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ATI RN MEDICAL SURGICAL PROCTORED EXAM 2025-2026
ACTUAL EXAM TEST BANK COMPLETE FREQUENTLY
TESTED QUESTIONS AND CORRECT DETAILE RATIONAILE,
ALREADY GRADED A+
Question 1 — Acute Coronary Syndrome (NSTEMI/STEMI) initial
management
A 64-year-old man arrives with chest pressure, diaphoresis, and an ECG
showing ST depressions in V2–V4. He is alert, SpO₂ 98% on room air, BP
142/86, HR 96. Which initial action should the nurse perform first?
A. Administer supplemental oxygen by nasal cannula at 4 L/min.
B. Give chewable aspirin (162–325 mg) immediately unless contraindicated.
C. Administer sublingual nitroglycerin without assessing blood pressure.
D. Start an IV infusion of heparin prior to confirming diagnosis.
E. Obtain a fasting lipid panel before any medication is given.
Correct answer: B. Give chewable aspirin (162–325 mg) immediately unless
contraindicated.
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Rationale: Early aspirin reduces mortality in suspected acute coronary syndrome
and is part of initial management unless there’s a contraindication (e.g., aspirin
allergy). Routine supplemental oxygen is not recommended for normoxic patients
(SpO₂ ≥ 90–94%); give O₂ only if hypoxemic. Nitroglycerin is reasonable for pain
but only after BP assessment. Anticoagulation timing depends on diagnosis and
interventional plan. Lipid testing is not urgent in the initial resuscitation phase.
(See guideline summaries on routine oxygen in ACS). PMC+1
Question 2 — Heart Failure with Pulmonary Edema
A 72-year-old woman with known systolic heart failure (EF 25%) is admitted with
severe dyspnea, bilateral crackles, and SpO₂ 86% on room air. She is cool and
diaphoretic; BP 170/98, HR 110. Which intervention should the nurse implement
first?
A. Administer high-flow IV furosemide (bolus) and position upright.
B. Give a 1-liter IV bolus of normal saline rapidly.
C. Start dobutamine drip immediately without further assessment.
D. Apply warmed blankets and restrict oxygen.
E. Hold all heart failure medications until cardiology consult.
Correct answer: A. Administer high-flow IV furosemide (bolus) and position
upright.
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Rationale: Acute pulmonary edema from fluid overload is treated emergently with
IV loop diuretics and upright positioning to reduce venous return and improve
ventilation; oxygen and noninvasive ventilation (CPAP/BiPAP) may be needed.
Rapid IV fluid bolus is contraindicated in cardiogenic pulmonary edema. Inotropic
support may be required if cardiogenic shock is present, but diuresis and
oxygenation come first. Routine holding of all HF meds without assessment is
inappropriate.
Question 3 — COPD Exacerbation oxygen target
A 59-year-old man with severe COPD exacerbation arrives with RR 30, SpO₂ 82%
on room air. You are to start supplemental oxygen. Which target saturation should
the nurse titrate to initially?
A. SpO₂ 99–100%
B. SpO₂ 94–98%
C. SpO₂ 88–92%
D. SpO₂ < 85% to avoid suppressing respiratory drive
E. Titrate to maintain PaCO₂ > 60 mm Hg
Correct answer: C. SpO₂ 88–92%
Rationale: For patients at risk of hypercapnic respiratory failure (COPD), target
SpO₂ of 88–92% is recommended to avoid worsening CO₂ retention while
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ensuring adequate oxygenation. High targets (94–98%) are for most acutely ill
patients without hypercapnia risk. Avoid routine hyperoxia; do not aim for near-
100%. PMC+1
Question 4 — Pulmonary Embolism (PE) immediate nursing action
A post-op patient develops sudden pleuritic chest pain and acute dyspnea. Pulse
120, BP 100/60, SpO₂ 88%. Provider suspects pulmonary embolism. Which is the
nurse’s highest priority?
A. Obtain a D-dimer and wait for result before starting treatment.
B. Start supplemental oxygen and prepare for immediate anticoagulation per
protocol.
C. Administer IV morphine to relieve chest pain before diagnostics.
D. Encourage the patient to ambulate to relieve symptoms.
E. Apply warm compresses to the chest.
Correct answer: B. Start supplemental oxygen and prepare for immediate
anticoagulation per protocol.
Rationale: In suspected PE with hypoxemia, administer oxygen and
prepare/obtain orders for immediate anticoagulation (unless contraindicated); do
not delay therapy awaiting D-dimer if clinical suspicion is high. Pain control is
ATI RN MEDICAL SURGICAL PROCTORED EXAM 2025-2026
ACTUAL EXAM TEST BANK COMPLETE FREQUENTLY
TESTED QUESTIONS AND CORRECT DETAILE RATIONAILE,
ALREADY GRADED A+
Question 1 — Acute Coronary Syndrome (NSTEMI/STEMI) initial
management
A 64-year-old man arrives with chest pressure, diaphoresis, and an ECG
showing ST depressions in V2–V4. He is alert, SpO₂ 98% on room air, BP
142/86, HR 96. Which initial action should the nurse perform first?
A. Administer supplemental oxygen by nasal cannula at 4 L/min.
B. Give chewable aspirin (162–325 mg) immediately unless contraindicated.
C. Administer sublingual nitroglycerin without assessing blood pressure.
D. Start an IV infusion of heparin prior to confirming diagnosis.
E. Obtain a fasting lipid panel before any medication is given.
Correct answer: B. Give chewable aspirin (162–325 mg) immediately unless
contraindicated.
,2 | Page
Rationale: Early aspirin reduces mortality in suspected acute coronary syndrome
and is part of initial management unless there’s a contraindication (e.g., aspirin
allergy). Routine supplemental oxygen is not recommended for normoxic patients
(SpO₂ ≥ 90–94%); give O₂ only if hypoxemic. Nitroglycerin is reasonable for pain
but only after BP assessment. Anticoagulation timing depends on diagnosis and
interventional plan. Lipid testing is not urgent in the initial resuscitation phase.
(See guideline summaries on routine oxygen in ACS). PMC+1
Question 2 — Heart Failure with Pulmonary Edema
A 72-year-old woman with known systolic heart failure (EF 25%) is admitted with
severe dyspnea, bilateral crackles, and SpO₂ 86% on room air. She is cool and
diaphoretic; BP 170/98, HR 110. Which intervention should the nurse implement
first?
A. Administer high-flow IV furosemide (bolus) and position upright.
B. Give a 1-liter IV bolus of normal saline rapidly.
C. Start dobutamine drip immediately without further assessment.
D. Apply warmed blankets and restrict oxygen.
E. Hold all heart failure medications until cardiology consult.
Correct answer: A. Administer high-flow IV furosemide (bolus) and position
upright.
,3 | Page
Rationale: Acute pulmonary edema from fluid overload is treated emergently with
IV loop diuretics and upright positioning to reduce venous return and improve
ventilation; oxygen and noninvasive ventilation (CPAP/BiPAP) may be needed.
Rapid IV fluid bolus is contraindicated in cardiogenic pulmonary edema. Inotropic
support may be required if cardiogenic shock is present, but diuresis and
oxygenation come first. Routine holding of all HF meds without assessment is
inappropriate.
Question 3 — COPD Exacerbation oxygen target
A 59-year-old man with severe COPD exacerbation arrives with RR 30, SpO₂ 82%
on room air. You are to start supplemental oxygen. Which target saturation should
the nurse titrate to initially?
A. SpO₂ 99–100%
B. SpO₂ 94–98%
C. SpO₂ 88–92%
D. SpO₂ < 85% to avoid suppressing respiratory drive
E. Titrate to maintain PaCO₂ > 60 mm Hg
Correct answer: C. SpO₂ 88–92%
Rationale: For patients at risk of hypercapnic respiratory failure (COPD), target
SpO₂ of 88–92% is recommended to avoid worsening CO₂ retention while
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ensuring adequate oxygenation. High targets (94–98%) are for most acutely ill
patients without hypercapnia risk. Avoid routine hyperoxia; do not aim for near-
100%. PMC+1
Question 4 — Pulmonary Embolism (PE) immediate nursing action
A post-op patient develops sudden pleuritic chest pain and acute dyspnea. Pulse
120, BP 100/60, SpO₂ 88%. Provider suspects pulmonary embolism. Which is the
nurse’s highest priority?
A. Obtain a D-dimer and wait for result before starting treatment.
B. Start supplemental oxygen and prepare for immediate anticoagulation per
protocol.
C. Administer IV morphine to relieve chest pain before diagnostics.
D. Encourage the patient to ambulate to relieve symptoms.
E. Apply warm compresses to the chest.
Correct answer: B. Start supplemental oxygen and prepare for immediate
anticoagulation per protocol.
Rationale: In suspected PE with hypoxemia, administer oxygen and
prepare/obtain orders for immediate anticoagulation (unless contraindicated); do
not delay therapy awaiting D-dimer if clinical suspicion is high. Pain control is
