1|Page
ATI CAPSTONE MEDICAL-SURGICAL ASSESSMENT 1 & 2 (2026)
| 160+ QUESTIONS WITH CORRECT ANSWERS & RATIONALES,
ALREADY GRADED A+
Question 1
Topic: COPD / Respiratory Management
A 70-year-old patient with COPD presents with worsening dyspnea and
increased sputum. Which of the following should the nurse implement first?
A. Start high‐flow oxygen at 100 %
B. Administer a nebulized short-acting bronchodilator
C. Initiate corticosteroid intravenously
D. Perform chest physiotherapy
Correct Answer: B. Administer a nebulized short-acting bronchodilator
Rationale: The first priority in COPD exacerbation is to relieve
bronchospasm and improve airflow. Bronchodilators (e.g., albuterol) are
first line. Oxygen is given cautiously to maintain target SpO₂, not 100 %.
Reference Link: 2025 GOLD Report / pocket guide (for COPD
management) — https://goldcopd.org/wp-content/uploads/2024/11/Pocket-
Guide-2025-v1.0-New-Format-15Nov2024_WMV.pdf GOLD
Question 2
Topic: COPD / Pharmacologic Treatment
According to the GOLD strategy, which combination is recommended for a
patient with persistent symptoms and exacerbations on monotherapy?
A. LABA + ICS
B. LAMA + ICS
C. LABA + LAMA
D. Triple therapy (LABA + LAMA + ICS) for all patients
,2|Page
Correct Answer: C. LABA + LAMA
Rationale: GOLD recommends escalation to dual long-acting
bronchodilators (LABA + LAMA) for patients who remain symptomatic on
monotherapy. ICS is usually reserved for those with frequent exacerbations
and certain eosinophil counts. PMC+1
Reference Link: GOLD strategy documents
GOLD+2GOLD+2
Question 3
Topic: Heart Failure / Guideline-Directed Medical Therapy (GDMT)
Which of the following classes is newly emphasized in the 2022
AHA/ACC/HFSA guideline as part of standard therapy for heart failure with
reduced ejection fraction (HFrEF)?
A. Beta-blockers
B. ACE inhibitors
C. Mineralocorticoid receptor antagonists (MRAs)
D. SGLT2 inhibitors
Correct Answer: D. SGLT2 inhibitors
Rationale: The 2022 guidelines formally include SGLT2 inhibitors as part
of guideline-directed medical therapy due to benefits on hospitalization and
mortality. AHA Journals+2PMC+2
Reference Link: 2022 AHA/ACC/HFSA Guideline for the Management of
Heart Failure —
https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063 AHA
Journals
Question 4
Topic: Heart Failure / Acute Decompensation
A patient with known heart failure is admitted with acute decompensation:
dyspnea at rest, orthopnea, and pulmonary edema on chest X-ray. Which
intervention is highest priority?
,3|Page
A. Start warfarin
B. Administer IV diuretics
C. Begin digoxin
D. Increase sodium intake
Correct Answer: B. Administer IV diuretics
Rationale: In decompensated HF with volume overload, reducing preload
through diuresis is critical to relieve pulmonary congestion. The others are
not immediate priorities.
Reference Link: 2022 AHA/ACC/HFSA Guideline / HF decompensation
management (see guideline document) PMC+1
Question 5
Topic: Arrhythmia / Atrial Fibrillation
Which guideline provides the most recent recommendations for diagnosis
and management of atrial fibrillation?
A. 2021 ACC HF Guideline
B. 2023 ACC/AHA/ACCP/HRS Guideline
C. 2022 GOLD Report
D. 2020 NIH Stroke Scale manual
Correct Answer: B. 2023 ACC/AHA/ACCP/HRS Guideline
Rationale: The 2023 guideline is the latest comprehensive document on
atrial fibrillation. AHA Journals
Reference Link:
https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193 AHA
Journals
Question 6
Topic: COPD / Exacerbation Prevention
Which of the following vaccinations is strongly recommended for COPD
patients as part of prevention?
A. Influenza
, 4|Page
B. Tetanus only
C. Measles
D. HPV
Correct Answer: A. Influenza
Rationale: Annual influenza vaccination is standard for COPD patients to
reduce exacerbations. GOLD also recommends pneumococcal, Tdap, etc.
GOLD+1
Reference Link: GOLD 2025 Pocket Guide GOLD
Question 7
Topic: Electrolyte / Acid-Base
A patient in DKA has the following labs: K⁺ = 5.8 mEq/L, pH = 7.15,
bicarbonate = 10 mEq/L. Which intervention is most urgent?
A. Administer potassium immediately if below 5.0
B. Give sodium bicarbonate
C. Begin IV insulin infusion
D. Give oral glucose
Correct Answer: C. Begin IV insulin infusion
Rationale: Insulin is the primary therapy to reduce hyperglycemia and stop
ketone production; potassium is managed concurrently but insulin must start
carefully. Bicarbonate is reserved for very low pH (<6.9).
Question 8
Topic: Renal / Acute Kidney Injury
Which laboratory profile suggests intrinsic renal injury (e.g., acute tubular
necrosis) rather than pre-renal azotemia?
A. BUN:Cr > 20:1, fractional excretion of sodium (FeNa) < 1 %
B. BUN:Cr ~ 10-15:1, FeNa > 2 %
C. BUN:Cr > 20:1, FeNa > 2 %
D. BUN:Cr < 10:1, FeNa < 1 %
ATI CAPSTONE MEDICAL-SURGICAL ASSESSMENT 1 & 2 (2026)
| 160+ QUESTIONS WITH CORRECT ANSWERS & RATIONALES,
ALREADY GRADED A+
Question 1
Topic: COPD / Respiratory Management
A 70-year-old patient with COPD presents with worsening dyspnea and
increased sputum. Which of the following should the nurse implement first?
A. Start high‐flow oxygen at 100 %
B. Administer a nebulized short-acting bronchodilator
C. Initiate corticosteroid intravenously
D. Perform chest physiotherapy
Correct Answer: B. Administer a nebulized short-acting bronchodilator
Rationale: The first priority in COPD exacerbation is to relieve
bronchospasm and improve airflow. Bronchodilators (e.g., albuterol) are
first line. Oxygen is given cautiously to maintain target SpO₂, not 100 %.
Reference Link: 2025 GOLD Report / pocket guide (for COPD
management) — https://goldcopd.org/wp-content/uploads/2024/11/Pocket-
Guide-2025-v1.0-New-Format-15Nov2024_WMV.pdf GOLD
Question 2
Topic: COPD / Pharmacologic Treatment
According to the GOLD strategy, which combination is recommended for a
patient with persistent symptoms and exacerbations on monotherapy?
A. LABA + ICS
B. LAMA + ICS
C. LABA + LAMA
D. Triple therapy (LABA + LAMA + ICS) for all patients
,2|Page
Correct Answer: C. LABA + LAMA
Rationale: GOLD recommends escalation to dual long-acting
bronchodilators (LABA + LAMA) for patients who remain symptomatic on
monotherapy. ICS is usually reserved for those with frequent exacerbations
and certain eosinophil counts. PMC+1
Reference Link: GOLD strategy documents
GOLD+2GOLD+2
Question 3
Topic: Heart Failure / Guideline-Directed Medical Therapy (GDMT)
Which of the following classes is newly emphasized in the 2022
AHA/ACC/HFSA guideline as part of standard therapy for heart failure with
reduced ejection fraction (HFrEF)?
A. Beta-blockers
B. ACE inhibitors
C. Mineralocorticoid receptor antagonists (MRAs)
D. SGLT2 inhibitors
Correct Answer: D. SGLT2 inhibitors
Rationale: The 2022 guidelines formally include SGLT2 inhibitors as part
of guideline-directed medical therapy due to benefits on hospitalization and
mortality. AHA Journals+2PMC+2
Reference Link: 2022 AHA/ACC/HFSA Guideline for the Management of
Heart Failure —
https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063 AHA
Journals
Question 4
Topic: Heart Failure / Acute Decompensation
A patient with known heart failure is admitted with acute decompensation:
dyspnea at rest, orthopnea, and pulmonary edema on chest X-ray. Which
intervention is highest priority?
,3|Page
A. Start warfarin
B. Administer IV diuretics
C. Begin digoxin
D. Increase sodium intake
Correct Answer: B. Administer IV diuretics
Rationale: In decompensated HF with volume overload, reducing preload
through diuresis is critical to relieve pulmonary congestion. The others are
not immediate priorities.
Reference Link: 2022 AHA/ACC/HFSA Guideline / HF decompensation
management (see guideline document) PMC+1
Question 5
Topic: Arrhythmia / Atrial Fibrillation
Which guideline provides the most recent recommendations for diagnosis
and management of atrial fibrillation?
A. 2021 ACC HF Guideline
B. 2023 ACC/AHA/ACCP/HRS Guideline
C. 2022 GOLD Report
D. 2020 NIH Stroke Scale manual
Correct Answer: B. 2023 ACC/AHA/ACCP/HRS Guideline
Rationale: The 2023 guideline is the latest comprehensive document on
atrial fibrillation. AHA Journals
Reference Link:
https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193 AHA
Journals
Question 6
Topic: COPD / Exacerbation Prevention
Which of the following vaccinations is strongly recommended for COPD
patients as part of prevention?
A. Influenza
, 4|Page
B. Tetanus only
C. Measles
D. HPV
Correct Answer: A. Influenza
Rationale: Annual influenza vaccination is standard for COPD patients to
reduce exacerbations. GOLD also recommends pneumococcal, Tdap, etc.
GOLD+1
Reference Link: GOLD 2025 Pocket Guide GOLD
Question 7
Topic: Electrolyte / Acid-Base
A patient in DKA has the following labs: K⁺ = 5.8 mEq/L, pH = 7.15,
bicarbonate = 10 mEq/L. Which intervention is most urgent?
A. Administer potassium immediately if below 5.0
B. Give sodium bicarbonate
C. Begin IV insulin infusion
D. Give oral glucose
Correct Answer: C. Begin IV insulin infusion
Rationale: Insulin is the primary therapy to reduce hyperglycemia and stop
ketone production; potassium is managed concurrently but insulin must start
carefully. Bicarbonate is reserved for very low pH (<6.9).
Question 8
Topic: Renal / Acute Kidney Injury
Which laboratory profile suggests intrinsic renal injury (e.g., acute tubular
necrosis) rather than pre-renal azotemia?
A. BUN:Cr > 20:1, fractional excretion of sodium (FeNa) < 1 %
B. BUN:Cr ~ 10-15:1, FeNa > 2 %
C. BUN:Cr > 20:1, FeNa > 2 %
D. BUN:Cr < 10:1, FeNa < 1 %
