ATI Adult Medical Surgical Nursing (CMS)
Exam Actual Questions and Answers With
Expert Explanation (2026/2027 Update) |
Complete A+ Guide
Exam Blueprint:
Cardiovascular & Hematologic Disorders (20%) – 40 Qs
Respiratory Disorders (15%) – 30 Qs
Gastrointestinal & Hepatic Disorders (15%) – 30 Qs
Renal & Genitourinary Disorders (10%) – 20 Qs
Endocrine & Metabolic Disorders (10%) – 20 Qs
Neurologic & Musculoskeletal Disorders (15%) – 30 Qs
Immunologic, Infectious & Perioperative Care (15%) – 30 Qs
SECTION 1: CARDIOVASCULAR & HEMATOLOGIC DISORDERS –
Questions 1–40
1. A client with heart failure has crackles in all lung fields, jugular venous
distention, and 3+ pitting edema. Which medication should the nurse
expect to administer first?
A) Digoxin
B) Furosemide
C) Enalapril
D) Carvedilol
Answer: B
Rationale: Furosemide (loop diuretic) reduces preload by promoting
,diuresis, relieving pulmonary congestion and edema. It is first-line for acute
decompensated heart failure with fluid overload.
2. A client with atrial fibrillation is prescribed warfarin. Which laboratory test
should the nurse monitor to evaluate therapeutic effect?
A) aPTT
B) INR
C) Platelet count
D) Bleeding time
Answer: B
Rationale: Warfarin anticoagulation is monitored by INR; target INR 2-3 for
atrial fibrillation (2.5-3.5 for mechanical valves).
3. A client with chest pain is admitted with suspected acute coronary
syndrome (ACS). Which serum cardiac marker is most specific for
myocardial necrosis?
A) CK-MB
B) Myoglobin
C) Troponin I or T
D) C-reactive protein
Answer: C
Rationale: Troponin is the most specific and sensitive marker for
myocardial necrosis; elevated troponin indicates MI.
4. A client on a cardiac monitor shows ST-segment elevation in leads
V1-V4. Which coronary artery is most likely occluded?
A) Left circumflex artery
B) Right coronary artery
C) Left anterior descending artery (LAD)
D) Posterior descending artery
Answer: C
,Rationale: LAD occlusion causes anterior wall MI (ST elevation in V1-V4).
Right coronary artery occlusion causes inferior MI (II, III, aVF).
5. A client with a history of deep vein thrombosis (DVT) is prescribed
enoxaparin. The nurse should administer this medication via which route?
A) Intravenous push
B) Subcutaneous injection in the abdomen
C) Intramuscular injection
D) Oral
Answer: B
Rationale: Enoxaparin (low-molecular-weight heparin) is given
subcutaneously in the abdomen; rotate sites; do not expel air bubble.
6. A client after cardiac catheterization via the femoral artery has a
sandbag placed over the insertion site. Which finding requires immediate
nursing action?
A) Small amount of oozing around the site
B) Ecchymosis at the site
C) Expanding hematoma and loss of pulse in the affected leg
D) Mild groin discomfort
Answer: C
Rationale: Expanding hematoma with loss of distal pulse indicates possible
retroperitoneal bleeding or vessel occlusion; notify provider immediately.
7. A client with chronic heart failure has a prescription for carvedilol. The
nurse should monitor for which therapeutic effect?
A) Increased heart rate
B) Improved left ventricular ejection fraction (LVEF) and reduced mortality
C) Increased blood pressure
D) Decreased urinary output
Answer: B
, Rationale: Carvedilol is a beta-blocker that reduces mortality,
hospitalizations, and improves LVEF in heart failure with reduced ejection
fraction (HFrEF).
8. A client with hypertension is prescribed hydrochlorothiazide. Which
electrolyte imbalance should the nurse monitor?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypermagnesemia
Answer: B
Rationale: Thiazide diuretics cause hypokalemia (potassium wasting).
Monitor potassium levels and signs of hypokalemia (muscle weakness,
fatigue, arrhythmias).
9. A client with peripheral artery disease (PAD) complains of calf pain when
walking that resolves with rest. This symptom is known as:
A) Rest pain
B) Intermittent claudication
C) Venous stasis
D) Neuropathic pain
Answer: B
Rationale: Intermittent claudication is reproducible ischemic leg pain with
exercise, relieved by rest; it is a classic symptom of PAD.
10. A client with chronic venous insufficiency (CVI) has lower extremity
edema and brownish discoloration. Which nursing intervention is most
important?
A) Elevate legs above the heart and apply compression stockings
B) Keep legs in a dependent position
C) Apply heat packs to the legs
Exam Actual Questions and Answers With
Expert Explanation (2026/2027 Update) |
Complete A+ Guide
Exam Blueprint:
Cardiovascular & Hematologic Disorders (20%) – 40 Qs
Respiratory Disorders (15%) – 30 Qs
Gastrointestinal & Hepatic Disorders (15%) – 30 Qs
Renal & Genitourinary Disorders (10%) – 20 Qs
Endocrine & Metabolic Disorders (10%) – 20 Qs
Neurologic & Musculoskeletal Disorders (15%) – 30 Qs
Immunologic, Infectious & Perioperative Care (15%) – 30 Qs
SECTION 1: CARDIOVASCULAR & HEMATOLOGIC DISORDERS –
Questions 1–40
1. A client with heart failure has crackles in all lung fields, jugular venous
distention, and 3+ pitting edema. Which medication should the nurse
expect to administer first?
A) Digoxin
B) Furosemide
C) Enalapril
D) Carvedilol
Answer: B
Rationale: Furosemide (loop diuretic) reduces preload by promoting
,diuresis, relieving pulmonary congestion and edema. It is first-line for acute
decompensated heart failure with fluid overload.
2. A client with atrial fibrillation is prescribed warfarin. Which laboratory test
should the nurse monitor to evaluate therapeutic effect?
A) aPTT
B) INR
C) Platelet count
D) Bleeding time
Answer: B
Rationale: Warfarin anticoagulation is monitored by INR; target INR 2-3 for
atrial fibrillation (2.5-3.5 for mechanical valves).
3. A client with chest pain is admitted with suspected acute coronary
syndrome (ACS). Which serum cardiac marker is most specific for
myocardial necrosis?
A) CK-MB
B) Myoglobin
C) Troponin I or T
D) C-reactive protein
Answer: C
Rationale: Troponin is the most specific and sensitive marker for
myocardial necrosis; elevated troponin indicates MI.
4. A client on a cardiac monitor shows ST-segment elevation in leads
V1-V4. Which coronary artery is most likely occluded?
A) Left circumflex artery
B) Right coronary artery
C) Left anterior descending artery (LAD)
D) Posterior descending artery
Answer: C
,Rationale: LAD occlusion causes anterior wall MI (ST elevation in V1-V4).
Right coronary artery occlusion causes inferior MI (II, III, aVF).
5. A client with a history of deep vein thrombosis (DVT) is prescribed
enoxaparin. The nurse should administer this medication via which route?
A) Intravenous push
B) Subcutaneous injection in the abdomen
C) Intramuscular injection
D) Oral
Answer: B
Rationale: Enoxaparin (low-molecular-weight heparin) is given
subcutaneously in the abdomen; rotate sites; do not expel air bubble.
6. A client after cardiac catheterization via the femoral artery has a
sandbag placed over the insertion site. Which finding requires immediate
nursing action?
A) Small amount of oozing around the site
B) Ecchymosis at the site
C) Expanding hematoma and loss of pulse in the affected leg
D) Mild groin discomfort
Answer: C
Rationale: Expanding hematoma with loss of distal pulse indicates possible
retroperitoneal bleeding or vessel occlusion; notify provider immediately.
7. A client with chronic heart failure has a prescription for carvedilol. The
nurse should monitor for which therapeutic effect?
A) Increased heart rate
B) Improved left ventricular ejection fraction (LVEF) and reduced mortality
C) Increased blood pressure
D) Decreased urinary output
Answer: B
, Rationale: Carvedilol is a beta-blocker that reduces mortality,
hospitalizations, and improves LVEF in heart failure with reduced ejection
fraction (HFrEF).
8. A client with hypertension is prescribed hydrochlorothiazide. Which
electrolyte imbalance should the nurse monitor?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypermagnesemia
Answer: B
Rationale: Thiazide diuretics cause hypokalemia (potassium wasting).
Monitor potassium levels and signs of hypokalemia (muscle weakness,
fatigue, arrhythmias).
9. A client with peripheral artery disease (PAD) complains of calf pain when
walking that resolves with rest. This symptom is known as:
A) Rest pain
B) Intermittent claudication
C) Venous stasis
D) Neuropathic pain
Answer: B
Rationale: Intermittent claudication is reproducible ischemic leg pain with
exercise, relieved by rest; it is a classic symptom of PAD.
10. A client with chronic venous insufficiency (CVI) has lower extremity
edema and brownish discoloration. Which nursing intervention is most
important?
A) Elevate legs above the heart and apply compression stockings
B) Keep legs in a dependent position
C) Apply heat packs to the legs
