RN VATI Adult Medical Surgical Assessment
ACTUAL EXAM 2026/2027: 100% Verified
Questions & Correct Answers
Question 1:
A 58-year-old man is admitted with anterior STEMI and receives tenecteplase. Thirty minutes later
he develops stridor and swollen lips. Which action is most urgent?
A. Administer IV epinephrine 0.1 mg
B. Stop the alteplase infusion
C. Prepare for emergency intubation
D. Start high-flow oxygen and page anesthesia
Correct Answer: D
Rationale: Acute angio-edema post-thrombolytic suggests anaphylaxis; immediate high-flow oxygen
and airway expert standby follow AHA 2026 ACLS anaphylaxis algorithm.
Question 2:
,A patient with decompensated HF on dobutamine 5 mcg/kg/min develops new-onset AF with HR
160. BP 88/50. Which intervention is priority?
A. Prepare for synchronized cardioversion
B. Start diltiazem bolus
C. Increase dobutamine to 10 mcg/kg/min
D. Give IV metoprolol 5 mg
Correct Answer: A
Rationale: Rapid AF with hypotension is unstable; synchronized cardioversion (50–100 J) is
immediate Class-I therapy per AHA 2026 guidelines.
Question 3:
A post-cholecystectomy patient has a sudden drop in SpO₂ to 86 %, RR 32, BP 100/60.
Auscultation reveals absent breath sounds on the right. Which action should the nurse take first?
A. Call for stat chest X-ray
B. Administer 100 % oxygen by non-rebreather
C. Insert a large-bore IV line
D. Prepare for needle decompression
,Correct Answer: B
Rationale: Provide oxygen while preparing for potential tension pneumothorax; ABC sequence per
ATLS 2026.
Question 4:
A patient with DKA receives an insulin drip at 0.1 unit/kg/hr. Which value indicates the most
appropriate time to decrease the drip rate?
A. Glucose 250 mg/dL
B. Glucose 180 mg/dL
C. Glucose 140 mg/dL
D. Glucose 100 mg/dL
Correct Answer: D
Rationale: ADA 2026 DKA protocol recommends reducing insulin rate once glucose reaches
150–200 mg/dL to avoid hypoglycemia; 100 mg/dL necessitates decrease and dextrose addition.
Question 5:
A patient with COPD has ABG: pH 7.28, PaCO₂ 65, PaO₂ 58, HCO₃ 32. Which change in ventilator
settings is most appropriate?
, A. Increase PEEP by 3 cmH₂O
B. Increase tidal volume by 100 mL
C. Decrease respiratory rate by 2 breaths/min
D. Increase FiO₂ to 1.0
Correct Answer: C
Rationale: Compensated respiratory acidosis with COPD; permissive hypercapnia strategy—lower
RR to allow gradual CO₂ reduction and avoid auto-PEEP (ARDSNet 2026).
Question 6:
A patient with acute pancreatitis reports severe epigastric pain and vomits 500 mL bright red blood.
BP 80/40, HR 130. Which order is priority?
A. Start PPI infusion
B. Begin octreotide 50 mcg bolus
C. Insert two large-bore IVs and initiate rapid crystalloid
D. Arrange urgent EGD
Correct Answer: C
ACTUAL EXAM 2026/2027: 100% Verified
Questions & Correct Answers
Question 1:
A 58-year-old man is admitted with anterior STEMI and receives tenecteplase. Thirty minutes later
he develops stridor and swollen lips. Which action is most urgent?
A. Administer IV epinephrine 0.1 mg
B. Stop the alteplase infusion
C. Prepare for emergency intubation
D. Start high-flow oxygen and page anesthesia
Correct Answer: D
Rationale: Acute angio-edema post-thrombolytic suggests anaphylaxis; immediate high-flow oxygen
and airway expert standby follow AHA 2026 ACLS anaphylaxis algorithm.
Question 2:
,A patient with decompensated HF on dobutamine 5 mcg/kg/min develops new-onset AF with HR
160. BP 88/50. Which intervention is priority?
A. Prepare for synchronized cardioversion
B. Start diltiazem bolus
C. Increase dobutamine to 10 mcg/kg/min
D. Give IV metoprolol 5 mg
Correct Answer: A
Rationale: Rapid AF with hypotension is unstable; synchronized cardioversion (50–100 J) is
immediate Class-I therapy per AHA 2026 guidelines.
Question 3:
A post-cholecystectomy patient has a sudden drop in SpO₂ to 86 %, RR 32, BP 100/60.
Auscultation reveals absent breath sounds on the right. Which action should the nurse take first?
A. Call for stat chest X-ray
B. Administer 100 % oxygen by non-rebreather
C. Insert a large-bore IV line
D. Prepare for needle decompression
,Correct Answer: B
Rationale: Provide oxygen while preparing for potential tension pneumothorax; ABC sequence per
ATLS 2026.
Question 4:
A patient with DKA receives an insulin drip at 0.1 unit/kg/hr. Which value indicates the most
appropriate time to decrease the drip rate?
A. Glucose 250 mg/dL
B. Glucose 180 mg/dL
C. Glucose 140 mg/dL
D. Glucose 100 mg/dL
Correct Answer: D
Rationale: ADA 2026 DKA protocol recommends reducing insulin rate once glucose reaches
150–200 mg/dL to avoid hypoglycemia; 100 mg/dL necessitates decrease and dextrose addition.
Question 5:
A patient with COPD has ABG: pH 7.28, PaCO₂ 65, PaO₂ 58, HCO₃ 32. Which change in ventilator
settings is most appropriate?
, A. Increase PEEP by 3 cmH₂O
B. Increase tidal volume by 100 mL
C. Decrease respiratory rate by 2 breaths/min
D. Increase FiO₂ to 1.0
Correct Answer: C
Rationale: Compensated respiratory acidosis with COPD; permissive hypercapnia strategy—lower
RR to allow gradual CO₂ reduction and avoid auto-PEEP (ARDSNet 2026).
Question 6:
A patient with acute pancreatitis reports severe epigastric pain and vomits 500 mL bright red blood.
BP 80/40, HR 130. Which order is priority?
A. Start PPI infusion
B. Begin octreotide 50 mcg bolus
C. Insert two large-bore IVs and initiate rapid crystalloid
D. Arrange urgent EGD
Correct Answer: C
