CMS Med-Surg Proctored Exam - 2026/2027 |
Verified Answers & Clinical-Judgment Rationales
| ATI Proctored Assessment
CARDIOVASCULAR & HEMATOLOGY (28 Qs)
Q1
Shift report: 72-year-old admitted with acute HF exacerbation.
Vitals: BP 100/60, HR 118, RR 28, SpO₂ 92 % on 3 L NC.
Assessment: crackles posterior bases, 2+ pitting edema mid-calf, cool extremities.
Received furosemide 40 mg IV × 1. Which finding requires immediate intervention?
A. Pain 4/10
B. UOP 30 mL last hour
C. SpO₂ drops to 88 %
D. K⁺ 3.8 mEq/L
Correct: C
Rationale: ABC priority—acute drop in SpO₂ signals respiratory failure; ↑ O₂, re-position,
notify provider. Pain (A) not urgent; 30 mL/h UOP (B) acceptable after 1 diuretic dose; K⁺
3.8 (D) watch but not critical.
Q2
,Post-MI day 2 on heparin 18 units/kg/h. aPTT 110 sec (control 30). Client has no
bleeding. Nurse first:
A. Stop infusion, call provider
B. Reduce rate 2 units/kg/h
C. Continue—therapeutic for MI
D. Give protamine 10 mg IV
Correct: A
Rationale: aPTT > 3× control (>90 s) = hold dose & notify per protocol; protamine only if
active bleed.
Q3
Client with new-onset Afib on diltiazem drip at 10 mg/h. BP 92/58, HR 110. Prior BP
118/70. Action:
A. Increase drip to 15 mg/h
B. Stop drip, start amiodarone
C. Lower drip to 5 mg/h, call provider
D. Give fluid bolus 500 mL
Correct: C
Rationale: Hypotension from CCB; reduce rate, continue cardiac monitoring, notify for
rate/rhythm control alternative.
Q4
,Client post-PCI via radial approach. Dressing dry, pulses 2+, but reports severe
ipsilateral hand pain & numbness. Nurse suspects:
A. Expected neuropathy
B. Compartment syndrome
C. Vasovagal reaction
D. Hematoma formation
Correct: B
Rationale: Pain out of proportion + neuro deficits = compartment syndrome—emergency
fasciotomy consult.
Q5
Client with sickle-cell crisis on morphine PCA. O2 via NC, Hgb 7.2 g/dL. Which order
should nurse question?
A. Morphine 1 mg IV q10min PCA
B. Packed RBCs 1 unit over 3 h
C. D5W at 125 mL/h
D. Hydroxyurea 1 g PO daily
Correct: C
Rationale: D5W promotes sickling (hypotonic); use isotonic fluids. Hydroxyurea (D)
appropriate chronic.
Q6
, Client with DVT on heparin yells, “I can’t breathe!” RR 36, SpO₂ 88 %. BP 100/60. First
action:
A. Call rapid response, apply 100 % O₂
B. Auscultate lungs
C. Check aPTT level
D. Obtain chest x-ray order
Correct: A
Rationale: Sudden dyspnea = possible PE—support ABCs first; diagnostics follow.
Q7
Client with HTN & CKD 3 (eGFR 35) prescribed lisinopril 10 mg PO daily. K⁺ 5.3 mEq/L.
Nurse advises:
A. Hold dose, notify provider
B. Give with food
C. Encourage bananas for potassium
D. Recheck K in 1 week
Correct: A
Rationale: K > 5 + ACEi = hyperkalemia risk; hold and discuss alternative or dose
reduction.
Q8
Verified Answers & Clinical-Judgment Rationales
| ATI Proctored Assessment
CARDIOVASCULAR & HEMATOLOGY (28 Qs)
Q1
Shift report: 72-year-old admitted with acute HF exacerbation.
Vitals: BP 100/60, HR 118, RR 28, SpO₂ 92 % on 3 L NC.
Assessment: crackles posterior bases, 2+ pitting edema mid-calf, cool extremities.
Received furosemide 40 mg IV × 1. Which finding requires immediate intervention?
A. Pain 4/10
B. UOP 30 mL last hour
C. SpO₂ drops to 88 %
D. K⁺ 3.8 mEq/L
Correct: C
Rationale: ABC priority—acute drop in SpO₂ signals respiratory failure; ↑ O₂, re-position,
notify provider. Pain (A) not urgent; 30 mL/h UOP (B) acceptable after 1 diuretic dose; K⁺
3.8 (D) watch but not critical.
Q2
,Post-MI day 2 on heparin 18 units/kg/h. aPTT 110 sec (control 30). Client has no
bleeding. Nurse first:
A. Stop infusion, call provider
B. Reduce rate 2 units/kg/h
C. Continue—therapeutic for MI
D. Give protamine 10 mg IV
Correct: A
Rationale: aPTT > 3× control (>90 s) = hold dose & notify per protocol; protamine only if
active bleed.
Q3
Client with new-onset Afib on diltiazem drip at 10 mg/h. BP 92/58, HR 110. Prior BP
118/70. Action:
A. Increase drip to 15 mg/h
B. Stop drip, start amiodarone
C. Lower drip to 5 mg/h, call provider
D. Give fluid bolus 500 mL
Correct: C
Rationale: Hypotension from CCB; reduce rate, continue cardiac monitoring, notify for
rate/rhythm control alternative.
Q4
,Client post-PCI via radial approach. Dressing dry, pulses 2+, but reports severe
ipsilateral hand pain & numbness. Nurse suspects:
A. Expected neuropathy
B. Compartment syndrome
C. Vasovagal reaction
D. Hematoma formation
Correct: B
Rationale: Pain out of proportion + neuro deficits = compartment syndrome—emergency
fasciotomy consult.
Q5
Client with sickle-cell crisis on morphine PCA. O2 via NC, Hgb 7.2 g/dL. Which order
should nurse question?
A. Morphine 1 mg IV q10min PCA
B. Packed RBCs 1 unit over 3 h
C. D5W at 125 mL/h
D. Hydroxyurea 1 g PO daily
Correct: C
Rationale: D5W promotes sickling (hypotonic); use isotonic fluids. Hydroxyurea (D)
appropriate chronic.
Q6
, Client with DVT on heparin yells, “I can’t breathe!” RR 36, SpO₂ 88 %. BP 100/60. First
action:
A. Call rapid response, apply 100 % O₂
B. Auscultate lungs
C. Check aPTT level
D. Obtain chest x-ray order
Correct: A
Rationale: Sudden dyspnea = possible PE—support ABCs first; diagnostics follow.
Q7
Client with HTN & CKD 3 (eGFR 35) prescribed lisinopril 10 mg PO daily. K⁺ 5.3 mEq/L.
Nurse advises:
A. Hold dose, notify provider
B. Give with food
C. Encourage bananas for potassium
D. Recheck K in 1 week
Correct: A
Rationale: K > 5 + ACEi = hyperkalemia risk; hold and discuss alternative or dose
reduction.
Q8
