MED SURG CMS PROCTORED EXAM | ATI NURSING EDUCATION | 2026/2027
ATI NURSING EDUCATION
MED SURG CMS PROCTORED EXAM
2026/2027 Questions and Verified Answers
Latest Update - 2026/2027 Official Exam
85 P/F N/A
QUESTIONS PASSING SCORE RECERTIFICATION
TABLE OF CONTENTS
Sec 1 Cardiovascular Disorders Q1-Q11
Sec 2 Respiratory Disorders Q12-Q22
Sec 3 Gastrointestinal Disorders Q23-Q33
Sec 4 Renal and Urinary Disorders Q34-Q43
Sec 5 Endocrine Disorders Q44-Q53
Sec 6 Neurologic Disorders Q54-Q63
Sec 7 Musculoskeletal and Integumentary Q64-Q74
Sec 8 Hematologic and Immunologic Q75-Q85
INSTRUCTIONS
Instructions: This proctored examination contains 85 multiple-choice questions divided across 8 clinical content areas. Each question has four
answer options with only one correct response. Select the single best answer for each question. Read each clinical scenario carefully before
selecting your response. You will receive a Pass or Fail result based on your overall performance.
MED SURG CMS PROCTORED EXAM - 2026/2027 | Passing Score: Pass/Fail | Page 1 of 34
, 1 Cardiovascular Disorders Q1-Q11
Question 1
A 58-year-old man presents to the emergency department with crushing substernal chest pain radiating to the left arm,
diaphoresis, and nausea that began 45 minutes ago. His ECG reveals ST-segment elevation in leads V2 through V4.
Troponin I is markedly elevated. The nurse anticipates that the priority intervention is:
A. Obtaining a 12-lead ECG every 30 minutes to monitor for rhythm changes
B. Administering IV thrombolytic therapy or activating the cardiac catheterization lab for percutaneous coronary intervention
C. Administering IV nitroglycerin to relieve chest pain and reduce myocardial oxygen demand
D. Initiating beta-blocker therapy to reduce heart rate and myocardial workload
Correct Answer: B
Rationale:
The patient is experiencing an ST-elevation myocardial infarction (STEMI), and the priority intervention is prompt reperfusion either
via thrombolytic therapy or percutaneous coronary intervention (PCI). While nitroglycerin and beta-blockers are part of the overall
management, they do not restore coronary blood flow to the infarct-related artery, which is the definitive treatment to limit myocardial
damage.
Question 2
A 72-year-old woman with a history of heart failure is admitted with worsening dyspnea, orthopnea, and 3+ pitting edema in
both lower extremities. Her brain natriuretic peptide level is 1,200 pg/mL. The nurse understands that the primary
pathophysiologic mechanism responsible for her peripheral edema is:
A. Decreased cardiac output leading to activation of the renin-angiotensin-aldosterone system and sodium and water retention
B. Increased pulmonary vascular resistance causing right ventricular failure and systemic venous congestion
C. Reduced renal perfusion stimulating erythropoietin release and increasing blood volume
D. Elevated left atrial pressure causing pulmonary capillary leakage and peripheral fluid accumulation
Correct Answer: B
Rationale:
In right-sided heart failure, increased pulmonary vascular resistance and right ventricular dysfunction lead to systemic venous
congestion, which is the direct cause of peripheral edema. While the renin-angiotensin-aldosterone system does contribute to
volume overload, the peripheral edema in this context is most directly caused by systemic venous congestion from right ventricular
failure.
Question 3
A 65-year-old man with persistent atrial fibrillation is prescribed warfarin for stroke prevention. During a follow-up visit, his
INR is 5.2 with no active bleeding. The nurse should anticipate that the provider will order:
A. Administration of IV vitamin K to rapidly reverse anticoagulation effects
B. Holding the next dose of warfarin and rechecking the INR in 24 to 48 hours
C. Administering fresh frozen plasma to correct the coagulopathy immediately
D. Switching to a direct oral anticoagulant without further warfarin doses
MED SURG CMS PROCTORED EXAM - 2026/2027 | Passing Score: Pass/Fail | Page 2 of 34
,Correct Answer: C
Rationale:
An INR above 5.0 without active bleeding is managed by holding warfarin and monitoring, but the standard approach also includes
holding the dose and possibly giving a small dose of oral vitamin K depending on clinical context. Fresh frozen plasma is reserved
for life-threatening bleeding, not an asymptomatic elevated INR. The safest outpatient strategy for an INR of 5.2 without bleeding is
to hold warfarin and recheck within 24 to 48 hours.
Question 4
A 49-year-old man with no significant medical history presents with sudden-onset, tearing chest pain radiating to the back
between the scapulae. His blood pressure is 180/110 mm Hg in the right arm and 142/88 mm Hg in the left arm. The nurse
recognizes that the most critical initial nursing action is:
A. Obtaining a stat chest CT angiogram to confirm the suspected diagnosis of aortic dissection
B. Administering IV labetalol to reduce blood pressure and shear force on the aortic wall
C. Preparing the patient for emergent surgical repair of the ascending aorta
D. Administering IV morphine to control pain and reduce sympathetic stimulation
Correct Answer: B
Rationale:
In suspected aortic dissection, the most critical initial action is reducing blood pressure and heart rate to decrease shear force on the
aortic wall, preventing further dissection. Beta-blockers such as labetalol are the first-line agents. While diagnostic imaging and pain
control are important, reducing hemodynamic stress on the aorta takes priority to prevent catastrophic rupture.
Question 5
A 34-year-old man with a history of intravenous drug use is admitted with fever, chills, and a new holosystolic murmur at the
left lower sternal border. Blood cultures grow Staphylococcus aureus. Echocardiography reveals a 12-mm vegetation on the
tricuspid valve. The nurse identifies that the most common complication of infective endocarditis involving the tricuspid
valve is:
A. Systemic embolization to the brain resulting in hemorrhagic stroke
B. Septic pulmonary emboli causing multiple lung abscesses and infiltrates
C. Acute renal failure from immune complex glomerulonephritis
D. Complete heart block from extension of infection into the conduction system
Correct Answer: B
Rationale:
Right-sided infective endocarditis involving the tricuspid valve commonly results in septic pulmonary emboli, which can cause lung
abscesses, infiltrates, and pleuritic chest pain. Systemic emboli are characteristic of left-sided endocarditis. While glomerulonephritis
and conduction abnormalities can occur, septic pulmonary emboli are the most frequent complication of tricuspid valve involvement.
Question 6
A 61-year-old woman with type 2 diabetes reports increasing bilateral calf pain when walking uphill that resolves after 5
minutes of rest. On examination, her posterior tibial pulses are diminished bilaterally, and her ankle-brachial index is 0.65.
The nurse understands that the most appropriate initial management for this patient with peripheral arterial disease is:
A. Initiating a structured walking exercise program and starting a high-intensity statin
MED SURG CMS PROCTORED EXAM - 2026/2027 | Passing Score: Pass/Fail | Page 3 of 34
, B. Referring for lower extremity angiography and possible stent placement immediately
C. Prescribing cilostazol as a first-line monotherapy without lifestyle modifications
D. Scheduling the patient for a femoral-popliteal bypass graft procedure
Correct Answer: C
Rationale:
The gold-standard initial management for claudication from peripheral arterial disease includes a structured supervised walking
exercise program and high-intensity statin therapy to reduce cardiovascular risk and improve symptoms. Cilostazol can be added as
an adjunct but is not first-line monotherapy. Revascularization procedures are reserved for lifestyle-limiting claudication refractory to
medical therapy or for limb-threatening ischemia.
Question 7
A 47-year-old woman who underwent a total knee replacement 10 days ago presents with unilateral left calf swelling,
tenderness, and warmth. A Doppler ultrasound confirms a deep vein thrombosis in the left popliteal vein. The nurse
anticipates that the provider will initiate:
A. IV unfractionated heparin infusion with aPTT monitoring, followed by transition to oral anticoagulation
B. Subcutaneous low-molecular-weight heparin as a bridge to warfarin or direct oral anticoagulant therapy
C. Oral warfarin alone without parenteral anticoagulation because the DVT is distal
D. Thrombolytic therapy with alteplase to dissolve the clot and restore venous patency
Correct Answer: B
Rationale:
For acute deep vein thrombosis, the standard initial treatment is parenteral anticoagulation with low-molecular-weight heparin
bridged to a direct oral anticoagulant or warfarin. IV unfractionated heparin is reserved for patients with high bleeding risk or renal
failure. Thrombolytics are reserved for massive iliofemoral DVT with limb threat, not a popliteal DVT.
Question 8
A 55-year-old man with a history of hypertension and hyperlipidemia is diagnosed with an abdominal aortic aneurysm
measuring 4.8 cm in diameter. He is currently asymptomatic. The nurse recognizes that the appropriate management at
this time is:
A. Immediate referral for endovascular aneurysm repair because the diameter exceeds 4.5 cm
B. Continued surveillance imaging every 6 to 12 months with aggressive blood pressure and lipid management
C. Open surgical repair to prevent the high risk of rupture at this aneurysm size
D. Prescribing a beta-blocker only and rechecking the aneurysm size in 5 years
Correct Answer: C
Rationale:
Abdominal aortic aneurysms between 4.0 and 5.4 cm in diameter are managed conservatively with serial surveillance imaging every
6 to 12 months and aggressive cardiovascular risk factor modification including blood pressure and lipid control. Elective repair is
generally indicated when the aneurysm reaches 5.5 cm or grows more than 1 cm per year. Beta-blockers alone without surveillance
would be inappropriate.
Question 9
MED SURG CMS PROCTORED EXAM - 2026/2027 | Passing Score: Pass/Fail | Page 4 of 34
ATI NURSING EDUCATION
MED SURG CMS PROCTORED EXAM
2026/2027 Questions and Verified Answers
Latest Update - 2026/2027 Official Exam
85 P/F N/A
QUESTIONS PASSING SCORE RECERTIFICATION
TABLE OF CONTENTS
Sec 1 Cardiovascular Disorders Q1-Q11
Sec 2 Respiratory Disorders Q12-Q22
Sec 3 Gastrointestinal Disorders Q23-Q33
Sec 4 Renal and Urinary Disorders Q34-Q43
Sec 5 Endocrine Disorders Q44-Q53
Sec 6 Neurologic Disorders Q54-Q63
Sec 7 Musculoskeletal and Integumentary Q64-Q74
Sec 8 Hematologic and Immunologic Q75-Q85
INSTRUCTIONS
Instructions: This proctored examination contains 85 multiple-choice questions divided across 8 clinical content areas. Each question has four
answer options with only one correct response. Select the single best answer for each question. Read each clinical scenario carefully before
selecting your response. You will receive a Pass or Fail result based on your overall performance.
MED SURG CMS PROCTORED EXAM - 2026/2027 | Passing Score: Pass/Fail | Page 1 of 34
, 1 Cardiovascular Disorders Q1-Q11
Question 1
A 58-year-old man presents to the emergency department with crushing substernal chest pain radiating to the left arm,
diaphoresis, and nausea that began 45 minutes ago. His ECG reveals ST-segment elevation in leads V2 through V4.
Troponin I is markedly elevated. The nurse anticipates that the priority intervention is:
A. Obtaining a 12-lead ECG every 30 minutes to monitor for rhythm changes
B. Administering IV thrombolytic therapy or activating the cardiac catheterization lab for percutaneous coronary intervention
C. Administering IV nitroglycerin to relieve chest pain and reduce myocardial oxygen demand
D. Initiating beta-blocker therapy to reduce heart rate and myocardial workload
Correct Answer: B
Rationale:
The patient is experiencing an ST-elevation myocardial infarction (STEMI), and the priority intervention is prompt reperfusion either
via thrombolytic therapy or percutaneous coronary intervention (PCI). While nitroglycerin and beta-blockers are part of the overall
management, they do not restore coronary blood flow to the infarct-related artery, which is the definitive treatment to limit myocardial
damage.
Question 2
A 72-year-old woman with a history of heart failure is admitted with worsening dyspnea, orthopnea, and 3+ pitting edema in
both lower extremities. Her brain natriuretic peptide level is 1,200 pg/mL. The nurse understands that the primary
pathophysiologic mechanism responsible for her peripheral edema is:
A. Decreased cardiac output leading to activation of the renin-angiotensin-aldosterone system and sodium and water retention
B. Increased pulmonary vascular resistance causing right ventricular failure and systemic venous congestion
C. Reduced renal perfusion stimulating erythropoietin release and increasing blood volume
D. Elevated left atrial pressure causing pulmonary capillary leakage and peripheral fluid accumulation
Correct Answer: B
Rationale:
In right-sided heart failure, increased pulmonary vascular resistance and right ventricular dysfunction lead to systemic venous
congestion, which is the direct cause of peripheral edema. While the renin-angiotensin-aldosterone system does contribute to
volume overload, the peripheral edema in this context is most directly caused by systemic venous congestion from right ventricular
failure.
Question 3
A 65-year-old man with persistent atrial fibrillation is prescribed warfarin for stroke prevention. During a follow-up visit, his
INR is 5.2 with no active bleeding. The nurse should anticipate that the provider will order:
A. Administration of IV vitamin K to rapidly reverse anticoagulation effects
B. Holding the next dose of warfarin and rechecking the INR in 24 to 48 hours
C. Administering fresh frozen plasma to correct the coagulopathy immediately
D. Switching to a direct oral anticoagulant without further warfarin doses
MED SURG CMS PROCTORED EXAM - 2026/2027 | Passing Score: Pass/Fail | Page 2 of 34
,Correct Answer: C
Rationale:
An INR above 5.0 without active bleeding is managed by holding warfarin and monitoring, but the standard approach also includes
holding the dose and possibly giving a small dose of oral vitamin K depending on clinical context. Fresh frozen plasma is reserved
for life-threatening bleeding, not an asymptomatic elevated INR. The safest outpatient strategy for an INR of 5.2 without bleeding is
to hold warfarin and recheck within 24 to 48 hours.
Question 4
A 49-year-old man with no significant medical history presents with sudden-onset, tearing chest pain radiating to the back
between the scapulae. His blood pressure is 180/110 mm Hg in the right arm and 142/88 mm Hg in the left arm. The nurse
recognizes that the most critical initial nursing action is:
A. Obtaining a stat chest CT angiogram to confirm the suspected diagnosis of aortic dissection
B. Administering IV labetalol to reduce blood pressure and shear force on the aortic wall
C. Preparing the patient for emergent surgical repair of the ascending aorta
D. Administering IV morphine to control pain and reduce sympathetic stimulation
Correct Answer: B
Rationale:
In suspected aortic dissection, the most critical initial action is reducing blood pressure and heart rate to decrease shear force on the
aortic wall, preventing further dissection. Beta-blockers such as labetalol are the first-line agents. While diagnostic imaging and pain
control are important, reducing hemodynamic stress on the aorta takes priority to prevent catastrophic rupture.
Question 5
A 34-year-old man with a history of intravenous drug use is admitted with fever, chills, and a new holosystolic murmur at the
left lower sternal border. Blood cultures grow Staphylococcus aureus. Echocardiography reveals a 12-mm vegetation on the
tricuspid valve. The nurse identifies that the most common complication of infective endocarditis involving the tricuspid
valve is:
A. Systemic embolization to the brain resulting in hemorrhagic stroke
B. Septic pulmonary emboli causing multiple lung abscesses and infiltrates
C. Acute renal failure from immune complex glomerulonephritis
D. Complete heart block from extension of infection into the conduction system
Correct Answer: B
Rationale:
Right-sided infective endocarditis involving the tricuspid valve commonly results in septic pulmonary emboli, which can cause lung
abscesses, infiltrates, and pleuritic chest pain. Systemic emboli are characteristic of left-sided endocarditis. While glomerulonephritis
and conduction abnormalities can occur, septic pulmonary emboli are the most frequent complication of tricuspid valve involvement.
Question 6
A 61-year-old woman with type 2 diabetes reports increasing bilateral calf pain when walking uphill that resolves after 5
minutes of rest. On examination, her posterior tibial pulses are diminished bilaterally, and her ankle-brachial index is 0.65.
The nurse understands that the most appropriate initial management for this patient with peripheral arterial disease is:
A. Initiating a structured walking exercise program and starting a high-intensity statin
MED SURG CMS PROCTORED EXAM - 2026/2027 | Passing Score: Pass/Fail | Page 3 of 34
, B. Referring for lower extremity angiography and possible stent placement immediately
C. Prescribing cilostazol as a first-line monotherapy without lifestyle modifications
D. Scheduling the patient for a femoral-popliteal bypass graft procedure
Correct Answer: C
Rationale:
The gold-standard initial management for claudication from peripheral arterial disease includes a structured supervised walking
exercise program and high-intensity statin therapy to reduce cardiovascular risk and improve symptoms. Cilostazol can be added as
an adjunct but is not first-line monotherapy. Revascularization procedures are reserved for lifestyle-limiting claudication refractory to
medical therapy or for limb-threatening ischemia.
Question 7
A 47-year-old woman who underwent a total knee replacement 10 days ago presents with unilateral left calf swelling,
tenderness, and warmth. A Doppler ultrasound confirms a deep vein thrombosis in the left popliteal vein. The nurse
anticipates that the provider will initiate:
A. IV unfractionated heparin infusion with aPTT monitoring, followed by transition to oral anticoagulation
B. Subcutaneous low-molecular-weight heparin as a bridge to warfarin or direct oral anticoagulant therapy
C. Oral warfarin alone without parenteral anticoagulation because the DVT is distal
D. Thrombolytic therapy with alteplase to dissolve the clot and restore venous patency
Correct Answer: B
Rationale:
For acute deep vein thrombosis, the standard initial treatment is parenteral anticoagulation with low-molecular-weight heparin
bridged to a direct oral anticoagulant or warfarin. IV unfractionated heparin is reserved for patients with high bleeding risk or renal
failure. Thrombolytics are reserved for massive iliofemoral DVT with limb threat, not a popliteal DVT.
Question 8
A 55-year-old man with a history of hypertension and hyperlipidemia is diagnosed with an abdominal aortic aneurysm
measuring 4.8 cm in diameter. He is currently asymptomatic. The nurse recognizes that the appropriate management at
this time is:
A. Immediate referral for endovascular aneurysm repair because the diameter exceeds 4.5 cm
B. Continued surveillance imaging every 6 to 12 months with aggressive blood pressure and lipid management
C. Open surgical repair to prevent the high risk of rupture at this aneurysm size
D. Prescribing a beta-blocker only and rechecking the aneurysm size in 5 years
Correct Answer: C
Rationale:
Abdominal aortic aneurysms between 4.0 and 5.4 cm in diameter are managed conservatively with serial surveillance imaging every
6 to 12 months and aggressive cardiovascular risk factor modification including blood pressure and lipid control. Elective repair is
generally indicated when the aneurysm reaches 5.5 cm or grows more than 1 cm per year. Beta-blockers alone without surveillance
would be inappropriate.
Question 9
MED SURG CMS PROCTORED EXAM - 2026/2027 | Passing Score: Pass/Fail | Page 4 of 34
