COMPREHENSIVE ATI RN MED-SURG AND ADULT
MEDICAL SURGICAL PRACTICE EXAM - UPDATED 2026
(GRADED A+) UPDATED 2025/2026
Subject: Adult Medical-Surgical Nursing
Subtopic: Cardiovascular Disorders and Acute Care Nursing
Question 1: A nurse is caring for a client experiencing acute left-sided heart
failure. Which assessment finding should the nurse identify as the highest
priority?
A) Jugular venous distention
B) Bilateral pulmonary crackles and dyspnea
C) Hepatomegaly with peripheral edema
D) Weight gain of 1 kg over one week
Correct Answer: B) - Bilateral pulmonary crackles and dyspnea
Rationale: Acute left-sided heart failure causes pulmonary congestion due to
ineffective ventricular pumping, leading to fluid accumulation in the alveoli and
impaired gas exchange. Pulmonary crackles and dyspnea indicate potentially life-
threatening respiratory compromise requiring immediate intervention. Option A is
more associated with right-sided heart failure. Option C reflects systemic venous
congestion. Option D is clinically important but less immediately life-threatening
than respiratory failure.
Question 2: A nurse is teaching a client prescribed warfarin therapy for chronic
atrial fibrillation. Which client statement indicates understanding of the teaching?
A) “I should increase my intake of green leafy vegetables each day.”
B) “I will notify my provider if I notice unusual bruising or bleeding.”
C) “I can stop taking this medication once my heart rhythm improves.”
D) “I should take aspirin daily unless otherwise instructed.”
Correct Answer: B) - “I will notify my provider if I notice unusual bruising or
bleeding.”
Rationale: Warfarin increases bleeding risk by inhibiting vitamin K–dependent
clotting factors. Clients must monitor for signs of bleeding such as bruising,
hematuria, or melena. Option A is incorrect because sudden increases in vitamin K
intake may reduce warfarin effectiveness. Option C is unsafe because
discontinuation requires provider guidance. Option D is dangerous because aspirin
may further increase bleeding risk unless specifically prescribed.
,Question 3: A client with chronic obstructive pulmonary disease (COPD) is
receiving oxygen therapy. Which finding indicates oxygen-induced
hypoventilation?
A) Respiratory rate increases from 18/min to 24/min
B) Pulse oximetry reading increases from 84% to 92%
C) Increasing drowsiness and decreased respiratory effort
D) Productive cough with thick sputum production
Correct Answer: C) - Increasing drowsiness and decreased respiratory effort
Rationale: In some COPD clients with chronic hypercapnia, excessive oxygen
administration can suppress hypoxic respiratory drive, resulting in hypoventilation,
CO₂ retention, and altered mental status. Option A suggests respiratory
stimulation rather than suppression. Option B indicates improved oxygenation.
Option D reflects airway secretion issues rather than oxygen-induced respiratory
depression.
Question 4: A nurse is assessing a client who is experiencing hypovolemic shock
following a gastrointestinal hemorrhage. Which finding should the nurse expect?
A) Bradycardia with bounding peripheral pulses
B) Hypotension with cool clammy skin
C) Hypertension with flushed skin
D) Decreased respiratory rate and warm extremities
Correct Answer: B) - Hypotension with cool clammy skin
Rationale: Hypovolemic shock results from inadequate circulating blood volume,
causing compensatory vasoconstriction, tachycardia, hypotension, and cool
clammy skin due to poor tissue perfusion. Option A is inconsistent because
hypovolemia typically causes tachycardia and weak pulses. Option C contradicts
expected hemodynamic instability. Option D does not reflect compensatory shock
physiology.
Question 5: A nurse is caring for a client newly diagnosed with type 1 diabetes
mellitus. Which statement by the client requires further teaching?
A) “I should rotate my insulin injection sites regularly.”
B) “I may need to monitor my blood glucose more frequently during illness.”
C) “If I am unable to eat, I should skip my insulin dose entirely.”
D) “I should carry a source of fast-acting glucose with me.”
Correct Answer: C) - “If I am unable to eat, I should skip my insulin dose
,entirely.”
Rationale: Clients with type 1 diabetes require continuous insulin even during
illness or reduced oral intake because endogenous insulin production is absent.
Omitting insulin may precipitate diabetic ketoacidosis. Option A reflects proper
injection technique. Option B is correct because illness can elevate glucose levels.
Option D is appropriate hypoglycemia preparedness.
Question 6: A nurse is monitoring a client receiving intravenous potassium
chloride. Which finding requires immediate intervention?
A) Serum potassium level of 4.2 mEq/L
B) Burning sensation at the IV insertion site
C) Heart rate of 88/min with regular rhythm
D) Urine output of 45 mL/hr
Correct Answer: B) - Burning sensation at the IV insertion site
Rationale: Potassium chloride is highly irritating to veins and may cause
infiltration or phlebitis. Burning at the infusion site requires immediate assessment
and intervention to prevent tissue injury. Option A reflects a normal potassium
level. Option C is stable. Option D indicates adequate urine output supporting
potassium excretion.
Question 7: A client admitted with acute pancreatitis reports severe abdominal
pain. Which laboratory finding should the nurse expect?
A) Decreased serum amylase and lipase levels
B) Elevated serum amylase and lipase levels
C) Decreased hematocrit and blood glucose levels
D) Elevated calcium levels with metabolic alkalosis
Correct Answer: B) - Elevated serum amylase and lipase levels
Rationale: Acute pancreatitis causes pancreatic enzyme leakage into circulation,
producing elevated serum amylase and lipase levels. Option A contradicts
expected findings. Option C is inaccurate because glucose and hematocrit may
increase due to stress response and dehydration. Option D is inconsistent because
hypocalcemia may occur instead.
Question 8: A nurse is caring for a client with deep vein thrombosis (DVT). Which
intervention is contraindicated?
A) Applying warm moist compresses to the affected extremity
, B) Administering prescribed anticoagulants
C) Massaging the affected calf to reduce discomfort
D) Elevating the affected extremity
Correct Answer: C) - Massaging the affected calf to reduce discomfort
Rationale: Massaging an extremity affected by DVT may dislodge the thrombus,
increasing risk for pulmonary embolism. Options A, B, and D are common
therapeutic interventions supporting circulation and reducing complications.
Question 9: A client receiving heparin therapy develops hematuria and bleeding
gums. Which medication should the nurse anticipate administering?
A) Vitamin K
B) Protamine sulfate
C) Naloxone
D) Atropine sulfate
Correct Answer: B) - Protamine sulfate
Rationale: Protamine sulfate reverses the anticoagulant effects of heparin.
Vitamin K reverses warfarin. Naloxone reverses opioids. Atropine treats
bradycardia rather than anticoagulant toxicity.
Question 10: A nurse is evaluating a client 24 hr after thyroidectomy. Which
assessment finding requires immediate notification of the provider?
A) Hoarse voice and neck swelling
B) Pain level of 4 on a 0–10 scale
C) Blood pressure of 138/84 mm Hg
D) Mild sore throat when swallowing
Correct Answer: A) - Hoarse voice and neck swelling
Rationale: Hoarseness accompanied by neck swelling may indicate hemorrhage or
airway compromise following thyroidectomy and requires immediate intervention.
Option B reflects manageable postoperative discomfort. Option C is within
acceptable limits. Option D is a common postoperative complaint.
Question 11: A nurse is assessing a client with bacterial meningitis. Which finding
should the nurse expect?
A) Positive Kernig’s sign and nuchal rigidity
B) Bradycardia with hypothermia
C) Flaccid extremities without headache
MEDICAL SURGICAL PRACTICE EXAM - UPDATED 2026
(GRADED A+) UPDATED 2025/2026
Subject: Adult Medical-Surgical Nursing
Subtopic: Cardiovascular Disorders and Acute Care Nursing
Question 1: A nurse is caring for a client experiencing acute left-sided heart
failure. Which assessment finding should the nurse identify as the highest
priority?
A) Jugular venous distention
B) Bilateral pulmonary crackles and dyspnea
C) Hepatomegaly with peripheral edema
D) Weight gain of 1 kg over one week
Correct Answer: B) - Bilateral pulmonary crackles and dyspnea
Rationale: Acute left-sided heart failure causes pulmonary congestion due to
ineffective ventricular pumping, leading to fluid accumulation in the alveoli and
impaired gas exchange. Pulmonary crackles and dyspnea indicate potentially life-
threatening respiratory compromise requiring immediate intervention. Option A is
more associated with right-sided heart failure. Option C reflects systemic venous
congestion. Option D is clinically important but less immediately life-threatening
than respiratory failure.
Question 2: A nurse is teaching a client prescribed warfarin therapy for chronic
atrial fibrillation. Which client statement indicates understanding of the teaching?
A) “I should increase my intake of green leafy vegetables each day.”
B) “I will notify my provider if I notice unusual bruising or bleeding.”
C) “I can stop taking this medication once my heart rhythm improves.”
D) “I should take aspirin daily unless otherwise instructed.”
Correct Answer: B) - “I will notify my provider if I notice unusual bruising or
bleeding.”
Rationale: Warfarin increases bleeding risk by inhibiting vitamin K–dependent
clotting factors. Clients must monitor for signs of bleeding such as bruising,
hematuria, or melena. Option A is incorrect because sudden increases in vitamin K
intake may reduce warfarin effectiveness. Option C is unsafe because
discontinuation requires provider guidance. Option D is dangerous because aspirin
may further increase bleeding risk unless specifically prescribed.
,Question 3: A client with chronic obstructive pulmonary disease (COPD) is
receiving oxygen therapy. Which finding indicates oxygen-induced
hypoventilation?
A) Respiratory rate increases from 18/min to 24/min
B) Pulse oximetry reading increases from 84% to 92%
C) Increasing drowsiness and decreased respiratory effort
D) Productive cough with thick sputum production
Correct Answer: C) - Increasing drowsiness and decreased respiratory effort
Rationale: In some COPD clients with chronic hypercapnia, excessive oxygen
administration can suppress hypoxic respiratory drive, resulting in hypoventilation,
CO₂ retention, and altered mental status. Option A suggests respiratory
stimulation rather than suppression. Option B indicates improved oxygenation.
Option D reflects airway secretion issues rather than oxygen-induced respiratory
depression.
Question 4: A nurse is assessing a client who is experiencing hypovolemic shock
following a gastrointestinal hemorrhage. Which finding should the nurse expect?
A) Bradycardia with bounding peripheral pulses
B) Hypotension with cool clammy skin
C) Hypertension with flushed skin
D) Decreased respiratory rate and warm extremities
Correct Answer: B) - Hypotension with cool clammy skin
Rationale: Hypovolemic shock results from inadequate circulating blood volume,
causing compensatory vasoconstriction, tachycardia, hypotension, and cool
clammy skin due to poor tissue perfusion. Option A is inconsistent because
hypovolemia typically causes tachycardia and weak pulses. Option C contradicts
expected hemodynamic instability. Option D does not reflect compensatory shock
physiology.
Question 5: A nurse is caring for a client newly diagnosed with type 1 diabetes
mellitus. Which statement by the client requires further teaching?
A) “I should rotate my insulin injection sites regularly.”
B) “I may need to monitor my blood glucose more frequently during illness.”
C) “If I am unable to eat, I should skip my insulin dose entirely.”
D) “I should carry a source of fast-acting glucose with me.”
Correct Answer: C) - “If I am unable to eat, I should skip my insulin dose
,entirely.”
Rationale: Clients with type 1 diabetes require continuous insulin even during
illness or reduced oral intake because endogenous insulin production is absent.
Omitting insulin may precipitate diabetic ketoacidosis. Option A reflects proper
injection technique. Option B is correct because illness can elevate glucose levels.
Option D is appropriate hypoglycemia preparedness.
Question 6: A nurse is monitoring a client receiving intravenous potassium
chloride. Which finding requires immediate intervention?
A) Serum potassium level of 4.2 mEq/L
B) Burning sensation at the IV insertion site
C) Heart rate of 88/min with regular rhythm
D) Urine output of 45 mL/hr
Correct Answer: B) - Burning sensation at the IV insertion site
Rationale: Potassium chloride is highly irritating to veins and may cause
infiltration or phlebitis. Burning at the infusion site requires immediate assessment
and intervention to prevent tissue injury. Option A reflects a normal potassium
level. Option C is stable. Option D indicates adequate urine output supporting
potassium excretion.
Question 7: A client admitted with acute pancreatitis reports severe abdominal
pain. Which laboratory finding should the nurse expect?
A) Decreased serum amylase and lipase levels
B) Elevated serum amylase and lipase levels
C) Decreased hematocrit and blood glucose levels
D) Elevated calcium levels with metabolic alkalosis
Correct Answer: B) - Elevated serum amylase and lipase levels
Rationale: Acute pancreatitis causes pancreatic enzyme leakage into circulation,
producing elevated serum amylase and lipase levels. Option A contradicts
expected findings. Option C is inaccurate because glucose and hematocrit may
increase due to stress response and dehydration. Option D is inconsistent because
hypocalcemia may occur instead.
Question 8: A nurse is caring for a client with deep vein thrombosis (DVT). Which
intervention is contraindicated?
A) Applying warm moist compresses to the affected extremity
, B) Administering prescribed anticoagulants
C) Massaging the affected calf to reduce discomfort
D) Elevating the affected extremity
Correct Answer: C) - Massaging the affected calf to reduce discomfort
Rationale: Massaging an extremity affected by DVT may dislodge the thrombus,
increasing risk for pulmonary embolism. Options A, B, and D are common
therapeutic interventions supporting circulation and reducing complications.
Question 9: A client receiving heparin therapy develops hematuria and bleeding
gums. Which medication should the nurse anticipate administering?
A) Vitamin K
B) Protamine sulfate
C) Naloxone
D) Atropine sulfate
Correct Answer: B) - Protamine sulfate
Rationale: Protamine sulfate reverses the anticoagulant effects of heparin.
Vitamin K reverses warfarin. Naloxone reverses opioids. Atropine treats
bradycardia rather than anticoagulant toxicity.
Question 10: A nurse is evaluating a client 24 hr after thyroidectomy. Which
assessment finding requires immediate notification of the provider?
A) Hoarse voice and neck swelling
B) Pain level of 4 on a 0–10 scale
C) Blood pressure of 138/84 mm Hg
D) Mild sore throat when swallowing
Correct Answer: A) - Hoarse voice and neck swelling
Rationale: Hoarseness accompanied by neck swelling may indicate hemorrhage or
airway compromise following thyroidectomy and requires immediate intervention.
Option B reflects manageable postoperative discomfort. Option C is within
acceptable limits. Option D is a common postoperative complaint.
Question 11: A nurse is assessing a client with bacterial meningitis. Which finding
should the nurse expect?
A) Positive Kernig’s sign and nuchal rigidity
B) Bradycardia with hypothermia
C) Flaccid extremities without headache
