires special precautions. Cellular phones
are safe if kept 6 inches away.
Q10. A client is admitted with acute decompensated heart failure. Which assessment finding is most
indicative of worsening pulmonary congestion?
A) Jugular venous distention
B) Peripheral edema 2+
C) Crackles in the lung bases
D) Hepatomegaly
Answer: C
Explanation: Crackles (rales) indicate pulmonary edema from left‑sided failure. JVD, peripheral edema,
and hepatomegaly are signs of right‑sided failure.
Q11. The nurse is caring for a client with infective endocarditis. Which assessment finding is consistent
with this diagnosis?
A) Splinter hemorrhages
B) Painless, nonpruritic rash on the trunk
