ATI RN Adult Medical-Surgical Nursing
Proctored Exam,2025/2026 Edition. Correct
Questions and Answers
Question 1: Disease Processes - Acute Myocardial Infarction
A client presents with crushing chest pain radiating to the left arm, diaphoresis, and nausea. ECG shows
ST elevation in leads II, III, aVF. This indicates:
A. Unstable angina.
B. Inferior wall MI.
C. Anterior wall MI.
D. Pericarditis.
Rationale: Per AHA 2025 STEMI guidelines, ST elevation in II, III, aVF localizes to right coronary
artery occlusion affecting the inferior wall; immediate PCI is indicated to restore perfusion and reduce
mortality by 30%.
Question 2: Interventions - Heart Failure Management
For a client with HFrEF (EF 35%), the nurse prioritizes initiating:
A. Digoxin first-line.
B. ARNI (sacubitril/valsartan) with beta-blocker titration.
C. Diuretics only.
D. Calcium channel blockers.
Rationale: 2026 ACC/AHA HF guidelines recommend GDMT starting with ARNI for HFrEF to improve
EF and reduce hospitalizations by 20%; monitor BP to avoid hypotension during up-titration.
Question 3: Monitoring - Atrial Fibrillation
A client in AFib with RVR (HR 140 bpm) is cardioverted. Post-procedure, monitor for:
,A. Bradycardia.
B. Thromboembolic stroke (CHADS2-VASc score).
C. Hyperkalemia.
D. Hypoglycemia.
Rationale: AHA 2025 AFib protocols require anticoagulation pre-cardioversion if duration >48 hours;
safety monitoring includes neuro checks q4h to detect embolic events early.
Question 4: Labs - Cardiac Enzymes
Troponin I peaks at 24 hours post-MI at 5.2 ng/mL (normal <0.04). This confirms:
A. Muscle strain.
B. Acute MI with ongoing necrosis.
C. Renal failure.
D. Electrolyte imbalance.
Rationale: Elevated troponin per 2025 AHA biomarkers indicates myocyte damage; serial levels guide
reperfusion success, with decline signaling stabilization.
Question 5: Safety Considerations - Pacemaker Insertion
Post-pacemaker insertion, the client should avoid:
A. Arm exercises on affected side.
B. Placing arm above shoulder on implant side for 4-6 weeks.
C. Driving immediately.
D. Showering.
Rationale: Joint Commission 2026 safety standards prevent lead dislodgement; monitor site for infection
(redness, drainage) and educate on device ID card.
Question 6: Disease Processes - COPD Exacerbation
A client with COPD reports increased dyspnea, purple sputum, and fever. This suggests:
A. Asthma attack.
, B. Bacterial pneumonia superimposed on COPD.
C. Pulmonary embolism.
D. Heart failure.
Rationale: GOLD 2025 guidelines identify purulent sputum as infection marker; ABG may show CO2
retention, necessitating antibiotics and BiPAP.
Question 7: Interventions - Pneumonia Treatment
For community-acquired pneumonia, the nurse administers:
A. Vancomycin monotherapy.
B. Azithromycin + ceftriaxone per IDSA empiric regimen.
C. Oseltamivir.
D. Acyclovir.
Rationale: IDSA/ATS 2026 CAP guidelines recommend dual therapy for outpatient-to-inpatient
transition; monitor CURB-65 score for severity and de-escalation.
Question 8: Monitoring - Mechanical Ventilation
A client on volume-control ventilation has high peak pressures (45 cmH2O). The nurse suspects:
A. Adequate settings.
B. Tube kinking or bronchospasm.
C. Hypoxemia.
D. Hypercapnia.
Rationale: AACN 2025 vent management: pressures >40 cmH2O risk barotrauma; perform ET suction
and CXR to confirm position and intervene promptly.
Question 9: Labs - Arterial Blood Gas
ABG: pH 7.28, PaCO2 55 mmHg, HCO3 24 mEq/L in a COPD client indicates:
A. Metabolic acidosis.
B. Acute respiratory acidosis.
Proctored Exam,2025/2026 Edition. Correct
Questions and Answers
Question 1: Disease Processes - Acute Myocardial Infarction
A client presents with crushing chest pain radiating to the left arm, diaphoresis, and nausea. ECG shows
ST elevation in leads II, III, aVF. This indicates:
A. Unstable angina.
B. Inferior wall MI.
C. Anterior wall MI.
D. Pericarditis.
Rationale: Per AHA 2025 STEMI guidelines, ST elevation in II, III, aVF localizes to right coronary
artery occlusion affecting the inferior wall; immediate PCI is indicated to restore perfusion and reduce
mortality by 30%.
Question 2: Interventions - Heart Failure Management
For a client with HFrEF (EF 35%), the nurse prioritizes initiating:
A. Digoxin first-line.
B. ARNI (sacubitril/valsartan) with beta-blocker titration.
C. Diuretics only.
D. Calcium channel blockers.
Rationale: 2026 ACC/AHA HF guidelines recommend GDMT starting with ARNI for HFrEF to improve
EF and reduce hospitalizations by 20%; monitor BP to avoid hypotension during up-titration.
Question 3: Monitoring - Atrial Fibrillation
A client in AFib with RVR (HR 140 bpm) is cardioverted. Post-procedure, monitor for:
,A. Bradycardia.
B. Thromboembolic stroke (CHADS2-VASc score).
C. Hyperkalemia.
D. Hypoglycemia.
Rationale: AHA 2025 AFib protocols require anticoagulation pre-cardioversion if duration >48 hours;
safety monitoring includes neuro checks q4h to detect embolic events early.
Question 4: Labs - Cardiac Enzymes
Troponin I peaks at 24 hours post-MI at 5.2 ng/mL (normal <0.04). This confirms:
A. Muscle strain.
B. Acute MI with ongoing necrosis.
C. Renal failure.
D. Electrolyte imbalance.
Rationale: Elevated troponin per 2025 AHA biomarkers indicates myocyte damage; serial levels guide
reperfusion success, with decline signaling stabilization.
Question 5: Safety Considerations - Pacemaker Insertion
Post-pacemaker insertion, the client should avoid:
A. Arm exercises on affected side.
B. Placing arm above shoulder on implant side for 4-6 weeks.
C. Driving immediately.
D. Showering.
Rationale: Joint Commission 2026 safety standards prevent lead dislodgement; monitor site for infection
(redness, drainage) and educate on device ID card.
Question 6: Disease Processes - COPD Exacerbation
A client with COPD reports increased dyspnea, purple sputum, and fever. This suggests:
A. Asthma attack.
, B. Bacterial pneumonia superimposed on COPD.
C. Pulmonary embolism.
D. Heart failure.
Rationale: GOLD 2025 guidelines identify purulent sputum as infection marker; ABG may show CO2
retention, necessitating antibiotics and BiPAP.
Question 7: Interventions - Pneumonia Treatment
For community-acquired pneumonia, the nurse administers:
A. Vancomycin monotherapy.
B. Azithromycin + ceftriaxone per IDSA empiric regimen.
C. Oseltamivir.
D. Acyclovir.
Rationale: IDSA/ATS 2026 CAP guidelines recommend dual therapy for outpatient-to-inpatient
transition; monitor CURB-65 score for severity and de-escalation.
Question 8: Monitoring - Mechanical Ventilation
A client on volume-control ventilation has high peak pressures (45 cmH2O). The nurse suspects:
A. Adequate settings.
B. Tube kinking or bronchospasm.
C. Hypoxemia.
D. Hypercapnia.
Rationale: AACN 2025 vent management: pressures >40 cmH2O risk barotrauma; perform ET suction
and CXR to confirm position and intervene promptly.
Question 9: Labs - Arterial Blood Gas
ABG: pH 7.28, PaCO2 55 mmHg, HCO3 24 mEq/L in a COPD client indicates:
A. Metabolic acidosis.
B. Acute respiratory acidosis.
