ATI MEDICAL SURGICAL PROCTORED EXAM 2063
WITH NGN.
Cardiovascular (Questions 1-10)
1. A patient with acute decompensated heart failure has an ejection fraction of
25%. Which medication does the nurse expect to administer first?
• A) Digoxin
• B) Furosemide IV
• C) Carvedilol
• D) Spironolactone
Answer: B) Furosemide IV
Rationale: IV furosemide rapidly reduces preload, relieving pulmonary edema.
Beta-blockers (carvedilol) are for chronic HF, not acute.
2. A patient with atrial fibrillation is on warfarin. Which INR indicates therapeutic
range for this patient?
• A) 1.5
• B) 2.5
• C) 3.8
• D) 4.5
Answer: B) 2.5
Rationale: Target INR for atrial fibrillation is 2-3. 1.5 is subtherapeutic (stroke risk);
>4 increases bleeding risk.
3. A patient with an acute myocardial infarction (STEMI) reports chest pain
unrelieved by nitroglycerin. Which medication should the nurse prepare?
• A) Morphine sulfate
• B) Aspirin
• C) Metoprolol
• D) Heparin
Answer: A) Morphine sulfate
Rationale: Morphine reduces pain and preload, decreasing myocardial oxygen
demand. Aspirin is already given on arrival.
,4. A patient with a new onset of paroxysmal supraventricular tachycardia (PSVT)
has a heart rate of 190 bpm and is hypotensive. What is the priority intervention?
• A) Adenosine IV push
• B) Synchronized cardioversion
• C) Vagal maneuvers
• D) Amiodarone drip
Answer: B) Synchronized cardioversion
Rationale: Unstable PSVT with hypotension requires immediate synchronized
cardioversion. Adenosine is for stable patients.
5. A patient with infective endocarditis has a new onset of left-sided weakness.
What does the nurse suspect?
• A) Intracranial hemorrhage
• B) Septic emboli to the brain
• C) Hypoglycemia
• D) Medication side effect
Answer: B) Septic emboli to the brain
Rationale: Vegetations from endocarditis can embolize to the brain, causing
stroke. Notify provider immediately.
6. A patient with a permanent pacemaker has a heart rate of 42 bpm and reports
dizziness. What is the priority action?
• A) Check the pacemaker settings
• B) Apply a magnet over the pacemaker
• C) Notify the provider
• D) Obtain a 12-lead ECG
Answer: A) Check the pacemaker settings
Rationale: The pacemaker may have malfunctioned (failure to capture). A magnet
will convert it to fixed-rate pacing. Notify provider after assessment.
7. A patient with hypertension is started on lisinopril. Which finding requires
immediate intervention?
• A) Dry cough
• B) Serum potassium 5.8 mEq/L
• C) Serum creatinine 1.0 mg/dL
• D) Dizziness when standing
Answer: B) Serum potassium 5.8 mEq/L
, Rationale: ACE inhibitors can cause hyperkalemia (normal K+ 3.5-5.0). Hold
medication and notify provider. Dry cough is a side effect but not emergent.
8. A patient with a deep vein thrombosis (DVT) is on a heparin drip. Which lab
value indicates the heparin is therapeutic?
• A) INR 2.5
• B) aPTT 70 seconds (normal 25-35)
• C) Platelets 150,000/mm³
• D) PT 12 seconds
Answer: B) aPTT 70 seconds
Rationale: Heparin therapeutic aPTT is 1.5-2.5 times normal (about 60-80 sec).
INR monitors warfarin.
9. A patient with an abdominal aortic aneurysm (AAA) reports sudden, severe back
pain and hypotension. What is the priority?
• A) Administer pain medication
• B) Notify the surgeon immediately
• C) Prepare for CT scan
• D) Elevate the foot of the bed
Answer: B) Notify the surgeon immediately
Rationale: Sudden back pain with hypotension indicates AAA rupture. Emergency
surgery is needed. Do not delay for imaging.
10. A patient with Raynaud’s phenomenon has cold, blue fingers. Which
instruction should the nurse provide?
• A) Apply direct heat to the hands
• B) Avoid caffeine and smoking
• C) Wear tight gloves to retain heat
• D) Take cold showers to desensitize
Answer: B) Avoid caffeine and smoking
Rationale: Caffeine and nicotine are vasoconstrictors. Warmth is good, but direct
heat can cause burns. Loose gloves are better.
Respiratory (Questions 11-20)
, 11. A patient with status asthmaticus is receiving albuterol nebulizers every 20
minutes. The patient’s peak flow remains at 40% of personal best. What is the
priority action?
• A) Continue albuterol every 20 minutes
• B) Administer ipratropium bromide
• C) Prepare for intubation
• D) Give oral prednisone
Answer: C) Prepare for intubation
Rationale: Failure to improve with aggressive bronchodilators indicates
impending respiratory failure. Intubation may be needed.
12. A patient with a pulmonary embolism (PE) has an SpO2 of 89% on 4 L/min
oxygen. What is the priority intervention?
• A) Increase oxygen to 6 L/min
• B) Prepare for thrombolytics
• C) Position patient in high-Fowler’s
• D) Notify the rapid response team
Answer: D) Notify the rapid response team
Rationale: Hypoxemia despite oxygen suggests massive PE. Rapid response is
needed for possible thrombolytics or embolectomy.
13. A patient with a tracheostomy tube has thick, crusted secretions. Which
intervention is most effective?
• A) Suction every hour
• B) Instill normal saline before suctioning
• C) Increase humidification
• D) Change the inner cannula
Answer: C) Increase humidification
Rationale: Humidification loosens secretions. Saline instillation is not routinely
recommended (can cause hypoxia). Suction as needed.
14. A patient with a pneumothorax has a chest tube to water seal with no bubbling
in the water seal chamber. What does this indicate?
• A) The lung has re-expanded
• B) There is a system leak
• C) The chest tube is occluded
WITH NGN.
Cardiovascular (Questions 1-10)
1. A patient with acute decompensated heart failure has an ejection fraction of
25%. Which medication does the nurse expect to administer first?
• A) Digoxin
• B) Furosemide IV
• C) Carvedilol
• D) Spironolactone
Answer: B) Furosemide IV
Rationale: IV furosemide rapidly reduces preload, relieving pulmonary edema.
Beta-blockers (carvedilol) are for chronic HF, not acute.
2. A patient with atrial fibrillation is on warfarin. Which INR indicates therapeutic
range for this patient?
• A) 1.5
• B) 2.5
• C) 3.8
• D) 4.5
Answer: B) 2.5
Rationale: Target INR for atrial fibrillation is 2-3. 1.5 is subtherapeutic (stroke risk);
>4 increases bleeding risk.
3. A patient with an acute myocardial infarction (STEMI) reports chest pain
unrelieved by nitroglycerin. Which medication should the nurse prepare?
• A) Morphine sulfate
• B) Aspirin
• C) Metoprolol
• D) Heparin
Answer: A) Morphine sulfate
Rationale: Morphine reduces pain and preload, decreasing myocardial oxygen
demand. Aspirin is already given on arrival.
,4. A patient with a new onset of paroxysmal supraventricular tachycardia (PSVT)
has a heart rate of 190 bpm and is hypotensive. What is the priority intervention?
• A) Adenosine IV push
• B) Synchronized cardioversion
• C) Vagal maneuvers
• D) Amiodarone drip
Answer: B) Synchronized cardioversion
Rationale: Unstable PSVT with hypotension requires immediate synchronized
cardioversion. Adenosine is for stable patients.
5. A patient with infective endocarditis has a new onset of left-sided weakness.
What does the nurse suspect?
• A) Intracranial hemorrhage
• B) Septic emboli to the brain
• C) Hypoglycemia
• D) Medication side effect
Answer: B) Septic emboli to the brain
Rationale: Vegetations from endocarditis can embolize to the brain, causing
stroke. Notify provider immediately.
6. A patient with a permanent pacemaker has a heart rate of 42 bpm and reports
dizziness. What is the priority action?
• A) Check the pacemaker settings
• B) Apply a magnet over the pacemaker
• C) Notify the provider
• D) Obtain a 12-lead ECG
Answer: A) Check the pacemaker settings
Rationale: The pacemaker may have malfunctioned (failure to capture). A magnet
will convert it to fixed-rate pacing. Notify provider after assessment.
7. A patient with hypertension is started on lisinopril. Which finding requires
immediate intervention?
• A) Dry cough
• B) Serum potassium 5.8 mEq/L
• C) Serum creatinine 1.0 mg/dL
• D) Dizziness when standing
Answer: B) Serum potassium 5.8 mEq/L
, Rationale: ACE inhibitors can cause hyperkalemia (normal K+ 3.5-5.0). Hold
medication and notify provider. Dry cough is a side effect but not emergent.
8. A patient with a deep vein thrombosis (DVT) is on a heparin drip. Which lab
value indicates the heparin is therapeutic?
• A) INR 2.5
• B) aPTT 70 seconds (normal 25-35)
• C) Platelets 150,000/mm³
• D) PT 12 seconds
Answer: B) aPTT 70 seconds
Rationale: Heparin therapeutic aPTT is 1.5-2.5 times normal (about 60-80 sec).
INR monitors warfarin.
9. A patient with an abdominal aortic aneurysm (AAA) reports sudden, severe back
pain and hypotension. What is the priority?
• A) Administer pain medication
• B) Notify the surgeon immediately
• C) Prepare for CT scan
• D) Elevate the foot of the bed
Answer: B) Notify the surgeon immediately
Rationale: Sudden back pain with hypotension indicates AAA rupture. Emergency
surgery is needed. Do not delay for imaging.
10. A patient with Raynaud’s phenomenon has cold, blue fingers. Which
instruction should the nurse provide?
• A) Apply direct heat to the hands
• B) Avoid caffeine and smoking
• C) Wear tight gloves to retain heat
• D) Take cold showers to desensitize
Answer: B) Avoid caffeine and smoking
Rationale: Caffeine and nicotine are vasoconstrictors. Warmth is good, but direct
heat can cause burns. Loose gloves are better.
Respiratory (Questions 11-20)
, 11. A patient with status asthmaticus is receiving albuterol nebulizers every 20
minutes. The patient’s peak flow remains at 40% of personal best. What is the
priority action?
• A) Continue albuterol every 20 minutes
• B) Administer ipratropium bromide
• C) Prepare for intubation
• D) Give oral prednisone
Answer: C) Prepare for intubation
Rationale: Failure to improve with aggressive bronchodilators indicates
impending respiratory failure. Intubation may be needed.
12. A patient with a pulmonary embolism (PE) has an SpO2 of 89% on 4 L/min
oxygen. What is the priority intervention?
• A) Increase oxygen to 6 L/min
• B) Prepare for thrombolytics
• C) Position patient in high-Fowler’s
• D) Notify the rapid response team
Answer: D) Notify the rapid response team
Rationale: Hypoxemia despite oxygen suggests massive PE. Rapid response is
needed for possible thrombolytics or embolectomy.
13. A patient with a tracheostomy tube has thick, crusted secretions. Which
intervention is most effective?
• A) Suction every hour
• B) Instill normal saline before suctioning
• C) Increase humidification
• D) Change the inner cannula
Answer: C) Increase humidification
Rationale: Humidification loosens secretions. Saline instillation is not routinely
recommended (can cause hypoxia). Suction as needed.
14. A patient with a pneumothorax has a chest tube to water seal with no bubbling
in the water seal chamber. What does this indicate?
• A) The lung has re-expanded
• B) There is a system leak
• C) The chest tube is occluded
