TI MED SURG CMS PROCTORED
A
EXAM 2026-2027 | Latest Update |
Questions & Verified Answers | RN
Medical Surgical | Pass
Guaranteed - A+ Graded
=======================================================================
=
========
PART A – MULTIPLE CHOICE (Q1-85)
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========
* *Q1 (Cardiovascular – Heart Failure 2026):** A 68-year-old male with HFpEF (EF 55%) and
NYHA Class II symptoms presents for follow-up. His BP is 138/82 mmHg, HR 76 bpm. Current
meds: lisinopril 20 mg, furosemide 40 mg. According to 2026 heart failure guidelines, which
medication should be added next?
A. Digoxin 0.125 mg daily
B. Dapagliflozin 10 mg daily
C. Sacubitril/valsartan 49/51 mg BID
D. Hydralazine/isosorbide dinitrate
* *[CORRECT]** B
*Rationale: The 2026 ACC/AHA/HFSA heart failure guidelines now recommend SGLT2
inhibitors (dapagliflozin or empagliflozin) for HFpEF regardless of diabetes status, based on
DELIVER and EMPEROR-Preserved trials showing reduced CV death and hospitalization.
Digoxin is not indicated for HFpEF and may be harmful; sacubitril/valsartan is for HFrEF;
hydralazine/nitrates are for HFrEF in Black patients. Test tip: ATI emphasizes new 2026 HFpEF
updates—SGLT2i is now Class I recommendation for all HF patients.*
* *Q2 (Cardiovascular – Hypertension 2026):** A 45-year-old African American male has BP
142/88 mmHg on two occasions. He has no diabetes, CKD, or CVD. According to 2026
ACC/AHA guidelines, what is the target BP for this patient?
A. <140/90 mmHg
, . <130/80 mmHg
B
C. <150/90 mmHg (age-adjusted)
D. <120/80 mmHg (intensive target)
* *[CORRECT]** B
*Rationale: The 2026 ACC/AHA hypertension guidelines maintain a target of <130/80 mmHg for
most adults, including African American patients without compelling indications for higher
targets. This reflects SPRINT trial data showing CV benefit with tighter control. <140/90 is
outdated; <150/90 applies only to adults >65 with high treatment burden; <120/80 is not the
general target. Test tip: ATI tests the updated 2026 target—memorize <130/80 for most adults.*
* *Q3 (Cardiovascular – CAD/MI):** A 62-year-old presents with chest pain. ECG shows ST
elevation in leads V1-V4. Vital signs: BP 88/56, HR 110, RR 24. Which intervention takes
highest priority?
A. Administer sublingual nitroglycerin
B. Obtain a 12-lead ECG
C. Activate the cath lab for primary PCI
D. Start heparin infusion
* *[CORRECT]** C
*Rationale: This patient has an anterior STEMI with hypotension (cardiogenic shock), making
immediate reperfusion via primary PCI the highest priority per ACC/AHA
guidelines—door-to-balloon time <90 minutes. Nitroglycerin is contraindicated with hypotension
(SBP <90); ECG is already obtained; heparin is adjunctive but reperfusion comes first. Test tip:
On ATI, "highest priority" in STEMI with shock always means reperfusion/PCI.*
* *Q4 (Cardiovascular – Atrial Fibrillation):** A 72-year-old with nonvalvular AFib (CHADS2-VASc
= 4) is started on anticoagulation. Which medication is preferred per 2026 guidelines?
A. Warfarin (INR 2.0-3.0)
B. Apixaban 5 mg BID
C. Aspirin 81 mg daily
D. Dabigatran 75 mg BID (reduced dose)
* *[CORRECT]** B
*Rationale: 2026 guidelines and the 2024 AHA/ACC/HRS AFib guideline update recommend
DOACs (apixaban, rivaroxaban, dabigatran, edoxaban) as preferred over warfarin for
nonvalvular AFib due to lower bleeding risk and no INR monitoring. Apixaban has the best
safety profile (ARISTOTLE trial). Warfarin is reserved for mechanical valves or moderate-severe
mitral stenosis; aspirin alone is insufficient; reduced-dose dabigatran is for CrCl 15-30. Test tip:
ATI consistently tests DOAC preference—apixaban is the most commonly correct answer for
standard nonvalvular AFib.*
* *Q5 (Cardiovascular – Heart Failure Monitoring):** A patient with HFrEF is educated about
daily weights. Which statement indicates correct understanding?
, . "I should weigh myself after eating breakfast."
A
B. "A 2-pound gain in one day means I should call my doctor."
C. "I only need to weigh myself when I feel swollen."
D. "I can use different scales as long as they are digital."
* *[CORRECT]** B
*Rationale: Heart failure patients should weigh daily at the same time (morning, after voiding,
before eating) using the same scale; a 2-3 lb gain in 1 day or 5 lb in 1 week indicates fluid
retention requiring provider notification. Weighing after breakfast introduces variability; weighing
only when symptomatic misses early decompensation; different scales reduce accuracy. Test
tip: ATI tests the "2 lb in 1 day, 5 lb in 1 week" rule consistently.*
* *Q6 (Cardiovascular – Dysrhythmias):** A patient with new-onset atrial flutter is on a telemetry
unit. The nurse notes a heart rate of 152 bpm with 2:1 conduction. The patient is
hemodynamically stable. Which medication is first-line for rate control?
A. Amiodarone
B. Metoprolol
C. Adenosine
D. Flecainide
* *[CORRECT]** B
*Rationale: For hemodynamically stable atrial flutter with rapid ventricular response,
beta-blockers (metoprolol, esmolol) or non-DHP calcium channel blockers (diltiazem) are
first-line for rate control per ACC/AHA guidelines. Amiodarone is for rhythm control or refractory
cases; adenosine is diagnostic (reveals flutter waves) or for SVT, not rate control; flecainide is
for rhythm control in stable patients without structural heart disease. Test tip: ATI distinguishes
rate vs. rhythm control—beta-blockers are the safest first-line rate control agents.*
* *Q7 (Cardiovascular – Peripheral Vascular Disease):** A patient with peripheral artery disease
(ABI 0.65) asks about exercise. Which instruction is most appropriate?
A. "Avoid walking to prevent pain."
B. "Walk until moderate pain occurs, rest, then resume."
C. "Only exercise when pain-free."
D. "Use a wheelchair for long distances."
* *[CORRECT]** B
*Rationale: Supervised exercise therapy for PAD involves walking to the point of moderate
claudication pain, resting until pain resolves, then resuming—this builds collateral circulation per
AHA/ACC guidelines. Avoiding walking worsens outcomes; pain-free exercise is insufficient
stimulus; wheelchair dependence promotes deconditioning. Test tip: ATI tests "walk to moderate
pain, rest, repeat" as the cornerstone of PAD rehabilitation.*
, * *Q8 (Cardiovascular – Hypertension Emergency):** A patient presents with BP 220/130 mmHg,
headache, and papilledema. No acute target organ damage is found on workup. How should the
nurse expect the provider to manage this?
A. Reduce MAP by 25% within the first hour using IV labetalol
B. Lower BP to <160/100 within 1 hour with oral agents
C. Reduce BP gradually over 24-48 hours with oral medications
D. Administer sublingual nifedipine for rapid reduction
* *[CORRECT]** C
*Rationale: This is hypertensive urgency (severe hypertension without acute target organ
damage), which requires gradual BP reduction over 24-48 hours with oral medications to
prevent cerebral, coronary, or renal hypoperfusion. Rapid reduction (25% in 1 hour) is for
hypertensive emergency with organ damage; sublingual nifedipine is dangerous due to
precipitous drops and is contraindicated. Test tip: ATI distinguishes urgency vs.
emergency—urgency = gradual oral; emergency = controlled IV reduction.*
* *Q9 (Cardiovascular – MI Complications):** Three days post-STEMI, a patient suddenly
develops hypotension, elevated JVP, clear lungs, and muffled heart sounds. Which complication
is most likely?
A. Papillary muscle rupture
B. Ventricular septal defect
C. Cardiac tamponade
D. Free wall rupture
* *[CORRECT]** C
*Rationale: Beck's triad (hypotension, elevated JVP, muffled heart sounds) with clear lungs
indicates cardiac tamponade, a complication of ventricular free wall rupture or post-MI
pericarditis. Papillary muscle rupture causes acute MR with pulmonary edema; VSD causes a
new harsh holosystolic murmur with biventricular failure; free wall rupture leads to tamponade
but the triad identifies tamponade itself. Test tip: Memorize Beck's triad for tamponade on
ATI—it's a classic exam question.*
* *Q10 (Cardiovascular – Anticoagulation Reversal):** A patient on apixaban presents with GI
bleeding and hemodynamic instability. Which reversal agent should the nurse prepare?
A. Vitamin K 10 mg IV
B. Protamine sulfate
C. Andexanet alfa
D. Fresh frozen plasma
* *[CORRECT]** C
*Rationale: Andexanet alfa is the FDA-approved reversal agent for apixaban and rivaroxaban
(factor Xa inhibitors) in life-threatening bleeding. Vitamin K reverses warfarin; protamine
reverses heparin; FFP is ineffective for DOAC reversal and carries volume overload risk. Test
A
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 68-year-old male with HFpEF (EF 55%) and
NYHA Class II symptoms presents for follow-up. His BP is 138/82 mmHg, HR 76 bpm. Current
meds: lisinopril 20 mg, furosemide 40 mg. According to 2026 heart failure guidelines, which
medication should be added next?
A. Digoxin 0.125 mg daily
B. Dapagliflozin 10 mg daily
C. Sacubitril/valsartan 49/51 mg BID
D. Hydralazine/isosorbide dinitrate
* *[CORRECT]** B
*Rationale: The 2026 ACC/AHA/HFSA heart failure guidelines now recommend SGLT2
inhibitors (dapagliflozin or empagliflozin) for HFpEF regardless of diabetes status, based on
DELIVER and EMPEROR-Preserved trials showing reduced CV death and hospitalization.
Digoxin is not indicated for HFpEF and may be harmful; sacubitril/valsartan is for HFrEF;
hydralazine/nitrates are for HFrEF in Black patients. Test tip: ATI emphasizes new 2026 HFpEF
updates—SGLT2i is now Class I recommendation for all HF patients.*
* *Q2 (Cardiovascular – Hypertension 2026):** A 45-year-old African American male has BP
142/88 mmHg on two occasions. He has no diabetes, CKD, or CVD. According to 2026
ACC/AHA guidelines, what is the target BP for this patient?
A. <140/90 mmHg
, . <130/80 mmHg
B
C. <150/90 mmHg (age-adjusted)
D. <120/80 mmHg (intensive target)
* *[CORRECT]** B
*Rationale: The 2026 ACC/AHA hypertension guidelines maintain a target of <130/80 mmHg for
most adults, including African American patients without compelling indications for higher
targets. This reflects SPRINT trial data showing CV benefit with tighter control. <140/90 is
outdated; <150/90 applies only to adults >65 with high treatment burden; <120/80 is not the
general target. Test tip: ATI tests the updated 2026 target—memorize <130/80 for most adults.*
* *Q3 (Cardiovascular – CAD/MI):** A 62-year-old presents with chest pain. ECG shows ST
elevation in leads V1-V4. Vital signs: BP 88/56, HR 110, RR 24. Which intervention takes
highest priority?
A. Administer sublingual nitroglycerin
B. Obtain a 12-lead ECG
C. Activate the cath lab for primary PCI
D. Start heparin infusion
* *[CORRECT]** C
*Rationale: This patient has an anterior STEMI with hypotension (cardiogenic shock), making
immediate reperfusion via primary PCI the highest priority per ACC/AHA
guidelines—door-to-balloon time <90 minutes. Nitroglycerin is contraindicated with hypotension
(SBP <90); ECG is already obtained; heparin is adjunctive but reperfusion comes first. Test tip:
On ATI, "highest priority" in STEMI with shock always means reperfusion/PCI.*
* *Q4 (Cardiovascular – Atrial Fibrillation):** A 72-year-old with nonvalvular AFib (CHADS2-VASc
= 4) is started on anticoagulation. Which medication is preferred per 2026 guidelines?
A. Warfarin (INR 2.0-3.0)
B. Apixaban 5 mg BID
C. Aspirin 81 mg daily
D. Dabigatran 75 mg BID (reduced dose)
* *[CORRECT]** B
*Rationale: 2026 guidelines and the 2024 AHA/ACC/HRS AFib guideline update recommend
DOACs (apixaban, rivaroxaban, dabigatran, edoxaban) as preferred over warfarin for
nonvalvular AFib due to lower bleeding risk and no INR monitoring. Apixaban has the best
safety profile (ARISTOTLE trial). Warfarin is reserved for mechanical valves or moderate-severe
mitral stenosis; aspirin alone is insufficient; reduced-dose dabigatran is for CrCl 15-30. Test tip:
ATI consistently tests DOAC preference—apixaban is the most commonly correct answer for
standard nonvalvular AFib.*
* *Q5 (Cardiovascular – Heart Failure Monitoring):** A patient with HFrEF is educated about
daily weights. Which statement indicates correct understanding?
, . "I should weigh myself after eating breakfast."
A
B. "A 2-pound gain in one day means I should call my doctor."
C. "I only need to weigh myself when I feel swollen."
D. "I can use different scales as long as they are digital."
* *[CORRECT]** B
*Rationale: Heart failure patients should weigh daily at the same time (morning, after voiding,
before eating) using the same scale; a 2-3 lb gain in 1 day or 5 lb in 1 week indicates fluid
retention requiring provider notification. Weighing after breakfast introduces variability; weighing
only when symptomatic misses early decompensation; different scales reduce accuracy. Test
tip: ATI tests the "2 lb in 1 day, 5 lb in 1 week" rule consistently.*
* *Q6 (Cardiovascular – Dysrhythmias):** A patient with new-onset atrial flutter is on a telemetry
unit. The nurse notes a heart rate of 152 bpm with 2:1 conduction. The patient is
hemodynamically stable. Which medication is first-line for rate control?
A. Amiodarone
B. Metoprolol
C. Adenosine
D. Flecainide
* *[CORRECT]** B
*Rationale: For hemodynamically stable atrial flutter with rapid ventricular response,
beta-blockers (metoprolol, esmolol) or non-DHP calcium channel blockers (diltiazem) are
first-line for rate control per ACC/AHA guidelines. Amiodarone is for rhythm control or refractory
cases; adenosine is diagnostic (reveals flutter waves) or for SVT, not rate control; flecainide is
for rhythm control in stable patients without structural heart disease. Test tip: ATI distinguishes
rate vs. rhythm control—beta-blockers are the safest first-line rate control agents.*
* *Q7 (Cardiovascular – Peripheral Vascular Disease):** A patient with peripheral artery disease
(ABI 0.65) asks about exercise. Which instruction is most appropriate?
A. "Avoid walking to prevent pain."
B. "Walk until moderate pain occurs, rest, then resume."
C. "Only exercise when pain-free."
D. "Use a wheelchair for long distances."
* *[CORRECT]** B
*Rationale: Supervised exercise therapy for PAD involves walking to the point of moderate
claudication pain, resting until pain resolves, then resuming—this builds collateral circulation per
AHA/ACC guidelines. Avoiding walking worsens outcomes; pain-free exercise is insufficient
stimulus; wheelchair dependence promotes deconditioning. Test tip: ATI tests "walk to moderate
pain, rest, repeat" as the cornerstone of PAD rehabilitation.*
, * *Q8 (Cardiovascular – Hypertension Emergency):** A patient presents with BP 220/130 mmHg,
headache, and papilledema. No acute target organ damage is found on workup. How should the
nurse expect the provider to manage this?
A. Reduce MAP by 25% within the first hour using IV labetalol
B. Lower BP to <160/100 within 1 hour with oral agents
C. Reduce BP gradually over 24-48 hours with oral medications
D. Administer sublingual nifedipine for rapid reduction
* *[CORRECT]** C
*Rationale: This is hypertensive urgency (severe hypertension without acute target organ
damage), which requires gradual BP reduction over 24-48 hours with oral medications to
prevent cerebral, coronary, or renal hypoperfusion. Rapid reduction (25% in 1 hour) is for
hypertensive emergency with organ damage; sublingual nifedipine is dangerous due to
precipitous drops and is contraindicated. Test tip: ATI distinguishes urgency vs.
emergency—urgency = gradual oral; emergency = controlled IV reduction.*
* *Q9 (Cardiovascular – MI Complications):** Three days post-STEMI, a patient suddenly
develops hypotension, elevated JVP, clear lungs, and muffled heart sounds. Which complication
is most likely?
A. Papillary muscle rupture
B. Ventricular septal defect
C. Cardiac tamponade
D. Free wall rupture
* *[CORRECT]** C
*Rationale: Beck's triad (hypotension, elevated JVP, muffled heart sounds) with clear lungs
indicates cardiac tamponade, a complication of ventricular free wall rupture or post-MI
pericarditis. Papillary muscle rupture causes acute MR with pulmonary edema; VSD causes a
new harsh holosystolic murmur with biventricular failure; free wall rupture leads to tamponade
but the triad identifies tamponade itself. Test tip: Memorize Beck's triad for tamponade on
ATI—it's a classic exam question.*
* *Q10 (Cardiovascular – Anticoagulation Reversal):** A patient on apixaban presents with GI
bleeding and hemodynamic instability. Which reversal agent should the nurse prepare?
A. Vitamin K 10 mg IV
B. Protamine sulfate
C. Andexanet alfa
D. Fresh frozen plasma
* *[CORRECT]** C
*Rationale: Andexanet alfa is the FDA-approved reversal agent for apixaban and rivaroxaban
(factor Xa inhibitors) in life-threatening bleeding. Vitamin K reverses warfarin; protamine
reverses heparin; FFP is ineffective for DOAC reversal and carries volume overload risk. Test
