ATI PN MEDICAL-SURGICAL FINAL EXAM 2026/2027 |
Verified Version | Expert Answers with Rationales |
NCLEX-PN Aligned | ATI CMS Blueprint | Pass Guaranteed -
A+ Graded
Section 1: Cardiovascular & Hematologic Disorders (Questions 1–18)
Q1. A patient with HFrEF is instructed to restrict fluid intake to 2 L daily and weigh
himself every morning. Yesterday his weight was 78.5 kg. Today it is 80.0 kg. How much
fluid has he retained?
A. 0.5 L
B. 1.0 L
C. 1.5 L [CORRECT]
D. 2.0 L
Rationale: 1 kg of weight gain corresponds to approximately 1 L of fluid retention. The
patient gained 1.5 kg (80.0 − 78.5), indicating 1.5 L of retained fluid requiring immediate
provider notification and possible diuretic adjustment per ATI CMS heart failure
protocols.
Correct Answer: C
Q2. The nurse receives report on four patients. Which patient should the nurse see
FIRST?
A. A patient with HFpEF who reports mild fatigue after walking to the bathroom
B. A patient 2 hours post-MI with chest pain rated 8/10 and diaphoresis [CORRECT]
C. A patient with DVT awaiting discharge on warfarin
D. A patient with iron deficiency anemia requesting PRN stool softener
,Rationale: The post-MI patient with unrelieved chest pain and diaphoresis may be
experiencing recurrent ischemia or infarction extension, requiring immediate ECG and
provider notification per ATI CMS priority framework (ABCs and unstable vs. stable).
Correct Answer: B
Q3. A patient with HFpEF is being discharged. Which statement by the patient indicates
correct understanding of the disease?
A. "My heart muscle is too weak to pump effectively."
B. "My heart muscle is stiff and cannot relax properly to fill with blood." [CORRECT]
C. "I need to take digoxin to help my heart fill better."
D. "I will always have an audible S3 gallop at home."
Rationale: HFpEF is characterized by a stiff, noncompliant left ventricle that cannot relax
and fill during diastole. HFrEF involves systolic dysfunction and weakened pump
function; S3 is associated with HFrEF, not HFpEF.
Correct Answer: B
Q4. A patient taking digoxin reports nausea and states the room lights appear to have
yellow halos. The nurse checks the digoxin level. Which result supports toxicity?
A. 0.4 ng/mL
B. 0.6 ng/mL
C. 1.0 ng/mL
D. 1.4 ng/mL [CORRECT]
Rationale: The therapeutic range for digoxin in HF is 0.5–0.8 ng/mL. Levels >0.8 ng/mL
increase toxicity risk, and nausea plus yellow/green visual halos are classic signs of
digoxin toxicity requiring immediate provider notification and holding doses.
Correct Answer: D
Q5. A patient started on lisinopril for HF returns for follow-up. Which assessment
finding requires immediate nursing intervention?
A. Blood pressure 128/78 mmHg
,B. Potassium 5.8 mEq/L [CORRECT]
C. Mild dry cough reported at night
D. Serum creatinine increased from 1.0 to 1.2 mg/dL
Rationale: ACE inhibitors such as lisinopril can cause hyperkalemia due to decreased
aldosterone; a potassium of 5.8 mEq/L is dangerously elevated and requires immediate
intervention. A dry cough is a common side effect, and a slight creatinine rise is
expected; BP 128/78 is at goal.
Correct Answer: B
Q6. A patient arrives in the ED with crushing substernal chest pain radiating to the left
arm, diaphoresis, and nausea. Vital signs: BP 98/60, HR 110, SpO2 88%. Which
intervention should the nurse implement FIRST?
A. Administer morphine 2 mg IV
B. Apply oxygen at 2 L NC [CORRECT]
C. Give nitroglycerin 0.4 mg SL
D. Chewable aspirin 325 mg
Rationale: Per the MONA protocol and ATI CMS, oxygen is indicated first when SpO2 is
<90%. Although all MONA interventions are priorities, oxygenation takes precedence to
correct hypoxemia before administering morphine, nitroglycerin, or aspirin.
Correct Answer: B
Q7. A patient with suspected NSTEMI had troponin drawn in the ED. When does troponin
typically peak after myocardial injury?
A. 2–4 hours
B. 6–8 hours
C. 12–16 hours
D. 24 hours [CORRECT]
Rationale: Troponin levels begin to rise within 3–6 hours of myocardial injury and
typically peak at approximately 24 hours, remaining elevated for up to 10–14 days.
CK-MB peaks earlier (12–24 hours), making troponin the preferred marker for MI.
, Correct Answer: D
Q8. A patient with chest pain is prescribed sublingual nitroglycerin. Which patient
statement requires the nurse to hold the medication and notify the provider?
A. "I took sildenafil 2 hours ago for erectile dysfunction." [CORRECT]
B. "My blood pressure is usually 140/90 at home."
C. "I have a headache almost every day."
D. "I am allergic to penicillin."
Rationale: Nitroglycerin is contraindicated within 24–48 hours of PDE5 inhibitor use
(sildenafil, tadalafil) due to the risk of profound hypotension and cardiovascular
collapse. The other options do not contraindicate nitroglycerin administration.
Correct Answer: A
Q9. A patient with STEMI arrives in the ED. Which time goal is the standard for
percutaneous coronary intervention?
A. Door-to-balloon time <30 minutes
B. Door-to-balloon time <60 minutes
C. Door-to-balloon time <90 minutes [CORRECT]
D. Door-to-balloon time <120 minutes
Rationale: The gold standard door-to-balloon time for STEMI is <90 minutes. If PCI
cannot be performed within 120 minutes, thrombolytics such as alteplase or
tenecteplase should be considered for reperfusion.
Correct Answer: C
Q10. A patient is admitted after total hip replacement. Which factor places this patient
at highest risk for DVT?
A. Age 45 years
B. History of hypertension
C. Major orthopedic surgery [CORRECT]
D. Female gender
Verified Version | Expert Answers with Rationales |
NCLEX-PN Aligned | ATI CMS Blueprint | Pass Guaranteed -
A+ Graded
Section 1: Cardiovascular & Hematologic Disorders (Questions 1–18)
Q1. A patient with HFrEF is instructed to restrict fluid intake to 2 L daily and weigh
himself every morning. Yesterday his weight was 78.5 kg. Today it is 80.0 kg. How much
fluid has he retained?
A. 0.5 L
B. 1.0 L
C. 1.5 L [CORRECT]
D. 2.0 L
Rationale: 1 kg of weight gain corresponds to approximately 1 L of fluid retention. The
patient gained 1.5 kg (80.0 − 78.5), indicating 1.5 L of retained fluid requiring immediate
provider notification and possible diuretic adjustment per ATI CMS heart failure
protocols.
Correct Answer: C
Q2. The nurse receives report on four patients. Which patient should the nurse see
FIRST?
A. A patient with HFpEF who reports mild fatigue after walking to the bathroom
B. A patient 2 hours post-MI with chest pain rated 8/10 and diaphoresis [CORRECT]
C. A patient with DVT awaiting discharge on warfarin
D. A patient with iron deficiency anemia requesting PRN stool softener
,Rationale: The post-MI patient with unrelieved chest pain and diaphoresis may be
experiencing recurrent ischemia or infarction extension, requiring immediate ECG and
provider notification per ATI CMS priority framework (ABCs and unstable vs. stable).
Correct Answer: B
Q3. A patient with HFpEF is being discharged. Which statement by the patient indicates
correct understanding of the disease?
A. "My heart muscle is too weak to pump effectively."
B. "My heart muscle is stiff and cannot relax properly to fill with blood." [CORRECT]
C. "I need to take digoxin to help my heart fill better."
D. "I will always have an audible S3 gallop at home."
Rationale: HFpEF is characterized by a stiff, noncompliant left ventricle that cannot relax
and fill during diastole. HFrEF involves systolic dysfunction and weakened pump
function; S3 is associated with HFrEF, not HFpEF.
Correct Answer: B
Q4. A patient taking digoxin reports nausea and states the room lights appear to have
yellow halos. The nurse checks the digoxin level. Which result supports toxicity?
A. 0.4 ng/mL
B. 0.6 ng/mL
C. 1.0 ng/mL
D. 1.4 ng/mL [CORRECT]
Rationale: The therapeutic range for digoxin in HF is 0.5–0.8 ng/mL. Levels >0.8 ng/mL
increase toxicity risk, and nausea plus yellow/green visual halos are classic signs of
digoxin toxicity requiring immediate provider notification and holding doses.
Correct Answer: D
Q5. A patient started on lisinopril for HF returns for follow-up. Which assessment
finding requires immediate nursing intervention?
A. Blood pressure 128/78 mmHg
,B. Potassium 5.8 mEq/L [CORRECT]
C. Mild dry cough reported at night
D. Serum creatinine increased from 1.0 to 1.2 mg/dL
Rationale: ACE inhibitors such as lisinopril can cause hyperkalemia due to decreased
aldosterone; a potassium of 5.8 mEq/L is dangerously elevated and requires immediate
intervention. A dry cough is a common side effect, and a slight creatinine rise is
expected; BP 128/78 is at goal.
Correct Answer: B
Q6. A patient arrives in the ED with crushing substernal chest pain radiating to the left
arm, diaphoresis, and nausea. Vital signs: BP 98/60, HR 110, SpO2 88%. Which
intervention should the nurse implement FIRST?
A. Administer morphine 2 mg IV
B. Apply oxygen at 2 L NC [CORRECT]
C. Give nitroglycerin 0.4 mg SL
D. Chewable aspirin 325 mg
Rationale: Per the MONA protocol and ATI CMS, oxygen is indicated first when SpO2 is
<90%. Although all MONA interventions are priorities, oxygenation takes precedence to
correct hypoxemia before administering morphine, nitroglycerin, or aspirin.
Correct Answer: B
Q7. A patient with suspected NSTEMI had troponin drawn in the ED. When does troponin
typically peak after myocardial injury?
A. 2–4 hours
B. 6–8 hours
C. 12–16 hours
D. 24 hours [CORRECT]
Rationale: Troponin levels begin to rise within 3–6 hours of myocardial injury and
typically peak at approximately 24 hours, remaining elevated for up to 10–14 days.
CK-MB peaks earlier (12–24 hours), making troponin the preferred marker for MI.
, Correct Answer: D
Q8. A patient with chest pain is prescribed sublingual nitroglycerin. Which patient
statement requires the nurse to hold the medication and notify the provider?
A. "I took sildenafil 2 hours ago for erectile dysfunction." [CORRECT]
B. "My blood pressure is usually 140/90 at home."
C. "I have a headache almost every day."
D. "I am allergic to penicillin."
Rationale: Nitroglycerin is contraindicated within 24–48 hours of PDE5 inhibitor use
(sildenafil, tadalafil) due to the risk of profound hypotension and cardiovascular
collapse. The other options do not contraindicate nitroglycerin administration.
Correct Answer: A
Q9. A patient with STEMI arrives in the ED. Which time goal is the standard for
percutaneous coronary intervention?
A. Door-to-balloon time <30 minutes
B. Door-to-balloon time <60 minutes
C. Door-to-balloon time <90 minutes [CORRECT]
D. Door-to-balloon time <120 minutes
Rationale: The gold standard door-to-balloon time for STEMI is <90 minutes. If PCI
cannot be performed within 120 minutes, thrombolytics such as alteplase or
tenecteplase should be considered for reperfusion.
Correct Answer: C
Q10. A patient is admitted after total hip replacement. Which factor places this patient
at highest risk for DVT?
A. Age 45 years
B. History of hypertension
C. Major orthopedic surgery [CORRECT]
D. Female gender
