ATI Capstone Adult Medical-Surgical
Comprehensive Examination - V3.1
Advanced/Hard Level Practice Questions with
Detailed Rationales
Cardiovascular Disorders (Questions 1-12)
1. A nurse in the cardiac intensive care unit is caring for a client
who was admitted 4 hours ago with an acute inferior wall ST-
segment elevation myocardial infarction (STEMI). The client
received thrombolytic therapy 2 hours ago. Which of the
following assessment findings should the nurse identify as the
highest priority to report to the healthcare provider?
A. Serum troponin I level of 4.2 ng/mL (reference range < 0.04
ng/mL)
B. New-onset third-degree atrioventricular heart block with a
ventricular rate of 38/min
C. ST-segment elevation of 2 mm in leads II, III, and aVF
D. Serum creatine kinase-MB (CK-MB) level of 15 ng/mL (reference
range < 5 ng/mL)
Correct Answer: B
,Rationale: An inferior wall MI commonly involves the right coronary
artery, which supplies the sinoatrial and atrioventricular nodes.
New-onset third-degree heart block with symptomatic bradycardia
(rate 38/min) is a life-threatening complication requiring immediate
intervention (atropine, temporary pacing). Elevated troponin (4.2
ng/mL) and CK-MB (15 ng/mL) are expected findings following
acute MI and thrombolytic therapy. ST-segment elevation in the
inferior leads is consistent with the client's diagnosis and is
expected to resolve gradually with reperfusion therapy. The
bradyarrhythmia represents the greatest immediate threat to
hemodynamic stability.
2. A nurse is assessing a client who has chronic heart failure with
a left ventricular ejection fraction (LVEF) of 25%. The client is
receiving a continuous intravenous infusion of milrinone. Which
of the following findings indicates the medication is having the
desired therapeutic effect?
A. Blood pressure 88/52 mmHg with a heart rate of 112/min
B. Central venous pressure (CVP) of 12 mm Hg and pulmonary
artery wedge pressure (PAWP) of 22 mm Hg
C. Cardiac index of 3.2 L/min/m² with a systemic vascular resistance
(SVR) of 800 dynes/sec/cm⁻⁵
D. Urine output of 25 mL/hr over the past 4 hours
Correct Answer: C
Rationale: Milrinone is a phosphodiesterase III inhibitor with both
inotropic and vasodilatory effects. The desired therapeutic effects
,include increased cardiac output/index (normal CI: 2.5-4.0
L/min/m²) and decreased systemic vascular resistance (normal SVR:
800-1200 dynes/sec/cm⁻⁵). A cardiac index of 3.2 L/min/m² with
SVR of 800 dynes/sec/cm⁻⁵ indicates improved cardiac function and
reduced afterload. Hypotension (88/52) with tachycardia (112/min)
suggests excessive vasodilation or hypovolemia. Elevated CVP (12
mm Hg) and PAWP (22 mm Hg) indicate persistent fluid overload.
Oliguria (25 mL/hr) indicates inadequate renal perfusion.
3. A nurse is providing discharge teaching to a client who has a
new prescription for sacubitril/valsartan (Entresto) for the
management of heart failure with reduced ejection fraction
(HFrEF). Which of the following statements by the client indicates
a need for further teaching?
A. "I will monitor my blood pressure daily at home and report any
readings below 100/60 mm Hg."
B. "I will report any swelling of my face, tongue, or throat
immediately to my healthcare provider."
C. "I will stop taking this medication immediately if I develop a dry,
persistent cough."
D. "I will avoid taking potassium supplements while on this
medication."
Correct Answer: C
Rationale: Sacubitril/valsartan is a combination angiotensin
receptor-neprilysin inhibitor (ARNI) used for HFrEF. A dry cough is a
common adverse effect of ACE inhibitors (due to bradykinin
, accumulation), but it is NOT a reason to discontinue
sacubitril/valsartan. The client should report the cough to the
provider for evaluation, but abrupt discontinuation can worsen
heart failure. Blood pressure should be monitored (hypotension is a
common adverse effect). Angioedema (swelling of face, tongue,
throat) is a serious adverse effect requiring immediate reporting.
Potassium supplements should be avoided due to the risk of
hyperkalemia.
4. A nurse in the emergency department is assessing a client who
reports sudden onset of palpitations, lightheadedness, and chest
pressure. The cardiac monitor reveals a narrow-complex
tachycardia at a rate of 180/min with no visible P waves. The
client is alert, oriented, and has a blood pressure of 110/68 mm
Hg. Which of the following interventions should the nurse
implement first?
A. Administer amiodarone 150 mg IV push over 10 minutes
B. Perform synchronized cardioversion at 50-100 J biphasic
C. Instruct the client to perform vagal maneuvers (bearing down,
carotid sinus massage)
D. Administer adenosine 6 mg rapid IV push followed by a rapid
saline flush
Correct Answer: D
Rationale: The client is experiencing supraventricular tachycardia
(SVT) as evidenced by narrow-complex tachycardia > 150/min,
absent P waves, and hemodynamic stability (alert, normotensive).
Comprehensive Examination - V3.1
Advanced/Hard Level Practice Questions with
Detailed Rationales
Cardiovascular Disorders (Questions 1-12)
1. A nurse in the cardiac intensive care unit is caring for a client
who was admitted 4 hours ago with an acute inferior wall ST-
segment elevation myocardial infarction (STEMI). The client
received thrombolytic therapy 2 hours ago. Which of the
following assessment findings should the nurse identify as the
highest priority to report to the healthcare provider?
A. Serum troponin I level of 4.2 ng/mL (reference range < 0.04
ng/mL)
B. New-onset third-degree atrioventricular heart block with a
ventricular rate of 38/min
C. ST-segment elevation of 2 mm in leads II, III, and aVF
D. Serum creatine kinase-MB (CK-MB) level of 15 ng/mL (reference
range < 5 ng/mL)
Correct Answer: B
,Rationale: An inferior wall MI commonly involves the right coronary
artery, which supplies the sinoatrial and atrioventricular nodes.
New-onset third-degree heart block with symptomatic bradycardia
(rate 38/min) is a life-threatening complication requiring immediate
intervention (atropine, temporary pacing). Elevated troponin (4.2
ng/mL) and CK-MB (15 ng/mL) are expected findings following
acute MI and thrombolytic therapy. ST-segment elevation in the
inferior leads is consistent with the client's diagnosis and is
expected to resolve gradually with reperfusion therapy. The
bradyarrhythmia represents the greatest immediate threat to
hemodynamic stability.
2. A nurse is assessing a client who has chronic heart failure with
a left ventricular ejection fraction (LVEF) of 25%. The client is
receiving a continuous intravenous infusion of milrinone. Which
of the following findings indicates the medication is having the
desired therapeutic effect?
A. Blood pressure 88/52 mmHg with a heart rate of 112/min
B. Central venous pressure (CVP) of 12 mm Hg and pulmonary
artery wedge pressure (PAWP) of 22 mm Hg
C. Cardiac index of 3.2 L/min/m² with a systemic vascular resistance
(SVR) of 800 dynes/sec/cm⁻⁵
D. Urine output of 25 mL/hr over the past 4 hours
Correct Answer: C
Rationale: Milrinone is a phosphodiesterase III inhibitor with both
inotropic and vasodilatory effects. The desired therapeutic effects
,include increased cardiac output/index (normal CI: 2.5-4.0
L/min/m²) and decreased systemic vascular resistance (normal SVR:
800-1200 dynes/sec/cm⁻⁵). A cardiac index of 3.2 L/min/m² with
SVR of 800 dynes/sec/cm⁻⁵ indicates improved cardiac function and
reduced afterload. Hypotension (88/52) with tachycardia (112/min)
suggests excessive vasodilation or hypovolemia. Elevated CVP (12
mm Hg) and PAWP (22 mm Hg) indicate persistent fluid overload.
Oliguria (25 mL/hr) indicates inadequate renal perfusion.
3. A nurse is providing discharge teaching to a client who has a
new prescription for sacubitril/valsartan (Entresto) for the
management of heart failure with reduced ejection fraction
(HFrEF). Which of the following statements by the client indicates
a need for further teaching?
A. "I will monitor my blood pressure daily at home and report any
readings below 100/60 mm Hg."
B. "I will report any swelling of my face, tongue, or throat
immediately to my healthcare provider."
C. "I will stop taking this medication immediately if I develop a dry,
persistent cough."
D. "I will avoid taking potassium supplements while on this
medication."
Correct Answer: C
Rationale: Sacubitril/valsartan is a combination angiotensin
receptor-neprilysin inhibitor (ARNI) used for HFrEF. A dry cough is a
common adverse effect of ACE inhibitors (due to bradykinin
, accumulation), but it is NOT a reason to discontinue
sacubitril/valsartan. The client should report the cough to the
provider for evaluation, but abrupt discontinuation can worsen
heart failure. Blood pressure should be monitored (hypotension is a
common adverse effect). Angioedema (swelling of face, tongue,
throat) is a serious adverse effect requiring immediate reporting.
Potassium supplements should be avoided due to the risk of
hyperkalemia.
4. A nurse in the emergency department is assessing a client who
reports sudden onset of palpitations, lightheadedness, and chest
pressure. The cardiac monitor reveals a narrow-complex
tachycardia at a rate of 180/min with no visible P waves. The
client is alert, oriented, and has a blood pressure of 110/68 mm
Hg. Which of the following interventions should the nurse
implement first?
A. Administer amiodarone 150 mg IV push over 10 minutes
B. Perform synchronized cardioversion at 50-100 J biphasic
C. Instruct the client to perform vagal maneuvers (bearing down,
carotid sinus massage)
D. Administer adenosine 6 mg rapid IV push followed by a rapid
saline flush
Correct Answer: D
Rationale: The client is experiencing supraventricular tachycardia
(SVT) as evidenced by narrow-complex tachycardia > 150/min,
absent P waves, and hemodynamic stability (alert, normotensive).
