RN Adult Medical-Surgical Nursing Content
Mastery Series Ed 12.0 ATI CMS Official
Practice Exam Actual Exam 2026/2027 with
Detailed Rationales | Complete Exam-Style
Questions | Pass Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: CARDIOVASCULAR & HEMATOLOGIC DISORDERS Q1 – Q17
══════════════════════════════════════
Question 1 of 100
A 68-year-old male with a history of hypertension and hyperlipidemia is admitted with
crushing substernal chest pain radiating to his left jaw. His vital signs are BP 158/94, HR 102,
RR 22, SpO2 91% on room air. The 12-lead ECG shows ST-segment elevation in leads V1
through V4. After initiating oxygen and establishing IV access, which action should the nurse
prioritize?
A. Administer sublingual nitroglycerin 0.4 mg every 5 minutes
B. Obtain a stat chest X-ray to rule out aortic dissection
C. Administer chewable aspirin 325 mg if not contraindicated ✓ CORRECT
D. Prepare the patient for immediate synchronized cardioversion
Correct Answer: C
Rationale: In a patient with STEMI, chewable aspirin administration is a priority intervention
that reduces mortality by inhibiting platelet aggregation and preventing further thrombus
formation, and it should be given immediately after oxygen and IV access unless true allergy
exists. While nitroglycerin may be appropriate later, administering it before aspirin delays a
proven mortality-reducing therapy, and chest X-ray is not the priority when ECG already
confirms STEMI. ATI CMS emphasizes that aspirin should be given within 10 minutes of
arrival for any suspected MI.
Question 2 of 100
A 54-year-old female with heart failure presents with increasing dyspnea, orthopnea, and
weight gain of 4.5 kg over 3 days. Her lungs have crackles bilaterally, JVD is present at 45
degrees, and her vital signs are BP 142/88, HR 110, RR 26, SpO2 88% on room air. The provider
,orders furosemide 80 mg IV push. Which assessment should the nurse perform immediately
before administering this dose?
A. Auscultate lung sounds and assess for S3 gallop
B. Verify the patient's most recent serum potassium level ✓ CORRECT
C. Check the patient's blood glucose level
D. Palpate peripheral pulses and capillary refill
Correct Answer: B
Rationale: Furosemide is a potent loop diuretic that causes significant renal potassium
wasting, and administering 80 mg IV without verifying recent potassium could precipitate
life-threatening hypokalemia or cardiac dysrhythmias in a patient already volume overloaded
and tachycardic. While lung sounds and S3 assessment are important for monitoring heart
failure status, they do not present an immediate safety risk before diuretic administration the
way unchecked electrolyte imbalance does. ATI CMS frequently tests medication safety by
requiring nurses to verify electrolytes before loop diuretics, especially with high-dose IV
therapy.
Question 3 of 100
A 72-year-old male with chronic atrial fibrillation takes warfarin 5 mg daily. He presents to the
clinic with melena, fatigue, and a hematocrit of 28%. His INR is 6.8. The provider orders
vitamin K 10 mg subcutaneously and holds warfarin. Which additional intervention should the
nurse anticipate and prepare for?
A. Administer protamine sulfate 1 mg per 100 units of heparin
B. Prepare to administer fresh frozen plasma ✓ CORRECT
C. Initiate a heparin drip at 18 units/kg/hr
D. Administer a bolus of aspirin 325 mg
Correct Answer: B
Rationale: Fresh frozen plasma contains clotting factors II, VII, IX, and X and is indicated for
rapid reversal of warfarin-induced bleeding when the INR is significantly elevated and the
patient shows signs of active hemorrhage such as melena and anemia. Protamine sulfate
reverses heparin, not warfarin, and initiating heparin or giving aspirin would worsen bleeding
in a patient with an INR of 6.8 and active GI bleeding. ATI CMS tests anticoagulation reversal
frequently — remember vitamin K works slowly over hours, while FFP provides immediate
factor replacement for active bleeding.
Question 4 of 100
A 61-year-old female is admitted with new-onset heart failure and an ejection fraction of 30%.
Her home medications include metformin, lisinopril, and hydrochlorothiazide. The provider
discontinues hydrochlorothiazide and starts carvedilol 3.125 mg twice daily. Two hours after
,the first dose, the patient becomes dizzy when attempting to stand, and her BP drops from
132/78 supine to 94/58 standing. Which action should the nurse take first?
A. Hold the next dose of carvedilol and notify the provider
B. Assist the patient back to bed and assess orthostatic vitals ✓ CORRECT
C. Administer a 500 mL bolus of normal saline
D. Increase the lisinopril dose to counteract the hypotension
Correct Answer: B
Rationale: First-dose orthostatic hypotension is a common and expected adverse effect of
nonselective beta-blockers like carvedilol, and the immediate nursing priority is to ensure
patient safety by assisting them to a supine position and confirming orthostatic changes
before determining if the medication should be held. Administering a fluid bolus is not
indicated without provider orders in a heart failure patient, and increasing lisinopril would
worsen hypotension rather than correct it. ATI CMS prioritization questions require the nurse
to ensure immediate patient safety before notifying the provider or making medication
decisions.
Question 5 of 100
A 45-year-old female with sickle cell disease presents with severe joint pain, a temperature of
38.9°C, and a new systolic murmur at the left sternal border. Her hemoglobin is 6.2 g/dL, and
her reticulocyte count is elevated. Which nursing intervention is the priority?
A. Begin a blood transfusion with packed red blood cells
B. Administer IV fluids at 1.5 times maintenance and apply oxygen ✓ CORRECT
C. Administer meperidine 50 mg IV for pain control
D. Prepare the patient for immediate splenectomy
Correct Answer: B
Rationale: This patient is experiencing a vaso-occlusive crisis with possible acute chest
syndrome or infection, and the priority interventions are aggressive hydration to reduce blood
viscosity and oxygen to improve tissue perfusion and prevent further sickling, following the
standard vaso-occlusive crisis protocol. While pain management is important, meperidine is
contraindicated in sickle cell disease due to normeperidine accumulation causing seizures,
and transfusion is reserved for specific indications like stroke or acute chest syndrome with
severe hypoxia. ATI CMS emphasizes that hydration and oxygen are the foundational
interventions for any sickle cell crisis before addressing pain or considering transfusion.
Question 6 of 100
A 79-year-old male with a history of CAD and two prior stents presents with recurrent chest
pain at rest. His troponin I is 0.8 ng/mL, and the provider diagnoses non-ST-elevation
myocardial infarction (NSTEMI). The patient is started on a heparin infusion and eptifibatide.
, Four hours later, the nurse notices oozing around the IV site and a drop in hemoglobin from
13.2 to 10.8 g/dL. Which action should the nurse take immediately?
A. Apply firm pressure to the site and notify the provider ✓ CORRECT
B. Discontinue the heparin drip and flush the line with saline
C. Administer vitamin K 10 mg subcutaneously
D. Increase the eptifibatide infusion rate to maintain anticoagulation
Correct Answer: A
Rationale: When a patient on dual anticoagulation therapy shows signs of bleeding with a
significant hemoglobin drop, the nurse must first apply direct pressure to control active
hemorrhage and then notify the provider to determine if anticoagulants should be
discontinued or reversed. Discontinuing heparin without provider orders is outside nursing
scope, vitamin K does not reverse heparin or glycoprotein IIb/IIIa inhibitors, and increasing
eptifibatide would worsen bleeding. ATI CMS tests the "Take Action" step by requiring nurses
to control bleeding first before making medication decisions that require provider
collaboration.
Question 7 of 100
A 58-year-old female is admitted for uncontrolled hypertension with a blood pressure of
198/118 mmHg. She reports a headache and blurred vision. Fundoscopic examination reveals
papilledema. The provider orders a labetalol infusion. Thirty minutes after starting the
infusion, her BP is 160/92. Which action should the nurse take?
A. Increase the labetalol infusion rate to achieve a faster drop
B. Continue the current infusion rate and reassess in 30 minutes ✓ CORRECT
C. Stop the infusion and administer a bolus of normal saline
D. Administer sublingual nifedipine 10 mg for faster control
Correct Answer: B
Rationale: In hypertensive emergency, the goal is to lower mean arterial pressure by no more
than 10-20% in the first hour to prevent cerebral hypoperfusion, stroke, or coronary ischemia
from overly rapid reduction, so a BP of 160/92 represents appropriate initial progress that
should be maintained. Increasing the rate or using sublingual nifedipine could cause a
precipitous drop and end-organ ischemia, and stopping the infusion is unnecessary when the
patient remains hypertensive. ATI CMS frequently tests that nurses must avoid rapid BP
reduction in hypertensive emergencies, as too-fast correction is more dangerous than the
hypertension itself.
Question 8 of 100
A 67-year-old male with severe peripheral arterial disease is scheduled for a femoral-popliteal
bypass graft. Preoperative labs reveal a hemoglobin of 9.8 g/dL and a hematocrit of 29%. The
Mastery Series Ed 12.0 ATI CMS Official
Practice Exam Actual Exam 2026/2027 with
Detailed Rationales | Complete Exam-Style
Questions | Pass Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: CARDIOVASCULAR & HEMATOLOGIC DISORDERS Q1 – Q17
══════════════════════════════════════
Question 1 of 100
A 68-year-old male with a history of hypertension and hyperlipidemia is admitted with
crushing substernal chest pain radiating to his left jaw. His vital signs are BP 158/94, HR 102,
RR 22, SpO2 91% on room air. The 12-lead ECG shows ST-segment elevation in leads V1
through V4. After initiating oxygen and establishing IV access, which action should the nurse
prioritize?
A. Administer sublingual nitroglycerin 0.4 mg every 5 minutes
B. Obtain a stat chest X-ray to rule out aortic dissection
C. Administer chewable aspirin 325 mg if not contraindicated ✓ CORRECT
D. Prepare the patient for immediate synchronized cardioversion
Correct Answer: C
Rationale: In a patient with STEMI, chewable aspirin administration is a priority intervention
that reduces mortality by inhibiting platelet aggregation and preventing further thrombus
formation, and it should be given immediately after oxygen and IV access unless true allergy
exists. While nitroglycerin may be appropriate later, administering it before aspirin delays a
proven mortality-reducing therapy, and chest X-ray is not the priority when ECG already
confirms STEMI. ATI CMS emphasizes that aspirin should be given within 10 minutes of
arrival for any suspected MI.
Question 2 of 100
A 54-year-old female with heart failure presents with increasing dyspnea, orthopnea, and
weight gain of 4.5 kg over 3 days. Her lungs have crackles bilaterally, JVD is present at 45
degrees, and her vital signs are BP 142/88, HR 110, RR 26, SpO2 88% on room air. The provider
,orders furosemide 80 mg IV push. Which assessment should the nurse perform immediately
before administering this dose?
A. Auscultate lung sounds and assess for S3 gallop
B. Verify the patient's most recent serum potassium level ✓ CORRECT
C. Check the patient's blood glucose level
D. Palpate peripheral pulses and capillary refill
Correct Answer: B
Rationale: Furosemide is a potent loop diuretic that causes significant renal potassium
wasting, and administering 80 mg IV without verifying recent potassium could precipitate
life-threatening hypokalemia or cardiac dysrhythmias in a patient already volume overloaded
and tachycardic. While lung sounds and S3 assessment are important for monitoring heart
failure status, they do not present an immediate safety risk before diuretic administration the
way unchecked electrolyte imbalance does. ATI CMS frequently tests medication safety by
requiring nurses to verify electrolytes before loop diuretics, especially with high-dose IV
therapy.
Question 3 of 100
A 72-year-old male with chronic atrial fibrillation takes warfarin 5 mg daily. He presents to the
clinic with melena, fatigue, and a hematocrit of 28%. His INR is 6.8. The provider orders
vitamin K 10 mg subcutaneously and holds warfarin. Which additional intervention should the
nurse anticipate and prepare for?
A. Administer protamine sulfate 1 mg per 100 units of heparin
B. Prepare to administer fresh frozen plasma ✓ CORRECT
C. Initiate a heparin drip at 18 units/kg/hr
D. Administer a bolus of aspirin 325 mg
Correct Answer: B
Rationale: Fresh frozen plasma contains clotting factors II, VII, IX, and X and is indicated for
rapid reversal of warfarin-induced bleeding when the INR is significantly elevated and the
patient shows signs of active hemorrhage such as melena and anemia. Protamine sulfate
reverses heparin, not warfarin, and initiating heparin or giving aspirin would worsen bleeding
in a patient with an INR of 6.8 and active GI bleeding. ATI CMS tests anticoagulation reversal
frequently — remember vitamin K works slowly over hours, while FFP provides immediate
factor replacement for active bleeding.
Question 4 of 100
A 61-year-old female is admitted with new-onset heart failure and an ejection fraction of 30%.
Her home medications include metformin, lisinopril, and hydrochlorothiazide. The provider
discontinues hydrochlorothiazide and starts carvedilol 3.125 mg twice daily. Two hours after
,the first dose, the patient becomes dizzy when attempting to stand, and her BP drops from
132/78 supine to 94/58 standing. Which action should the nurse take first?
A. Hold the next dose of carvedilol and notify the provider
B. Assist the patient back to bed and assess orthostatic vitals ✓ CORRECT
C. Administer a 500 mL bolus of normal saline
D. Increase the lisinopril dose to counteract the hypotension
Correct Answer: B
Rationale: First-dose orthostatic hypotension is a common and expected adverse effect of
nonselective beta-blockers like carvedilol, and the immediate nursing priority is to ensure
patient safety by assisting them to a supine position and confirming orthostatic changes
before determining if the medication should be held. Administering a fluid bolus is not
indicated without provider orders in a heart failure patient, and increasing lisinopril would
worsen hypotension rather than correct it. ATI CMS prioritization questions require the nurse
to ensure immediate patient safety before notifying the provider or making medication
decisions.
Question 5 of 100
A 45-year-old female with sickle cell disease presents with severe joint pain, a temperature of
38.9°C, and a new systolic murmur at the left sternal border. Her hemoglobin is 6.2 g/dL, and
her reticulocyte count is elevated. Which nursing intervention is the priority?
A. Begin a blood transfusion with packed red blood cells
B. Administer IV fluids at 1.5 times maintenance and apply oxygen ✓ CORRECT
C. Administer meperidine 50 mg IV for pain control
D. Prepare the patient for immediate splenectomy
Correct Answer: B
Rationale: This patient is experiencing a vaso-occlusive crisis with possible acute chest
syndrome or infection, and the priority interventions are aggressive hydration to reduce blood
viscosity and oxygen to improve tissue perfusion and prevent further sickling, following the
standard vaso-occlusive crisis protocol. While pain management is important, meperidine is
contraindicated in sickle cell disease due to normeperidine accumulation causing seizures,
and transfusion is reserved for specific indications like stroke or acute chest syndrome with
severe hypoxia. ATI CMS emphasizes that hydration and oxygen are the foundational
interventions for any sickle cell crisis before addressing pain or considering transfusion.
Question 6 of 100
A 79-year-old male with a history of CAD and two prior stents presents with recurrent chest
pain at rest. His troponin I is 0.8 ng/mL, and the provider diagnoses non-ST-elevation
myocardial infarction (NSTEMI). The patient is started on a heparin infusion and eptifibatide.
, Four hours later, the nurse notices oozing around the IV site and a drop in hemoglobin from
13.2 to 10.8 g/dL. Which action should the nurse take immediately?
A. Apply firm pressure to the site and notify the provider ✓ CORRECT
B. Discontinue the heparin drip and flush the line with saline
C. Administer vitamin K 10 mg subcutaneously
D. Increase the eptifibatide infusion rate to maintain anticoagulation
Correct Answer: A
Rationale: When a patient on dual anticoagulation therapy shows signs of bleeding with a
significant hemoglobin drop, the nurse must first apply direct pressure to control active
hemorrhage and then notify the provider to determine if anticoagulants should be
discontinued or reversed. Discontinuing heparin without provider orders is outside nursing
scope, vitamin K does not reverse heparin or glycoprotein IIb/IIIa inhibitors, and increasing
eptifibatide would worsen bleeding. ATI CMS tests the "Take Action" step by requiring nurses
to control bleeding first before making medication decisions that require provider
collaboration.
Question 7 of 100
A 58-year-old female is admitted for uncontrolled hypertension with a blood pressure of
198/118 mmHg. She reports a headache and blurred vision. Fundoscopic examination reveals
papilledema. The provider orders a labetalol infusion. Thirty minutes after starting the
infusion, her BP is 160/92. Which action should the nurse take?
A. Increase the labetalol infusion rate to achieve a faster drop
B. Continue the current infusion rate and reassess in 30 minutes ✓ CORRECT
C. Stop the infusion and administer a bolus of normal saline
D. Administer sublingual nifedipine 10 mg for faster control
Correct Answer: B
Rationale: In hypertensive emergency, the goal is to lower mean arterial pressure by no more
than 10-20% in the first hour to prevent cerebral hypoperfusion, stroke, or coronary ischemia
from overly rapid reduction, so a BP of 160/92 represents appropriate initial progress that
should be maintained. Increasing the rate or using sublingual nifedipine could cause a
precipitous drop and end-organ ischemia, and stopping the infusion is unnecessary when the
patient remains hypertensive. ATI CMS frequently tests that nurses must avoid rapid BP
reduction in hypertensive emergencies, as too-fast correction is more dangerous than the
hypertension itself.
Question 8 of 100
A 67-year-old male with severe peripheral arterial disease is scheduled for a femoral-popliteal
bypass graft. Preoperative labs reveal a hemoglobin of 9.8 g/dL and a hematocrit of 29%. The
