TI MED SURG CMS
A
PROCTORED EXAM 2026-2027
| Latest Update | Questions &
Verified Answers | RN Medical
Surgical | Pass Guaranteed -
A+ Graded
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PART A – MULTIPLE CHOICE (Q1‑85)
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Q1 (Cardiovascular – Heart Failure 2026): A 72-year-old client with HFpEF (ejection fraction
55%) is prescribed dapagliflozin 10 mg daily. The nurse should include which teaching point?
A. "This medication will improve your heart's pumping ability."
B. "You may notice increased urination and should stay well hydrated."
C. "Take this medication only if your blood sugar is elevated."
D. "This is a temporary medication until your ejection fraction improves."
[CORRECT] B
Rationale: The 2026 ACC/AHA/HFSA heart failure guidelines now recommend SGLT2 inhibitors
(dapagliflozin, empagliflozin) for HFpEF regardless of diabetes status, primarily for reducing
hospitalization and cardiovascular death; they work through diuresis and metabolic effects, not
by improving contractility. Option A is incorrect because SGLT2 inhibitors do not increase
ejection fraction in HFpEF. Option C is incorrect because these agents are indicated for HFpEF
independent of glycemic control. Option D is incorrect because SGLT2 inhibitors are chronic
therapy, not temporary. Test-taking tip: On ATI, remember SGLT2 inhibitors are now first-line for
ALL heart failure types (HFrEF, HFmrEF, HFpEF) – this is a high-yield 2026 update.
, 2 (Cardiovascular – Hypertension 2026): A 58-year-old client with newly diagnosed
Q
hypertension has a BP of 138/86 mmHg. According to the 2026 ACC/AHA guidelines, which is
the nurse's priority action?
A. Recommend lifestyle modifications and recheck in 3 months.
B. Initiate single antihypertensive therapy immediately.
C. Begin combination therapy with an ACE inhibitor and thiazide diuretic.
D. Obtain ambulatory blood pressure monitoring before any intervention.
[CORRECT] A
Rationale: The 2026 ACC/AHA hypertension guidelines maintain a target of <130/80 mmHg for
most adults, but a reading of 138/86 mmHg in a newly diagnosed, low-risk patient warrants
lifestyle modification (DASH diet, sodium restriction, exercise, weight loss) with reassessment in
3 months before pharmacologic intervention. Option B is premature without confirmed
hypertension or elevated cardiovascular risk. Option C is reserved for stage 2 hypertension
(≥140/90) or stage 1 with high ASCVD risk. Option D is useful for white-coat hypertension
evaluation but is not the priority first step. Test-taking tip: ATI tests knowledge of staging and
initial management – lifestyle modification is always the foundation for stage 1 hypertension
without compelling indications.
Q3 (Cardiovascular – CAD/MI): A client presents with chest pain, ST-elevation in leads V1-V4,
and is scheduled for primary PCI. The nurse notes the door-to-balloon time is 95 minutes.
Which action should the nurse take?
A. Document the time and continue preparation for PCI.
B. Notify the physician that the door-to-balloon time exceeds 90 minutes.
C. Administer fibrinolytic therapy immediately.
D. Request transfer to a facility with faster PCI capabilities.
[CORRECT] B
Rationale: Current AHA/ACC guidelines specify a door-to-balloon time of ≤90 minutes for
STEMI patients undergoing primary PCI; exceeding this threshold requires notification and may
trigger consideration of fibrinolytic therapy if PCI cannot be performed within 120 minutes of first
medical contact. Option A ignores the critical time benchmark. Option C should only be
considered if PCI cannot be achieved within 120 minutes total ischemic time. Option D is not
appropriate for a client already at a PCI-capable facility. Test-taking tip: ATI emphasizes
time-critical interventions – memorize door-to-balloon ≤90 min and door-to-needle ≤30 min for
STEMI.
Q4 (Cardiovascular – Dysrhythmias): A client with newly diagnosed nonvalvular atrial fibrillation
is started on anticoagulation. According to 2026 guidelines, which medication is preferred over
warfarin?
A. Aspirin 81 mg daily
B. Clopidogrel 75 mg daily
C. Apixaban 5 mg twice daily
D. Unfractionated heparin IV infusion
[CORRECT] C
Rationale: The 2026 ACC/AHA/HRS guidelines and multiple RCTs (ARISTOTLE, ROCKET-AF)
demonstrate that DOACs (apixaban, rivaroxaban, dabigatran, edoxaban) are preferred over
warfarin for nonvalvular AF due to lower risk of intracranial hemorrhage, fewer drug-food
,interactions, and no routine INR monitoring. Option A is inadequate stroke prevention for AF.
Option B is an antiplatelet, not an anticoagulant. Option D is for acute settings or bridging, not
long-term management. Test-taking tip: On ATI, "DOAC preferred over warfarin for nonvalvular
AF" is a recurring high-yield concept; remember apixaban has the best safety profile.
Q5 (Cardiovascular – Heart Failure): A client with acute decompensated heart failure has the
following vital signs: BP 92/58 mmHg, HR 118 bpm, RR 28/min, SpO2 89% on room air. Which
intervention should the nurse prioritize?
A. Administer furosemide 40 mg IV push
B. Initiate high-flow nasal cannula oxygen at 15 L/min
C. Prepare for inotropic support with dobutamine
D. Place the client in high-Fowler's position and administer oxygen
[CORRECT] D
Rationale: This client is in acute cardiogenic shock with hypoxemia; the priority is the ABCs –
positioning (high-Fowler's to reduce preload) and oxygenation to improve tissue perfusion
before pharmacologic interventions. Option A (diuresis) is contraindicated in hypotension as it
further reduces preload. Option B (high-flow nasal cannula) may be appropriate after initial
oxygen, but positioning comes first. Option C (inotropes) is indicated for persistent hypotension
after optimization of preload and afterload, not as the first intervention. Test-taking tip: ATI
prioritization questions follow ABCs; always address airway and breathing before circulation
pharmacology in acute decompensated HF.
Q6 (Cardiovascular – Peripheral Vascular Disease): A client with peripheral artery disease
(PAD) is prescribed cilostazol 100 mg twice daily. Which teaching should the nurse provide?
A. "Take this medication with food to reduce GI upset."
B. "You can expect relief from claudication pain within 1-2 weeks."
C. "This medication is contraindicated if you have heart failure."
D. "Stop taking this medication if you experience headaches."
[CORRECT] C
Rationale: Cilostazol is a phosphodiesterase-3 inhibitor that is absolutely contraindicated in
clients with heart failure of any severity due to increased mortality risk; this is an FDA black box
warning. Option A is incorrect because cilostazol should be taken on an empty stomach (30
minutes before or 2 hours after meals) for optimal absorption. Option B is incorrect because
therapeutic effects on claudication typically require 2-4 weeks or longer. Option D is incorrect
because headaches are common side effects that usually resolve with continued use and are
not a reason to discontinue. Test-taking tip: ATI frequently tests contraindications – cilostazol +
heart failure is a classic dangerous combination.
Q7 (Cardiovascular – Hypertension): A client taking lisinopril reports a dry, hacking cough. The
nurse anticipates which provider order?
A. Discontinue lisinopril and start losartan
B. Add dextromethorphan for cough suppression
C. Reduce the lisinopril dose and monitor
D. Switch to a calcium channel blocker
[CORRECT] A
Rationale: ACE inhibitor-induced cough (bradykinin-mediated) occurs in 5-20% of patients and
is an indication to switch to an ARB (losartan) which does not affect bradykinin metabolism; this
, is the standard of care per 2026 hypertension guidelines. Option B masks the symptom without
addressing the cause. Option C is ineffective because the cough is dose-independent. Option D
is a reasonable alternative but ARB substitution is preferred as it maintains RAAS blockade
benefits. Test-taking tip: On ATI, "ACE cough → switch to ARB" is a classic test question;
losartan is the prototypical ARB.
Q8 (Cardiovascular – CAD): A client with stable angina is prescribed ranolazine. The nurse
should teach the client to avoid which substance?
A. Grapefruit juice
B. Dairy products
C. Green leafy vegetables
D. Alcohol
[CORRECT] A
Rationale: Ranolazine is metabolized by CYP3A4 and P-glycoprotein; grapefruit juice inhibits
CYP3A4, leading to dangerous accumulation and QT prolongation risk. Option B is not relevant.
Option C (green leafy vegetables) affects warfarin, not ranolazine. Option D is not specifically
contraindicated. Test-taking tip: ATI tests drug-food interactions frequently – grapefruit juice +
CYP3A4 substrates (ranolazine, simvastatin, amiodarone) is high-yield.
Q9 (Cardiovascular – Dysrhythmias): A client is receiving amiodarone for ventricular
tachycardia. Which finding requires immediate nursing intervention?
A. Blue-gray skin discoloration
B. Thyroid-stimulating hormone (TSH) level of 0.2 mIU/L
C. Prolonged QT interval on ECG
D. Mild peripheral neuropathy
[CORRECT] C
Rationale: Amiodarone can cause torsades de pointes via QT prolongation; a QTc >500 ms or
an increase >60 ms from baseline requires immediate discontinuation and cardiac monitoring.
Option A (skin discoloration) is a known chronic side effect. Option B (low TSH) indicates
amiodarone-induced thyrotoxicosis or hypothyroidism requiring monitoring but not immediate
action. Option D (neuropathy) is a chronic adverse effect. Test-taking tip: On ATI, QT
prolongation with antiarrhythmics is always the priority because it can precipitate fatal
dysrhythmias.
Q10 (Cardiovascular – Heart Failure): A client with HFrEF is prescribed sacubitril/valsartan
(Entresto). The nurse should verify which laboratory value before administration?
A. Serum creatinine
B. Serum potassium
C. Blood urea nitrogen (BUN)
D. Serum sodium
[CORRECT] B
Rationale: Sacubitril/valsartan can cause hyperkalemia, especially when combined with ACE
inhibitors, ARBs, or spironolactone; baseline and periodic potassium monitoring is essential.
Option A (creatinine) is important but not the most critical pre-administration check. Option C
(BUN) is less specific. Option D (sodium) is relevant for hyponatremia in HF but not the priority
safety check for this medication. Test-taking tip: ATI emphasizes that sacubitril/valsartan is
A
PROCTORED EXAM 2026-2027
| Latest Update | Questions &
Verified Answers | RN Medical
Surgical | Pass Guaranteed -
A+ Graded
=======================================================================
=
========
PART A – MULTIPLE CHOICE (Q1‑85)
========================================================================
========
Q1 (Cardiovascular – Heart Failure 2026): A 72-year-old client with HFpEF (ejection fraction
55%) is prescribed dapagliflozin 10 mg daily. The nurse should include which teaching point?
A. "This medication will improve your heart's pumping ability."
B. "You may notice increased urination and should stay well hydrated."
C. "Take this medication only if your blood sugar is elevated."
D. "This is a temporary medication until your ejection fraction improves."
[CORRECT] B
Rationale: The 2026 ACC/AHA/HFSA heart failure guidelines now recommend SGLT2 inhibitors
(dapagliflozin, empagliflozin) for HFpEF regardless of diabetes status, primarily for reducing
hospitalization and cardiovascular death; they work through diuresis and metabolic effects, not
by improving contractility. Option A is incorrect because SGLT2 inhibitors do not increase
ejection fraction in HFpEF. Option C is incorrect because these agents are indicated for HFpEF
independent of glycemic control. Option D is incorrect because SGLT2 inhibitors are chronic
therapy, not temporary. Test-taking tip: On ATI, remember SGLT2 inhibitors are now first-line for
ALL heart failure types (HFrEF, HFmrEF, HFpEF) – this is a high-yield 2026 update.
, 2 (Cardiovascular – Hypertension 2026): A 58-year-old client with newly diagnosed
Q
hypertension has a BP of 138/86 mmHg. According to the 2026 ACC/AHA guidelines, which is
the nurse's priority action?
A. Recommend lifestyle modifications and recheck in 3 months.
B. Initiate single antihypertensive therapy immediately.
C. Begin combination therapy with an ACE inhibitor and thiazide diuretic.
D. Obtain ambulatory blood pressure monitoring before any intervention.
[CORRECT] A
Rationale: The 2026 ACC/AHA hypertension guidelines maintain a target of <130/80 mmHg for
most adults, but a reading of 138/86 mmHg in a newly diagnosed, low-risk patient warrants
lifestyle modification (DASH diet, sodium restriction, exercise, weight loss) with reassessment in
3 months before pharmacologic intervention. Option B is premature without confirmed
hypertension or elevated cardiovascular risk. Option C is reserved for stage 2 hypertension
(≥140/90) or stage 1 with high ASCVD risk. Option D is useful for white-coat hypertension
evaluation but is not the priority first step. Test-taking tip: ATI tests knowledge of staging and
initial management – lifestyle modification is always the foundation for stage 1 hypertension
without compelling indications.
Q3 (Cardiovascular – CAD/MI): A client presents with chest pain, ST-elevation in leads V1-V4,
and is scheduled for primary PCI. The nurse notes the door-to-balloon time is 95 minutes.
Which action should the nurse take?
A. Document the time and continue preparation for PCI.
B. Notify the physician that the door-to-balloon time exceeds 90 minutes.
C. Administer fibrinolytic therapy immediately.
D. Request transfer to a facility with faster PCI capabilities.
[CORRECT] B
Rationale: Current AHA/ACC guidelines specify a door-to-balloon time of ≤90 minutes for
STEMI patients undergoing primary PCI; exceeding this threshold requires notification and may
trigger consideration of fibrinolytic therapy if PCI cannot be performed within 120 minutes of first
medical contact. Option A ignores the critical time benchmark. Option C should only be
considered if PCI cannot be achieved within 120 minutes total ischemic time. Option D is not
appropriate for a client already at a PCI-capable facility. Test-taking tip: ATI emphasizes
time-critical interventions – memorize door-to-balloon ≤90 min and door-to-needle ≤30 min for
STEMI.
Q4 (Cardiovascular – Dysrhythmias): A client with newly diagnosed nonvalvular atrial fibrillation
is started on anticoagulation. According to 2026 guidelines, which medication is preferred over
warfarin?
A. Aspirin 81 mg daily
B. Clopidogrel 75 mg daily
C. Apixaban 5 mg twice daily
D. Unfractionated heparin IV infusion
[CORRECT] C
Rationale: The 2026 ACC/AHA/HRS guidelines and multiple RCTs (ARISTOTLE, ROCKET-AF)
demonstrate that DOACs (apixaban, rivaroxaban, dabigatran, edoxaban) are preferred over
warfarin for nonvalvular AF due to lower risk of intracranial hemorrhage, fewer drug-food
,interactions, and no routine INR monitoring. Option A is inadequate stroke prevention for AF.
Option B is an antiplatelet, not an anticoagulant. Option D is for acute settings or bridging, not
long-term management. Test-taking tip: On ATI, "DOAC preferred over warfarin for nonvalvular
AF" is a recurring high-yield concept; remember apixaban has the best safety profile.
Q5 (Cardiovascular – Heart Failure): A client with acute decompensated heart failure has the
following vital signs: BP 92/58 mmHg, HR 118 bpm, RR 28/min, SpO2 89% on room air. Which
intervention should the nurse prioritize?
A. Administer furosemide 40 mg IV push
B. Initiate high-flow nasal cannula oxygen at 15 L/min
C. Prepare for inotropic support with dobutamine
D. Place the client in high-Fowler's position and administer oxygen
[CORRECT] D
Rationale: This client is in acute cardiogenic shock with hypoxemia; the priority is the ABCs –
positioning (high-Fowler's to reduce preload) and oxygenation to improve tissue perfusion
before pharmacologic interventions. Option A (diuresis) is contraindicated in hypotension as it
further reduces preload. Option B (high-flow nasal cannula) may be appropriate after initial
oxygen, but positioning comes first. Option C (inotropes) is indicated for persistent hypotension
after optimization of preload and afterload, not as the first intervention. Test-taking tip: ATI
prioritization questions follow ABCs; always address airway and breathing before circulation
pharmacology in acute decompensated HF.
Q6 (Cardiovascular – Peripheral Vascular Disease): A client with peripheral artery disease
(PAD) is prescribed cilostazol 100 mg twice daily. Which teaching should the nurse provide?
A. "Take this medication with food to reduce GI upset."
B. "You can expect relief from claudication pain within 1-2 weeks."
C. "This medication is contraindicated if you have heart failure."
D. "Stop taking this medication if you experience headaches."
[CORRECT] C
Rationale: Cilostazol is a phosphodiesterase-3 inhibitor that is absolutely contraindicated in
clients with heart failure of any severity due to increased mortality risk; this is an FDA black box
warning. Option A is incorrect because cilostazol should be taken on an empty stomach (30
minutes before or 2 hours after meals) for optimal absorption. Option B is incorrect because
therapeutic effects on claudication typically require 2-4 weeks or longer. Option D is incorrect
because headaches are common side effects that usually resolve with continued use and are
not a reason to discontinue. Test-taking tip: ATI frequently tests contraindications – cilostazol +
heart failure is a classic dangerous combination.
Q7 (Cardiovascular – Hypertension): A client taking lisinopril reports a dry, hacking cough. The
nurse anticipates which provider order?
A. Discontinue lisinopril and start losartan
B. Add dextromethorphan for cough suppression
C. Reduce the lisinopril dose and monitor
D. Switch to a calcium channel blocker
[CORRECT] A
Rationale: ACE inhibitor-induced cough (bradykinin-mediated) occurs in 5-20% of patients and
is an indication to switch to an ARB (losartan) which does not affect bradykinin metabolism; this
, is the standard of care per 2026 hypertension guidelines. Option B masks the symptom without
addressing the cause. Option C is ineffective because the cough is dose-independent. Option D
is a reasonable alternative but ARB substitution is preferred as it maintains RAAS blockade
benefits. Test-taking tip: On ATI, "ACE cough → switch to ARB" is a classic test question;
losartan is the prototypical ARB.
Q8 (Cardiovascular – CAD): A client with stable angina is prescribed ranolazine. The nurse
should teach the client to avoid which substance?
A. Grapefruit juice
B. Dairy products
C. Green leafy vegetables
D. Alcohol
[CORRECT] A
Rationale: Ranolazine is metabolized by CYP3A4 and P-glycoprotein; grapefruit juice inhibits
CYP3A4, leading to dangerous accumulation and QT prolongation risk. Option B is not relevant.
Option C (green leafy vegetables) affects warfarin, not ranolazine. Option D is not specifically
contraindicated. Test-taking tip: ATI tests drug-food interactions frequently – grapefruit juice +
CYP3A4 substrates (ranolazine, simvastatin, amiodarone) is high-yield.
Q9 (Cardiovascular – Dysrhythmias): A client is receiving amiodarone for ventricular
tachycardia. Which finding requires immediate nursing intervention?
A. Blue-gray skin discoloration
B. Thyroid-stimulating hormone (TSH) level of 0.2 mIU/L
C. Prolonged QT interval on ECG
D. Mild peripheral neuropathy
[CORRECT] C
Rationale: Amiodarone can cause torsades de pointes via QT prolongation; a QTc >500 ms or
an increase >60 ms from baseline requires immediate discontinuation and cardiac monitoring.
Option A (skin discoloration) is a known chronic side effect. Option B (low TSH) indicates
amiodarone-induced thyrotoxicosis or hypothyroidism requiring monitoring but not immediate
action. Option D (neuropathy) is a chronic adverse effect. Test-taking tip: On ATI, QT
prolongation with antiarrhythmics is always the priority because it can precipitate fatal
dysrhythmias.
Q10 (Cardiovascular – Heart Failure): A client with HFrEF is prescribed sacubitril/valsartan
(Entresto). The nurse should verify which laboratory value before administration?
A. Serum creatinine
B. Serum potassium
C. Blood urea nitrogen (BUN)
D. Serum sodium
[CORRECT] B
Rationale: Sacubitril/valsartan can cause hyperkalemia, especially when combined with ACE
inhibitors, ARBs, or spironolactone; baseline and periodic potassium monitoring is essential.
Option A (creatinine) is important but not the most critical pre-administration check. Option C
(BUN) is less specific. Option D (sodium) is relevant for hyponatremia in HF but not the priority
safety check for this medication. Test-taking tip: ATI emphasizes that sacubitril/valsartan is
