ATI Med Surg CMS Proctored Exam — 100
Practice Questions with Answers
Section 1: Cardiovascular Nursing (Q1–20)
1. A client with acute myocardial infarction is experiencing chest pain. Which medication
should the nurse expect to administer first?
A) Metoprolol
B) Lisinopril
C) Morphine
D) Aspirin
Answer: C
Rationale: In acute MI, morphine is administered first as a primary intervention because it
provides immediate pain relief, reduces anxiety, decreases cardiac workload, and causes
vasodilation to improve coronary blood flow .
2. A nurse is caring for a client post-MI receiving heparin therapy. Which laboratory value
indicates therapeutic anticoagulation?
A) Prothrombin time (PT) of 18 seconds
B) International Normalized Ratio (INR) of 2-3
C) Activated partial thromboplastin time (aPTT) of 1.5-2.5 times the control value
D) Platelet count of 250,000/mm³
Answer: C
Rationale: Heparin therapy is monitored using the aPTT, with therapeutic levels ranging
from 1.5 to 2.5 times the control value. PT and INR are used to monitor warfarin therapy .
3. A client is scheduled for coronary artery bypass graft (CABG) surgery. Which
preoperative teaching point is most important?
A) The client will be able to resume driving immediately after discharge
B) Coughing and deep breathing exercises will help prevent postoperative complications
C) Pain medication will not be necessary after the first 24 hours
D) The client should avoid any activity for 6 weeks postoperatively
Answer: B
Rationale: Coughing and deep breathing are essential postoperative nursing interventions
that prevent atelectasis and pneumonia by promoting lung expansion and clearance of
secretions .
,4. A nurse is assessing a client with congestive heart failure (CHF). Which finding indicates
worsening heart failure?
A) Increased urine output with normal specific gravity
B) Weight gain of 3 pounds in 1 week
C) Blood pressure of 130/85 mmHg
D) Heart rate of 70 beats per minute
Answer: B
Rationale: Rapid weight gain (more than 2-3 pounds in 1-2 days or 5 pounds in a week)
indicates fluid retention and worsening heart failure .
5. A client with acute pulmonary edema suddenly becomes anxious, tachypneic, and has
frothy pink sputum. Oxygen saturation is 84% on room air. What is the nurse's priority
action?
A) Obtain a stat chest x-ray
B) Place client in high Fowler's position and apply oxygen
C) Administer IV furosemide first
D) Encourage coughing and deep breathing
Answer: B
Rationale: Airway and breathing take priority. Upright positioning improves lung expansion
and oxygenation immediately .
6. A client with atrial fibrillation is prescribed warfarin. Which statement by the client
indicates a need for further education?
A) "I'll maintain consistent vitamin K intake from foods like spinach and broccoli"
B) "I can take over-the-counter pain relievers like aspirin when I have a headache"
C) "I'll have my PT/INR checked regularly as scheduled by my provider"
D) "I'll report any unusual bleeding or bruising"
Answer: B
Rationale: Aspirin increases bleeding risk when taken with warfarin. The client should avoid
aspirin and other NSAIDs unless specifically prescribed .
7. A client receiving IV heparin has an aPTT of 110 seconds. The nurse notes no active
bleeding. What is the best action?
A) Continue infusion at same rate
B) Increase heparin dose
C) Hold infusion per protocol
D) Administer vitamin K
, Answer: C
Rationale: Therapeutic aPTT is elevated beyond range; infusion must be held or adjusted
even without visible bleeding .
8. A client with chronic atrial fibrillation is at highest risk for:
A) Heart failure
B) Myocardial infarction
C) Ischemic stroke
D) Pulmonary embolism
Answer: C
Rationale: Nonvalvular atrial fibrillation increases stroke risk 5-fold due to thrombus
formation in the left atrial appendage .
9. A client is prescribed sublingual nitroglycerin. Which statement indicates understanding
of the teaching?
A) "I can keep my medications for 1 year before replacing it."
B) "I should lie down when I take this medication."
C) "I should discontinue this medication if I develop a headache."
D) "I can take up to 5 tablets in 15 minutes before seeking medical attention."
Answer: B
Rationale: Clients should lie down when taking sublingual nitroglycerin to prevent
hypotension and syncope .
10. A client who had an MI 3 days ago reports sudden shortness of breath and crackles
auscultated in bilateral lung bases. The nurse suspects:
A) Pulmonary embolism
B) Cardiogenic pulmonary edema
C) Pneumonia
D) Medication reaction
Answer: B
Rationale: Crackles and dyspnea following MI suggest left ventricular failure and pulmonary
congestion (cardiogenic pulmonary edema) .
11. A client with heart failure reports a 5-lb weight gain in 3 days. The nurse should FIRST:
A) Encourage a low-sodium diet
B) Assess for peripheral edema and crackles
C) Increase the diuretic dose without consulting
D) Restrict all oral fluids to 500 mL/day
Practice Questions with Answers
Section 1: Cardiovascular Nursing (Q1–20)
1. A client with acute myocardial infarction is experiencing chest pain. Which medication
should the nurse expect to administer first?
A) Metoprolol
B) Lisinopril
C) Morphine
D) Aspirin
Answer: C
Rationale: In acute MI, morphine is administered first as a primary intervention because it
provides immediate pain relief, reduces anxiety, decreases cardiac workload, and causes
vasodilation to improve coronary blood flow .
2. A nurse is caring for a client post-MI receiving heparin therapy. Which laboratory value
indicates therapeutic anticoagulation?
A) Prothrombin time (PT) of 18 seconds
B) International Normalized Ratio (INR) of 2-3
C) Activated partial thromboplastin time (aPTT) of 1.5-2.5 times the control value
D) Platelet count of 250,000/mm³
Answer: C
Rationale: Heparin therapy is monitored using the aPTT, with therapeutic levels ranging
from 1.5 to 2.5 times the control value. PT and INR are used to monitor warfarin therapy .
3. A client is scheduled for coronary artery bypass graft (CABG) surgery. Which
preoperative teaching point is most important?
A) The client will be able to resume driving immediately after discharge
B) Coughing and deep breathing exercises will help prevent postoperative complications
C) Pain medication will not be necessary after the first 24 hours
D) The client should avoid any activity for 6 weeks postoperatively
Answer: B
Rationale: Coughing and deep breathing are essential postoperative nursing interventions
that prevent atelectasis and pneumonia by promoting lung expansion and clearance of
secretions .
,4. A nurse is assessing a client with congestive heart failure (CHF). Which finding indicates
worsening heart failure?
A) Increased urine output with normal specific gravity
B) Weight gain of 3 pounds in 1 week
C) Blood pressure of 130/85 mmHg
D) Heart rate of 70 beats per minute
Answer: B
Rationale: Rapid weight gain (more than 2-3 pounds in 1-2 days or 5 pounds in a week)
indicates fluid retention and worsening heart failure .
5. A client with acute pulmonary edema suddenly becomes anxious, tachypneic, and has
frothy pink sputum. Oxygen saturation is 84% on room air. What is the nurse's priority
action?
A) Obtain a stat chest x-ray
B) Place client in high Fowler's position and apply oxygen
C) Administer IV furosemide first
D) Encourage coughing and deep breathing
Answer: B
Rationale: Airway and breathing take priority. Upright positioning improves lung expansion
and oxygenation immediately .
6. A client with atrial fibrillation is prescribed warfarin. Which statement by the client
indicates a need for further education?
A) "I'll maintain consistent vitamin K intake from foods like spinach and broccoli"
B) "I can take over-the-counter pain relievers like aspirin when I have a headache"
C) "I'll have my PT/INR checked regularly as scheduled by my provider"
D) "I'll report any unusual bleeding or bruising"
Answer: B
Rationale: Aspirin increases bleeding risk when taken with warfarin. The client should avoid
aspirin and other NSAIDs unless specifically prescribed .
7. A client receiving IV heparin has an aPTT of 110 seconds. The nurse notes no active
bleeding. What is the best action?
A) Continue infusion at same rate
B) Increase heparin dose
C) Hold infusion per protocol
D) Administer vitamin K
, Answer: C
Rationale: Therapeutic aPTT is elevated beyond range; infusion must be held or adjusted
even without visible bleeding .
8. A client with chronic atrial fibrillation is at highest risk for:
A) Heart failure
B) Myocardial infarction
C) Ischemic stroke
D) Pulmonary embolism
Answer: C
Rationale: Nonvalvular atrial fibrillation increases stroke risk 5-fold due to thrombus
formation in the left atrial appendage .
9. A client is prescribed sublingual nitroglycerin. Which statement indicates understanding
of the teaching?
A) "I can keep my medications for 1 year before replacing it."
B) "I should lie down when I take this medication."
C) "I should discontinue this medication if I develop a headache."
D) "I can take up to 5 tablets in 15 minutes before seeking medical attention."
Answer: B
Rationale: Clients should lie down when taking sublingual nitroglycerin to prevent
hypotension and syncope .
10. A client who had an MI 3 days ago reports sudden shortness of breath and crackles
auscultated in bilateral lung bases. The nurse suspects:
A) Pulmonary embolism
B) Cardiogenic pulmonary edema
C) Pneumonia
D) Medication reaction
Answer: B
Rationale: Crackles and dyspnea following MI suggest left ventricular failure and pulmonary
congestion (cardiogenic pulmonary edema) .
11. A client with heart failure reports a 5-lb weight gain in 3 days. The nurse should FIRST:
A) Encourage a low-sodium diet
B) Assess for peripheral edema and crackles
C) Increase the diuretic dose without consulting
D) Restrict all oral fluids to 500 mL/day
