ATI Adult Medical-Surgical Cardiovascular Disorders Exam –
Unit 4 | 2026/2027 Latest Edition
75 Real Exam-Based Questions with Verified Answers | 100%
Accuracy | ATI Adult Med-Surg Mastery | Graded A+
Section 1: Coronary Artery Disease & Acute Coronary Syndromes (Questions 1-20)
Q1: A 58-year-old male presents to the ED with severe, crushing substernal chest pain
radiating to his left jaw, diaphoresis, and nausea for 45 minutes. Vital signs: BP 102/68,
HR 112, RR 24, SpO2 94% on room air. The nurse obtains a 12-lead EKG. Which EKG
finding would indicate the highest priority for immediate reperfusion therapy?
● A. ST depression in leads V4-V6
● B. ST elevation >2mm in leads V1-V4 [CORRECT]
● C. T-wave inversions in leads II, III, aVF
● D. Sinus tachycardia with no ST changes
Correct Answer: B
Rationale: B is correct. [CORRECT] STEMI Identification & Priority: ST elevation is the
hallmark of a ST-elevation myocardial infarction (STEMI), indicating acute, complete
coronary artery occlusion. Elevation in V1-V4 indicates an anterior wall MI, which carries
the highest mortality due to the large area of myocardium at risk. "Time is muscle" –
this finding mandates immediate reperfusion (PCI or fibrinolytics) per ACC/AHA 2026
guidelines. Anterior MIs have the highest risk for cardiogenic shock and malignant
dysrhythmias. Why others are wrong: (A) ST depression indicates ischemia/NSTEMI
requiring anticoagulation but not emergent reperfusion. (C) T-wave inversions suggest
evolving ischemia or NSTEMI. (D) Non-specific finding requiring troponins but not
emergent cath lab activation.
,Q2: A client with NSTEMI is receiving heparin infusion at 1,000 units/hour. The most
recent aPTT is 28 seconds (control 30 seconds, therapeutic range 60-80 seconds).
What is the nurse's priority action?
● A. Continue the infusion at the current rate
● B. Increase the infusion rate per protocol and notify provider [CORRECT]
● C. Administer protamine sulfate
● D. Discontinue the heparin and switch to oral warfarin
Correct Answer: B
Rationale: B is correct. [CORRECT] Heparin Dosing Management: The aPTT of 28
seconds is subtherapeutic (below control value of 30 seconds, well below therapeutic
60-80 seconds). This indicates inadequate anticoagulation with risk of thrombus
progression. Per ACC/AHA 2026 NSTEMI guidelines, the nurse should increase the
infusion rate per institutional protocol (typically by 100-200 units/hr) and notify the
provider. Recheck aPTT in 6 hours. Why others are wrong: (A) Subtherapeutic levels
require dose adjustment. (C) Protamine reverses heparin overdose, not indicated here.
(D) Warfarin takes days to achieve therapeutic effect and is not first-line for acute
NSTEMI.
Q3: A client post-PCI with drug-eluting stent (DES) placement asks why they must take
dual antiplatelet therapy (DAPT) for 12 months. What is the nurse's best response?
● A. "The stent is permanent and requires long-term blood thinning to prevent
movement."
● B. "The stent surface can trigger clot formation until it's fully covered by your own
tissue, which takes about a year. Stopping early can cause a fatal heart attack.
[CORRECT]"
● C. "Your doctor prefers 12 months, but 3 months is usually sufficient."
● D. "The medications prevent restenosis from scar tissue growth."
,Correct Answer: B
Rationale: B is correct. [CORRECT] DAPT Mechanism & Duration: Drug-eluting stents
delay endothelialization (tissue covering of the stent struts). Until complete
endothelialization occurs (typically 12 months), the exposed stent surface is
thrombogenic. Premature discontinuation of DAPT (aspirin + P2Y12 inhibitor) is the
strongest predictor of stent thrombosis, which has 40-60% mortality. Per ACC/AHA
2026 guidelines, 12 months of DAPT is standard for DES unless high bleeding risk
mandates shorter duration. Why others are wrong: (A) Stents don't move; antiplatelets
don't "thin blood." (C) 3 months is insufficient for DES and dangerous. (D) DES prevent
restenosis via antiproliferative drugs, not DAPT; DAPT prevents thrombosis.
Q4: (SATA) A client with acute chest pain is receiving nitroglycerin IV at 10 mcg/min.
Which assessments are essential for the nurse to perform every 15 minutes? Select all
that apply.
● A. Blood pressure [CORRECT]
● B. Heart rate and rhythm [CORRECT]
● C. Pain level (0-10 scale) [CORRECT]
● D. Headache severity [CORRECT]
● E. Serum potassium level
Correct Answer: A, B, C, D
Rationale: A, B, C, and D are correct. [CORRECT] Nitroglycerin Monitoring: IV
nitroglycerin is a potent venous and arterial dilator that can cause hypotension, reflex
tachycardia, and headaches (common side effect from vasodilation). Continuous
monitoring of hemodynamics (BP, HR) and therapeutic effect (pain relief) is mandatory
per ACC/AHA ACS guidelines. Headache assessment monitors side effects and client
comfort. Why E is wrong: Nitroglycerin does not significantly affect potassium levels;
this is not a priority monitoring parameter.
, Q5: A client with STEMI is receiving alteplase (tPA) for fibrinolytic therapy. Which finding
requires immediate intervention?
● A. Blood pressure 148/92 mm Hg
● B. Sudden onset severe headache with change in level of consciousness
[CORRECT]
● C. Mild oozing at the IV insertion site
● D. Nausea rated 3/10
Correct Answer: B
Rationale: B is correct. [CORRECT] Fibrinolytic Complication: This presentation suggests
intracranial hemorrhage (ICH), the most feared complication of fibrinolytic therapy. tPA
lyses clots systemically, not just in the coronary artery. Sudden severe headache, altered
mental status, or neurological deficits require immediate discontinuation of tPA,
emergency CT scan, and neurosurgery consultation. Mortality from ICH approaches
60%. Why others are wrong: (A) Hypertension is common post-MI but not emergent. (C)
Minor oozing is expected; apply pressure. (D) Nausea is common and manageable with
antiemetics.
Q6: A nurse is caring for a client 24 hours post-MI. The client asks when sexual activity
can be resumed. What is the best nursing response?
● A. "You should avoid sexual activity for at least 6 months to prevent another heart
attack."
● B. "Most clients can resume sexual activity within 1 week after an uncomplicated
MI, when you can climb two flights of stairs without symptoms. [CORRECT]"
● C. "Sexual activity is too strenuous and should be avoided permanently."
● D. "Wait until your troponin levels return to normal."
Correct Answer: B
Unit 4 | 2026/2027 Latest Edition
75 Real Exam-Based Questions with Verified Answers | 100%
Accuracy | ATI Adult Med-Surg Mastery | Graded A+
Section 1: Coronary Artery Disease & Acute Coronary Syndromes (Questions 1-20)
Q1: A 58-year-old male presents to the ED with severe, crushing substernal chest pain
radiating to his left jaw, diaphoresis, and nausea for 45 minutes. Vital signs: BP 102/68,
HR 112, RR 24, SpO2 94% on room air. The nurse obtains a 12-lead EKG. Which EKG
finding would indicate the highest priority for immediate reperfusion therapy?
● A. ST depression in leads V4-V6
● B. ST elevation >2mm in leads V1-V4 [CORRECT]
● C. T-wave inversions in leads II, III, aVF
● D. Sinus tachycardia with no ST changes
Correct Answer: B
Rationale: B is correct. [CORRECT] STEMI Identification & Priority: ST elevation is the
hallmark of a ST-elevation myocardial infarction (STEMI), indicating acute, complete
coronary artery occlusion. Elevation in V1-V4 indicates an anterior wall MI, which carries
the highest mortality due to the large area of myocardium at risk. "Time is muscle" –
this finding mandates immediate reperfusion (PCI or fibrinolytics) per ACC/AHA 2026
guidelines. Anterior MIs have the highest risk for cardiogenic shock and malignant
dysrhythmias. Why others are wrong: (A) ST depression indicates ischemia/NSTEMI
requiring anticoagulation but not emergent reperfusion. (C) T-wave inversions suggest
evolving ischemia or NSTEMI. (D) Non-specific finding requiring troponins but not
emergent cath lab activation.
,Q2: A client with NSTEMI is receiving heparin infusion at 1,000 units/hour. The most
recent aPTT is 28 seconds (control 30 seconds, therapeutic range 60-80 seconds).
What is the nurse's priority action?
● A. Continue the infusion at the current rate
● B. Increase the infusion rate per protocol and notify provider [CORRECT]
● C. Administer protamine sulfate
● D. Discontinue the heparin and switch to oral warfarin
Correct Answer: B
Rationale: B is correct. [CORRECT] Heparin Dosing Management: The aPTT of 28
seconds is subtherapeutic (below control value of 30 seconds, well below therapeutic
60-80 seconds). This indicates inadequate anticoagulation with risk of thrombus
progression. Per ACC/AHA 2026 NSTEMI guidelines, the nurse should increase the
infusion rate per institutional protocol (typically by 100-200 units/hr) and notify the
provider. Recheck aPTT in 6 hours. Why others are wrong: (A) Subtherapeutic levels
require dose adjustment. (C) Protamine reverses heparin overdose, not indicated here.
(D) Warfarin takes days to achieve therapeutic effect and is not first-line for acute
NSTEMI.
Q3: A client post-PCI with drug-eluting stent (DES) placement asks why they must take
dual antiplatelet therapy (DAPT) for 12 months. What is the nurse's best response?
● A. "The stent is permanent and requires long-term blood thinning to prevent
movement."
● B. "The stent surface can trigger clot formation until it's fully covered by your own
tissue, which takes about a year. Stopping early can cause a fatal heart attack.
[CORRECT]"
● C. "Your doctor prefers 12 months, but 3 months is usually sufficient."
● D. "The medications prevent restenosis from scar tissue growth."
,Correct Answer: B
Rationale: B is correct. [CORRECT] DAPT Mechanism & Duration: Drug-eluting stents
delay endothelialization (tissue covering of the stent struts). Until complete
endothelialization occurs (typically 12 months), the exposed stent surface is
thrombogenic. Premature discontinuation of DAPT (aspirin + P2Y12 inhibitor) is the
strongest predictor of stent thrombosis, which has 40-60% mortality. Per ACC/AHA
2026 guidelines, 12 months of DAPT is standard for DES unless high bleeding risk
mandates shorter duration. Why others are wrong: (A) Stents don't move; antiplatelets
don't "thin blood." (C) 3 months is insufficient for DES and dangerous. (D) DES prevent
restenosis via antiproliferative drugs, not DAPT; DAPT prevents thrombosis.
Q4: (SATA) A client with acute chest pain is receiving nitroglycerin IV at 10 mcg/min.
Which assessments are essential for the nurse to perform every 15 minutes? Select all
that apply.
● A. Blood pressure [CORRECT]
● B. Heart rate and rhythm [CORRECT]
● C. Pain level (0-10 scale) [CORRECT]
● D. Headache severity [CORRECT]
● E. Serum potassium level
Correct Answer: A, B, C, D
Rationale: A, B, C, and D are correct. [CORRECT] Nitroglycerin Monitoring: IV
nitroglycerin is a potent venous and arterial dilator that can cause hypotension, reflex
tachycardia, and headaches (common side effect from vasodilation). Continuous
monitoring of hemodynamics (BP, HR) and therapeutic effect (pain relief) is mandatory
per ACC/AHA ACS guidelines. Headache assessment monitors side effects and client
comfort. Why E is wrong: Nitroglycerin does not significantly affect potassium levels;
this is not a priority monitoring parameter.
, Q5: A client with STEMI is receiving alteplase (tPA) for fibrinolytic therapy. Which finding
requires immediate intervention?
● A. Blood pressure 148/92 mm Hg
● B. Sudden onset severe headache with change in level of consciousness
[CORRECT]
● C. Mild oozing at the IV insertion site
● D. Nausea rated 3/10
Correct Answer: B
Rationale: B is correct. [CORRECT] Fibrinolytic Complication: This presentation suggests
intracranial hemorrhage (ICH), the most feared complication of fibrinolytic therapy. tPA
lyses clots systemically, not just in the coronary artery. Sudden severe headache, altered
mental status, or neurological deficits require immediate discontinuation of tPA,
emergency CT scan, and neurosurgery consultation. Mortality from ICH approaches
60%. Why others are wrong: (A) Hypertension is common post-MI but not emergent. (C)
Minor oozing is expected; apply pressure. (D) Nausea is common and manageable with
antiemetics.
Q6: A nurse is caring for a client 24 hours post-MI. The client asks when sexual activity
can be resumed. What is the best nursing response?
● A. "You should avoid sexual activity for at least 6 months to prevent another heart
attack."
● B. "Most clients can resume sexual activity within 1 week after an uncomplicated
MI, when you can climb two flights of stairs without symptoms. [CORRECT]"
● C. "Sexual activity is too strenuous and should be avoided permanently."
● D. "Wait until your troponin levels return to normal."
Correct Answer: B
