ATI Adult Medical Surgical
Cardiovascular Disorders Unit 4 Exam
ACTUAL EXAM 2026/2027 | ATI Med
Surg Cardiac Unit 4 | Verified Q&A |
Pass Guaranteed - A+ Graded
Section 1 – Coronary Artery Disease, Angina, Myocardial Infarction (Questions 1–30)
Q1. A nurse is assessing a client 6 hours after onset of chest pain. ECG shows ST-segment elevation in
leads II, III, and aVF. Cardiac enzymes are elevated. Which of the following is the priority nursing action?
A. Administer sublingual nitroglycerin 0.4 mg every 5 minutes for up to 3 doses.
B. Prepare the client for immediate percutaneous coronary intervention (PCI). [CORRECT]
C. Apply supplemental oxygen at 2 L/min via nasal cannula.
D. Obtain a stat 12-lead ECG.
Correct Answer: B
Rationale: ST elevation in inferior leads (II, III, aVF) indicates acute inferior STEMI. PCI within 90 minutes
of first medical contact is the gold standard reperfusion therapy and absolute priority. A is incorrect
because nitroglycerin may cause profound hypotension in inferior MI, especially with right ventricular
involvement (preload dependent); vasodilation without reperfusion is contraindicated as priority. C is
incorrect because supplemental oxygen is only indicated if SpO2 < 90%, respiratory distress, or high-risk
features; routine oxygen is no longer recommended for all chest pain patients and does not address the
occluded coronary artery. D is incorrect because the ECG described is already diagnostic of STEMI;
obtaining another ECG delays critical reperfusion time. ATI tip: For STEMI, "door-to-balloon time" under
90 minutes is the priority quality metric; every minute of delay increases mortality.
Q2. A nurse is caring for a client with unstable angina who reports chest pain rated 6/10. The client
received sublingual nitroglycerin 0.4 mg × 3 doses 10 minutes ago with no relief. Which action should
the nurse take first?
, A. Administer morphine sulfate 2 mg IV.
B. Notify the provider and anticipate heparin infusion. [CORRECT]
C. Apply a second nitroglycerin patch.
D. Place the client in high-Fowler's position.
Correct Answer: B
Rationale: Chest pain unrelieved by 3 doses of sublingual nitroglycerin indicates progression to acute
coronary syndrome (ACS) or NSTEMI; immediate provider notification and anticoagulation therapy
(heparin, enoxaparin) are indicated to prevent thrombus propagation. A is incorrect because while
morphine may be ordered for pain, it does not address the underlying ischemic pathology and may mask
symptoms; provider notification takes priority for definitive therapy. C is incorrect because additional
nitroglycerin beyond 3 doses without provider order exceeds safe parameters and may cause severe
hypotension or reflex tachycardia. D is incorrect because positioning does not address coronary
occlusion; high-Fowler's is used for respiratory distress, not cardiac ischemia. ATI tip: "Nitro unrelieved
by 3 doses = call provider; this is the classic ACS progression signal."
Q3. A nurse is reviewing discharge instructions with a client who had PCI with stent placement for
STEMI. Which statement by the client indicates understanding of the teaching?
A. "I can stop taking my aspirin once the chest pain goes away completely."
B. "I will take clopidogrel every day for at least 12 months to keep my stent open." [CORRECT]
C. "I should avoid all exercise because it might dislodge the stent."
D. "I need to call my doctor if I have bruising while taking aspirin."
Correct Answer: B
Rationale: Dual antiplatelet therapy (DAPT) with aspirin + P2Y12 inhibitor (clopidogrel, ticagrelor, or
prasugrel) is mandatory for 12 months post-stent to prevent stent thrombosis, which carries 40-60%
mortality. A is incorrect because aspirin is lifelong therapy, not temporary; discontinuation risks acute
stent thrombosis and fatal MI. C is incorrect because cardiac rehabilitation with progressive exercise is
essential post-PCI; stents endothelize within weeks and cannot be dislodged by activity. D is incorrect
because minor bruising is expected with antiplatelet therapy; the client should call for black/tarry stools,
vomiting blood, or severe bleeding, not routine bruising. ATI tip: "DAPT for 12 months is non-negotiable;
premature discontinuation is a leading cause of stent thrombosis death."
,Q4. A nurse is caring for a client 24 hours post-MI. The client suddenly develops jugular venous
distension, clear lung sounds, and hypotension with bradycardia. Which complication should the nurse
suspect?
A. Left ventricular failure with pulmonary edema.
B. Right ventricular infarction. [CORRECT]
C. Cardiac tamponade.
D. Papillary muscle rupture.
Correct Answer: B
Rationale: Right ventricular infarction (RVMI) classically presents with JVD, clear lungs, and hypotension
with bradycardia (Bezold-Jarisch reflex) in the setting of inferior MI; the right ventricle fails to pump
blood forward, causing venous congestion without pulmonary edema. A is incorrect because left
ventricular failure would produce crackles, dyspnea, and pulmonary edema, not clear lungs with JVD. C
is incorrect because tamponade presents with Beck's triad (JVD, hypotension, muffled heart sounds)
and pulsus paradoxus, not isolated bradycardia with clear lungs. D is incorrect because papillary muscle
rupture causes acute mitral regurgitation with pulmonary edema, a new holosystolic murmur, and
cardiogenic shock—not isolated right-sided findings. ATI tip: "JVD + clear lungs + hypotension = right
ventricular MI until proven otherwise; avoid nitrates and diuretics which reduce preload."
Q5. A client is receiving tissue plasminogen activator (tPA) for acute ischemic stroke. The nurse should
monitor for which adverse effect?
A. Hypoglycemia.
B. Bleeding. [CORRECT]
C. Bradycardia.
D. Hyperkalemia.
Correct Answer: B
Rationale: tPA is a thrombolytic agent that converts plasminogen to plasmin, dissolving fibrin clots; the
primary adverse effect is bleeding (intracranial hemorrhage, GI bleeding, ecchymosis), occurring in 6-7%
of patients. A is incorrect because tPA does not affect glucose metabolism. C is incorrect because tPA
does not directly affect heart rate; bradycardia is not a characteristic adverse effect. D is incorrect
because tPA does not cause hyperkalemia; it affects the coagulation cascade, not electrolyte balance.
ATI tip: "Bleeding is the enemy with thrombolytics; monitor BP strictly (<185/110 mmHg pre-tPA,
<180/105 post-tPA) and watch for neurological deterioration indicating ICH."
, Q6. A nurse is assessing a client with chronic stable angina. Which finding requires immediate
intervention?
A. Blood pressure 138/84 mmHg.
B. Chest pain occurring at rest for 15 minutes. [CORRECT]
C. Heart rate 76 beats/minute.
D. Respiratory rate 18 breaths/minute.
Correct Answer: B
Rationale: Angina at rest (duration >10-15 minutes) indicates unstable angina or NSTEMI, representing
plaque rupture with subtotal coronary occlusion; this is a medical emergency requiring immediate ECG,
troponins, and provider notification. A is incorrect because 138/84 is mildly elevated but not emergent
in this context. C is incorrect because 76 bpm is normal sinus rhythm. D is incorrect because 18
breaths/minute is within normal range (12-20). ATI tip: "Stable angina = exertion-triggered, relieved by
rest/nitro; unstable/rest angina = plaque rupture, medical emergency."
Q7. A nurse is caring for a client post-cardiac catheterization via the femoral approach. Which action is
priority?
A. Maintain the client on strict bed rest with the affected leg straight for 4-6 hours. [CORRECT]
B. Encourage ambulation within 30 minutes to prevent DVT.
C. Remove the pressure dressing after 1 hour to assess the site.
D. Elevate the head of the bed to 90 degrees for comfort.
Correct Answer: B
Rationale: Femoral access requires bed rest with the leg straight (often sandbag or C-clamp pressure)
for 4-6 hours to allow the arterial puncture site to seal and prevent bleeding/hematoma; premature
mobilization risks retroperitoneal hemorrhage. B is incorrect because early ambulation after femoral
access causes shearing at the puncture site and life-threatening bleeding; radial access allows earlier
ambulation. C is incorrect because removing the dressing at 1 hour disrupts hemostasis; site checks are
done through the dressing. D is incorrect because high Fowler's increases intra-abdominal pressure and
shear stress on the femoral site; supine or slight reverse Trendelenburg is preferred. ATI tip: "Femoral =
4-6 hours flat; radial = 2 hours then ambulation; know your access site protocols."
Q8. A client is prescribed atorvastatin 40 mg daily post-MI. The nurse should include which teaching?
A. "Take this medication in the morning with breakfast for best absorption."
Cardiovascular Disorders Unit 4 Exam
ACTUAL EXAM 2026/2027 | ATI Med
Surg Cardiac Unit 4 | Verified Q&A |
Pass Guaranteed - A+ Graded
Section 1 – Coronary Artery Disease, Angina, Myocardial Infarction (Questions 1–30)
Q1. A nurse is assessing a client 6 hours after onset of chest pain. ECG shows ST-segment elevation in
leads II, III, and aVF. Cardiac enzymes are elevated. Which of the following is the priority nursing action?
A. Administer sublingual nitroglycerin 0.4 mg every 5 minutes for up to 3 doses.
B. Prepare the client for immediate percutaneous coronary intervention (PCI). [CORRECT]
C. Apply supplemental oxygen at 2 L/min via nasal cannula.
D. Obtain a stat 12-lead ECG.
Correct Answer: B
Rationale: ST elevation in inferior leads (II, III, aVF) indicates acute inferior STEMI. PCI within 90 minutes
of first medical contact is the gold standard reperfusion therapy and absolute priority. A is incorrect
because nitroglycerin may cause profound hypotension in inferior MI, especially with right ventricular
involvement (preload dependent); vasodilation without reperfusion is contraindicated as priority. C is
incorrect because supplemental oxygen is only indicated if SpO2 < 90%, respiratory distress, or high-risk
features; routine oxygen is no longer recommended for all chest pain patients and does not address the
occluded coronary artery. D is incorrect because the ECG described is already diagnostic of STEMI;
obtaining another ECG delays critical reperfusion time. ATI tip: For STEMI, "door-to-balloon time" under
90 minutes is the priority quality metric; every minute of delay increases mortality.
Q2. A nurse is caring for a client with unstable angina who reports chest pain rated 6/10. The client
received sublingual nitroglycerin 0.4 mg × 3 doses 10 minutes ago with no relief. Which action should
the nurse take first?
, A. Administer morphine sulfate 2 mg IV.
B. Notify the provider and anticipate heparin infusion. [CORRECT]
C. Apply a second nitroglycerin patch.
D. Place the client in high-Fowler's position.
Correct Answer: B
Rationale: Chest pain unrelieved by 3 doses of sublingual nitroglycerin indicates progression to acute
coronary syndrome (ACS) or NSTEMI; immediate provider notification and anticoagulation therapy
(heparin, enoxaparin) are indicated to prevent thrombus propagation. A is incorrect because while
morphine may be ordered for pain, it does not address the underlying ischemic pathology and may mask
symptoms; provider notification takes priority for definitive therapy. C is incorrect because additional
nitroglycerin beyond 3 doses without provider order exceeds safe parameters and may cause severe
hypotension or reflex tachycardia. D is incorrect because positioning does not address coronary
occlusion; high-Fowler's is used for respiratory distress, not cardiac ischemia. ATI tip: "Nitro unrelieved
by 3 doses = call provider; this is the classic ACS progression signal."
Q3. A nurse is reviewing discharge instructions with a client who had PCI with stent placement for
STEMI. Which statement by the client indicates understanding of the teaching?
A. "I can stop taking my aspirin once the chest pain goes away completely."
B. "I will take clopidogrel every day for at least 12 months to keep my stent open." [CORRECT]
C. "I should avoid all exercise because it might dislodge the stent."
D. "I need to call my doctor if I have bruising while taking aspirin."
Correct Answer: B
Rationale: Dual antiplatelet therapy (DAPT) with aspirin + P2Y12 inhibitor (clopidogrel, ticagrelor, or
prasugrel) is mandatory for 12 months post-stent to prevent stent thrombosis, which carries 40-60%
mortality. A is incorrect because aspirin is lifelong therapy, not temporary; discontinuation risks acute
stent thrombosis and fatal MI. C is incorrect because cardiac rehabilitation with progressive exercise is
essential post-PCI; stents endothelize within weeks and cannot be dislodged by activity. D is incorrect
because minor bruising is expected with antiplatelet therapy; the client should call for black/tarry stools,
vomiting blood, or severe bleeding, not routine bruising. ATI tip: "DAPT for 12 months is non-negotiable;
premature discontinuation is a leading cause of stent thrombosis death."
,Q4. A nurse is caring for a client 24 hours post-MI. The client suddenly develops jugular venous
distension, clear lung sounds, and hypotension with bradycardia. Which complication should the nurse
suspect?
A. Left ventricular failure with pulmonary edema.
B. Right ventricular infarction. [CORRECT]
C. Cardiac tamponade.
D. Papillary muscle rupture.
Correct Answer: B
Rationale: Right ventricular infarction (RVMI) classically presents with JVD, clear lungs, and hypotension
with bradycardia (Bezold-Jarisch reflex) in the setting of inferior MI; the right ventricle fails to pump
blood forward, causing venous congestion without pulmonary edema. A is incorrect because left
ventricular failure would produce crackles, dyspnea, and pulmonary edema, not clear lungs with JVD. C
is incorrect because tamponade presents with Beck's triad (JVD, hypotension, muffled heart sounds)
and pulsus paradoxus, not isolated bradycardia with clear lungs. D is incorrect because papillary muscle
rupture causes acute mitral regurgitation with pulmonary edema, a new holosystolic murmur, and
cardiogenic shock—not isolated right-sided findings. ATI tip: "JVD + clear lungs + hypotension = right
ventricular MI until proven otherwise; avoid nitrates and diuretics which reduce preload."
Q5. A client is receiving tissue plasminogen activator (tPA) for acute ischemic stroke. The nurse should
monitor for which adverse effect?
A. Hypoglycemia.
B. Bleeding. [CORRECT]
C. Bradycardia.
D. Hyperkalemia.
Correct Answer: B
Rationale: tPA is a thrombolytic agent that converts plasminogen to plasmin, dissolving fibrin clots; the
primary adverse effect is bleeding (intracranial hemorrhage, GI bleeding, ecchymosis), occurring in 6-7%
of patients. A is incorrect because tPA does not affect glucose metabolism. C is incorrect because tPA
does not directly affect heart rate; bradycardia is not a characteristic adverse effect. D is incorrect
because tPA does not cause hyperkalemia; it affects the coagulation cascade, not electrolyte balance.
ATI tip: "Bleeding is the enemy with thrombolytics; monitor BP strictly (<185/110 mmHg pre-tPA,
<180/105 post-tPA) and watch for neurological deterioration indicating ICH."
, Q6. A nurse is assessing a client with chronic stable angina. Which finding requires immediate
intervention?
A. Blood pressure 138/84 mmHg.
B. Chest pain occurring at rest for 15 minutes. [CORRECT]
C. Heart rate 76 beats/minute.
D. Respiratory rate 18 breaths/minute.
Correct Answer: B
Rationale: Angina at rest (duration >10-15 minutes) indicates unstable angina or NSTEMI, representing
plaque rupture with subtotal coronary occlusion; this is a medical emergency requiring immediate ECG,
troponins, and provider notification. A is incorrect because 138/84 is mildly elevated but not emergent
in this context. C is incorrect because 76 bpm is normal sinus rhythm. D is incorrect because 18
breaths/minute is within normal range (12-20). ATI tip: "Stable angina = exertion-triggered, relieved by
rest/nitro; unstable/rest angina = plaque rupture, medical emergency."
Q7. A nurse is caring for a client post-cardiac catheterization via the femoral approach. Which action is
priority?
A. Maintain the client on strict bed rest with the affected leg straight for 4-6 hours. [CORRECT]
B. Encourage ambulation within 30 minutes to prevent DVT.
C. Remove the pressure dressing after 1 hour to assess the site.
D. Elevate the head of the bed to 90 degrees for comfort.
Correct Answer: B
Rationale: Femoral access requires bed rest with the leg straight (often sandbag or C-clamp pressure)
for 4-6 hours to allow the arterial puncture site to seal and prevent bleeding/hematoma; premature
mobilization risks retroperitoneal hemorrhage. B is incorrect because early ambulation after femoral
access causes shearing at the puncture site and life-threatening bleeding; radial access allows earlier
ambulation. C is incorrect because removing the dressing at 1 hour disrupts hemostasis; site checks are
done through the dressing. D is incorrect because high Fowler's increases intra-abdominal pressure and
shear stress on the femoral site; supine or slight reverse Trendelenburg is preferred. ATI tip: "Femoral =
4-6 hours flat; radial = 2 hours then ambulation; know your access site protocols."
Q8. A client is prescribed atorvastatin 40 mg daily post-MI. The nurse should include which teaching?
A. "Take this medication in the morning with breakfast for best absorption."
