MS MED SURG PROCTORED EXAM
C
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 2026): A 72-year-old patient with HFpEF (EF 55%) and
NYHA Class II symptoms presents for follow-up. Current medications include lisinopril and
furosemide. According to 2026 heart failure guidelines, which medication should be added to
reduce hospitalization and cardiovascular death?
A. Digoxin
B. Dapagliflozin (SGLT2 inhibitor)
C. Isosorbide dinitrate
D. Ivabradine
[CORRECT] B
Rationale: The 2026 ACC/AHA/HFSA heart failure guidelines now recommend SGLT2 inhibitors
(dapagliflozin or empagliflozin) for HFpEF regardless of diabetes status, based on DELIVER
and EMPEROR-Preserved trials showing reduced CV death and heart failure hospitalizations.
Digoxin is not indicated for HFpEF and may increase mortality risk in this population. Test-taking
tip: On ATI exams, always select the newest guideline-supported therapy when HFpEF is
mentioned—SGLT2i is the 2026 game-changer.
Q2 (Cardiovascular – Hypertension 2026): A 58-year-old African American patient with
hypertension, BMI 32, and eGFR 68 mL/min/1.73m² has BP readings averaging 138/86 mmHg
on home monitoring. According to the 2026 ACC/AHA hypertension guidelines, what is the
target BP for this patient?
A. <140/90 mmHg
B. <130/80 mmHg
C. <120/80 mmHg
D. <135/85 mmHg
[CORRECT] B
Rationale: The 2026 ACC/AHA guidelines maintain the target of <130/80 mmHg for most adults,
including African American patients, to reduce cardiovascular events and stroke risk; the
SPRINT trial data continues to support intensive control in high-risk populations. <140/90 is the
, utdated JNC-8 target and will be a common ATI distractor. Test-taking tip: When you see "most
o
adults" or "general population" on ATI, default to <130/80 unless the patient is >65 with limited
life expectancy or orthostatic hypotension.
Q3 (Cardiovascular – CAD/MI): A patient with chest pain arrives in the ED. ECG shows
ST-segment elevation in leads V1-V4. Vital signs: BP 92/58, HR 110, SpO2 94%. Which
intervention takes highest priority?
A. Administer sublingual nitroglycerin
B. Prepare for primary PCI within 90 minutes
C. Start heparin infusion
D. Give aspirin 325 mg chewable
[CORRECT] B
Rationale: This patient has an anterior STEMI with hypotension (cardiogenic shock); primary
PCI within 90 minutes of first medical contact is the gold standard and takes priority over all
other interventions per AHA 2025 STEMI guidelines. Nitroglycerin is contraindicated with
hypotension (SBP <90) and could worsen hemodynamics. Test-taking tip: On ATI,
"door-to-balloon time <90 minutes" always trumps medication administration in STEMI with
hemodynamic compromise.
Q4 (Cardiovascular – Atrial Fibrillation): A 68-year-old patient with nonvalvular atrial fibrillation
(CHADS₂-VASc score 4) is being discharged. Which anticoagulant is preferred according to
current guidelines?
A. Warfarin (INR goal 2-3)
B. Aspirin 81 mg daily
C. Apixaban (DOAC)
D. Clopidogrel 75 mg daily
[CORRECT] C
Rationale: The 2026 AHA/ACC/HRS guidelines recommend DOACs (apixaban, rivaroxaban,
dabigatran, edoxaban) as preferred over warfarin for nonvalvular AFib due to lower bleeding
risk, no monitoring requirements, and reduced ICH; apixaban has the best safety profile with
lowest GI bleeding rates. Warfarin is now reserved for mechanical heart valves or
moderate-severe mitral stenosis. Test-taking tip: If the stem says "nonvalvular AFib,"
immediately eliminate warfarin and antiplatelets—DOAC is the 2026 standard answer.
Q5 (Cardiovascular – Heart Failure): A patient with HFrEF (EF 30%) is receiving IV furosemide
80 mg BID. Which assessment finding indicates the medication is achieving the desired
therapeutic effect?
A. Weight gain of 2 lb in 24 hours
B. Decreased jugular venous distension
C. Increased serum creatinine from 1.0 to 2.1 mg/dL
D. New-onset confusion
[CORRECT] B
Rationale: Furosemide reduces preload by promoting diuresis; decreased JVD indicates
reduced venous congestion and improved fluid status, which is the primary therapeutic goal in
decompensated HFrEF. Weight gain indicates worsening fluid retention, not improvement.
Test-taking tip: On ATI, always link loop diuretics to "decreased JVD, decreased peripheral
edema, and daily weight loss" as positive outcomes.
, 6 (Cardiovascular – Peripheral Vascular Disease): A patient with peripheral artery disease
Q
(ABI 0.65) reports severe leg pain at rest. Which medication is first-line for symptom relief and
cardiovascular risk reduction?
A. Aspirin 81 mg + supervised exercise therapy
B. Clopidogrel 75 mg alone
C. Cilostazol 100 mg BID
D. Warfarin anticoagulation
[CORRECT] A
Rationale: The 2026 ACC/AHA PAD guidelines recommend antiplatelet therapy (aspirin or
clopidogrel) PLUS supervised exercise therapy as first-line for claudication; exercise improves
walking distance by 50-200% and reduces CV events. Cilostazol is second-line for claudication
but does not reduce cardiovascular risk. Test-taking tip: ATI emphasizes "exercise + antiplatelet"
as the combination answer for PAD—never select medication alone.
Q7 (Cardiovascular – Dysrhythmias): A patient with new-onset atrial fibrillation (HR 154, BP
110/72) is hemodynamically stable. Which medication is appropriate for rate control?
A. Adenosine 6 mg rapid IV push
B. Metoprolol 5 mg IV q5min x 3
C. Amiodarone 150 mg IV bolus
D. Atropine 0.5 mg IV
[CORRECT] B
Rationale: Metoprolol (a beta-blocker) is first-line for rate control in stable AFib with rapid
ventricular response; it slows AV nodal conduction and reduces myocardial oxygen demand.
Adenosine is for SVT/PSVT, not AFib. Test-taking tip: On ATI, "stable AFib with RVR" =
beta-blocker or non-DHP calcium channel blocker; "unstable" = synchronized cardioversion.
Q8 (Cardiovascular – Anticoagulation): A patient on rivaroxaban 20 mg daily for DVT treatment
needs an invasive dental procedure. What is the appropriate perioperative management?
A. Stop rivaroxaban 5 days prior and bridge with enoxaparin
B. Stop rivaroxaban 24-48 hours prior; no bridging needed
C. Continue rivaroxaban through the procedure
D. Switch to warfarin 2 weeks before the procedure
[CORRECT] B
Rationale: For DOACs with low bleeding risk procedures, discontinuation 24-48 hours prior
(based on renal function) without bridging is recommended per 2026 CHEST guidelines;
DOACs have rapid onset/offset making bridging unnecessary and potentially harmful. Bridging
is only indicated for warfarin with high thrombotic risk. Test-taking tip: ATI loves testing that
DOACs do NOT require bridging—this distinguishes them from warfarin management.
Q9 (Respiratory – COPD GOLD 2026): A 68-year-old with COPD (FEV₁ 42% predicted, 3
exacerbations last year, mMRC dyspnea score 3) is starting initial maintenance therapy.
According to GOLD 2026, which regimen is recommended first-line for this Group E patient?
A. SABA PRN only
B. LABA + LAMA combination
C. ICS + LABA
D. Theophylline sustained-release
[CORRECT] B
, ationale: GOLD 2026 recommends LABA+LAMA as initial therapy for Group E (frequent
R
exacerbators, high symptom burden) due to superior reduction in exacerbations and improved
lung function versus monotherapy; the ETHOS trial supports this approach. ICS is reserved for
eosinophilic/asthmatic features or frequent exacerbations despite LABA+LAMA. Test-taking tip:
On ATI, "Group E COPD" = LABA+LAMA first; only add ICS if eosinophils >300 or
asthma-COPD overlap.
Q10 (Respiratory – COPD Oxygen): A patient with COPD has an ABG: pH 7.36, PaCO₂ 52,
PaO₂ 58, HCO₃ 30 on room air. What is the target oxygen saturation range?
A. 94-98%
B. 88-92%
C. >98%
D. 85-90%
[CORRECT] B
Rationale: The target SpO2 for COPD patients with chronic hypercapnia (CO₂ retainers) is
88-92% per GOLD 2026 and BTS guidelines; higher oxygen levels suppress hypoxic drive,
worsening hypercapnia and respiratory acidosis. 94-98% is for normal patients without CO₂
retention. Test-taking tip: ATI always tests the "hypoxic drive" concept—if PaCO₂ is elevated,
oxygen target drops to 88-92%.
Q11 (Respiratory – Asthma GINA 2026): A 24-year-old with moderate persistent asthma uses
albuterol PRN and fluticasone/salmeterol daily. She reports using albuterol 4 times weekly for
breakthrough symptoms. According to GINA 2026, what change is recommended?
A. Increase fluticasone/salmeterol to high dose
B. Switch to ICS-formoterol as reliever and maintenance
C. Add oral prednisone 40 mg daily
D. Add tiotropium (LAMA)
[CORRECT] B
Rationale: GINA 2026 recommends ICS-formoterol as both reliever and maintenance (MART
regimen) for Steps 3-5 asthma; this reduces severe exacerbations by 50% compared to SABA
reliever by ensuring anti-inflammatory coverage with every reliever use. Increasing ICS dose
alone misses the reliever issue. Test-taking tip: "ICS-formoterol as reliever" is the 2026 GINA
paradigm shift—ATI will test this as the new standard over SABA PRN.
Q12 (Respiratory – Pneumonia): A 65-year-old is admitted with community-acquired pneumonia
(CURB-65 score 2). Which antibiotic regimen is most appropriate per updated IDSA/ATS 2026
guidelines?
A. Vancomycin + piperacillin-tazobactam
B. Ceftriaxone 1 g IV daily + azithromycin 500 mg daily
C. Levofloxacin 750 mg IV daily alone
D. Meropenem 1 g IV q8h
[CORRECT] B
Rationale: For non-ICU CAP with comorbidities or high severity (CURB-65 ≥2), 2026 IDSA/ATS
guidelines recommend beta-lactam + macrolide OR respiratory fluoroquinolone monotherapy;
ceftriaxone + azithromycin covers typical and atypical pathogens. Vancomycin/pip-tazo is for
HAP/VAP or MRSA risk. Test-taking tip: ATI distinguishes CAP from HAP—CAP gets
ceftriaxone + macrolide or doxycycline; reserve broad-spectrum for healthcare-associated.
C
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 2026): A 72-year-old patient with HFpEF (EF 55%) and
NYHA Class II symptoms presents for follow-up. Current medications include lisinopril and
furosemide. According to 2026 heart failure guidelines, which medication should be added to
reduce hospitalization and cardiovascular death?
A. Digoxin
B. Dapagliflozin (SGLT2 inhibitor)
C. Isosorbide dinitrate
D. Ivabradine
[CORRECT] B
Rationale: The 2026 ACC/AHA/HFSA heart failure guidelines now recommend SGLT2 inhibitors
(dapagliflozin or empagliflozin) for HFpEF regardless of diabetes status, based on DELIVER
and EMPEROR-Preserved trials showing reduced CV death and heart failure hospitalizations.
Digoxin is not indicated for HFpEF and may increase mortality risk in this population. Test-taking
tip: On ATI exams, always select the newest guideline-supported therapy when HFpEF is
mentioned—SGLT2i is the 2026 game-changer.
Q2 (Cardiovascular – Hypertension 2026): A 58-year-old African American patient with
hypertension, BMI 32, and eGFR 68 mL/min/1.73m² has BP readings averaging 138/86 mmHg
on home monitoring. According to the 2026 ACC/AHA hypertension guidelines, what is the
target BP for this patient?
A. <140/90 mmHg
B. <130/80 mmHg
C. <120/80 mmHg
D. <135/85 mmHg
[CORRECT] B
Rationale: The 2026 ACC/AHA guidelines maintain the target of <130/80 mmHg for most adults,
including African American patients, to reduce cardiovascular events and stroke risk; the
SPRINT trial data continues to support intensive control in high-risk populations. <140/90 is the
, utdated JNC-8 target and will be a common ATI distractor. Test-taking tip: When you see "most
o
adults" or "general population" on ATI, default to <130/80 unless the patient is >65 with limited
life expectancy or orthostatic hypotension.
Q3 (Cardiovascular – CAD/MI): A patient with chest pain arrives in the ED. ECG shows
ST-segment elevation in leads V1-V4. Vital signs: BP 92/58, HR 110, SpO2 94%. Which
intervention takes highest priority?
A. Administer sublingual nitroglycerin
B. Prepare for primary PCI within 90 minutes
C. Start heparin infusion
D. Give aspirin 325 mg chewable
[CORRECT] B
Rationale: This patient has an anterior STEMI with hypotension (cardiogenic shock); primary
PCI within 90 minutes of first medical contact is the gold standard and takes priority over all
other interventions per AHA 2025 STEMI guidelines. Nitroglycerin is contraindicated with
hypotension (SBP <90) and could worsen hemodynamics. Test-taking tip: On ATI,
"door-to-balloon time <90 minutes" always trumps medication administration in STEMI with
hemodynamic compromise.
Q4 (Cardiovascular – Atrial Fibrillation): A 68-year-old patient with nonvalvular atrial fibrillation
(CHADS₂-VASc score 4) is being discharged. Which anticoagulant is preferred according to
current guidelines?
A. Warfarin (INR goal 2-3)
B. Aspirin 81 mg daily
C. Apixaban (DOAC)
D. Clopidogrel 75 mg daily
[CORRECT] C
Rationale: The 2026 AHA/ACC/HRS guidelines recommend DOACs (apixaban, rivaroxaban,
dabigatran, edoxaban) as preferred over warfarin for nonvalvular AFib due to lower bleeding
risk, no monitoring requirements, and reduced ICH; apixaban has the best safety profile with
lowest GI bleeding rates. Warfarin is now reserved for mechanical heart valves or
moderate-severe mitral stenosis. Test-taking tip: If the stem says "nonvalvular AFib,"
immediately eliminate warfarin and antiplatelets—DOAC is the 2026 standard answer.
Q5 (Cardiovascular – Heart Failure): A patient with HFrEF (EF 30%) is receiving IV furosemide
80 mg BID. Which assessment finding indicates the medication is achieving the desired
therapeutic effect?
A. Weight gain of 2 lb in 24 hours
B. Decreased jugular venous distension
C. Increased serum creatinine from 1.0 to 2.1 mg/dL
D. New-onset confusion
[CORRECT] B
Rationale: Furosemide reduces preload by promoting diuresis; decreased JVD indicates
reduced venous congestion and improved fluid status, which is the primary therapeutic goal in
decompensated HFrEF. Weight gain indicates worsening fluid retention, not improvement.
Test-taking tip: On ATI, always link loop diuretics to "decreased JVD, decreased peripheral
edema, and daily weight loss" as positive outcomes.
, 6 (Cardiovascular – Peripheral Vascular Disease): A patient with peripheral artery disease
Q
(ABI 0.65) reports severe leg pain at rest. Which medication is first-line for symptom relief and
cardiovascular risk reduction?
A. Aspirin 81 mg + supervised exercise therapy
B. Clopidogrel 75 mg alone
C. Cilostazol 100 mg BID
D. Warfarin anticoagulation
[CORRECT] A
Rationale: The 2026 ACC/AHA PAD guidelines recommend antiplatelet therapy (aspirin or
clopidogrel) PLUS supervised exercise therapy as first-line for claudication; exercise improves
walking distance by 50-200% and reduces CV events. Cilostazol is second-line for claudication
but does not reduce cardiovascular risk. Test-taking tip: ATI emphasizes "exercise + antiplatelet"
as the combination answer for PAD—never select medication alone.
Q7 (Cardiovascular – Dysrhythmias): A patient with new-onset atrial fibrillation (HR 154, BP
110/72) is hemodynamically stable. Which medication is appropriate for rate control?
A. Adenosine 6 mg rapid IV push
B. Metoprolol 5 mg IV q5min x 3
C. Amiodarone 150 mg IV bolus
D. Atropine 0.5 mg IV
[CORRECT] B
Rationale: Metoprolol (a beta-blocker) is first-line for rate control in stable AFib with rapid
ventricular response; it slows AV nodal conduction and reduces myocardial oxygen demand.
Adenosine is for SVT/PSVT, not AFib. Test-taking tip: On ATI, "stable AFib with RVR" =
beta-blocker or non-DHP calcium channel blocker; "unstable" = synchronized cardioversion.
Q8 (Cardiovascular – Anticoagulation): A patient on rivaroxaban 20 mg daily for DVT treatment
needs an invasive dental procedure. What is the appropriate perioperative management?
A. Stop rivaroxaban 5 days prior and bridge with enoxaparin
B. Stop rivaroxaban 24-48 hours prior; no bridging needed
C. Continue rivaroxaban through the procedure
D. Switch to warfarin 2 weeks before the procedure
[CORRECT] B
Rationale: For DOACs with low bleeding risk procedures, discontinuation 24-48 hours prior
(based on renal function) without bridging is recommended per 2026 CHEST guidelines;
DOACs have rapid onset/offset making bridging unnecessary and potentially harmful. Bridging
is only indicated for warfarin with high thrombotic risk. Test-taking tip: ATI loves testing that
DOACs do NOT require bridging—this distinguishes them from warfarin management.
Q9 (Respiratory – COPD GOLD 2026): A 68-year-old with COPD (FEV₁ 42% predicted, 3
exacerbations last year, mMRC dyspnea score 3) is starting initial maintenance therapy.
According to GOLD 2026, which regimen is recommended first-line for this Group E patient?
A. SABA PRN only
B. LABA + LAMA combination
C. ICS + LABA
D. Theophylline sustained-release
[CORRECT] B
, ationale: GOLD 2026 recommends LABA+LAMA as initial therapy for Group E (frequent
R
exacerbators, high symptom burden) due to superior reduction in exacerbations and improved
lung function versus monotherapy; the ETHOS trial supports this approach. ICS is reserved for
eosinophilic/asthmatic features or frequent exacerbations despite LABA+LAMA. Test-taking tip:
On ATI, "Group E COPD" = LABA+LAMA first; only add ICS if eosinophils >300 or
asthma-COPD overlap.
Q10 (Respiratory – COPD Oxygen): A patient with COPD has an ABG: pH 7.36, PaCO₂ 52,
PaO₂ 58, HCO₃ 30 on room air. What is the target oxygen saturation range?
A. 94-98%
B. 88-92%
C. >98%
D. 85-90%
[CORRECT] B
Rationale: The target SpO2 for COPD patients with chronic hypercapnia (CO₂ retainers) is
88-92% per GOLD 2026 and BTS guidelines; higher oxygen levels suppress hypoxic drive,
worsening hypercapnia and respiratory acidosis. 94-98% is for normal patients without CO₂
retention. Test-taking tip: ATI always tests the "hypoxic drive" concept—if PaCO₂ is elevated,
oxygen target drops to 88-92%.
Q11 (Respiratory – Asthma GINA 2026): A 24-year-old with moderate persistent asthma uses
albuterol PRN and fluticasone/salmeterol daily. She reports using albuterol 4 times weekly for
breakthrough symptoms. According to GINA 2026, what change is recommended?
A. Increase fluticasone/salmeterol to high dose
B. Switch to ICS-formoterol as reliever and maintenance
C. Add oral prednisone 40 mg daily
D. Add tiotropium (LAMA)
[CORRECT] B
Rationale: GINA 2026 recommends ICS-formoterol as both reliever and maintenance (MART
regimen) for Steps 3-5 asthma; this reduces severe exacerbations by 50% compared to SABA
reliever by ensuring anti-inflammatory coverage with every reliever use. Increasing ICS dose
alone misses the reliever issue. Test-taking tip: "ICS-formoterol as reliever" is the 2026 GINA
paradigm shift—ATI will test this as the new standard over SABA PRN.
Q12 (Respiratory – Pneumonia): A 65-year-old is admitted with community-acquired pneumonia
(CURB-65 score 2). Which antibiotic regimen is most appropriate per updated IDSA/ATS 2026
guidelines?
A. Vancomycin + piperacillin-tazobactam
B. Ceftriaxone 1 g IV daily + azithromycin 500 mg daily
C. Levofloxacin 750 mg IV daily alone
D. Meropenem 1 g IV q8h
[CORRECT] B
Rationale: For non-ICU CAP with comorbidities or high severity (CURB-65 ≥2), 2026 IDSA/ATS
guidelines recommend beta-lactam + macrolide OR respiratory fluoroquinolone monotherapy;
ceftriaxone + azithromycin covers typical and atypical pathogens. Vancomycin/pip-tazo is for
HAP/VAP or MRSA risk. Test-taking tip: ATI distinguishes CAP from HAP—CAP gets
ceftriaxone + macrolide or doxycycline; reserve broad-spectrum for healthcare-associated.
