1
ATI Med Surg Proctored ACTUAL EXAM
2026/2027 | Version 1 | Latest Update with
NGN Questions & Verified Answers | Pass
Guaranteed - A+ Graded
1. A 68-year-old with NYHA Class III heart failure (EF 30 %) is started on empagliflozin 10
mg daily. Which finding best indicates the drug’s therapeutic effect after 1 week?
A. Weight loss 1 kg
B. Serum creatinine unchanged
C. Systolic BP ↓ 8 mmHg
D. BNP ↓ from 650 to 480 pg/mL
Correct: D
Rationale: Empagliflozin rapidly reduces ventricular filling pressures → ↓ BNP; weight and BP
changes lag.
2. Item Type: Matrix/Grid
A patient arrives with acute chest pain and is ruled in for STEMI. For each parameter,
indicate whether it is Expected, Unexpected, or Requires Immediate Intervention:
Table
Copy
Requires Immediate
Parameter Expected Unexpected Intervention
ST elevation in leads V2-
V4 ✓
BP 88/50 mmHg ✓
,2
Requires Immediate
Parameter Expected Unexpected Intervention
HR 110 bpm ✓
PVCs 4/min ✓
Correct: See table
Rationale: Hypotension and frequent PVCs signal cardiogenic shock/arrhythmia risk needing
urgent action.
3. A client with COPD (FEV₁ 42 %) receives ipratropium 500 mcg nebulizer. Which
assessment requires immediate intervention?
A. Heart rate 92 bpm
B. Urinary retention 800 mL
C. Dry mouth
D. Tremor
Correct: B
Rationale: Anticholinergic → bladder outlet obstruction; 800 mL retention can precipitate AKI.
4. Item Type: Multiple Response (Select All)
The nurse is caring for a patient in DKA receiving an insulin infusion. Which
assessments are most critical in the first 4 h? (Select all.)
☐ Serum glucose q1h
☐ Potassium q2h
☐ Urine output q4h
☐ Mental status q30min
☐ pH q6h
Correct: Serum glucose q1h, Potassium q2h, Mental status q30min
Rationale: Glucose guides titration; K⁺ shifts rapidly with insulin; cerebral edema presents early.
5. A 55-year-old with acute pancreatitis has pain 9/10 and BP 86/40 mmHg, HR 120. Which
fluid order is most appropriate?
A. 0.9 % NaCl 500 mL over 2 h
, 3
B. LR 1 L bolus over 30 min
C. D5½NS 250 mL/h
D. 0.45 % NaCl 200 mL/h
Correct: B
Rationale: Hypotension indicates hemorrhagic pancreatitis; isotonic crystalloid bolus restores
perfusion.
6. Item Type: Drag-and-Drop/Ordered Response
Place the following steps in order for managing a patient with pulmonary embolism and
BP 72/48 mmHg:
7. Administer oxygen to maintain SpO₂ > 94 %
8. Start heparin 80 units/kg bolus
9. Obtain CT pulmonary angiogram
10. Give 500 mL NS bolus
11. Prepare for possible thrombolysis
Correct Order: 1 → 4 → 2 → 3 → 5
Rationale: Oxygen and fluids address hypoxia and right-heart preload; anticoagulation before
imaging if high suspicion; thrombolysis ready for shock.
7. A patient with CKD stage 4 (GFR 22 mL/min) is prescribed metformin 500 mg BID. The
nurse’s priority action is:
A. Hold dose and clarify prescription
B. Give with antiemetic
C. Monitor creatinine in 2 weeks
D. Educate on hypoglycemia
Correct: A
Rationale: Metformin is contraindicated < 30 mL/min due to lactic acidosis risk.
8. Item Type: Cloze (Drop-Down)
A patient with MS is started on ocrelizumab. Before the first infusion, the nurse verifies
hepatitis B status. If HBsAg is ____ (positive/negative) and anti-HBc is ____
(positive/negative), the drug is contraindicated due to risk of ____ (re-
activation/fibrosis/carcinoma).
ATI Med Surg Proctored ACTUAL EXAM
2026/2027 | Version 1 | Latest Update with
NGN Questions & Verified Answers | Pass
Guaranteed - A+ Graded
1. A 68-year-old with NYHA Class III heart failure (EF 30 %) is started on empagliflozin 10
mg daily. Which finding best indicates the drug’s therapeutic effect after 1 week?
A. Weight loss 1 kg
B. Serum creatinine unchanged
C. Systolic BP ↓ 8 mmHg
D. BNP ↓ from 650 to 480 pg/mL
Correct: D
Rationale: Empagliflozin rapidly reduces ventricular filling pressures → ↓ BNP; weight and BP
changes lag.
2. Item Type: Matrix/Grid
A patient arrives with acute chest pain and is ruled in for STEMI. For each parameter,
indicate whether it is Expected, Unexpected, or Requires Immediate Intervention:
Table
Copy
Requires Immediate
Parameter Expected Unexpected Intervention
ST elevation in leads V2-
V4 ✓
BP 88/50 mmHg ✓
,2
Requires Immediate
Parameter Expected Unexpected Intervention
HR 110 bpm ✓
PVCs 4/min ✓
Correct: See table
Rationale: Hypotension and frequent PVCs signal cardiogenic shock/arrhythmia risk needing
urgent action.
3. A client with COPD (FEV₁ 42 %) receives ipratropium 500 mcg nebulizer. Which
assessment requires immediate intervention?
A. Heart rate 92 bpm
B. Urinary retention 800 mL
C. Dry mouth
D. Tremor
Correct: B
Rationale: Anticholinergic → bladder outlet obstruction; 800 mL retention can precipitate AKI.
4. Item Type: Multiple Response (Select All)
The nurse is caring for a patient in DKA receiving an insulin infusion. Which
assessments are most critical in the first 4 h? (Select all.)
☐ Serum glucose q1h
☐ Potassium q2h
☐ Urine output q4h
☐ Mental status q30min
☐ pH q6h
Correct: Serum glucose q1h, Potassium q2h, Mental status q30min
Rationale: Glucose guides titration; K⁺ shifts rapidly with insulin; cerebral edema presents early.
5. A 55-year-old with acute pancreatitis has pain 9/10 and BP 86/40 mmHg, HR 120. Which
fluid order is most appropriate?
A. 0.9 % NaCl 500 mL over 2 h
, 3
B. LR 1 L bolus over 30 min
C. D5½NS 250 mL/h
D. 0.45 % NaCl 200 mL/h
Correct: B
Rationale: Hypotension indicates hemorrhagic pancreatitis; isotonic crystalloid bolus restores
perfusion.
6. Item Type: Drag-and-Drop/Ordered Response
Place the following steps in order for managing a patient with pulmonary embolism and
BP 72/48 mmHg:
7. Administer oxygen to maintain SpO₂ > 94 %
8. Start heparin 80 units/kg bolus
9. Obtain CT pulmonary angiogram
10. Give 500 mL NS bolus
11. Prepare for possible thrombolysis
Correct Order: 1 → 4 → 2 → 3 → 5
Rationale: Oxygen and fluids address hypoxia and right-heart preload; anticoagulation before
imaging if high suspicion; thrombolysis ready for shock.
7. A patient with CKD stage 4 (GFR 22 mL/min) is prescribed metformin 500 mg BID. The
nurse’s priority action is:
A. Hold dose and clarify prescription
B. Give with antiemetic
C. Monitor creatinine in 2 weeks
D. Educate on hypoglycemia
Correct: A
Rationale: Metformin is contraindicated < 30 mL/min due to lactic acidosis risk.
8. Item Type: Cloze (Drop-Down)
A patient with MS is started on ocrelizumab. Before the first infusion, the nurse verifies
hepatitis B status. If HBsAg is ____ (positive/negative) and anti-HBc is ____
(positive/negative), the drug is contraindicated due to risk of ____ (re-
activation/fibrosis/carcinoma).
