ATI Med-Surg Proctored Exam (2026)
NGN-Style Questions, Case Scenario
& Answers, 100% Verified Graded A+
SECTION 1: CARDIOVASCULAR DISORDERS
CASE SCENARIO 1: Acute Myocardial Infarction (Questions 1-8)
A 58-year-old male presents to the ED with crushing substernal chest pain radiating to his left arm,
accompanied by diaphoresis, nausea, and shortness of breath. Symptoms began 45 minutes ago. PMH:
hypertension, hyperlipidemia, type 2 diabetes. Vital signs: HR 118 bpm, BP 150/90 mmHg, RR 24/min,
SpO2 94% on room air. ECG shows ST-segment elevation in leads V2–V4 .
Q1. (Recognize Cues) Which assessment findings are consistent with an acute STEMI? (Select all that
apply.)
• A) Crushing substernal chest pain
• B) Pain radiating to the left arm
• C) Diaphoresis
• D) Oxygen saturation of 94%
• E) ST-segment elevation in leads V2–V4
• F) Blood pressure 150/90 mmHg
✅ Answer: A, B, C, E
Rationale: Crushing chest pain, radiation to the left arm, and diaphoresis are classic signs of acute MI.
ST-segment elevation in contiguous leads (V2–V4) indicates anterior wall STEMI .
,Q2. (Analyze Cues) The ECG shows ST-segment elevation in leads V2–V4. This indicates which coronary
artery is most likely occluded?
• A) Right coronary artery
• B) Left circumflex artery
• C) Left anterior descending artery
• D) Posterior descending artery
✅ Answer: C
Rationale: Leads V2–V4 correspond to the anterior wall of the left ventricle, supplied by the left anterior
descending (LAD) artery. The RCA supplies the inferior wall (II, III, aVF). The circumflex supplies the
lateral wall (I, aVL, V5–V6) .
Q3. (Generate Solutions) The nurse administers aspirin 324 mg chewed. Which statement best
explains the purpose of aspirin in acute MI?
• A) To relieve chest pain directly
• B) To dissolve the existing clot
• C) To inhibit platelet aggregation and prevent further clot formation
• D) To decrease heart rate and myocardial oxygen demand
✅ Answer: C
Rationale: Aspirin irreversibly inhibits cyclooxygenase (COX), reducing thromboxane A2 and preventing
platelet aggregation. It does not dissolve existing clots (thrombolytics do that) but prevents further clot
formation .
Q4. (Take Actions) The patient suddenly becomes unresponsive. The cardiac monitor shows
ventricular fibrillation. Which action should the nurse take first?
• A) Administer epinephrine 1 mg IV push
• B) Perform defibrillation with 200 joules (biphasic)
• C) Start chest compressions
• D) Prepare for intubation
✅ Answer: B
Rationale: For witnessed ventricular fibrillation, the priority is immediate defibrillation. ACLS guidelines:
defibrillate as soon as the defibrillator is available, then CPR, then epinephrine .
Q5. (Evaluate Outcomes) Following defibrillation and CPR, the patient's rhythm converts to sinus
tachycardia with frequent PVCs. Which electrolyte imbalance should the nurse suspect?
• A) Hyperkalemia
• B) Hypokalemia
, • C) Hypocalcemia
• D) Hypermagnesemia
✅ Answer: B
Rationale: Hypokalemia can cause cardiac arrhythmias, including PVCs. Patients with MI are at risk for
hypokalemia due to stress response and diuretic use .
Q6. (Prioritize Hypotheses) The patient's troponin I level is 12.5 ng/mL (normal <0.04). Which
statement best explains this finding?
• A) Troponin is elevated in all patients with chest pain
• B) Troponin I is specific to cardiac muscle and indicates myocardial necrosis
• C) Troponin I is elevated due to skeletal muscle injury
• D) Troponin I elevation is a normal response to stress
✅ Answer: B
Rationale: Troponin I is highly specific to cardiac muscle. Elevated levels indicate myocardial necrosis.
This is the gold standard for diagnosing MI .
Q7. (Generate Solutions) The provider orders heparin IV. What is the purpose of heparin in the
management of STEMI?
• A) To dissolve the coronary clot
• B) To prevent further thrombus formation
• C) To reduce myocardial oxygen demand
• D) To dilate coronary arteries
✅ Answer: B
Rationale: Heparin prevents further thrombus formation by inhibiting thrombin and factor Xa.
Thrombolytics dissolve clots; nitroglycerin dilates vessels .
Q8. (Evaluate Outcomes) The patient is scheduled for PCI. What is the target time from first medical
contact to PCI for a STEMI patient?
• A) 30 minutes
• B) 60 minutes
• C) 90 minutes
• D) 120 minutes
✅ Answer: C
Rationale: The AHA/ACC guidelines recommend primary PCI within 90 minutes of first medical contact
for STEMI patients presenting to a PCI-capable hospital .
NGN-Style Questions, Case Scenario
& Answers, 100% Verified Graded A+
SECTION 1: CARDIOVASCULAR DISORDERS
CASE SCENARIO 1: Acute Myocardial Infarction (Questions 1-8)
A 58-year-old male presents to the ED with crushing substernal chest pain radiating to his left arm,
accompanied by diaphoresis, nausea, and shortness of breath. Symptoms began 45 minutes ago. PMH:
hypertension, hyperlipidemia, type 2 diabetes. Vital signs: HR 118 bpm, BP 150/90 mmHg, RR 24/min,
SpO2 94% on room air. ECG shows ST-segment elevation in leads V2–V4 .
Q1. (Recognize Cues) Which assessment findings are consistent with an acute STEMI? (Select all that
apply.)
• A) Crushing substernal chest pain
• B) Pain radiating to the left arm
• C) Diaphoresis
• D) Oxygen saturation of 94%
• E) ST-segment elevation in leads V2–V4
• F) Blood pressure 150/90 mmHg
✅ Answer: A, B, C, E
Rationale: Crushing chest pain, radiation to the left arm, and diaphoresis are classic signs of acute MI.
ST-segment elevation in contiguous leads (V2–V4) indicates anterior wall STEMI .
,Q2. (Analyze Cues) The ECG shows ST-segment elevation in leads V2–V4. This indicates which coronary
artery is most likely occluded?
• A) Right coronary artery
• B) Left circumflex artery
• C) Left anterior descending artery
• D) Posterior descending artery
✅ Answer: C
Rationale: Leads V2–V4 correspond to the anterior wall of the left ventricle, supplied by the left anterior
descending (LAD) artery. The RCA supplies the inferior wall (II, III, aVF). The circumflex supplies the
lateral wall (I, aVL, V5–V6) .
Q3. (Generate Solutions) The nurse administers aspirin 324 mg chewed. Which statement best
explains the purpose of aspirin in acute MI?
• A) To relieve chest pain directly
• B) To dissolve the existing clot
• C) To inhibit platelet aggregation and prevent further clot formation
• D) To decrease heart rate and myocardial oxygen demand
✅ Answer: C
Rationale: Aspirin irreversibly inhibits cyclooxygenase (COX), reducing thromboxane A2 and preventing
platelet aggregation. It does not dissolve existing clots (thrombolytics do that) but prevents further clot
formation .
Q4. (Take Actions) The patient suddenly becomes unresponsive. The cardiac monitor shows
ventricular fibrillation. Which action should the nurse take first?
• A) Administer epinephrine 1 mg IV push
• B) Perform defibrillation with 200 joules (biphasic)
• C) Start chest compressions
• D) Prepare for intubation
✅ Answer: B
Rationale: For witnessed ventricular fibrillation, the priority is immediate defibrillation. ACLS guidelines:
defibrillate as soon as the defibrillator is available, then CPR, then epinephrine .
Q5. (Evaluate Outcomes) Following defibrillation and CPR, the patient's rhythm converts to sinus
tachycardia with frequent PVCs. Which electrolyte imbalance should the nurse suspect?
• A) Hyperkalemia
• B) Hypokalemia
, • C) Hypocalcemia
• D) Hypermagnesemia
✅ Answer: B
Rationale: Hypokalemia can cause cardiac arrhythmias, including PVCs. Patients with MI are at risk for
hypokalemia due to stress response and diuretic use .
Q6. (Prioritize Hypotheses) The patient's troponin I level is 12.5 ng/mL (normal <0.04). Which
statement best explains this finding?
• A) Troponin is elevated in all patients with chest pain
• B) Troponin I is specific to cardiac muscle and indicates myocardial necrosis
• C) Troponin I is elevated due to skeletal muscle injury
• D) Troponin I elevation is a normal response to stress
✅ Answer: B
Rationale: Troponin I is highly specific to cardiac muscle. Elevated levels indicate myocardial necrosis.
This is the gold standard for diagnosing MI .
Q7. (Generate Solutions) The provider orders heparin IV. What is the purpose of heparin in the
management of STEMI?
• A) To dissolve the coronary clot
• B) To prevent further thrombus formation
• C) To reduce myocardial oxygen demand
• D) To dilate coronary arteries
✅ Answer: B
Rationale: Heparin prevents further thrombus formation by inhibiting thrombin and factor Xa.
Thrombolytics dissolve clots; nitroglycerin dilates vessels .
Q8. (Evaluate Outcomes) The patient is scheduled for PCI. What is the target time from first medical
contact to PCI for a STEMI patient?
• A) 30 minutes
• B) 60 minutes
• C) 90 minutes
• D) 120 minutes
✅ Answer: C
Rationale: The AHA/ACC guidelines recommend primary PCI within 90 minutes of first medical contact
for STEMI patients presenting to a PCI-capable hospital .
