MS MED SURG PROCTORED
C
EXAM 2026-2027 | Latest Update
| Questions & Verified Answers |
ATI RN Medical Surgical | Pass
Guaranteed - A+ Graded
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PART A – MULTIPLE CHOICE (Q1‑85)
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Q1 (Cardiovascular – Heart Failure): A 72-year-old client with newly diagnosed heart failure is
being educated on daily self-monitoring. Which statement by the client indicates a correct
understanding of the teaching?
A. "I should weigh myself at different times each day to track trends."
B. "I should call my provider if I gain 2 pounds in one day or 5 pounds in one week."
C. "I should skip my diuretic if my weight drops by 1 pound in a day."
D. "I should only weigh myself when I feel short of breath."
[CORRECT] B
Rationale: The AHA/ACC 2022 heart failure guidelines recommend daily weights at the same
time each morning after voiding, with notification to the provider for a weight gain of 2-3 pounds
in 24 hours or 5 pounds in one week, as this indicates fluid retention requiring intervention.
Option A is incorrect because inconsistent timing affects accuracy; Option C is incorrect
because diuretics should never be skipped without provider direction; Option D is incorrect
because daily weighing is preventive, not reactive.
Q2 (Cardiovascular – Hypertension): A nurse is reviewing first-line antihypertensive medications
with a client. Which medication class is recommended as first-line for uncomplicated
hypertension in non-Black patients according to JNC-8?
A. Calcium channel blockers (CCBs)
B. Thiazide diuretics
C. Angiotensin-converting enzyme inhibitors (ACEIs)
D. Beta-blockers
[CORRECT] C
, ationale: JNC-8 guidelines recommend thiazide diuretics, CCBs, ACEIs, or ARBs as first-line
R
for non-Black patients, with ACEIs/ARBs preferred in those with CKD or diabetes; however, for
the general non-Black population, ACEIs are commonly first-line due to renal protection
benefits. Option B is first-line for Black patients; Option D (beta-blockers) is no longer first-line
for uncomplicated hypertension per JNC-8. Test-taking tip: Know racial differences in
hypertension pharmacotherapy for ATI.
Q3 (Cardiovascular – CAD/Angina): A client experiencing anginal chest pain asks the nurse
how to properly use sublingual nitroglycerin. Which instruction is most appropriate?
A. "Take up to 5 tablets at 5-minute intervals before calling 911."
B. "Chew the tablet thoroughly before swallowing to enhance absorption."
C. "Sit or lie down before taking the tablet to prevent hypotension."
D. "Store the tablets in a clear plastic pillbox for easy access."
[CORRECT] C
Rationale: Nitroglycerin causes venodilation and can precipitate orthostatic hypotension;
therefore, the client should sit or lie down before administration to prevent falls, per AHA
guidelines. Option A is incorrect because only 3 tablets at 5-minute intervals are recommended
before calling 911 if pain persists; Option B is incorrect because sublingual tablets should
dissolve under the tongue, not be chewed; Option D is incorrect because nitroglycerin is
light-sensitive and should remain in its original dark glass bottle.
Q4 (Cardiovascular – MI): A client with a suspected acute myocardial infarction has the
following lab results: troponin I 0.8 ng/mL (normal <0.04), CK-MB 12 ng/mL (normal <6), and
myoglobin 120 ng/mL (normal <70). Which lab value is most specific for diagnosing myocardial
infarction?
A. Myoglobin
B. CK-MB
C. Troponin I
D. All are equally specific
[CORRECT] C
Rationale: Troponin I is the most cardiac-specific biomarker for myocardial infarction, as it is
released only from cardiac muscle and remains elevated for 7-10 days, per the Fourth Universal
Definition of MI (2018). Option A (myoglobin) rises earliest but lacks cardiac specificity; Option B
(CK-MB) is less specific than troponin and can be elevated in skeletal muscle injury. Test-taking
tip: On ATI, troponin is always the "most specific" answer for MI diagnosis.
Q5 (Cardiovascular – Dysrhythmias): A client with atrial fibrillation is prescribed warfarin. The
nurse notes the INR is 4.2. Which action should the nurse take first?
A. Administer vitamin K as ordered
B. Hold the next dose of warfarin and notify the provider
C. Continue the warfarin and recheck the INR in 24 hours
D. Administer a loading dose of heparin
[CORRECT] B
Rationale: The therapeutic INR range for atrial fibrillation is 2.0-3.0; an INR of 4.2 indicates
supratherapeutic anticoagulation with bleeding risk, requiring the nurse to hold the next dose
and notify the provider per anticoagulation protocols. Option A (vitamin K) is reserved for INR
, 10 or active bleeding; Option C is unsafe as it increases bleeding risk; Option D is
>
inappropriate as heparin would further increase anticoagulation.
Q6 (Cardiovascular – Dysrhythmias): A client suddenly becomes unresponsive, pulseless, and
the monitor shows ventricular fibrillation. Which is the priority intervention?
A. Establish IV access and administer epinephrine
B. Perform synchronized cardioversion at 200 J
C. Begin high-quality CPR and defibrillate as soon as the defibrillator is available
D. Administer amiodarone 300 mg IV push
[CORRECT] C
Rationale: Per the 2020 AHA ACLS guidelines, the immediate priority for pulseless VT/VF is
high-quality CPR with minimal interruptions and defibrillation within 2 minutes, as early
defibrillation is the most effective intervention for survival. Option A is important but follows
defibrillation; Option B is incorrect because synchronized cardioversion is for unstable
tachyarrhythmias with a pulse; Option D is given after the second shock if VF persists.
Q7 (Cardiovascular – Heart Blocks): A client has a heart rate of 38 bpm with a regular rhythm, P
waves present before each QRS complex, and a PR interval of 0.24 seconds that remains
constant. The nurse identifies this as:
A. First-degree AV block
B. Second-degree AV block Type I (Wenckebach)
C. Second-degree AV block Type II
D. Third-degree AV block
[CORRECT] A
Rationale: First-degree AV block is characterized by a prolonged but constant PR interval (>0.20
seconds) with a 1:1 relationship between P waves and QRS complexes, matching this client's
presentation. Option B shows progressive PR interval prolongation; Option C shows dropped
beats with constant PR intervals; Option D shows complete AV dissociation with no relationship
between P waves and QRS complexes.
Q8 (Cardiovascular – PAD vs. CVI): A client reports leg pain when walking that is relieved by
rest. On assessment, the nurse notes hair loss on the lower legs, thin shiny skin, and
diminished pedal pulses. These findings are consistent with:
A. Chronic venous insufficiency (CVI)
B. Peripheral arterial disease (PAD)
C. Deep vein thrombosis (DVT)
D. Cellulitis
[CORRECT] B
Rationale: PAD presents with intermittent claudication (pain with walking relieved by rest), hair
loss, thin shiny skin, and diminished pulses due to arterial insufficiency, per ACC/AHA
guidelines. Option A (CVI) presents with edema, brown discoloration, and ulceration around the
ankles; Option C (DVT) presents with unilateral swelling, warmth, and pain; Option D (cellulitis)
presents with erythema, warmth, and fever.
Q9 (Cardiovascular – Hypertension): A nurse is caring for a client with hypertension who is
prescribed lisinopril. Which assessment finding requires immediate intervention?
A. Blood pressure 138/88 mmHg
B. Dry, nonproductive cough
, . Angioedema of the lips and tongue
C
D. Mild dizziness upon standing
[CORRECT] C
Rationale: Angioedema (swelling of lips, tongue, or airway) is a life-threatening adverse effect of
ACE inhibitors requiring immediate discontinuation of the drug and emergency intervention, per
FDA black box warning. Option A is a near-target BP; Option B is a common but non-emergent
side effect; Option D indicates orthostatic hypotension requiring caution but not immediate
intervention.
Q10 (Cardiovascular – Heart Failure): A client with left-sided heart failure develops acute
pulmonary edema. Which position should the nurse place the client in immediately?
A. High Fowler's with legs dependent
B. Supine with legs elevated
C. Left lateral recumbent
D. Trendelenburg
[CORRECT] A
Rationale: High Fowler's position with legs dependent reduces venous return to the heart
(preload), decreases pulmonary congestion, and maximizes lung expansion, per AHA heart
failure management guidelines. Option B increases preload and worsens pulmonary edema;
Option C is used for left ventricular hypertrophy assessment; Option D increases intracranial
pressure and is contraindicated.
Q11 (Cardiovascular – MI): A client receiving thrombolytic therapy (tPA) for an acute MI must be
monitored for which complication?
A. Hypotension
B. Bleeding
C. Bradycardia
D. Hypertension
[CORRECT] B
Rationale: Thrombolytic therapy carries a significant risk of bleeding, including intracranial
hemorrhage, which is the most serious complication requiring close neurological and bleeding
assessments per AHA/ACC guidelines. Option A may occur but is not the primary complication;
Option C is not associated with tPA; Option D is not a typical complication.
Q12 (Cardiovascular – Dysrhythmias): A client with a new permanent pacemaker is being
discharged. Which statement by the client indicates a need for further teaching?
A. "I will avoid lifting my left arm above my shoulder for 4-6 weeks."
B. "I can use my cell phone on the same side as my pacemaker."
C. "I should inform airport security about my pacemaker before screening."
D. "I will check my pulse daily and report rates below 60 bpm."
[CORRECT] B
Rationale: Clients with pacemakers should avoid placing cell phones directly over the
pacemaker generator or holding them on the same side as the device, as electromagnetic
interference can affect pacemaker function, per device manufacturer guidelines. Option A is
correct to prevent lead displacement; Option C is correct for airport safety; Option D is correct
for monitoring pacemaker function.
C
EXAM 2026-2027 | Latest Update
| Questions & Verified Answers |
ATI RN Medical Surgical | Pass
Guaranteed - A+ Graded
=======================================================================
=
========
PART A – MULTIPLE CHOICE (Q1‑85)
========================================================================
========
Q1 (Cardiovascular – Heart Failure): A 72-year-old client with newly diagnosed heart failure is
being educated on daily self-monitoring. Which statement by the client indicates a correct
understanding of the teaching?
A. "I should weigh myself at different times each day to track trends."
B. "I should call my provider if I gain 2 pounds in one day or 5 pounds in one week."
C. "I should skip my diuretic if my weight drops by 1 pound in a day."
D. "I should only weigh myself when I feel short of breath."
[CORRECT] B
Rationale: The AHA/ACC 2022 heart failure guidelines recommend daily weights at the same
time each morning after voiding, with notification to the provider for a weight gain of 2-3 pounds
in 24 hours or 5 pounds in one week, as this indicates fluid retention requiring intervention.
Option A is incorrect because inconsistent timing affects accuracy; Option C is incorrect
because diuretics should never be skipped without provider direction; Option D is incorrect
because daily weighing is preventive, not reactive.
Q2 (Cardiovascular – Hypertension): A nurse is reviewing first-line antihypertensive medications
with a client. Which medication class is recommended as first-line for uncomplicated
hypertension in non-Black patients according to JNC-8?
A. Calcium channel blockers (CCBs)
B. Thiazide diuretics
C. Angiotensin-converting enzyme inhibitors (ACEIs)
D. Beta-blockers
[CORRECT] C
, ationale: JNC-8 guidelines recommend thiazide diuretics, CCBs, ACEIs, or ARBs as first-line
R
for non-Black patients, with ACEIs/ARBs preferred in those with CKD or diabetes; however, for
the general non-Black population, ACEIs are commonly first-line due to renal protection
benefits. Option B is first-line for Black patients; Option D (beta-blockers) is no longer first-line
for uncomplicated hypertension per JNC-8. Test-taking tip: Know racial differences in
hypertension pharmacotherapy for ATI.
Q3 (Cardiovascular – CAD/Angina): A client experiencing anginal chest pain asks the nurse
how to properly use sublingual nitroglycerin. Which instruction is most appropriate?
A. "Take up to 5 tablets at 5-minute intervals before calling 911."
B. "Chew the tablet thoroughly before swallowing to enhance absorption."
C. "Sit or lie down before taking the tablet to prevent hypotension."
D. "Store the tablets in a clear plastic pillbox for easy access."
[CORRECT] C
Rationale: Nitroglycerin causes venodilation and can precipitate orthostatic hypotension;
therefore, the client should sit or lie down before administration to prevent falls, per AHA
guidelines. Option A is incorrect because only 3 tablets at 5-minute intervals are recommended
before calling 911 if pain persists; Option B is incorrect because sublingual tablets should
dissolve under the tongue, not be chewed; Option D is incorrect because nitroglycerin is
light-sensitive and should remain in its original dark glass bottle.
Q4 (Cardiovascular – MI): A client with a suspected acute myocardial infarction has the
following lab results: troponin I 0.8 ng/mL (normal <0.04), CK-MB 12 ng/mL (normal <6), and
myoglobin 120 ng/mL (normal <70). Which lab value is most specific for diagnosing myocardial
infarction?
A. Myoglobin
B. CK-MB
C. Troponin I
D. All are equally specific
[CORRECT] C
Rationale: Troponin I is the most cardiac-specific biomarker for myocardial infarction, as it is
released only from cardiac muscle and remains elevated for 7-10 days, per the Fourth Universal
Definition of MI (2018). Option A (myoglobin) rises earliest but lacks cardiac specificity; Option B
(CK-MB) is less specific than troponin and can be elevated in skeletal muscle injury. Test-taking
tip: On ATI, troponin is always the "most specific" answer for MI diagnosis.
Q5 (Cardiovascular – Dysrhythmias): A client with atrial fibrillation is prescribed warfarin. The
nurse notes the INR is 4.2. Which action should the nurse take first?
A. Administer vitamin K as ordered
B. Hold the next dose of warfarin and notify the provider
C. Continue the warfarin and recheck the INR in 24 hours
D. Administer a loading dose of heparin
[CORRECT] B
Rationale: The therapeutic INR range for atrial fibrillation is 2.0-3.0; an INR of 4.2 indicates
supratherapeutic anticoagulation with bleeding risk, requiring the nurse to hold the next dose
and notify the provider per anticoagulation protocols. Option A (vitamin K) is reserved for INR
, 10 or active bleeding; Option C is unsafe as it increases bleeding risk; Option D is
>
inappropriate as heparin would further increase anticoagulation.
Q6 (Cardiovascular – Dysrhythmias): A client suddenly becomes unresponsive, pulseless, and
the monitor shows ventricular fibrillation. Which is the priority intervention?
A. Establish IV access and administer epinephrine
B. Perform synchronized cardioversion at 200 J
C. Begin high-quality CPR and defibrillate as soon as the defibrillator is available
D. Administer amiodarone 300 mg IV push
[CORRECT] C
Rationale: Per the 2020 AHA ACLS guidelines, the immediate priority for pulseless VT/VF is
high-quality CPR with minimal interruptions and defibrillation within 2 minutes, as early
defibrillation is the most effective intervention for survival. Option A is important but follows
defibrillation; Option B is incorrect because synchronized cardioversion is for unstable
tachyarrhythmias with a pulse; Option D is given after the second shock if VF persists.
Q7 (Cardiovascular – Heart Blocks): A client has a heart rate of 38 bpm with a regular rhythm, P
waves present before each QRS complex, and a PR interval of 0.24 seconds that remains
constant. The nurse identifies this as:
A. First-degree AV block
B. Second-degree AV block Type I (Wenckebach)
C. Second-degree AV block Type II
D. Third-degree AV block
[CORRECT] A
Rationale: First-degree AV block is characterized by a prolonged but constant PR interval (>0.20
seconds) with a 1:1 relationship between P waves and QRS complexes, matching this client's
presentation. Option B shows progressive PR interval prolongation; Option C shows dropped
beats with constant PR intervals; Option D shows complete AV dissociation with no relationship
between P waves and QRS complexes.
Q8 (Cardiovascular – PAD vs. CVI): A client reports leg pain when walking that is relieved by
rest. On assessment, the nurse notes hair loss on the lower legs, thin shiny skin, and
diminished pedal pulses. These findings are consistent with:
A. Chronic venous insufficiency (CVI)
B. Peripheral arterial disease (PAD)
C. Deep vein thrombosis (DVT)
D. Cellulitis
[CORRECT] B
Rationale: PAD presents with intermittent claudication (pain with walking relieved by rest), hair
loss, thin shiny skin, and diminished pulses due to arterial insufficiency, per ACC/AHA
guidelines. Option A (CVI) presents with edema, brown discoloration, and ulceration around the
ankles; Option C (DVT) presents with unilateral swelling, warmth, and pain; Option D (cellulitis)
presents with erythema, warmth, and fever.
Q9 (Cardiovascular – Hypertension): A nurse is caring for a client with hypertension who is
prescribed lisinopril. Which assessment finding requires immediate intervention?
A. Blood pressure 138/88 mmHg
B. Dry, nonproductive cough
, . Angioedema of the lips and tongue
C
D. Mild dizziness upon standing
[CORRECT] C
Rationale: Angioedema (swelling of lips, tongue, or airway) is a life-threatening adverse effect of
ACE inhibitors requiring immediate discontinuation of the drug and emergency intervention, per
FDA black box warning. Option A is a near-target BP; Option B is a common but non-emergent
side effect; Option D indicates orthostatic hypotension requiring caution but not immediate
intervention.
Q10 (Cardiovascular – Heart Failure): A client with left-sided heart failure develops acute
pulmonary edema. Which position should the nurse place the client in immediately?
A. High Fowler's with legs dependent
B. Supine with legs elevated
C. Left lateral recumbent
D. Trendelenburg
[CORRECT] A
Rationale: High Fowler's position with legs dependent reduces venous return to the heart
(preload), decreases pulmonary congestion, and maximizes lung expansion, per AHA heart
failure management guidelines. Option B increases preload and worsens pulmonary edema;
Option C is used for left ventricular hypertrophy assessment; Option D increases intracranial
pressure and is contraindicated.
Q11 (Cardiovascular – MI): A client receiving thrombolytic therapy (tPA) for an acute MI must be
monitored for which complication?
A. Hypotension
B. Bleeding
C. Bradycardia
D. Hypertension
[CORRECT] B
Rationale: Thrombolytic therapy carries a significant risk of bleeding, including intracranial
hemorrhage, which is the most serious complication requiring close neurological and bleeding
assessments per AHA/ACC guidelines. Option A may occur but is not the primary complication;
Option C is not associated with tPA; Option D is not a typical complication.
Q12 (Cardiovascular – Dysrhythmias): A client with a new permanent pacemaker is being
discharged. Which statement by the client indicates a need for further teaching?
A. "I will avoid lifting my left arm above my shoulder for 4-6 weeks."
B. "I can use my cell phone on the same side as my pacemaker."
C. "I should inform airport security about my pacemaker before screening."
D. "I will check my pulse daily and report rates below 60 bpm."
[CORRECT] B
Rationale: Clients with pacemakers should avoid placing cell phones directly over the
pacemaker generator or holding them on the same side as the device, as electromagnetic
interference can affect pacemaker function, per device manufacturer guidelines. Option A is
correct to prevent lead displacement; Option C is correct for airport safety; Option D is correct
for monitoring pacemaker function.
