Adult-Gerontology Primary Care NP Practice
Examination Questions & 100% Verified
Answers # Ace Your 2026 RN ATI Med-Surg
Proctored Exam with Confidence!
1. A 68 year old male with hypertension and diabetes presents with fatigue
and a "heaviness" in his chest that radiates to his left arm. EKG shows ST segment
depression in leads V3 V6. Troponin I is elevated. What is the most likely
diagnosis?
Answer: Non ST segment elevation myocardial infarction (NSTEMI).
Rationale: ST segment depression and elevated cardiac biomarkers indicate
myocardial ischemia and necrosis without full thickness myocardial infarction
(which would show ST elevation). NSTEMI is managed with antiplatelet agents,
anticoagulation, beta blockers, and cardiac catheterization.
2. A 72 year old female complains of progressive dyspnea on exertion,
orthopnea, and bilateral lower extremity edema. BNP is 1,200 pg/mL.
Echocardiogram reveals left ventricular ejection fraction of 35%. What class of
medication is the cornerstone of mortality reduction in this condition?
Answer: Beta blockers (e.g., Carvedilol, Metoprolol Succinate) in
combination with ACE inhibitors/ARBs.
Rationale: Heart failure with reduced ejection fraction (HFrEF) is managed
with guideline directed medical therapy (GDMT). Beta blockers reduce mortality
by blocking the deleterious effects of sympathetic activation on the failing
myocardium.
, 3. A 65 year old male with COPD presents with increased sputum purulence,
worsened dyspnea, and an increased cough for 3 days. He has no fever. What is
the most likely diagnosis?
Answer: Acute exacerbation of COPD (AECOPD).
Rationale: Anthonisen criteria for AECOPD include increased dyspnea,
sputum volume, and sputum purulence. Antibiotics and short acting
bronchodilators are the mainstays of treatment.
4. A 70 year old female with a 50 pack year smoking history is found to have a
2 cm solitary pulmonary nodule on chest X ray. What is the gold standard for
further evaluation?
Answer: CT scan of the chest with contrast (low dose CT screening protocol
or diagnostic CT).
Rationale: The Fleischner Society guidelines guide management based on
nodule size, morphology, and patient risk factors. PET scan and biopsy may follow
if the CT suggests malignancy.
5. A 75 year old with a history of benign prostatic hyperplasia presents with
acute onset of suprapubic pain and inability to void for 12 hours. Bladder scan
shows 900 mL. What is the immediate management?
Answer: Insertion of a Foley catheter to relieve the obstruction.
Rationale: Acute urinary retention is a urological emergency. Immediate
decompression prevents bladder muscle damage and hydronephrosis. Alpha
blockers (Tamsulosin) are initiated to relax the prostate.
6. A 60 year old patient with diabetes and hypertension has an LDL cholesterol
of 190 mg/dL despite maximum atorvastatin. What class of medication should be
added according to ACC/AHA guidelines?
, Answer: Ezetimibe (a cholesterol absorption inhibitor) or a PCSK9 inhibitor.
Rationale: For very high risk ASCVD patients not at goal on maximal statin
therapy, adding Ezetimibe is the next step. If still not at goal, PCSK9 inhibitors
(Alirocumab, Evolocumab) are indicated.
7. A 66 year old female presents with a "thunderclap" headache, nausea, and
photophobia. She has no history of migraines. CT head is negative. What is the
next definitive diagnostic test?
Answer: Lumbar puncture to evaluate for xanthochromia or red blood cells
(subarachnoid hemorrhage).
Rationale: A CT scan can miss a small subarachnoid hemorrhage. Lumbar
puncture is mandatory when the clinical suspicion is high.
8. A 78 year old nursing home patient develops foul smelling, watery diarrhea
and abdominal cramping after a course of Clindamycin for a dental infection.
What is the most likely diagnosis, and what is the treatment?
Answer: Clostridioides difficile infection. Treatment: Oral Vancomycin or
Fidaxomicin.
Rationale: C. diff colitis presents with watery diarrhea and leukocytosis,
triggered by antibiotic disruption of gut flora. Metronidazole is an alternative if
oral vancomycin is unavailable.
9. A 64 year old male with cirrhosis presents with a distended abdomen,
shifting dullness, and a fluid wave. What is the most serious complication of this
condition that requires immediate paracentesis analysis?
Answer: Spontaneous Bacterial Peritonitis (SBP).
Rationale: SBP is diagnosed by an ascitic fluid absolute neutrophil count
(ANC) > 250 cells/mm³. It requires immediate IV antibiotics (Cefotaxime) and
albumin infusion to prevent hepatorenal syndrome.
Examination Questions & 100% Verified
Answers # Ace Your 2026 RN ATI Med-Surg
Proctored Exam with Confidence!
1. A 68 year old male with hypertension and diabetes presents with fatigue
and a "heaviness" in his chest that radiates to his left arm. EKG shows ST segment
depression in leads V3 V6. Troponin I is elevated. What is the most likely
diagnosis?
Answer: Non ST segment elevation myocardial infarction (NSTEMI).
Rationale: ST segment depression and elevated cardiac biomarkers indicate
myocardial ischemia and necrosis without full thickness myocardial infarction
(which would show ST elevation). NSTEMI is managed with antiplatelet agents,
anticoagulation, beta blockers, and cardiac catheterization.
2. A 72 year old female complains of progressive dyspnea on exertion,
orthopnea, and bilateral lower extremity edema. BNP is 1,200 pg/mL.
Echocardiogram reveals left ventricular ejection fraction of 35%. What class of
medication is the cornerstone of mortality reduction in this condition?
Answer: Beta blockers (e.g., Carvedilol, Metoprolol Succinate) in
combination with ACE inhibitors/ARBs.
Rationale: Heart failure with reduced ejection fraction (HFrEF) is managed
with guideline directed medical therapy (GDMT). Beta blockers reduce mortality
by blocking the deleterious effects of sympathetic activation on the failing
myocardium.
, 3. A 65 year old male with COPD presents with increased sputum purulence,
worsened dyspnea, and an increased cough for 3 days. He has no fever. What is
the most likely diagnosis?
Answer: Acute exacerbation of COPD (AECOPD).
Rationale: Anthonisen criteria for AECOPD include increased dyspnea,
sputum volume, and sputum purulence. Antibiotics and short acting
bronchodilators are the mainstays of treatment.
4. A 70 year old female with a 50 pack year smoking history is found to have a
2 cm solitary pulmonary nodule on chest X ray. What is the gold standard for
further evaluation?
Answer: CT scan of the chest with contrast (low dose CT screening protocol
or diagnostic CT).
Rationale: The Fleischner Society guidelines guide management based on
nodule size, morphology, and patient risk factors. PET scan and biopsy may follow
if the CT suggests malignancy.
5. A 75 year old with a history of benign prostatic hyperplasia presents with
acute onset of suprapubic pain and inability to void for 12 hours. Bladder scan
shows 900 mL. What is the immediate management?
Answer: Insertion of a Foley catheter to relieve the obstruction.
Rationale: Acute urinary retention is a urological emergency. Immediate
decompression prevents bladder muscle damage and hydronephrosis. Alpha
blockers (Tamsulosin) are initiated to relax the prostate.
6. A 60 year old patient with diabetes and hypertension has an LDL cholesterol
of 190 mg/dL despite maximum atorvastatin. What class of medication should be
added according to ACC/AHA guidelines?
, Answer: Ezetimibe (a cholesterol absorption inhibitor) or a PCSK9 inhibitor.
Rationale: For very high risk ASCVD patients not at goal on maximal statin
therapy, adding Ezetimibe is the next step. If still not at goal, PCSK9 inhibitors
(Alirocumab, Evolocumab) are indicated.
7. A 66 year old female presents with a "thunderclap" headache, nausea, and
photophobia. She has no history of migraines. CT head is negative. What is the
next definitive diagnostic test?
Answer: Lumbar puncture to evaluate for xanthochromia or red blood cells
(subarachnoid hemorrhage).
Rationale: A CT scan can miss a small subarachnoid hemorrhage. Lumbar
puncture is mandatory when the clinical suspicion is high.
8. A 78 year old nursing home patient develops foul smelling, watery diarrhea
and abdominal cramping after a course of Clindamycin for a dental infection.
What is the most likely diagnosis, and what is the treatment?
Answer: Clostridioides difficile infection. Treatment: Oral Vancomycin or
Fidaxomicin.
Rationale: C. diff colitis presents with watery diarrhea and leukocytosis,
triggered by antibiotic disruption of gut flora. Metronidazole is an alternative if
oral vancomycin is unavailable.
9. A 64 year old male with cirrhosis presents with a distended abdomen,
shifting dullness, and a fluid wave. What is the most serious complication of this
condition that requires immediate paracentesis analysis?
Answer: Spontaneous Bacterial Peritonitis (SBP).
Rationale: SBP is diagnosed by an ascitic fluid absolute neutrophil count
(ANC) > 250 cells/mm³. It requires immediate IV antibiotics (Cefotaxime) and
albumin infusion to prevent hepatorenal syndrome.
