ATI Adult Medical-Surgical Nursing | Unit 4 Exam
Cardiovascular Disorders | 2026/2027
45 Questions & Verified Rationale
SECTION 1: CORONARY ARTERY DISEASE & ACUTE CORONARY
SYNDROMES (Questions 1-15)
Q1. A 58-year-old male arrives in the ED reporting severe substernal chest pain that
radiates to his left arm, unrelieved by three sublingual nitroglycerin tablets. An EKG
shows ST-segment elevation in leads II, III, and aVF. The nurse prepares the client for
emergent percutaneous coronary intervention (PCI). Which action is the nurse's priority
while awaiting the cardiac catheterization team?
A. Administer morphine sulfate 4 mg IV as prescribed for pain.
B. Obtain a full set of vital signs.
C. Apply oxygen via nasal cannula to keep SpO2 >90%. [CORRECT]
D. Begin a continuous infusion of nitroglycerin.
Correct Answer: C
Rationale (Clinical Judgment: Prioritizing Hypotheses): The priority in any acute cardiac
event is to maximize myocardial oxygen delivery and minimize oxygen demand.
Administering supplemental oxygen is a rapid, non-invasive intervention to increase
oxygen saturation and reduce myocardial ischemia. While pain management (A) and
continuous nitroglycerin (D) are important interventions, ensuring adequate oxygenation
is the foundational priority that supports all other therapies. Vital signs (B) should be
obtained, but do not take precedence over an immediate life-supporting intervention.
The EKG changes (ST elevation in II, III, aVF) indicate an inferior wall STEMI, which often
,involves the right coronary artery and may be associated with bradycardia or heart
block; oxygen supports perfusion during these potential complications.
Q2. A client with unstable angina is receiving intravenous heparin. The nurse notes the
client's aPTT is 95 seconds (control 30 seconds, therapeutic range 60-80 seconds).
Based on this result, what is the nurse's most appropriate action?
A. Continue the infusion at the current rate and reassess in 4 hours.
B. Decrease the infusion rate per protocol and notify the provider. [CORRECT]
C. Administer protamine sulfate immediately.
D. Obtain a STAT PT/INR.
Correct Answer: B
Rationale (Clinical Judgment: Analyzing Cues, Taking Action): An aPTT of 95 seconds is
supratherapeutic (above the usual therapeutic range of 1.5-2.5 times control, or 60-80
seconds). This increases bleeding risk. The appropriate action is to decrease the
infusion rate per institutional protocol and notify the provider. Protamine sulfate (C) is
the antidote for heparin overdose, but is reserved for life-threatening bleeding or severe
overdose, not for mild elevation above therapeutic range. Continuing the current rate (A)
increases bleeding risk. PT/INR (D) monitors warfarin therapy, not heparin.
Q3. A 67-year-old female is admitted with chest pain. Her troponin I levels are: 0.04
ng/mL on admission, 0.8 ng/mL at 6 hours, and 2.5 ng/mL at 12 hours. Her CK-MB is 8
U/L (normal <6). What do these laboratory findings indicate?
A. Stable angina with no myocardial damage.
B. Acute myocardial infarction with ongoing myocardial injury. [CORRECT]
C. Old myocardial infarction from previous event.
D. Congestive heart failure exacerbation.
, Correct Answer: B
Rationale (Clinical Judgment: Analyzing Cues): Troponin I is highly specific for cardiac
muscle injury. The rising pattern (0.04 → 0.8 → 2.5) indicates acute, ongoing
myocardial necrosis, characteristic of acute MI. Troponin rises within 4-6 hours, peaks
at 12-24 hours, and remains elevated for 7-10 days. CK-MB is less specific but supports
the diagnosis. Stable angina (A) does not cause troponin elevation. An old MI (C) would
show persistently elevated troponin without the rising pattern. Heart failure (D) does not
typically cause significant troponin elevation unless there is acute decompensation with
demand ischemia.
Q4. [Multiple Select] A nurse is providing discharge teaching to a client who had an
NSTEMI and received a drug-eluting coronary stent. Which instructions should the nurse
include? Select all that apply.
A. [CORRECT] "Take your aspirin and clopidogrel every day exactly as prescribed. Do not
stop them without talking to your cardiologist."
B. "You may resume heavy lifting and strenuous exercise in 2 weeks."
C. [CORRECT] "Report any fever, unusual bruising, or black, tarry stools to your provider
immediately."
D. "If you miss a dose of your anticoagulant, double the next dose."
E. [CORRECT] "Attend cardiac rehabilitation as strongly recommended; it significantly
improves outcomes and reduces mortality."
Correct Answers: A, C, E
Rationale (Clinical Judgment: Evaluating Outcomes, Generating Solutions):
● Dual Antiplatelet Therapy (DAPT): Aspirin + P2Y12 inhibitor (clopidogrel,
ticagrelor, or prasugrel) is mandatory for 12 months after drug-eluting stent (DES)
placement to prevent stent thrombosis, which has high mortality. Premature
discontinuation is the strongest predictor of stent thrombosis (A).
Cardiovascular Disorders | 2026/2027
45 Questions & Verified Rationale
SECTION 1: CORONARY ARTERY DISEASE & ACUTE CORONARY
SYNDROMES (Questions 1-15)
Q1. A 58-year-old male arrives in the ED reporting severe substernal chest pain that
radiates to his left arm, unrelieved by three sublingual nitroglycerin tablets. An EKG
shows ST-segment elevation in leads II, III, and aVF. The nurse prepares the client for
emergent percutaneous coronary intervention (PCI). Which action is the nurse's priority
while awaiting the cardiac catheterization team?
A. Administer morphine sulfate 4 mg IV as prescribed for pain.
B. Obtain a full set of vital signs.
C. Apply oxygen via nasal cannula to keep SpO2 >90%. [CORRECT]
D. Begin a continuous infusion of nitroglycerin.
Correct Answer: C
Rationale (Clinical Judgment: Prioritizing Hypotheses): The priority in any acute cardiac
event is to maximize myocardial oxygen delivery and minimize oxygen demand.
Administering supplemental oxygen is a rapid, non-invasive intervention to increase
oxygen saturation and reduce myocardial ischemia. While pain management (A) and
continuous nitroglycerin (D) are important interventions, ensuring adequate oxygenation
is the foundational priority that supports all other therapies. Vital signs (B) should be
obtained, but do not take precedence over an immediate life-supporting intervention.
The EKG changes (ST elevation in II, III, aVF) indicate an inferior wall STEMI, which often
,involves the right coronary artery and may be associated with bradycardia or heart
block; oxygen supports perfusion during these potential complications.
Q2. A client with unstable angina is receiving intravenous heparin. The nurse notes the
client's aPTT is 95 seconds (control 30 seconds, therapeutic range 60-80 seconds).
Based on this result, what is the nurse's most appropriate action?
A. Continue the infusion at the current rate and reassess in 4 hours.
B. Decrease the infusion rate per protocol and notify the provider. [CORRECT]
C. Administer protamine sulfate immediately.
D. Obtain a STAT PT/INR.
Correct Answer: B
Rationale (Clinical Judgment: Analyzing Cues, Taking Action): An aPTT of 95 seconds is
supratherapeutic (above the usual therapeutic range of 1.5-2.5 times control, or 60-80
seconds). This increases bleeding risk. The appropriate action is to decrease the
infusion rate per institutional protocol and notify the provider. Protamine sulfate (C) is
the antidote for heparin overdose, but is reserved for life-threatening bleeding or severe
overdose, not for mild elevation above therapeutic range. Continuing the current rate (A)
increases bleeding risk. PT/INR (D) monitors warfarin therapy, not heparin.
Q3. A 67-year-old female is admitted with chest pain. Her troponin I levels are: 0.04
ng/mL on admission, 0.8 ng/mL at 6 hours, and 2.5 ng/mL at 12 hours. Her CK-MB is 8
U/L (normal <6). What do these laboratory findings indicate?
A. Stable angina with no myocardial damage.
B. Acute myocardial infarction with ongoing myocardial injury. [CORRECT]
C. Old myocardial infarction from previous event.
D. Congestive heart failure exacerbation.
, Correct Answer: B
Rationale (Clinical Judgment: Analyzing Cues): Troponin I is highly specific for cardiac
muscle injury. The rising pattern (0.04 → 0.8 → 2.5) indicates acute, ongoing
myocardial necrosis, characteristic of acute MI. Troponin rises within 4-6 hours, peaks
at 12-24 hours, and remains elevated for 7-10 days. CK-MB is less specific but supports
the diagnosis. Stable angina (A) does not cause troponin elevation. An old MI (C) would
show persistently elevated troponin without the rising pattern. Heart failure (D) does not
typically cause significant troponin elevation unless there is acute decompensation with
demand ischemia.
Q4. [Multiple Select] A nurse is providing discharge teaching to a client who had an
NSTEMI and received a drug-eluting coronary stent. Which instructions should the nurse
include? Select all that apply.
A. [CORRECT] "Take your aspirin and clopidogrel every day exactly as prescribed. Do not
stop them without talking to your cardiologist."
B. "You may resume heavy lifting and strenuous exercise in 2 weeks."
C. [CORRECT] "Report any fever, unusual bruising, or black, tarry stools to your provider
immediately."
D. "If you miss a dose of your anticoagulant, double the next dose."
E. [CORRECT] "Attend cardiac rehabilitation as strongly recommended; it significantly
improves outcomes and reduces mortality."
Correct Answers: A, C, E
Rationale (Clinical Judgment: Evaluating Outcomes, Generating Solutions):
● Dual Antiplatelet Therapy (DAPT): Aspirin + P2Y12 inhibitor (clopidogrel,
ticagrelor, or prasugrel) is mandatory for 12 months after drug-eluting stent (DES)
placement to prevent stent thrombosis, which has high mortality. Premature
discontinuation is the strongest predictor of stent thrombosis (A).
