ATI MED SURG CMS PROCTORED EXAM 2026/2027 | Verified
Questions & Answers | Latest Update | Comprehensive
Med-Surg Mastery | Pass Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR DISORDERS (25 Questions)
Q1: A 72-year-old male with HFrEF presents with a 6-pound weight gain over 3 days,
worsening dyspnea on exertion, and 3+ pitting edema in bilateral lower extremities. His
current medications include lisinopril, metoprolol, and furosemide. Which nursing
intervention is the priority?
A. Increase the metoprolol dose to improve cardiac output
B. Administer a fluid bolus of normal saline to improve perfusion
C. Notify the provider and assess for possible medication adjustment or additional
diuretic therapy
D. Instruct the patient to restrict all sodium and fluid intake independently
C. [CORRECT]
Correct Answer: C
Rationale: Acute decompensated heart failure with rapid weight gain and edema
indicates fluid overload requiring provider notification for possible diuretic adjustment
or additional therapy. Increasing metoprolol could worsen decompensation, fluid bolus
exacerbates overload, and independent dietary restriction without provider guidance is
unsafe.
Q2: A patient with acute coronary syndrome is prescribed nitroglycerin sublingually.
Which finding requires immediate intervention before administration?
A. Blood pressure of 142/88 mmHg
B. Heart rate of 78 beats per minute
C. Blood pressure of 88/52 mmHg
D. Respiratory rate of 18 breaths per minute
C. [CORRECT]
Correct Answer: C
,Rationale: Nitroglycerin is contraindicated with systolic blood pressure <90 mmHg due
to risk of profound hypotension and syncope; the nurse must hold the dose and notify
the provider. Options A, B, and D are within acceptable parameters for nitroglycerin
administration.
Q3: A patient with atrial fibrillation is prescribed warfarin with a target INR of 2.0-3.0.
The patient reports eating large amounts of spinach and kale daily. Which instruction is
essential?
A. Continue the current diet as vitamin K has no effect on warfarin
B. Maintain consistent vitamin K intake and have INR monitored regularly
C. Avoid all green vegetables completely to prevent bleeding
D. Double the warfarin dose to counteract the vitamin K
B. [CORRECT]
Correct Answer: B
Rationale: Consistent vitamin K intake allows stable warfarin dosing; fluctuations in
dietary vitamin K cause unpredictable INR variations requiring frequent monitoring.
Avoiding all vegetables is nutritionally inadequate, and dose adjustments without INR
results are dangerous.
Q4: A patient post-CABG has a chest tube with 150 mL of bright red drainage in the first
hour. Which action is the priority?
A. Clamp the chest tube to prevent excessive blood loss
B. Document the finding as normal postoperative drainage
C. Notify the surgeon immediately as this exceeds expected drainage
D. Milk the tubing vigorously to maintain patency
C. [CORRECT]
Correct Answer: C
Rationale: Chest tube drainage >100 mL/hour for 2-3 consecutive hours indicates
postoperative hemorrhage and requires immediate surgical evaluation; clamping risks
tension pneumothorax. Option B is unsafe as this exceeds normal parameters, and
vigorous milking is not indicated.
Q5: A patient with peripheral arterial disease has a non-healing ulcer on the right great
toe. The foot is cool, pale, and pedal pulses are absent. Which intervention is most
appropriate?
,A. Apply warm compresses to increase circulation
B. Elevate the leg above heart level to reduce edema
C. Keep the foot in a dependent position and avoid pressure on the heel
D. Massage the foot vigorously to stimulate blood flow
C. [CORRECT]
Correct Answer: C
Rationale: Dependent positioning improves arterial perfusion to ischemic tissues in PAD,
and heel offloading prevents further ulceration. Warm compresses can cause burns in
insensate tissue, elevation further compromises perfusion, and massage risks tissue
damage.
Q6: A patient with a mechanical mitral valve replacement is scheduled for dental
cleaning. Which instruction is essential?
A. No special precautions are needed for dental procedures
B. Take prophylactic antibiotics before the procedure as prescribed
C. Stop warfarin 5 days before the dental appointment
D. Avoid all dental work permanently to prevent infection
B. [CORRECT]
Correct Answer: B
Rationale: Prosthetic valve patients require antibiotic prophylaxis before dental
procedures to prevent infective endocarditis from bacteremia. Option A is dangerous,
discontinuing warfarin requires provider guidance, and avoiding all dental work is
unnecessary.
Q7: A patient with a DVT is receiving enoxaparin 40 mg subcutaneously daily. The
patient reports abdominal pain and bruising. Laboratory results show platelets at
85,000/mm³. Which action is the priority?
A. Continue the current dose and monitor platelets daily
B. Discontinue enoxaparin immediately and notify the provider
C. Switch to oral warfarin without bridging
D. Administer a platelet transfusion
B. [CORRECT]
Correct Answer: B
Rationale: A platelet count of 85,000/mm³ with heparin exposure suggests
heparin-induced thrombocytopenia (HIT); discontinuing all heparin immediately is
, critical to prevent thrombotic complications. Continuing enoxaparin or switching to
warfarin alone could worsen thrombosis.
Q8: A patient with heart failure has a BNP of 1,850 pg/mL. Which statement best
explains the clinical significance of this finding?
A. The BNP level indicates normal cardiac function
B. Elevated BNP suggests ventricular wall stretch and worsening heart failure
C. The BNP level is falsely elevated due to renal dysfunction alone
D. BNP is only elevated during acute myocardial infarction
B. [CORRECT]
Correct Answer: B
Rationale: BNP is released from ventricular myocardium in response to wall stretch
from volume overload; levels >400 pg/mL strongly support decompensated heart
failure. While renal dysfunction can elevate BNP, a level of 1,850 is clinically significant
for heart failure exacerbation.
Q9: A patient with a permanent pacemaker presents with dizziness and syncope. The
monitor shows pacemaker spikes without subsequent QRS complexes. Which condition
is present?
A. Pacemaker syndrome
B. Failure to capture
C. Failure to pace
D. Oversensing
B. [CORRECT]
Correct Answer: B
Rationale: Failure to capture occurs when the pacemaker spike is present but does not
depolarize the myocardium (no QRS complex), resulting in symptomatic bradycardia.
Pacemaker syndrome presents with cannon A waves, failure to pace shows no spikes,
and oversensing shows inappropriate pauses.
Q10: A patient with hypertension is prescribed hydrochlorothiazide. Which finding
requires immediate nursing intervention?
A. Blood pressure of 128/76 mmHg
B. Serum potassium of 3.2 mEq/L
C. Urine output of 50 mL/hour
Questions & Answers | Latest Update | Comprehensive
Med-Surg Mastery | Pass Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR DISORDERS (25 Questions)
Q1: A 72-year-old male with HFrEF presents with a 6-pound weight gain over 3 days,
worsening dyspnea on exertion, and 3+ pitting edema in bilateral lower extremities. His
current medications include lisinopril, metoprolol, and furosemide. Which nursing
intervention is the priority?
A. Increase the metoprolol dose to improve cardiac output
B. Administer a fluid bolus of normal saline to improve perfusion
C. Notify the provider and assess for possible medication adjustment or additional
diuretic therapy
D. Instruct the patient to restrict all sodium and fluid intake independently
C. [CORRECT]
Correct Answer: C
Rationale: Acute decompensated heart failure with rapid weight gain and edema
indicates fluid overload requiring provider notification for possible diuretic adjustment
or additional therapy. Increasing metoprolol could worsen decompensation, fluid bolus
exacerbates overload, and independent dietary restriction without provider guidance is
unsafe.
Q2: A patient with acute coronary syndrome is prescribed nitroglycerin sublingually.
Which finding requires immediate intervention before administration?
A. Blood pressure of 142/88 mmHg
B. Heart rate of 78 beats per minute
C. Blood pressure of 88/52 mmHg
D. Respiratory rate of 18 breaths per minute
C. [CORRECT]
Correct Answer: C
,Rationale: Nitroglycerin is contraindicated with systolic blood pressure <90 mmHg due
to risk of profound hypotension and syncope; the nurse must hold the dose and notify
the provider. Options A, B, and D are within acceptable parameters for nitroglycerin
administration.
Q3: A patient with atrial fibrillation is prescribed warfarin with a target INR of 2.0-3.0.
The patient reports eating large amounts of spinach and kale daily. Which instruction is
essential?
A. Continue the current diet as vitamin K has no effect on warfarin
B. Maintain consistent vitamin K intake and have INR monitored regularly
C. Avoid all green vegetables completely to prevent bleeding
D. Double the warfarin dose to counteract the vitamin K
B. [CORRECT]
Correct Answer: B
Rationale: Consistent vitamin K intake allows stable warfarin dosing; fluctuations in
dietary vitamin K cause unpredictable INR variations requiring frequent monitoring.
Avoiding all vegetables is nutritionally inadequate, and dose adjustments without INR
results are dangerous.
Q4: A patient post-CABG has a chest tube with 150 mL of bright red drainage in the first
hour. Which action is the priority?
A. Clamp the chest tube to prevent excessive blood loss
B. Document the finding as normal postoperative drainage
C. Notify the surgeon immediately as this exceeds expected drainage
D. Milk the tubing vigorously to maintain patency
C. [CORRECT]
Correct Answer: C
Rationale: Chest tube drainage >100 mL/hour for 2-3 consecutive hours indicates
postoperative hemorrhage and requires immediate surgical evaluation; clamping risks
tension pneumothorax. Option B is unsafe as this exceeds normal parameters, and
vigorous milking is not indicated.
Q5: A patient with peripheral arterial disease has a non-healing ulcer on the right great
toe. The foot is cool, pale, and pedal pulses are absent. Which intervention is most
appropriate?
,A. Apply warm compresses to increase circulation
B. Elevate the leg above heart level to reduce edema
C. Keep the foot in a dependent position and avoid pressure on the heel
D. Massage the foot vigorously to stimulate blood flow
C. [CORRECT]
Correct Answer: C
Rationale: Dependent positioning improves arterial perfusion to ischemic tissues in PAD,
and heel offloading prevents further ulceration. Warm compresses can cause burns in
insensate tissue, elevation further compromises perfusion, and massage risks tissue
damage.
Q6: A patient with a mechanical mitral valve replacement is scheduled for dental
cleaning. Which instruction is essential?
A. No special precautions are needed for dental procedures
B. Take prophylactic antibiotics before the procedure as prescribed
C. Stop warfarin 5 days before the dental appointment
D. Avoid all dental work permanently to prevent infection
B. [CORRECT]
Correct Answer: B
Rationale: Prosthetic valve patients require antibiotic prophylaxis before dental
procedures to prevent infective endocarditis from bacteremia. Option A is dangerous,
discontinuing warfarin requires provider guidance, and avoiding all dental work is
unnecessary.
Q7: A patient with a DVT is receiving enoxaparin 40 mg subcutaneously daily. The
patient reports abdominal pain and bruising. Laboratory results show platelets at
85,000/mm³. Which action is the priority?
A. Continue the current dose and monitor platelets daily
B. Discontinue enoxaparin immediately and notify the provider
C. Switch to oral warfarin without bridging
D. Administer a platelet transfusion
B. [CORRECT]
Correct Answer: B
Rationale: A platelet count of 85,000/mm³ with heparin exposure suggests
heparin-induced thrombocytopenia (HIT); discontinuing all heparin immediately is
, critical to prevent thrombotic complications. Continuing enoxaparin or switching to
warfarin alone could worsen thrombosis.
Q8: A patient with heart failure has a BNP of 1,850 pg/mL. Which statement best
explains the clinical significance of this finding?
A. The BNP level indicates normal cardiac function
B. Elevated BNP suggests ventricular wall stretch and worsening heart failure
C. The BNP level is falsely elevated due to renal dysfunction alone
D. BNP is only elevated during acute myocardial infarction
B. [CORRECT]
Correct Answer: B
Rationale: BNP is released from ventricular myocardium in response to wall stretch
from volume overload; levels >400 pg/mL strongly support decompensated heart
failure. While renal dysfunction can elevate BNP, a level of 1,850 is clinically significant
for heart failure exacerbation.
Q9: A patient with a permanent pacemaker presents with dizziness and syncope. The
monitor shows pacemaker spikes without subsequent QRS complexes. Which condition
is present?
A. Pacemaker syndrome
B. Failure to capture
C. Failure to pace
D. Oversensing
B. [CORRECT]
Correct Answer: B
Rationale: Failure to capture occurs when the pacemaker spike is present but does not
depolarize the myocardium (no QRS complex), resulting in symptomatic bradycardia.
Pacemaker syndrome presents with cannon A waves, failure to pace shows no spikes,
and oversensing shows inappropriate pauses.
Q10: A patient with hypertension is prescribed hydrochlorothiazide. Which finding
requires immediate nursing intervention?
A. Blood pressure of 128/76 mmHg
B. Serum potassium of 3.2 mEq/L
C. Urine output of 50 mL/hour
