RN Adult Medical-Surgical Nursing Edition
12.0 Questions and Answers with Rationales
| 2026/2027 Verified | ATI Medical-Surgical
Nursing Review | NCLEX-RN Preparation
Study Guide
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-27)
Q1: A nurse is caring for a client with acute decompensated heart failure. Which
assessment finding requires immediate intervention?
A) Bibasilar crackles
B) Jugular venous distention at 45°
C) Oxygen saturation 84% on room air
D) 2+ pitting edema of lower extremities
Correct Answer: C
Rationale: SpO₂ 84% indicates severe hypoxemia and respiratory failure, requiring
immediate oxygen therapy and possible escalation to BiPAP or intubation. While
crackles (A), JVD (B), and edema (D) are expected findings in decompensated HF, they
do not represent immediate threats to oxygenation. Target SpO₂ 88-92% in COPD
patients, but 84% is critically low for any patient.
,Q2: A client with heart failure is prescribed furosemide 40 mg IV twice daily. Which
laboratory value requires immediate notification of the healthcare provider?
A) Sodium 134 mEq/L
B) Potassium 2.8 mEq/L
C) Chloride 98 mEq/L
D) Magnesium 1.8 mg/dL
Correct Answer: B
Rationale: Severe hypokalemia (K⁺ <3.0 mEq/L) is life-threatening and increases risk of
ventricular dysrhythmias. Loop diuretics cause potassium wasting. Replacement should
begin immediately. Sodium 134 (A) is mild hyponatremia. Chloride 98 (C) and
magnesium 1.8 (D) are within acceptable ranges.
Q3: A client presents with substernal chest pressure radiating to the left arm,
diaphoresis, and nausea. ECG shows ST-segment elevation in leads V1-V4. Which
intervention is the priority?
A) Administer sublingual nitroglycerin
B) Obtain serial cardiac troponins
C) Prepare for emergent percutaneous coronary intervention (PCI)
D) Apply supplemental oxygen at 4 L/min
Correct Answer: C
,Rationale: Anterior STEMI (V1-V4) requires emergent reperfusion therapy.
Door-to-balloon time should be <90 minutes. While MONA (morphine, oxygen,
nitroglycerin, aspirin) is important, reperfusion is the priority intervention that saves
myocardium. Troponins (B) confirm diagnosis but do not delay reperfusion. Oxygen (D)
only if SpO₂ <90%.
Q4: A client with new-onset atrial fibrillation has a ventricular rate of 152 bpm and blood
pressure 88/52 mmHg. Which intervention is indicated?
A) IV metoprolol for rate control
B) Synchronized cardioversion
C) IV digoxin loading dose
D) Oral anticoagulation initiation
Correct Answer: B
Rationale: AFib with rapid ventricular response causing hemodynamic instability
(hypotension, altered mental status, chest pain, or heart failure) requires immediate
synchronized cardioversion. Stable patients receive rate control (A) or rhythm control.
Anticoagulation (D) is important for stroke prevention but not the immediate priority in
unstable tachycardia.
Q5: A client with essential hypertension has a blood pressure of 224/136 mmHg and
reports severe headache and visual changes. Which action is priority?
A) Recheck blood pressure in both arms in 15 minutes
B) Administer oral antihypertensive medication
, C) Administer IV antihypertensive therapy as ordered
D) Obtain CT scan of the brain
Correct Answer: C
Rationale: Hypertensive emergency (BP >180/120 with target organ
damage—neurologic symptoms here) requires immediate IV antihypertensive therapy
(nicardipine, clevidipine, or labetalol) with careful titration to prevent cerebral
hypoperfusion. Oral agents (B) are too slow. Rechecking (A) delays treatment. CT (D)
may be needed but hemodynamic stabilization is first.
Q6: A client with HFrEF (EF 30%) is being discharged. Which medication regimen has
the strongest evidence for mortality reduction?
A) Furosemide and digoxin
B) ACE inhibitor, beta-blocker, MRA, and SGLT2 inhibitor
C) Hydralazine-isosorbide dinitrate
D) Calcium channel blocker and nitrates
Correct Answer: B
Rationale: Guideline-directed medical therapy (GDMT) for HFrEF includes: ACE
inhibitor/ARB/ARNI, evidence-based beta-blocker (metoprolol succinate, carvedilol, or
bisoprolol), mineralocorticoid receptor antagonist (spironolactone/eplerenone), and
SGLT2 inhibitor (dapagliflozin/empagliflozin). This combination reduces mortality and
hospitalization. Diuretics (A) treat symptoms but don't improve survival.
Hydralazine-ISDN (C) is for ACE-intolerant or Black patients. CCBs (D) may worsen HF.
12.0 Questions and Answers with Rationales
| 2026/2027 Verified | ATI Medical-Surgical
Nursing Review | NCLEX-RN Preparation
Study Guide
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-27)
Q1: A nurse is caring for a client with acute decompensated heart failure. Which
assessment finding requires immediate intervention?
A) Bibasilar crackles
B) Jugular venous distention at 45°
C) Oxygen saturation 84% on room air
D) 2+ pitting edema of lower extremities
Correct Answer: C
Rationale: SpO₂ 84% indicates severe hypoxemia and respiratory failure, requiring
immediate oxygen therapy and possible escalation to BiPAP or intubation. While
crackles (A), JVD (B), and edema (D) are expected findings in decompensated HF, they
do not represent immediate threats to oxygenation. Target SpO₂ 88-92% in COPD
patients, but 84% is critically low for any patient.
,Q2: A client with heart failure is prescribed furosemide 40 mg IV twice daily. Which
laboratory value requires immediate notification of the healthcare provider?
A) Sodium 134 mEq/L
B) Potassium 2.8 mEq/L
C) Chloride 98 mEq/L
D) Magnesium 1.8 mg/dL
Correct Answer: B
Rationale: Severe hypokalemia (K⁺ <3.0 mEq/L) is life-threatening and increases risk of
ventricular dysrhythmias. Loop diuretics cause potassium wasting. Replacement should
begin immediately. Sodium 134 (A) is mild hyponatremia. Chloride 98 (C) and
magnesium 1.8 (D) are within acceptable ranges.
Q3: A client presents with substernal chest pressure radiating to the left arm,
diaphoresis, and nausea. ECG shows ST-segment elevation in leads V1-V4. Which
intervention is the priority?
A) Administer sublingual nitroglycerin
B) Obtain serial cardiac troponins
C) Prepare for emergent percutaneous coronary intervention (PCI)
D) Apply supplemental oxygen at 4 L/min
Correct Answer: C
,Rationale: Anterior STEMI (V1-V4) requires emergent reperfusion therapy.
Door-to-balloon time should be <90 minutes. While MONA (morphine, oxygen,
nitroglycerin, aspirin) is important, reperfusion is the priority intervention that saves
myocardium. Troponins (B) confirm diagnosis but do not delay reperfusion. Oxygen (D)
only if SpO₂ <90%.
Q4: A client with new-onset atrial fibrillation has a ventricular rate of 152 bpm and blood
pressure 88/52 mmHg. Which intervention is indicated?
A) IV metoprolol for rate control
B) Synchronized cardioversion
C) IV digoxin loading dose
D) Oral anticoagulation initiation
Correct Answer: B
Rationale: AFib with rapid ventricular response causing hemodynamic instability
(hypotension, altered mental status, chest pain, or heart failure) requires immediate
synchronized cardioversion. Stable patients receive rate control (A) or rhythm control.
Anticoagulation (D) is important for stroke prevention but not the immediate priority in
unstable tachycardia.
Q5: A client with essential hypertension has a blood pressure of 224/136 mmHg and
reports severe headache and visual changes. Which action is priority?
A) Recheck blood pressure in both arms in 15 minutes
B) Administer oral antihypertensive medication
, C) Administer IV antihypertensive therapy as ordered
D) Obtain CT scan of the brain
Correct Answer: C
Rationale: Hypertensive emergency (BP >180/120 with target organ
damage—neurologic symptoms here) requires immediate IV antihypertensive therapy
(nicardipine, clevidipine, or labetalol) with careful titration to prevent cerebral
hypoperfusion. Oral agents (B) are too slow. Rechecking (A) delays treatment. CT (D)
may be needed but hemodynamic stabilization is first.
Q6: A client with HFrEF (EF 30%) is being discharged. Which medication regimen has
the strongest evidence for mortality reduction?
A) Furosemide and digoxin
B) ACE inhibitor, beta-blocker, MRA, and SGLT2 inhibitor
C) Hydralazine-isosorbide dinitrate
D) Calcium channel blocker and nitrates
Correct Answer: B
Rationale: Guideline-directed medical therapy (GDMT) for HFrEF includes: ACE
inhibitor/ARB/ARNI, evidence-based beta-blocker (metoprolol succinate, carvedilol, or
bisoprolol), mineralocorticoid receptor antagonist (spironolactone/eplerenone), and
SGLT2 inhibitor (dapagliflozin/empagliflozin). This combination reduces mortality and
hospitalization. Diuretics (A) treat symptoms but don't improve survival.
Hydralazine-ISDN (C) is for ACE-intolerant or Black patients. CCBs (D) may worsen HF.
