RN ATI Advanced Medical Surgical Proctored EXAM
2023-2024 WITH NGN ACTUAL REAL EXAM
ACCURATE QUESTIONS AND ANSWERS WITH
RATIONALES | VERIFIED AND LATEST
UPDATED | GUARANTEED PASS
Question 1:
A patient with acute myocardial infarction (MI) is receiving thrombolytic therapy.
Which assessment finding indicates the therapy is effective?
A. Increased ST-segment elevation
B. Resolution of chest pain and ST-segment return to baseline
C. Development of new Q waves
D. Increased cardiac enzyme levels
Correct Answer: B. Resolution of chest pain and ST-segment return to baseline
Rationale: Successful thrombolytic therapy is indicated by resolution of chest
pain, return of ST-segments to baseline (or > 50% reduction), and reperfusion
arrhythmias. Development of new Q waves indicates myocardial necrosis. Cardiac
enzymes peak after MI and are not immediate indicators of successful
thrombolysis. The patient should be monitored for signs of bleeding, a major
complication of thrombolytic therapy.
Question 2:
A patient with heart failure is prescribed digoxin and furosemide. The nurse should
monitor for which electrolyte imbalance that increases the risk of digoxin toxicity?
A. Hyperkalemia
B. Hypokalemia
C. Hyponatremia
D. Hypercalcemia
Correct Answer: B. Hypokalemia
Rationale: Furosemide is a loop diuretic that causes potassium loss. Hypokalemia
increases the risk of digoxin toxicity by enhancing the binding of digoxin to the
Na+/K+-ATPase pump. Signs of digoxin toxicity include nausea, vomiting, visual
,disturbances (yellow-green halos), and cardiac arrhythmias. Serum potassium
should be maintained within normal limits (3.5-5.0 mEq/L) in patients on digoxin.
Question 3:
A patient with unstable angina is prescribed clopidogrel. The nurse understands
that this medication:
A. Inhibits platelet aggregation by blocking glycoprotein IIb/IIIa receptors
B. Is a prodrug that requires CYP2C19 activation to inhibit platelet
aggregation
C. Is a direct thrombin inhibitor
D. Inhibits vitamin K-dependent clotting factors
Correct Answer: B. Is a prodrug that requires CYP2C19 activation to inhibit
platelet aggregation
Rationale: Clopidogrel is a prodrug that requires hepatic metabolism by CYP2C19
to become active. The active metabolite irreversibly inhibits the P2Y12 ADP
receptor on platelets, preventing platelet aggregation. Patients with CYP2C19
genetic polymorphisms may have reduced efficacy. Concomitant use of CYP2C19
inhibitors (omeprazole) should be avoided.
Question 4:
A patient with atrial fibrillation is started on warfarin. The nurse should teach the
patient to avoid which food?
A. Grapefruit juice
B. Leafy green vegetables (high in vitamin K)
C. Dairy products
D. Caffeine
Correct Answer: B. Leafy green vegetables (high in vitamin K)
Rationale: Warfarin inhibits vitamin K-dependent clotting factors. Foods high in
vitamin K (leafy green vegetables: spinach, kale, broccoli) can decrease the
anticoagulant effect of warfarin. Patients should maintain consistent vitamin K
intake and avoid large fluctuations. Grapefruit juice interacts with statins and
calcium channel blockers, not warfarin. Regular INR monitoring is essential.
,Question 5:
A patient with peripheral arterial disease (PAD) reports leg pain that occurs with
walking and is relieved by rest. The nurse documents this as:
A. Neuropathic pain
B. Venous insufficiency
C. Intermittent claudication
D. Rest pain
Correct Answer: C. Intermittent claudication
Rationale: Intermittent claudication is pain in the lower extremities that occurs
with exercise (walking) and is relieved by rest. It is caused by inadequate blood
flow due to arterial stenosis. Rest pain is a more severe symptom that occurs at rest
and indicates critical limb ischemia. Venous insufficiency typically causes
swelling, skin changes, and pain that improves with elevation.
Question 6:
A patient with heart failure has crackles in the lung bases, jugular venous
distention, and peripheral edema. The nurse should anticipate which medication
order?
A. Furosemide (Lasix)
B. Digoxin
C. Metoprolol
D. Spironolactone
Correct Answer: A. Furosemide (Lasix)
Rationale: The patient is showing signs of fluid overload (crackles, JVD, edema),
indicating worsening heart failure. Furosemide is a loop diuretic that will reduce
fluid volume, relieve pulmonary congestion, and decrease edema. Digoxin
improves contractility but does not address fluid overload directly. Metoprolol is a
beta-blocker used for chronic HF management, not acute decompensation.
Spironolactone is a potassium-sparing diuretic used as an adjunct.
, Question 7:
A patient post-MI is prescribed metoprolol. The nurse understands that the purpose
of this medication is to:
A. Increase cardiac contractility
B. Decrease myocardial oxygen demand by reducing heart rate and
contractility
C. Dilate coronary arteries
D. Reduce platelet aggregation
Correct Answer: B. Decrease myocardial oxygen demand by reducing heart rate
and contractility
Rationale: Metoprolol is a cardioselective beta-1 blocker that reduces heart rate
and myocardial contractility, decreasing myocardial oxygen demand. This is
beneficial post-MI to prevent further ischemia and reduce mortality. It also reduces
the risk of arrhythmias. The dose should be titrated to achieve a resting heart rate
of 50-60 bpm, and it should be used cautiously in patients with heart block or
asthma.
Question 8:
A patient with suspected myocardial infarction has an elevated troponin I level.
The nurse understands that troponin I:
A. Is a cardiac-specific biomarker that indicates myocardial necrosis
B. Is elevated in all types of chest pain
C. Returns to normal within 24 hours
D. Is only elevated in unstable angina
Correct Answer: A. Is a cardiac-specific biomarker that indicates myocardial
necrosis
Rationale: Troponin I is a cardiac-specific protein that is released into the
bloodstream when myocardial necrosis occurs. It is the preferred biomarker for MI
diagnosis due to its high sensitivity and specificity. It rises within 3-4 hours of MI,
peaks at 12-24 hours, and remains elevated for 7-10 days. Unlike CK-MB,
troponin I is not found in skeletal muscle, making it more specific.
2023-2024 WITH NGN ACTUAL REAL EXAM
ACCURATE QUESTIONS AND ANSWERS WITH
RATIONALES | VERIFIED AND LATEST
UPDATED | GUARANTEED PASS
Question 1:
A patient with acute myocardial infarction (MI) is receiving thrombolytic therapy.
Which assessment finding indicates the therapy is effective?
A. Increased ST-segment elevation
B. Resolution of chest pain and ST-segment return to baseline
C. Development of new Q waves
D. Increased cardiac enzyme levels
Correct Answer: B. Resolution of chest pain and ST-segment return to baseline
Rationale: Successful thrombolytic therapy is indicated by resolution of chest
pain, return of ST-segments to baseline (or > 50% reduction), and reperfusion
arrhythmias. Development of new Q waves indicates myocardial necrosis. Cardiac
enzymes peak after MI and are not immediate indicators of successful
thrombolysis. The patient should be monitored for signs of bleeding, a major
complication of thrombolytic therapy.
Question 2:
A patient with heart failure is prescribed digoxin and furosemide. The nurse should
monitor for which electrolyte imbalance that increases the risk of digoxin toxicity?
A. Hyperkalemia
B. Hypokalemia
C. Hyponatremia
D. Hypercalcemia
Correct Answer: B. Hypokalemia
Rationale: Furosemide is a loop diuretic that causes potassium loss. Hypokalemia
increases the risk of digoxin toxicity by enhancing the binding of digoxin to the
Na+/K+-ATPase pump. Signs of digoxin toxicity include nausea, vomiting, visual
,disturbances (yellow-green halos), and cardiac arrhythmias. Serum potassium
should be maintained within normal limits (3.5-5.0 mEq/L) in patients on digoxin.
Question 3:
A patient with unstable angina is prescribed clopidogrel. The nurse understands
that this medication:
A. Inhibits platelet aggregation by blocking glycoprotein IIb/IIIa receptors
B. Is a prodrug that requires CYP2C19 activation to inhibit platelet
aggregation
C. Is a direct thrombin inhibitor
D. Inhibits vitamin K-dependent clotting factors
Correct Answer: B. Is a prodrug that requires CYP2C19 activation to inhibit
platelet aggregation
Rationale: Clopidogrel is a prodrug that requires hepatic metabolism by CYP2C19
to become active. The active metabolite irreversibly inhibits the P2Y12 ADP
receptor on platelets, preventing platelet aggregation. Patients with CYP2C19
genetic polymorphisms may have reduced efficacy. Concomitant use of CYP2C19
inhibitors (omeprazole) should be avoided.
Question 4:
A patient with atrial fibrillation is started on warfarin. The nurse should teach the
patient to avoid which food?
A. Grapefruit juice
B. Leafy green vegetables (high in vitamin K)
C. Dairy products
D. Caffeine
Correct Answer: B. Leafy green vegetables (high in vitamin K)
Rationale: Warfarin inhibits vitamin K-dependent clotting factors. Foods high in
vitamin K (leafy green vegetables: spinach, kale, broccoli) can decrease the
anticoagulant effect of warfarin. Patients should maintain consistent vitamin K
intake and avoid large fluctuations. Grapefruit juice interacts with statins and
calcium channel blockers, not warfarin. Regular INR monitoring is essential.
,Question 5:
A patient with peripheral arterial disease (PAD) reports leg pain that occurs with
walking and is relieved by rest. The nurse documents this as:
A. Neuropathic pain
B. Venous insufficiency
C. Intermittent claudication
D. Rest pain
Correct Answer: C. Intermittent claudication
Rationale: Intermittent claudication is pain in the lower extremities that occurs
with exercise (walking) and is relieved by rest. It is caused by inadequate blood
flow due to arterial stenosis. Rest pain is a more severe symptom that occurs at rest
and indicates critical limb ischemia. Venous insufficiency typically causes
swelling, skin changes, and pain that improves with elevation.
Question 6:
A patient with heart failure has crackles in the lung bases, jugular venous
distention, and peripheral edema. The nurse should anticipate which medication
order?
A. Furosemide (Lasix)
B. Digoxin
C. Metoprolol
D. Spironolactone
Correct Answer: A. Furosemide (Lasix)
Rationale: The patient is showing signs of fluid overload (crackles, JVD, edema),
indicating worsening heart failure. Furosemide is a loop diuretic that will reduce
fluid volume, relieve pulmonary congestion, and decrease edema. Digoxin
improves contractility but does not address fluid overload directly. Metoprolol is a
beta-blocker used for chronic HF management, not acute decompensation.
Spironolactone is a potassium-sparing diuretic used as an adjunct.
, Question 7:
A patient post-MI is prescribed metoprolol. The nurse understands that the purpose
of this medication is to:
A. Increase cardiac contractility
B. Decrease myocardial oxygen demand by reducing heart rate and
contractility
C. Dilate coronary arteries
D. Reduce platelet aggregation
Correct Answer: B. Decrease myocardial oxygen demand by reducing heart rate
and contractility
Rationale: Metoprolol is a cardioselective beta-1 blocker that reduces heart rate
and myocardial contractility, decreasing myocardial oxygen demand. This is
beneficial post-MI to prevent further ischemia and reduce mortality. It also reduces
the risk of arrhythmias. The dose should be titrated to achieve a resting heart rate
of 50-60 bpm, and it should be used cautiously in patients with heart block or
asthma.
Question 8:
A patient with suspected myocardial infarction has an elevated troponin I level.
The nurse understands that troponin I:
A. Is a cardiac-specific biomarker that indicates myocardial necrosis
B. Is elevated in all types of chest pain
C. Returns to normal within 24 hours
D. Is only elevated in unstable angina
Correct Answer: A. Is a cardiac-specific biomarker that indicates myocardial
necrosis
Rationale: Troponin I is a cardiac-specific protein that is released into the
bloodstream when myocardial necrosis occurs. It is the preferred biomarker for MI
diagnosis due to its high sensitivity and specificity. It rises within 3-4 hours of MI,
peaks at 12-24 hours, and remains elevated for 7-10 days. Unlike CK-MB,
troponin I is not found in skeletal muscle, making it more specific.
