RN ATI Advanced Medical Surgical Proctored EXAM 2023-2024
WITH NGN. Course
1. Post-cardiac catheterization, the client's affected leg is warm with a strong
distal pulse. What action should the nurse take?
• A. Massage the leg to improve circulation
• B. Apply a heating pad
• C. Document the findings as expected
• D. Notify the provider immediately
Answer: C. Document the findings as expected.
Rationale: Warmth, color, and strong pulses indicate normal perfusion post-
procedure. No intervention is needed; documentation is the appropriate nursing
action. Interventions would be required if there were signs of compromised
circulation, such as coolness, pallor, or diminished pulses .
2. A client has anaphylactic shock. Which medication is the priority?
• A. Diphenhydramine
• B. Epinephrine
• C. Methylprednisolone
• D. Albuterol
Answer: B. Epinephrine.
Rationale: Epinephrine is the first-line treatment for anaphylaxis. It works rapidly
to reverse severe vasodilation and bronchospasm, which are the primary life-
threatening effects of anaphylactic shock. Other medications like antihistamines
and corticosteroids are secondary treatments .
3. Which EKG change is associated with hyperkalemia?
• A. Flattened T-waves
• B. Peaked T-waves
, • C. Prolonged QT interval
• D. ST-segment elevation
Answer: B. Peaked T-waves.
Rationale: Tall, peaked ("tented") T-waves are the earliest and most characteristic
EKG sign of hyperkalemia. As potassium levels rise further, other changes such as
widening QRS complexes and ultimately a sine wave pattern may occur .
4. A client receiving IV heparin suddenly develops shortness of breath and a
drop in platelet count. What complication does the nurse suspect?
• A. Heparin-induced thrombocytopenia (HIT)
• B. Anaphylaxis
• C. Pulmonary embolism
• D. Fluid overload
Answer: A. Heparin-induced thrombocytopenia (HIT).
Rationale: A sudden drop in platelet count (thrombocytopenia) while on heparin
therapy is the hallmark of HIT, a serious immune-mediated reaction. HIT
paradoxically increases the risk of thrombosis, which could cause symptoms like
shortness of breath due to a pulmonary embolism .
5. What is the best position for a client with pericarditis to reduce pain?
• A. Supine with legs flat
• B. High-Fowler's
• C. Leaning forward while sitting
• D. Trendelenburg
Answer: C. Leaning forward while sitting.
Rationale: Leaning forward while sitting helps relieve the pressure on the
inflamed pericardial sac, which can significantly reduce the chest pain associated
with pericarditis. The pain is often worse when lying flat .
6. A client has a permanent pacemaker. What is the maximum heart rate the
nurse should observe?
, • A. 60 bpm
• B. 70 bpm
• C. 80 bpm
• D. The set rate (usually 60-100)
Answer: D. The set rate (usually 60-100).
Rationale: The permanent pacemaker fires at its programmed rate. The client's
intrinsic heart rate should not exceed the set rate if the pacemaker is capturing
properly. The specific set rate varies based on the client's needs and physician
orders .
7. Amiodarone is prescribed. Which adverse effect requires immediate
teaching?
• A. Blue-gray skin discoloration
• B. Pulmonary fibrosis (cough and dyspnea)
• C. Hypotension
• D. Photosensitivity
Answer: B. Pulmonary fibrosis (cough and dyspnea).
Rationale: Pulmonary toxicity is the most serious and potentially fatal adverse
effect of amiodarone. Clients must be instructed to report any persistent cough,
shortness of breath, or other respiratory symptoms to their provider
immediately .
8. A client has an abdominal aortic aneurysm (AAA). Which finding indicates
imminent rupture?
• A. Constant, dull back pain
• B. Sudden, severe back pain with hypotension
• C. Nausea and vomiting
• D. Bruit over the umbilicus
Answer: B. Sudden, severe back pain with hypotension.
Rationale: The classic presentation of a rupturing AAA is sudden, severe back or
, abdominal pain accompanied by hypotension and signs of hypovolemic shock.
This is a surgical emergency requiring immediate intervention. A bruit is an
expected finding with a non-ruptured AAA .
9. Which lab value is most important to monitor for a client on spironolactone?
• A. Sodium
• B. Chloride
• C. Potassium
• D. Magnesium
Answer: C. Potassium.
Rationale: Spironolactone is a potassium-sparing diuretic. This means it promotes
the excretion of sodium and water while retaining potassium. The major risk is
hyperkalemia, which can be life-threatening and cause cardiac arrhythmias .
10. A nurse using a morphine PCA pump notes a client is drowsy with a
respiratory rate of 8 breaths/min. What is the priority action?
• A. Encourage deep breathing and coughing
• B. Administer naloxone
• C. Notify the provider and prepare to reduce PCA dose
• D. Increase oxygen flow rate
Answer: B. Administer naloxone.
Rationale: A respiratory rate of 8 breaths/min with drowsiness indicates severe
respiratory depression, which can be life-threatening. Naloxone (Narcan) is the
specific antidote for opioid toxicity and should be administered immediately to
reverse the respiratory depression. While notifying the provider and adjusting the
dose are important, they are not the priority in a life-threatening situation .
11. A client receiving furosemide complains of muscle weakness and cramps.
Which lab value requires immediate attention?
• A. Sodium 140 mEq/L
• B. Potassium 2.8 mEq/L
WITH NGN. Course
1. Post-cardiac catheterization, the client's affected leg is warm with a strong
distal pulse. What action should the nurse take?
• A. Massage the leg to improve circulation
• B. Apply a heating pad
• C. Document the findings as expected
• D. Notify the provider immediately
Answer: C. Document the findings as expected.
Rationale: Warmth, color, and strong pulses indicate normal perfusion post-
procedure. No intervention is needed; documentation is the appropriate nursing
action. Interventions would be required if there were signs of compromised
circulation, such as coolness, pallor, or diminished pulses .
2. A client has anaphylactic shock. Which medication is the priority?
• A. Diphenhydramine
• B. Epinephrine
• C. Methylprednisolone
• D. Albuterol
Answer: B. Epinephrine.
Rationale: Epinephrine is the first-line treatment for anaphylaxis. It works rapidly
to reverse severe vasodilation and bronchospasm, which are the primary life-
threatening effects of anaphylactic shock. Other medications like antihistamines
and corticosteroids are secondary treatments .
3. Which EKG change is associated with hyperkalemia?
• A. Flattened T-waves
• B. Peaked T-waves
, • C. Prolonged QT interval
• D. ST-segment elevation
Answer: B. Peaked T-waves.
Rationale: Tall, peaked ("tented") T-waves are the earliest and most characteristic
EKG sign of hyperkalemia. As potassium levels rise further, other changes such as
widening QRS complexes and ultimately a sine wave pattern may occur .
4. A client receiving IV heparin suddenly develops shortness of breath and a
drop in platelet count. What complication does the nurse suspect?
• A. Heparin-induced thrombocytopenia (HIT)
• B. Anaphylaxis
• C. Pulmonary embolism
• D. Fluid overload
Answer: A. Heparin-induced thrombocytopenia (HIT).
Rationale: A sudden drop in platelet count (thrombocytopenia) while on heparin
therapy is the hallmark of HIT, a serious immune-mediated reaction. HIT
paradoxically increases the risk of thrombosis, which could cause symptoms like
shortness of breath due to a pulmonary embolism .
5. What is the best position for a client with pericarditis to reduce pain?
• A. Supine with legs flat
• B. High-Fowler's
• C. Leaning forward while sitting
• D. Trendelenburg
Answer: C. Leaning forward while sitting.
Rationale: Leaning forward while sitting helps relieve the pressure on the
inflamed pericardial sac, which can significantly reduce the chest pain associated
with pericarditis. The pain is often worse when lying flat .
6. A client has a permanent pacemaker. What is the maximum heart rate the
nurse should observe?
, • A. 60 bpm
• B. 70 bpm
• C. 80 bpm
• D. The set rate (usually 60-100)
Answer: D. The set rate (usually 60-100).
Rationale: The permanent pacemaker fires at its programmed rate. The client's
intrinsic heart rate should not exceed the set rate if the pacemaker is capturing
properly. The specific set rate varies based on the client's needs and physician
orders .
7. Amiodarone is prescribed. Which adverse effect requires immediate
teaching?
• A. Blue-gray skin discoloration
• B. Pulmonary fibrosis (cough and dyspnea)
• C. Hypotension
• D. Photosensitivity
Answer: B. Pulmonary fibrosis (cough and dyspnea).
Rationale: Pulmonary toxicity is the most serious and potentially fatal adverse
effect of amiodarone. Clients must be instructed to report any persistent cough,
shortness of breath, or other respiratory symptoms to their provider
immediately .
8. A client has an abdominal aortic aneurysm (AAA). Which finding indicates
imminent rupture?
• A. Constant, dull back pain
• B. Sudden, severe back pain with hypotension
• C. Nausea and vomiting
• D. Bruit over the umbilicus
Answer: B. Sudden, severe back pain with hypotension.
Rationale: The classic presentation of a rupturing AAA is sudden, severe back or
, abdominal pain accompanied by hypotension and signs of hypovolemic shock.
This is a surgical emergency requiring immediate intervention. A bruit is an
expected finding with a non-ruptured AAA .
9. Which lab value is most important to monitor for a client on spironolactone?
• A. Sodium
• B. Chloride
• C. Potassium
• D. Magnesium
Answer: C. Potassium.
Rationale: Spironolactone is a potassium-sparing diuretic. This means it promotes
the excretion of sodium and water while retaining potassium. The major risk is
hyperkalemia, which can be life-threatening and cause cardiac arrhythmias .
10. A nurse using a morphine PCA pump notes a client is drowsy with a
respiratory rate of 8 breaths/min. What is the priority action?
• A. Encourage deep breathing and coughing
• B. Administer naloxone
• C. Notify the provider and prepare to reduce PCA dose
• D. Increase oxygen flow rate
Answer: B. Administer naloxone.
Rationale: A respiratory rate of 8 breaths/min with drowsiness indicates severe
respiratory depression, which can be life-threatening. Naloxone (Narcan) is the
specific antidote for opioid toxicity and should be administered immediately to
reverse the respiratory depression. While notifying the provider and adjusting the
dose are important, they are not the priority in a life-threatening situation .
11. A client receiving furosemide complains of muscle weakness and cramps.
Which lab value requires immediate attention?
• A. Sodium 140 mEq/L
• B. Potassium 2.8 mEq/L
