ATI Med-Surg Proctored Exam ACTUAL EXAM 2026/2027 |
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Section 1: Cardiovascular (15 Questions)
Q1
A nurse is caring for a client with newly diagnosed systolic heart failure (HFrEF). Which
assessment finding best differentiates systolic from diastolic heart failure?
A. Presence of an S4 heart sound
B. Ejection fraction of 35% [CORRECT]
C. Preserved ejection fraction >50%
D. Jugular venous distension at 45 degrees
Correct Answer: B
Rationale: Systolic heart failure (HFrEF - Heart Failure with reduced Ejection Fraction) is
characterized by impaired contractility of the left ventricle, resulting in an ejection
fraction of 40% or less (typically <40%, often 35% or lower). This reflects the heart's
inability to pump effectively during systole. Diastolic heart failure (HFpEF - Heart Failure
with preserved Ejection Fraction) maintains normal or near-normal ejection fraction
(>50%) but has impaired ventricular relaxation and filling during diastole.
Distractor Analysis:
● A: An S4 heart sound indicates stiff, non-compliant ventricles and is more
commonly associated with diastolic dysfunction, not systolic failure.
● C: Preserved EF >50% is the hallmark of diastolic (HFpEF), not systolic heart
failure.
, ● D: JVD can occur in both systolic and diastolic heart failure due to elevated
right-sided pressures and volume overload; it does not differentiate between the
two types.
ATI Content Correlation: ATI Med-Surg Cardiovascular module emphasizes
understanding the pathophysiological differences between HFrEF and HFpEF, with
ejection fraction being the primary distinguishing diagnostic criterion.
Q2
A client with heart failure is prescribed furosemide (Lasix) 40 mg IV twice daily. Which
laboratory value requires immediate nursing intervention?
A. Serum sodium 138 mEq/L
B. Serum potassium 2.8 mEq/L [CORRECT]
C. Blood urea nitrogen 22 mg/dL
D. Serum creatinine 1.2 mg/dL
Correct Answer: B
Rationale: Furosemide is a loop diuretic that inhibits sodium and chloride reabsorption
in the ascending loop of Henle, causing increased excretion of water, sodium,
potassium, hydrogen, calcium, magnesium, and chloride. Hypokalemia (serum
potassium <3.5 mEq/L) is a serious adverse effect that can precipitate life-threatening
cardiac dysrhythmias. A potassium level of 2.8 mEq/L represents moderate
hypokalemia requiring immediate intervention, including potassium supplementation
and cardiac monitoring. Normal potassium range is 3.5-5.0 mEq/L; levels below 3.0
mEq/L significantly increase the risk of ventricular dysrhythmias.
Distractor Analysis:
, ● A: Sodium 138 mEq/L is within normal range (135-145 mEq/L); while loop
diuretics can cause hyponatremia, this value does not require immediate
intervention.
● C: BUN 22 mg/dL is mildly elevated but expected in heart failure due to prerenal
azotemia from decreased renal perfusion; not immediately dangerous.
● D: Creatinine 1.2 mg/dL is at the upper limit of normal; while furosemide can
affect renal function, this value does not represent acute kidney injury requiring
immediate action.
ATI Content Correlation: ATI emphasizes electrolyte monitoring with loop diuretics,
particularly the risk of hypokalemia and associated cardiac complications. The priority
framework (safety first) applies here—correcting potassium prevents lethal
dysrhythmias.
Q3
A client with a history of atrial fibrillation is prescribed warfarin (Coumadin). The nurse
notes the client's INR is 4.2. Which action should the nurse take first?
A. Administer the scheduled warfarin dose
B. Hold the warfarin dose and notify the provider [CORRECT]
C. Administer vitamin K immediately
D. Assess for signs of bleeding
Correct Answer: B
Rationale: The therapeutic INR range for atrial fibrillation is typically 2.0-3.0. An INR of
4.2 represents supratherapeutic anticoagulation, significantly increasing bleeding risk.
The nurse's first action is to hold the next warfarin dose to prevent further elevation of
the INR and notify the provider for further orders. While assessing for bleeding is
important, holding the medication that is causing the elevated INR takes priority to
prevent further harm. Vitamin K administration requires a provider order and is typically
reserved for INR >4.5 or active bleeding.
, Distractor Analysis:
● A: Administering the dose would further increase the INR and bleeding
risk—unsafe practice.
● C: Vitamin K is the antidote for warfarin but requires a provider order; nurses
cannot administer independently. Also, for INR 4.2 without bleeding, holding the
dose and monitoring may be sufficient per provider discretion.
● D: Assessment is important but does not address the ongoing cause (continued
warfarin administration); the medication must be held first.
ATI Content Correlation: ATI Med-Surg emphasizes the therapeutic range for warfarin
(INR 2-3 for AFib) and the protocol for elevated INR values. Priority setting follows the
"do no harm" principle—stop the causative agent first.
Q4
A client with chest pain is diagnosed with ST-elevation myocardial infarction (STEMI).
Which intervention should the nurse anticipate as the priority?
A. Administer thrombolytic therapy within 30 minutes
B. Prepare for percutaneous coronary intervention within 90 minutes [CORRECT]
C. Begin beta-blocker therapy within 24 hours
D. Initiate heparin infusion and monitor PTT
Correct Answer: B
Rationale: For STEMI, the goal is reperfusion therapy as quickly as possible to salvage
myocardium. Current AHA/ACC guidelines establish a door-to-balloon time of ≤90
minutes for primary PCI (percutaneous coronary intervention), which is the preferred
reperfusion strategy when available. PCI is superior to thrombolytics with lower rates of
recurrent MI, stroke, and death. The 90-minute window is critical—"time is muscle" in
myocardial infarction.
Distractor Analysis:
Complete Version | Latest Update | NGN Questions | Pass
Guaranteed - A+ Graded
Section 1: Cardiovascular (15 Questions)
Q1
A nurse is caring for a client with newly diagnosed systolic heart failure (HFrEF). Which
assessment finding best differentiates systolic from diastolic heart failure?
A. Presence of an S4 heart sound
B. Ejection fraction of 35% [CORRECT]
C. Preserved ejection fraction >50%
D. Jugular venous distension at 45 degrees
Correct Answer: B
Rationale: Systolic heart failure (HFrEF - Heart Failure with reduced Ejection Fraction) is
characterized by impaired contractility of the left ventricle, resulting in an ejection
fraction of 40% or less (typically <40%, often 35% or lower). This reflects the heart's
inability to pump effectively during systole. Diastolic heart failure (HFpEF - Heart Failure
with preserved Ejection Fraction) maintains normal or near-normal ejection fraction
(>50%) but has impaired ventricular relaxation and filling during diastole.
Distractor Analysis:
● A: An S4 heart sound indicates stiff, non-compliant ventricles and is more
commonly associated with diastolic dysfunction, not systolic failure.
● C: Preserved EF >50% is the hallmark of diastolic (HFpEF), not systolic heart
failure.
, ● D: JVD can occur in both systolic and diastolic heart failure due to elevated
right-sided pressures and volume overload; it does not differentiate between the
two types.
ATI Content Correlation: ATI Med-Surg Cardiovascular module emphasizes
understanding the pathophysiological differences between HFrEF and HFpEF, with
ejection fraction being the primary distinguishing diagnostic criterion.
Q2
A client with heart failure is prescribed furosemide (Lasix) 40 mg IV twice daily. Which
laboratory value requires immediate nursing intervention?
A. Serum sodium 138 mEq/L
B. Serum potassium 2.8 mEq/L [CORRECT]
C. Blood urea nitrogen 22 mg/dL
D. Serum creatinine 1.2 mg/dL
Correct Answer: B
Rationale: Furosemide is a loop diuretic that inhibits sodium and chloride reabsorption
in the ascending loop of Henle, causing increased excretion of water, sodium,
potassium, hydrogen, calcium, magnesium, and chloride. Hypokalemia (serum
potassium <3.5 mEq/L) is a serious adverse effect that can precipitate life-threatening
cardiac dysrhythmias. A potassium level of 2.8 mEq/L represents moderate
hypokalemia requiring immediate intervention, including potassium supplementation
and cardiac monitoring. Normal potassium range is 3.5-5.0 mEq/L; levels below 3.0
mEq/L significantly increase the risk of ventricular dysrhythmias.
Distractor Analysis:
, ● A: Sodium 138 mEq/L is within normal range (135-145 mEq/L); while loop
diuretics can cause hyponatremia, this value does not require immediate
intervention.
● C: BUN 22 mg/dL is mildly elevated but expected in heart failure due to prerenal
azotemia from decreased renal perfusion; not immediately dangerous.
● D: Creatinine 1.2 mg/dL is at the upper limit of normal; while furosemide can
affect renal function, this value does not represent acute kidney injury requiring
immediate action.
ATI Content Correlation: ATI emphasizes electrolyte monitoring with loop diuretics,
particularly the risk of hypokalemia and associated cardiac complications. The priority
framework (safety first) applies here—correcting potassium prevents lethal
dysrhythmias.
Q3
A client with a history of atrial fibrillation is prescribed warfarin (Coumadin). The nurse
notes the client's INR is 4.2. Which action should the nurse take first?
A. Administer the scheduled warfarin dose
B. Hold the warfarin dose and notify the provider [CORRECT]
C. Administer vitamin K immediately
D. Assess for signs of bleeding
Correct Answer: B
Rationale: The therapeutic INR range for atrial fibrillation is typically 2.0-3.0. An INR of
4.2 represents supratherapeutic anticoagulation, significantly increasing bleeding risk.
The nurse's first action is to hold the next warfarin dose to prevent further elevation of
the INR and notify the provider for further orders. While assessing for bleeding is
important, holding the medication that is causing the elevated INR takes priority to
prevent further harm. Vitamin K administration requires a provider order and is typically
reserved for INR >4.5 or active bleeding.
, Distractor Analysis:
● A: Administering the dose would further increase the INR and bleeding
risk—unsafe practice.
● C: Vitamin K is the antidote for warfarin but requires a provider order; nurses
cannot administer independently. Also, for INR 4.2 without bleeding, holding the
dose and monitoring may be sufficient per provider discretion.
● D: Assessment is important but does not address the ongoing cause (continued
warfarin administration); the medication must be held first.
ATI Content Correlation: ATI Med-Surg emphasizes the therapeutic range for warfarin
(INR 2-3 for AFib) and the protocol for elevated INR values. Priority setting follows the
"do no harm" principle—stop the causative agent first.
Q4
A client with chest pain is diagnosed with ST-elevation myocardial infarction (STEMI).
Which intervention should the nurse anticipate as the priority?
A. Administer thrombolytic therapy within 30 minutes
B. Prepare for percutaneous coronary intervention within 90 minutes [CORRECT]
C. Begin beta-blocker therapy within 24 hours
D. Initiate heparin infusion and monitor PTT
Correct Answer: B
Rationale: For STEMI, the goal is reperfusion therapy as quickly as possible to salvage
myocardium. Current AHA/ACC guidelines establish a door-to-balloon time of ≤90
minutes for primary PCI (percutaneous coronary intervention), which is the preferred
reperfusion strategy when available. PCI is superior to thrombolytics with lower rates of
recurrent MI, stroke, and death. The 90-minute window is critical—"time is muscle" in
myocardial infarction.
Distractor Analysis:
