ATI Cardiovascular Disorders Exam – Nursing Cardiovascular System Study Notes &
Exam Preparation (2025–2026)
Section 1: Coronary Artery Disease (Questions 1-12)
Q1. A 58-year-old patient presents to the ED with crushing chest pain for 2 hours. ECG
shows ST elevation in leads II, III, and aVF. Vital signs: BP 148/92, HR 102, RR 24, SpO2
94%. According to 2026 AHA STEMI guidelines, what is the maximum acceptable
door-to-balloon time for this patient?
A. 60 minutes
B. 90 minutes
C. 120 minutes
D. 150 minutes
Correct Answer: A
Explanation: The 2026 AHA STEMI guidelines have reduced the maximum acceptable
door-to-balloon time from 90 to 60 minutes for STEMI patients presenting to
PCI-capable facilities, based on evidence showing improved outcomes with earlier
reperfusion. This represents a significant shift from previous guidelines, emphasizing
the critical importance of immediate PCI activation.
Q2. A patient with NSTEMI has chest pain unrelieved by nitroglycerin. Troponin I is 2.8
ng/mL (normal <0.04). Which medication should be administered FIRST according to
2026 guidelines?
A. Metoprolol 25mg PO
B. Atorvastatin 80mg PO
C. Aspirin 324mg chewed
D. Clopidogrel 600mg loading dose
Correct Answer: C
,Explanation: Immediate aspirin administration remains the first priority in ACS
management, reducing mortality by 20-25% regardless of STEMI/NSTEMI classification.
The 2026 guidelines emphasize that aspirin should be given within 5 minutes of
diagnosis, before other antiplatelet agents. While high-intensity statin therapy is
important, it's not the immediate first intervention.
Q3. A 72-year-old with diabetes presents with chest pain. High-sensitivity troponin I
levels are 6 ng/L at 0 hours and 8 ng/L at 3 hours (99th percentile: 16 ng/L for men, 12
ng/L for women). What is the appropriate interpretation?
A. Rule-out MI, discharge home
B. Borderline elevation, repeat in 6 hours
C. Rising pattern indicates MI
D. Sex-specific interpretation needed
Correct Answer: D
Explanation: The 2026 guidelines mandate sex-specific interpretation of high-sensitivity
troponin, as women have lower 99th percentile values. For this female patient, both
values are below the female threshold of 12 ng/L, suggesting no MI. However, the rising
pattern warrants clinical correlation and may indicate unstable angina or other cardiac
pathology requiring further evaluation.
Q4. Post-PCI patient receives ticagrelor 180mg loading dose. Which patient education
point is MOST important?
A. "Take this medication with food only"
B. "You may experience mild dyspnea"
C. "Avoid all aspirin products"
D. "Stop if you notice bruising"
Correct Answer: B
, Explanation: Ticagrelor commonly causes mild dyspnea in 10-15% of patients due to
increased adenosine levels, which typically resolves within 1-2 weeks. Patients should
be educated that this is expected and not to discontinue the medication. Premature
discontinuation of dual antiplatelet therapy increases stent thrombosis risk by 300%.
Q5. A patient with STEMI receives tenecteplase. Which assessment finding requires
IMMEDIATE intervention?
A. BP 100/60 mmHg
B. Epistaxis during administration
C. Sudden severe headache
D. Nausea and vomiting
Correct Answer: C
Explanation: Sudden severe headache during fibrinolytic administration is the classic
presentation of intracranial hemorrhage, the most catastrophic complication with 50%
mortality. Immediate cessation of thrombolytic, stat CT head, and neurosurgical
consultation are required. While epistaxis may indicate bleeding, it's typically self-limited
and doesn't require immediate intervention.
Q6. According to 2026 guidelines, which STEMI patient is NOT a candidate for primary
PCI?
A. Symptom onset 4 hours ago
B. Cardiogenic shock developing 18 hours post-onset
C. Age 88 with dementia
D. Late presentation 28 hours post-onset, stable
Correct Answer: D
Explanation: The 2026 guidelines recommend primary PCI up to 12 hours from
symptom onset, extendable to 24 hours if ongoing ischemia, hemodynamic instability,
Exam Preparation (2025–2026)
Section 1: Coronary Artery Disease (Questions 1-12)
Q1. A 58-year-old patient presents to the ED with crushing chest pain for 2 hours. ECG
shows ST elevation in leads II, III, and aVF. Vital signs: BP 148/92, HR 102, RR 24, SpO2
94%. According to 2026 AHA STEMI guidelines, what is the maximum acceptable
door-to-balloon time for this patient?
A. 60 minutes
B. 90 minutes
C. 120 minutes
D. 150 minutes
Correct Answer: A
Explanation: The 2026 AHA STEMI guidelines have reduced the maximum acceptable
door-to-balloon time from 90 to 60 minutes for STEMI patients presenting to
PCI-capable facilities, based on evidence showing improved outcomes with earlier
reperfusion. This represents a significant shift from previous guidelines, emphasizing
the critical importance of immediate PCI activation.
Q2. A patient with NSTEMI has chest pain unrelieved by nitroglycerin. Troponin I is 2.8
ng/mL (normal <0.04). Which medication should be administered FIRST according to
2026 guidelines?
A. Metoprolol 25mg PO
B. Atorvastatin 80mg PO
C. Aspirin 324mg chewed
D. Clopidogrel 600mg loading dose
Correct Answer: C
,Explanation: Immediate aspirin administration remains the first priority in ACS
management, reducing mortality by 20-25% regardless of STEMI/NSTEMI classification.
The 2026 guidelines emphasize that aspirin should be given within 5 minutes of
diagnosis, before other antiplatelet agents. While high-intensity statin therapy is
important, it's not the immediate first intervention.
Q3. A 72-year-old with diabetes presents with chest pain. High-sensitivity troponin I
levels are 6 ng/L at 0 hours and 8 ng/L at 3 hours (99th percentile: 16 ng/L for men, 12
ng/L for women). What is the appropriate interpretation?
A. Rule-out MI, discharge home
B. Borderline elevation, repeat in 6 hours
C. Rising pattern indicates MI
D. Sex-specific interpretation needed
Correct Answer: D
Explanation: The 2026 guidelines mandate sex-specific interpretation of high-sensitivity
troponin, as women have lower 99th percentile values. For this female patient, both
values are below the female threshold of 12 ng/L, suggesting no MI. However, the rising
pattern warrants clinical correlation and may indicate unstable angina or other cardiac
pathology requiring further evaluation.
Q4. Post-PCI patient receives ticagrelor 180mg loading dose. Which patient education
point is MOST important?
A. "Take this medication with food only"
B. "You may experience mild dyspnea"
C. "Avoid all aspirin products"
D. "Stop if you notice bruising"
Correct Answer: B
, Explanation: Ticagrelor commonly causes mild dyspnea in 10-15% of patients due to
increased adenosine levels, which typically resolves within 1-2 weeks. Patients should
be educated that this is expected and not to discontinue the medication. Premature
discontinuation of dual antiplatelet therapy increases stent thrombosis risk by 300%.
Q5. A patient with STEMI receives tenecteplase. Which assessment finding requires
IMMEDIATE intervention?
A. BP 100/60 mmHg
B. Epistaxis during administration
C. Sudden severe headache
D. Nausea and vomiting
Correct Answer: C
Explanation: Sudden severe headache during fibrinolytic administration is the classic
presentation of intracranial hemorrhage, the most catastrophic complication with 50%
mortality. Immediate cessation of thrombolytic, stat CT head, and neurosurgical
consultation are required. While epistaxis may indicate bleeding, it's typically self-limited
and doesn't require immediate intervention.
Q6. According to 2026 guidelines, which STEMI patient is NOT a candidate for primary
PCI?
A. Symptom onset 4 hours ago
B. Cardiogenic shock developing 18 hours post-onset
C. Age 88 with dementia
D. Late presentation 28 hours post-onset, stable
Correct Answer: D
Explanation: The 2026 guidelines recommend primary PCI up to 12 hours from
symptom onset, extendable to 24 hours if ongoing ischemia, hemodynamic instability,
