ATI PN ADULT MEDICAL SURGICAL CMS FINAL EXAM
2026/2027 | Questions & Detailed Correct Answers | ATI CMS
Blueprint | NCLEX-PN Aligned | A+ Grade | Pass Guaranteed -
A+ Graded
Section 1: Cardiovascular & Hematologic Disorders (Questions 1-22)
Q1. A patient weighing 88 kg is started on a heparin infusion per weight-based protocol:
80 units/kg IV bolus, then 18 units/kg/hr continuous infusion. How many units per hour
should the nurse program into the pump?
A. 1,320 units/hr
B. 1,440 units/hr
C. 1,584 units/hr
D. 1,760 units/hr
Correct format: C. 1,584 units/hr [CORRECT]
Rationale: 88 kg × 18 units/kg/hr = 1,584 units/hr; the nurse must verify the calculation,
monitor the aPTT, and titrate per protocol per ATI CMS anticoagulation and medication
safety guidelines.
Correct Answer: C
Q2. The nurse receives report on four patients. Which patient should the nurse see
FIRST?
A. A patient with heart failure reporting a 2-lb weight gain over 3 days
B. A patient 2 hours post-PCI with a groin hematoma and blood pressure 96/58 mmHg
C. A patient with stage 1 hypertension requesting medication for a headache rated 3/10
D. A patient with a DVT complaining of mild calf tenderness
Correct format: B. A patient 2 hours post-PCI with a groin hematoma and blood
pressure 96/58 mmHg [CORRECT]
,Rationale: Post-PCI groin hematoma with hypotension signals potential retroperitoneal
hemorrhage and hemodynamic instability, requiring immediate assessment and
intervention per ATI CMS cardiovascular prioritization and NCLEX-PN safety principles.
Correct Answer: B
Q3. The nurse is teaching a patient with HFrEF about daily self-management. Which
statements by the patient indicate understanding? (Select all that apply.)
A. "I will weigh myself every morning after I urinate using the same scale."
B. "I should drink at least 3 liters of fluid each day to stay hydrated."
C. "I will call my provider if I gain 3 pounds in one day."
D. "I will take my furosemide in the morning to avoid waking at night."
E. "Some ankle swelling at night is normal and does not need to be reported."
Correct format: A, C, D [CORRECT]
Rationale: Heart failure self-management requires daily weights, a 2 L/day fluid
restriction (not 3 L), morning diuretic dosing to prevent nocturia, and reporting weight
gain >2–3 lb/day or >5 lb/week or new edema immediately per ATI CMS heart failure
guidelines.
Correct Answer: A, C, D
Q4. A patient with HFpEF is admitted with worsening dyspnea. Which assessment
finding best differentiates fluid overload in HFpEF from HFrEF?
A. Presence of an S3 gallop
B. Elevated jugular venous distension
C. Ejection fraction ≥50% on echocardiogram
D. Peripheral pitting edema 2+
Correct format: C. Ejection fraction ≥50% on echocardiogram [CORRECT]
Rationale: HFpEF is defined by preserved ejection fraction (≥50%) with impaired
diastolic filling, whereas HFrEF is characterized by reduced ejection fraction (<40%);
both can present with JVD, edema, and S3, making echo the differentiating test per ATI
CMS heart failure content.
Correct Answer: C
Q5. A patient taking digoxin reports nausea, vomiting, and seeing yellow halos around
lights. The digoxin level is 1.8 ng/mL. What is the nurse's priority action?
A. Administer the next scheduled dose
B. Hold the dose and notify the provider
,C. Obtain a serum potassium level and administer the dose
D. Teach the patient that these are expected side effects
Correct format: B. Hold the dose and notify the provider [CORRECT]
Rationale: Digoxin toxicity manifests with gastrointestinal symptoms, visual changes
(yellow/green halos), and arrhythmias; therapeutic levels are 0.5–0.8 ng/mL, so a level
of 1.8 ng/mL with symptoms warrants holding the dose and provider notification per ATI
CMS pharmacology guidelines.
Correct Answer: B
Q6. A patient prescribed lisinopril develops swelling of the tongue and lips. Which
intervention is the nurse's priority?
A. Administer IV furosemide
B. Discontinue the ACE inhibitor and maintain the airway
C. Give sublingual nitroglycerin
D. Start a heparin infusion
Correct format: B. Discontinue the ACE inhibitor and maintain the airway [CORRECT]
Rationale: Angioedema of the tongue and lips is a life-threatening adverse effect of ACE
inhibitors that can rapidly compromise the airway; the nurse must stop the drug, ensure
airway patency, and obtain emergency assistance per ATI CMS cardiovascular safety
standards.
Correct Answer: B
Q7. On a cardiac telemetry unit, which task is most appropriate for the nurse to delegate
to the LPN?
A. Developing the plan of care for a patient post-MI
B. Administering the initial dose of metoprolol to a new admission
C. Reinforcing diet teaching for a patient with heart failure
D. Performing the initial post-operative assessment on a patient after CABG
Correct format: C. Reinforcing diet teaching for a patient with heart failure [CORRECT]
Rationale: LPN scope of practice includes reinforcing previously taught education and
caring for stable patients; initial assessments, care planning, and first-dose medication
administration for new admissions remain within RN scope per ATI CMS delegation and
NCLEX-PN leadership content.
Correct Answer: C
, Q8. A patient's digoxin level is reported as 0.4 ng/mL. The patient has new-onset atrial
fibrillation with a rapid ventricular response. Which action should the nurse anticipate?
A. Preparing to administer the scheduled maintenance dose
B. Notifying the provider that the level is below therapeutic range
C. Holding the dose due to bradycardia
D. Requesting a stat dose of digoxin immune Fab
Correct format: B. Notifying the provider that the level is below therapeutic range
[CORRECT]
Rationale: A digoxin level of 0.4 ng/mL is below the therapeutic range of 0.5–0.8 ng/mL
for heart failure and may be subtherapeutic for rate control in atrial fibrillation; the nurse
should report this to the provider for possible dose adjustment per ATI CMS
pharmacology guidelines.
Correct Answer: B
Q9. A patient with chest pain is prescribed sublingual nitroglycerin. Which finding in the
patient's history is a contraindication to administration?
A. Blood pressure 162/94 mmHg
B. Use of sildenafil 18 hours ago
C. History of stable angina for 2 years
D. Allergy to aspirin
Correct format: B. Use of sildenafil 18 hours ago [CORRECT]
Rationale: Nitroglycerin is contraindicated within 24–48 hours of phosphodiesterase-5
inhibitor use (sildenafil, tadalafil) due to the risk of profound hypotension and
cardiovascular collapse per ATI CMS acute coronary syndrome and medication safety
content.
Correct Answer: B
Q10. Place the following interventions for a patient with an acute STEMI in the correct
order of priority.
1. Administer chewable aspirin 325 mg
2. Obtain a 12-lead EKG
3. Assess pain and vital signs
4. Initiate reperfusion therapy (PCI or thrombolytics)
Correct format: 3, 2, 1, 4 [CORRECT]
2026/2027 | Questions & Detailed Correct Answers | ATI CMS
Blueprint | NCLEX-PN Aligned | A+ Grade | Pass Guaranteed -
A+ Graded
Section 1: Cardiovascular & Hematologic Disorders (Questions 1-22)
Q1. A patient weighing 88 kg is started on a heparin infusion per weight-based protocol:
80 units/kg IV bolus, then 18 units/kg/hr continuous infusion. How many units per hour
should the nurse program into the pump?
A. 1,320 units/hr
B. 1,440 units/hr
C. 1,584 units/hr
D. 1,760 units/hr
Correct format: C. 1,584 units/hr [CORRECT]
Rationale: 88 kg × 18 units/kg/hr = 1,584 units/hr; the nurse must verify the calculation,
monitor the aPTT, and titrate per protocol per ATI CMS anticoagulation and medication
safety guidelines.
Correct Answer: C
Q2. The nurse receives report on four patients. Which patient should the nurse see
FIRST?
A. A patient with heart failure reporting a 2-lb weight gain over 3 days
B. A patient 2 hours post-PCI with a groin hematoma and blood pressure 96/58 mmHg
C. A patient with stage 1 hypertension requesting medication for a headache rated 3/10
D. A patient with a DVT complaining of mild calf tenderness
Correct format: B. A patient 2 hours post-PCI with a groin hematoma and blood
pressure 96/58 mmHg [CORRECT]
,Rationale: Post-PCI groin hematoma with hypotension signals potential retroperitoneal
hemorrhage and hemodynamic instability, requiring immediate assessment and
intervention per ATI CMS cardiovascular prioritization and NCLEX-PN safety principles.
Correct Answer: B
Q3. The nurse is teaching a patient with HFrEF about daily self-management. Which
statements by the patient indicate understanding? (Select all that apply.)
A. "I will weigh myself every morning after I urinate using the same scale."
B. "I should drink at least 3 liters of fluid each day to stay hydrated."
C. "I will call my provider if I gain 3 pounds in one day."
D. "I will take my furosemide in the morning to avoid waking at night."
E. "Some ankle swelling at night is normal and does not need to be reported."
Correct format: A, C, D [CORRECT]
Rationale: Heart failure self-management requires daily weights, a 2 L/day fluid
restriction (not 3 L), morning diuretic dosing to prevent nocturia, and reporting weight
gain >2–3 lb/day or >5 lb/week or new edema immediately per ATI CMS heart failure
guidelines.
Correct Answer: A, C, D
Q4. A patient with HFpEF is admitted with worsening dyspnea. Which assessment
finding best differentiates fluid overload in HFpEF from HFrEF?
A. Presence of an S3 gallop
B. Elevated jugular venous distension
C. Ejection fraction ≥50% on echocardiogram
D. Peripheral pitting edema 2+
Correct format: C. Ejection fraction ≥50% on echocardiogram [CORRECT]
Rationale: HFpEF is defined by preserved ejection fraction (≥50%) with impaired
diastolic filling, whereas HFrEF is characterized by reduced ejection fraction (<40%);
both can present with JVD, edema, and S3, making echo the differentiating test per ATI
CMS heart failure content.
Correct Answer: C
Q5. A patient taking digoxin reports nausea, vomiting, and seeing yellow halos around
lights. The digoxin level is 1.8 ng/mL. What is the nurse's priority action?
A. Administer the next scheduled dose
B. Hold the dose and notify the provider
,C. Obtain a serum potassium level and administer the dose
D. Teach the patient that these are expected side effects
Correct format: B. Hold the dose and notify the provider [CORRECT]
Rationale: Digoxin toxicity manifests with gastrointestinal symptoms, visual changes
(yellow/green halos), and arrhythmias; therapeutic levels are 0.5–0.8 ng/mL, so a level
of 1.8 ng/mL with symptoms warrants holding the dose and provider notification per ATI
CMS pharmacology guidelines.
Correct Answer: B
Q6. A patient prescribed lisinopril develops swelling of the tongue and lips. Which
intervention is the nurse's priority?
A. Administer IV furosemide
B. Discontinue the ACE inhibitor and maintain the airway
C. Give sublingual nitroglycerin
D. Start a heparin infusion
Correct format: B. Discontinue the ACE inhibitor and maintain the airway [CORRECT]
Rationale: Angioedema of the tongue and lips is a life-threatening adverse effect of ACE
inhibitors that can rapidly compromise the airway; the nurse must stop the drug, ensure
airway patency, and obtain emergency assistance per ATI CMS cardiovascular safety
standards.
Correct Answer: B
Q7. On a cardiac telemetry unit, which task is most appropriate for the nurse to delegate
to the LPN?
A. Developing the plan of care for a patient post-MI
B. Administering the initial dose of metoprolol to a new admission
C. Reinforcing diet teaching for a patient with heart failure
D. Performing the initial post-operative assessment on a patient after CABG
Correct format: C. Reinforcing diet teaching for a patient with heart failure [CORRECT]
Rationale: LPN scope of practice includes reinforcing previously taught education and
caring for stable patients; initial assessments, care planning, and first-dose medication
administration for new admissions remain within RN scope per ATI CMS delegation and
NCLEX-PN leadership content.
Correct Answer: C
, Q8. A patient's digoxin level is reported as 0.4 ng/mL. The patient has new-onset atrial
fibrillation with a rapid ventricular response. Which action should the nurse anticipate?
A. Preparing to administer the scheduled maintenance dose
B. Notifying the provider that the level is below therapeutic range
C. Holding the dose due to bradycardia
D. Requesting a stat dose of digoxin immune Fab
Correct format: B. Notifying the provider that the level is below therapeutic range
[CORRECT]
Rationale: A digoxin level of 0.4 ng/mL is below the therapeutic range of 0.5–0.8 ng/mL
for heart failure and may be subtherapeutic for rate control in atrial fibrillation; the nurse
should report this to the provider for possible dose adjustment per ATI CMS
pharmacology guidelines.
Correct Answer: B
Q9. A patient with chest pain is prescribed sublingual nitroglycerin. Which finding in the
patient's history is a contraindication to administration?
A. Blood pressure 162/94 mmHg
B. Use of sildenafil 18 hours ago
C. History of stable angina for 2 years
D. Allergy to aspirin
Correct format: B. Use of sildenafil 18 hours ago [CORRECT]
Rationale: Nitroglycerin is contraindicated within 24–48 hours of phosphodiesterase-5
inhibitor use (sildenafil, tadalafil) due to the risk of profound hypotension and
cardiovascular collapse per ATI CMS acute coronary syndrome and medication safety
content.
Correct Answer: B
Q10. Place the following interventions for a patient with an acute STEMI in the correct
order of priority.
1. Administer chewable aspirin 325 mg
2. Obtain a 12-lead EKG
3. Assess pain and vital signs
4. Initiate reperfusion therapy (PCI or thrombolytics)
Correct format: 3, 2, 1, 4 [CORRECT]
