ATI MEDICAL-SURGICAL PROCTORED FINAL EXAM
2026/2027 | Latest ATI CMS Blueprint | 100 Questions
with Rationale | Pass Guaranteed - A+ Graded
Section 1: Cardiovascular & Hematologic Disorders (Questions
1-18)
Q1. A 72-year-old male is admitted with acute decompensated heart failure. His vital
signs are BP 162/94 mmHg, HR 110 bpm (irregularly irregular), RR 28/min, SpO2 88%
on room air. He has 3+ pitting edema and bilateral crackles to the mid-lung fields.
Using the ABC priority framework, which intervention should the nurse implement
FIRST?
A. Administer IV furosemide for volume overload
B. Apply supplemental oxygen and position the patient upright
C. Obtain a 12-lead ECG to assess cardiac rhythm
D. Insert a Foley catheter to monitor urine output
B. Apply supplemental oxygen and position the patient upright [CORRECT]
Rationale: The ABC priority framework places airway and breathing before circulation.
This patient has severe hypoxemia (SpO2 88%) and respiratory distress (RR 28,
crackles). Oxygenation is the immediate priority—applying supplemental oxygen and
upright positioning (reduces venous return and improves ventilation) addresses the
life-threatening hypoxemia before other interventions. Furosemide (A), ECG (C), and
Foley insertion (D) are important but follow oxygenation.
Correct Answer: B
Q2. A patient with atrial fibrillation is prescribed warfarin 5 mg daily. The nurse notes
the INR is 4.2. Which action should the nurse take?
,A. Administer vitamin K 10 mg IV immediately
B. Hold the next warfarin dose and notify the provider
C. Increase the warfarin dose to achieve therapeutic anticoagulation
D. Administer fresh frozen plasma prophylactically
B. Hold the next warfarin dose and notify the provider [CORRECT]
Rationale: An INR of 4.2 is above the therapeutic range (typically 2.0-3.0 for atrial
fibrillation). The appropriate action is to hold the next dose and notify the provider
for dose adjustment. Vitamin K (A) is reserved for INR >10 or active bleeding.
Increasing the dose (C) would worsen the supratherapeutic INR. Fresh frozen plasma
(D) is for active bleeding or pre-procedure reversal, not asymptomatic elevated INR.
Correct Answer: B
Q3. A patient with chronic heart failure is prescribed carvedilol. The nurse
understands that the primary therapeutic effect of this medication is:
A. Increased myocardial contractility through beta-1 agonism
B. Decreased cardiac workload through beta-1, beta-2, and alpha-1 blockade
C. Vasodilation through direct arterial smooth muscle relaxation
D. Increased renal perfusion through dopaminergic receptor activation
B. Decreased cardiac workload through beta-1, beta-2, and alpha-1 blockade
[CORRECT]
Rationale: Carvedilol is a non-selective beta-blocker with alpha-1 blocking activity. It
reduces heart rate (beta-1), decreases myocardial oxygen demand, reduces afterload
through vasodilation (alpha-1), and prevents arrhythmias. It is a cornerstone of HFrEF
management. It does not increase contractility (A)—that describes dobutamine.
Direct arterial vasodilation (C) describes hydralazine. Dopaminergic activation (D)
describes low-dose dopamine.
Correct Answer: B
,Q4. A patient with deep vein thrombosis is receiving enoxaparin 40 mg subcutaneous
daily. The nurse should teach the patient to report which symptom immediately?
A. Mild bruising at the injection site
B. Black, tarry stools
C. Mild headache
D. Slight dizziness when standing
B. Black, tarry stools [CORRECT]
Rationale: Black, tarry stools (melena) indicate gastrointestinal bleeding, a serious
adverse effect of anticoagulant therapy requiring immediate medical attention. Mild
bruising at injection sites (A) is expected with subcutaneous heparin. Mild headache
(C) and slight dizziness (D) are not typically associated with serious enoxaparin
complications.
Correct Answer: B
Q5. A patient with sickle cell disease is admitted with vaso-occlusive crisis. The nurse
delegates which task to the unlicensed assistive personnel (UAP)?
A. Administering opioid pain medication
B. Providing aggressive oral hydration and recording intake
C. Assessing pain level and effectiveness of interventions
D. Teaching the patient about trigger avoidance
B. Providing aggressive oral hydration and recording intake [CORRECT]
Rationale: The nurse can delegate tasks that do not require clinical judgment or
assessment to UAPs. Providing oral hydration and recording intake/output are
appropriate delegation tasks. Administering medications (A), assessing pain (C), and
patient teaching (D) require nursing assessment and judgment and cannot be
delegated to UAPs.
Correct Answer: B
, Q6. A patient with a myocardial infarction received fibrinolytic therapy 2 hours ago.
Which finding requires immediate notification of the healthcare provider?
A. Blood pressure 138/84 mmHg
B. Occasional premature ventricular contractions
C. Sudden onset of severe headache with blood pressure 190/110 mmHg
D. Heart rate 88 beats/minute with regular rhythm
C. Sudden onset of severe headache with blood pressure 190/110 mmHg
[CORRECT]
Rationale: After fibrinolytic therapy, a sudden severe headache with hypertension is a
classic sign of intracranial hemorrhage, the most serious complication requiring
immediate intervention. Blood pressure 138/84 (A) and heart rate 88 (D) are within
acceptable ranges. Occasional PVCs (B) are common post-MI but do not require
immediate notification unless frequent, multifocal, or in runs.
Correct Answer: C
Q7. A patient with heart failure has the following laboratory values: BNP 850 pg/mL,
potassium 5.2 mEq/L, creatinine 1.8 mg/dL. The patient is prescribed lisinopril and
spironolactone. Which medication should the nurse question?
A. Lisinopril 10 mg PO daily
B. Metoprolol 50 mg PO BID
C. Furosemide 40 mg PO daily
D. Spironolactone 25 mg PO daily
D. Spironolactone 25 mg PO daily [CORRECT]
Rationale: Spironolactone is a potassium-sparing diuretic that can cause dangerous
hyperkalemia, especially when combined with ACE inhibitors (lisinopril) in patients
with renal impairment (creatinine 1.8). The patient already has elevated potassium
(5.2 mEq/L). This combination significantly increases the risk of life-threatening
hyperkalemia. Lisinopril (A) may also need adjustment but spironolactone is the most
immediately dangerous given the current potassium level.
Correct Answer: D
2026/2027 | Latest ATI CMS Blueprint | 100 Questions
with Rationale | Pass Guaranteed - A+ Graded
Section 1: Cardiovascular & Hematologic Disorders (Questions
1-18)
Q1. A 72-year-old male is admitted with acute decompensated heart failure. His vital
signs are BP 162/94 mmHg, HR 110 bpm (irregularly irregular), RR 28/min, SpO2 88%
on room air. He has 3+ pitting edema and bilateral crackles to the mid-lung fields.
Using the ABC priority framework, which intervention should the nurse implement
FIRST?
A. Administer IV furosemide for volume overload
B. Apply supplemental oxygen and position the patient upright
C. Obtain a 12-lead ECG to assess cardiac rhythm
D. Insert a Foley catheter to monitor urine output
B. Apply supplemental oxygen and position the patient upright [CORRECT]
Rationale: The ABC priority framework places airway and breathing before circulation.
This patient has severe hypoxemia (SpO2 88%) and respiratory distress (RR 28,
crackles). Oxygenation is the immediate priority—applying supplemental oxygen and
upright positioning (reduces venous return and improves ventilation) addresses the
life-threatening hypoxemia before other interventions. Furosemide (A), ECG (C), and
Foley insertion (D) are important but follow oxygenation.
Correct Answer: B
Q2. A patient with atrial fibrillation is prescribed warfarin 5 mg daily. The nurse notes
the INR is 4.2. Which action should the nurse take?
,A. Administer vitamin K 10 mg IV immediately
B. Hold the next warfarin dose and notify the provider
C. Increase the warfarin dose to achieve therapeutic anticoagulation
D. Administer fresh frozen plasma prophylactically
B. Hold the next warfarin dose and notify the provider [CORRECT]
Rationale: An INR of 4.2 is above the therapeutic range (typically 2.0-3.0 for atrial
fibrillation). The appropriate action is to hold the next dose and notify the provider
for dose adjustment. Vitamin K (A) is reserved for INR >10 or active bleeding.
Increasing the dose (C) would worsen the supratherapeutic INR. Fresh frozen plasma
(D) is for active bleeding or pre-procedure reversal, not asymptomatic elevated INR.
Correct Answer: B
Q3. A patient with chronic heart failure is prescribed carvedilol. The nurse
understands that the primary therapeutic effect of this medication is:
A. Increased myocardial contractility through beta-1 agonism
B. Decreased cardiac workload through beta-1, beta-2, and alpha-1 blockade
C. Vasodilation through direct arterial smooth muscle relaxation
D. Increased renal perfusion through dopaminergic receptor activation
B. Decreased cardiac workload through beta-1, beta-2, and alpha-1 blockade
[CORRECT]
Rationale: Carvedilol is a non-selective beta-blocker with alpha-1 blocking activity. It
reduces heart rate (beta-1), decreases myocardial oxygen demand, reduces afterload
through vasodilation (alpha-1), and prevents arrhythmias. It is a cornerstone of HFrEF
management. It does not increase contractility (A)—that describes dobutamine.
Direct arterial vasodilation (C) describes hydralazine. Dopaminergic activation (D)
describes low-dose dopamine.
Correct Answer: B
,Q4. A patient with deep vein thrombosis is receiving enoxaparin 40 mg subcutaneous
daily. The nurse should teach the patient to report which symptom immediately?
A. Mild bruising at the injection site
B. Black, tarry stools
C. Mild headache
D. Slight dizziness when standing
B. Black, tarry stools [CORRECT]
Rationale: Black, tarry stools (melena) indicate gastrointestinal bleeding, a serious
adverse effect of anticoagulant therapy requiring immediate medical attention. Mild
bruising at injection sites (A) is expected with subcutaneous heparin. Mild headache
(C) and slight dizziness (D) are not typically associated with serious enoxaparin
complications.
Correct Answer: B
Q5. A patient with sickle cell disease is admitted with vaso-occlusive crisis. The nurse
delegates which task to the unlicensed assistive personnel (UAP)?
A. Administering opioid pain medication
B. Providing aggressive oral hydration and recording intake
C. Assessing pain level and effectiveness of interventions
D. Teaching the patient about trigger avoidance
B. Providing aggressive oral hydration and recording intake [CORRECT]
Rationale: The nurse can delegate tasks that do not require clinical judgment or
assessment to UAPs. Providing oral hydration and recording intake/output are
appropriate delegation tasks. Administering medications (A), assessing pain (C), and
patient teaching (D) require nursing assessment and judgment and cannot be
delegated to UAPs.
Correct Answer: B
, Q6. A patient with a myocardial infarction received fibrinolytic therapy 2 hours ago.
Which finding requires immediate notification of the healthcare provider?
A. Blood pressure 138/84 mmHg
B. Occasional premature ventricular contractions
C. Sudden onset of severe headache with blood pressure 190/110 mmHg
D. Heart rate 88 beats/minute with regular rhythm
C. Sudden onset of severe headache with blood pressure 190/110 mmHg
[CORRECT]
Rationale: After fibrinolytic therapy, a sudden severe headache with hypertension is a
classic sign of intracranial hemorrhage, the most serious complication requiring
immediate intervention. Blood pressure 138/84 (A) and heart rate 88 (D) are within
acceptable ranges. Occasional PVCs (B) are common post-MI but do not require
immediate notification unless frequent, multifocal, or in runs.
Correct Answer: C
Q7. A patient with heart failure has the following laboratory values: BNP 850 pg/mL,
potassium 5.2 mEq/L, creatinine 1.8 mg/dL. The patient is prescribed lisinopril and
spironolactone. Which medication should the nurse question?
A. Lisinopril 10 mg PO daily
B. Metoprolol 50 mg PO BID
C. Furosemide 40 mg PO daily
D. Spironolactone 25 mg PO daily
D. Spironolactone 25 mg PO daily [CORRECT]
Rationale: Spironolactone is a potassium-sparing diuretic that can cause dangerous
hyperkalemia, especially when combined with ACE inhibitors (lisinopril) in patients
with renal impairment (creatinine 1.8). The patient already has elevated potassium
(5.2 mEq/L). This combination significantly increases the risk of life-threatening
hyperkalemia. Lisinopril (A) may also need adjustment but spironolactone is the most
immediately dangerous given the current potassium level.
Correct Answer: D
