ATI RN ADULT MEDICAL-SURGICAL PROCTORED
EXAM 2026/2027 | Updated | 100% Verified Answers
| ATI CMS Adult Med-Surg Blueprint | Pass
Guaranteed - A+ Graded
Section 1: Cardiovascular & Hematologic Disorders (Questions
1-18)
Q1. A 68-year-old male with a history of hypertension and type 2 diabetes presents
to the emergency department with crushing substernal chest pain radiating to his left
arm, diaphoresis, and nausea. His vital signs are BP 98/62 mmHg, HR 112 bpm, RR
24/min, SpO2 91% on room air. The 12-lead ECG shows ST-segment elevation in
leads V1-V4. Laboratory results reveal troponin I 0.8 ng/mL (normal <0.04). Which
action should the nurse prioritize?
A. Administer sublingual nitroglycerin 0.4 mg
B. Obtain a stat chest x-ray
C. Prepare the patient for immediate percutaneous coronary intervention (PCI)
D. Begin heparin infusion per protocol
Correct Answer: C [CORRECT]
Rationale: This patient presents with an anterior ST-elevation myocardial infarction
(STEMI) based on ST elevation in V1-V4. The 2026 ACC/AHA guidelines mandate
primary PCI within 90 minutes of first medical contact (door-to-balloon time). While
nitroglycerin and heparin are appropriate adjuncts, reperfusion is the priority.
Troponin is already elevated, confirming myocardial injury. (ATI CMS Adult Med-Surg
Ch. 22: Cardiovascular Disorders)
,Q2. A nurse is caring for a patient with systolic heart failure (HFrEF) who is receiving
lisinopril 20 mg daily, metoprolol succinate 50 mg daily, and furosemide 40 mg daily.
The patient reports increasing dyspnea on exertion and 3+ pitting edema in bilateral
lower extremities. Which assessment finding requires immediate nursing
intervention?
A. Weight gain of 2 lb over 3 days
B. Serum potassium 3.8 mEq/L
C. Blood pressure 88/52 mmHg with dizziness
D. Heart rate 68 bpm and regular
Correct Answer: C [CORRECT]
Rationale: Hypotension (88/52 mmHg) with dizziness indicates symptomatic
hypotension, likely from ACE inhibitor and beta-blocker therapy in the setting of
worsening heart failure. This requires immediate intervention to prevent cardiogenic
shock. A 2-lb weight gain indicates fluid retention but is not immediately life-
threatening; potassium 3.8 is within normal range; HR 68 is expected with beta-
blocker therapy. (ATI CMS Adult Med-Surg Ch. 22: Cardiovascular Disorders)
Q3. A patient with newly diagnosed atrial fibrillation is prescribed warfarin 5 mg
daily. The nurse is teaching the patient about dietary considerations. Which
statement by the patient indicates understanding of the teaching?
A. "I should avoid all green vegetables completely."
B. "I need to keep my vitamin K intake consistent from day to day."
C. "I can eat as much spinach as I want since I'm on warfarin."
D. "I should take vitamin K supplements to prevent bleeding."
Correct Answer: B [CORRECT]
Rationale: Warfarin antagonizes vitamin K-dependent clotting factors (II, VII, IX, X).
The key dietary teaching is maintaining consistent vitamin K intake rather than
avoidance, as fluctuations alter INR. Complete avoidance (A) is unnecessary;
unlimited spinach (C) would decrease warfarin efficacy; vitamin K supplements (D)
would antagonize therapy. (ATI CMS Adult Med-Surg Ch. 22: Cardiovascular
Disorders)
,Q4. A nurse is monitoring a patient receiving a heparin infusion for treatment of a
deep vein thrombosis (DVT). The patient's aPTT is 95 seconds (therapeutic range 60-
80 seconds). Based on this result, which action should the nurse take?
A. Continue the infusion at the current rate and recheck in 4 hours
B. Increase the infusion rate per protocol
C. Stop the infusion for 1 hour, then resume at a decreased rate
D. Administer protamine sulfate immediately
Correct Answer: C [CORRECT]
Rationale: An aPTT of 95 seconds is supratherapeutic (above 80-second upper limit).
Per heparin protocol, the nurse should hold the infusion briefly (typically 1 hour) and
resume at a reduced rate to prevent bleeding complications. Protamine sulfate (D) is
reserved for life-threatening hemorrhage; continuing (A) or increasing (B) the rate
would worsen over-anticoagulation. (ATI CMS Adult Med-Surg Ch. 22: Cardiovascular
Disorders)
Q5. A patient with a history of heart failure is prescribed digoxin 0.25 mg daily.
Before administering the dose, the nurse checks the patient's apical pulse and finds it
to be 52 bpm. Which action should the nurse take?
A. Administer the digoxin and notify the provider
B. Hold the digoxin and notify the provider
C. Check the radial pulse for 1 full minute
D. Administer the dose and recheck the pulse in 1 hour
Correct Answer: B [CORRECT]
Rationale: Digoxin should be held if the apical pulse is below 60 bpm (adult) due to
risk of bradycardia and heart block. The nurse must withhold the dose and notify the
provider. Administering (A, D) could precipitate severe bradycardia; checking radial
pulse (C) is inappropriate—apical pulse is the standard assessment for cardiac
glycosides. (ATI CMS Adult Med-Surg Ch. 22: Cardiovascular Disorders)
, Q6. A nurse is caring for a patient with chronic kidney disease stage 4 who develops
heparin-induced thrombocytopenia (HIT) following cardiac catheterization. Which
medication should the nurse anticipate being prescribed as an alternative
anticoagulant?
A. Enoxaparin
B. Argatroban
C. Warfarin monotherapy
D. Aspirin 325 mg daily
Correct Answer: B [CORRECT]
Rationale: Argatroban is a direct thrombin inhibitor and the preferred anticoagulant
for HIT because it does not interact with platelet factor 4 antibodies. Enoxaparin (A) is
contraindicated in HIT due to cross-reactivity with unfractionated heparin. Warfarin
(C) should never be initiated alone in acute HIT (risk of venous limb gangrene).
Aspirin (D) provides antiplatelet, not anticoagulant, effects. (ATI CMS Adult Med-Surg
Ch. 22: Cardiovascular Disorders)
Q7. A patient with acute decompensated heart failure is receiving IV furosemide 80
mg every 8 hours. Which laboratory value requires the most immediate follow-up by
the nurse?
A. Serum sodium 132 mEq/L
B. Serum potassium 2.9 mEq/L
C. Blood urea nitrogen 28 mg/dL
D. Hemoglobin 11.2 g/dL
Correct Answer: B [CORRECT]
Rationale: Furosemide is a loop diuretic that causes potassium wasting. A potassium
of 2.9 mEq/L represents severe hypokalemia that can precipitate life-threatening
cardiac dysrhythmias (U waves, ventricular tachycardia). While hyponatremia (A) and
elevated BUN (C) are expected findings, hypokalemia requires immediate potassium
replacement and cardiac monitoring. Mild anemia (D) is not immediately concerning.
(ATI CMS Adult Med-Surg Ch. 22: Cardiovascular Disorders)
EXAM 2026/2027 | Updated | 100% Verified Answers
| ATI CMS Adult Med-Surg Blueprint | Pass
Guaranteed - A+ Graded
Section 1: Cardiovascular & Hematologic Disorders (Questions
1-18)
Q1. A 68-year-old male with a history of hypertension and type 2 diabetes presents
to the emergency department with crushing substernal chest pain radiating to his left
arm, diaphoresis, and nausea. His vital signs are BP 98/62 mmHg, HR 112 bpm, RR
24/min, SpO2 91% on room air. The 12-lead ECG shows ST-segment elevation in
leads V1-V4. Laboratory results reveal troponin I 0.8 ng/mL (normal <0.04). Which
action should the nurse prioritize?
A. Administer sublingual nitroglycerin 0.4 mg
B. Obtain a stat chest x-ray
C. Prepare the patient for immediate percutaneous coronary intervention (PCI)
D. Begin heparin infusion per protocol
Correct Answer: C [CORRECT]
Rationale: This patient presents with an anterior ST-elevation myocardial infarction
(STEMI) based on ST elevation in V1-V4. The 2026 ACC/AHA guidelines mandate
primary PCI within 90 minutes of first medical contact (door-to-balloon time). While
nitroglycerin and heparin are appropriate adjuncts, reperfusion is the priority.
Troponin is already elevated, confirming myocardial injury. (ATI CMS Adult Med-Surg
Ch. 22: Cardiovascular Disorders)
,Q2. A nurse is caring for a patient with systolic heart failure (HFrEF) who is receiving
lisinopril 20 mg daily, metoprolol succinate 50 mg daily, and furosemide 40 mg daily.
The patient reports increasing dyspnea on exertion and 3+ pitting edema in bilateral
lower extremities. Which assessment finding requires immediate nursing
intervention?
A. Weight gain of 2 lb over 3 days
B. Serum potassium 3.8 mEq/L
C. Blood pressure 88/52 mmHg with dizziness
D. Heart rate 68 bpm and regular
Correct Answer: C [CORRECT]
Rationale: Hypotension (88/52 mmHg) with dizziness indicates symptomatic
hypotension, likely from ACE inhibitor and beta-blocker therapy in the setting of
worsening heart failure. This requires immediate intervention to prevent cardiogenic
shock. A 2-lb weight gain indicates fluid retention but is not immediately life-
threatening; potassium 3.8 is within normal range; HR 68 is expected with beta-
blocker therapy. (ATI CMS Adult Med-Surg Ch. 22: Cardiovascular Disorders)
Q3. A patient with newly diagnosed atrial fibrillation is prescribed warfarin 5 mg
daily. The nurse is teaching the patient about dietary considerations. Which
statement by the patient indicates understanding of the teaching?
A. "I should avoid all green vegetables completely."
B. "I need to keep my vitamin K intake consistent from day to day."
C. "I can eat as much spinach as I want since I'm on warfarin."
D. "I should take vitamin K supplements to prevent bleeding."
Correct Answer: B [CORRECT]
Rationale: Warfarin antagonizes vitamin K-dependent clotting factors (II, VII, IX, X).
The key dietary teaching is maintaining consistent vitamin K intake rather than
avoidance, as fluctuations alter INR. Complete avoidance (A) is unnecessary;
unlimited spinach (C) would decrease warfarin efficacy; vitamin K supplements (D)
would antagonize therapy. (ATI CMS Adult Med-Surg Ch. 22: Cardiovascular
Disorders)
,Q4. A nurse is monitoring a patient receiving a heparin infusion for treatment of a
deep vein thrombosis (DVT). The patient's aPTT is 95 seconds (therapeutic range 60-
80 seconds). Based on this result, which action should the nurse take?
A. Continue the infusion at the current rate and recheck in 4 hours
B. Increase the infusion rate per protocol
C. Stop the infusion for 1 hour, then resume at a decreased rate
D. Administer protamine sulfate immediately
Correct Answer: C [CORRECT]
Rationale: An aPTT of 95 seconds is supratherapeutic (above 80-second upper limit).
Per heparin protocol, the nurse should hold the infusion briefly (typically 1 hour) and
resume at a reduced rate to prevent bleeding complications. Protamine sulfate (D) is
reserved for life-threatening hemorrhage; continuing (A) or increasing (B) the rate
would worsen over-anticoagulation. (ATI CMS Adult Med-Surg Ch. 22: Cardiovascular
Disorders)
Q5. A patient with a history of heart failure is prescribed digoxin 0.25 mg daily.
Before administering the dose, the nurse checks the patient's apical pulse and finds it
to be 52 bpm. Which action should the nurse take?
A. Administer the digoxin and notify the provider
B. Hold the digoxin and notify the provider
C. Check the radial pulse for 1 full minute
D. Administer the dose and recheck the pulse in 1 hour
Correct Answer: B [CORRECT]
Rationale: Digoxin should be held if the apical pulse is below 60 bpm (adult) due to
risk of bradycardia and heart block. The nurse must withhold the dose and notify the
provider. Administering (A, D) could precipitate severe bradycardia; checking radial
pulse (C) is inappropriate—apical pulse is the standard assessment for cardiac
glycosides. (ATI CMS Adult Med-Surg Ch. 22: Cardiovascular Disorders)
, Q6. A nurse is caring for a patient with chronic kidney disease stage 4 who develops
heparin-induced thrombocytopenia (HIT) following cardiac catheterization. Which
medication should the nurse anticipate being prescribed as an alternative
anticoagulant?
A. Enoxaparin
B. Argatroban
C. Warfarin monotherapy
D. Aspirin 325 mg daily
Correct Answer: B [CORRECT]
Rationale: Argatroban is a direct thrombin inhibitor and the preferred anticoagulant
for HIT because it does not interact with platelet factor 4 antibodies. Enoxaparin (A) is
contraindicated in HIT due to cross-reactivity with unfractionated heparin. Warfarin
(C) should never be initiated alone in acute HIT (risk of venous limb gangrene).
Aspirin (D) provides antiplatelet, not anticoagulant, effects. (ATI CMS Adult Med-Surg
Ch. 22: Cardiovascular Disorders)
Q7. A patient with acute decompensated heart failure is receiving IV furosemide 80
mg every 8 hours. Which laboratory value requires the most immediate follow-up by
the nurse?
A. Serum sodium 132 mEq/L
B. Serum potassium 2.9 mEq/L
C. Blood urea nitrogen 28 mg/dL
D. Hemoglobin 11.2 g/dL
Correct Answer: B [CORRECT]
Rationale: Furosemide is a loop diuretic that causes potassium wasting. A potassium
of 2.9 mEq/L represents severe hypokalemia that can precipitate life-threatening
cardiac dysrhythmias (U waves, ventricular tachycardia). While hyponatremia (A) and
elevated BUN (C) are expected findings, hypokalemia requires immediate potassium
replacement and cardiac monitoring. Mild anemia (D) is not immediately concerning.
(ATI CMS Adult Med-Surg Ch. 22: Cardiovascular Disorders)
