TI Medical-Surgical Nursing Exam
A
Comprehensive Review Official Practice Exam
Actual Exam 2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
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SECTION 1: CARDIOVASCULAR & HEMATOLOGIC DISORDERS Q1 – Q10
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Question 1 of 50
A 58-year-old patient with a history of uncontrolled hypertension presents to the
emergency department with a severe headache, blurred vision, and a blood pressure of
210/120 mm Hg. The nurse anticipates an immediate order for intravenous
antihypertensive therapy. What is the primary nursing goal during the initial hours of
treatment?
. Lower the diastolic pressure to 100 mm Hg within the first two hours
A
B. Reduce the mean arterial pressure by 50% within the first hour
C. Maintain the blood pressure at 120/80 mm Hg to prevent end-organ damage
D. Administer oral beta-blockers to achieve a gradual reduction over 24 hours
orrect Answer: A
C
Rationale: In a hypertensive crisis, the goal is to reduce the mean arterial pressure by no
more than 25% in the first hour, then to around 160/100 over the next 2-6 hours to
prevent cerebral hypoperfusion. Dropping the pressure too rapidly, as in reducing it by
,50%, can cause ischemic stroke or renal failure. Always remember the ATI rule of thumb
for hypertensive crisis: lower slowly to protect the brain.
Question 2 of 50
A 72-year-old patient admitted with acute decompensated heart failure has a pulmonary
artery catheter. The nurse notes a pulmonary artery wedge pressure (PAWP) of 24 mm
Hg and a cardiac output of 3.2 L/min. Based on these hemodynamic parameters, what
is the priority nursing intervention?
. Administer a prescribed intravenous fluid bolus of normal saline
A
B. Administer a prescribed dose of intravenous furosemide
C. Prepare for immediate synchronized cardioversion
D. Apply continuous positive airway pressure (CPAP)
orrect Answer: B
C
Rationale: A PAWP of 24 mm Hg indicates significant fluid overload and increased
preload, requiring immediate diuresis with intravenous furosemide to reduce pulmonary
congestion. Administering a fluid bolus would worsen the heart failure and pulmonary
edema. On the ATI exam, always correlate high PAWP with the need for preload
reduction.
Question 3 of 50
A 65-year-old patient with coronary artery disease is prescribed sublingual nitroglycerin
for exertional angina. The nurse evaluates the patient's understanding of the
medication. What statement by the patient indicates a need for further teaching?
, . I should sit down before taking the medication to prevent dizziness
A
B. I can take up to three tablets five minutes apart if the pain persists
C. I should swallow the tablet whole with a full glass of water
D. I will store the medication in the original amber glass bottle
orrect Answer: C
C
Rationale: Sublingual nitroglycerin must be absorbed through the oral mucosa for rapid
onset, so swallowing it whole renders it ineffective for acute angina. While sitting down
prevents orthostatic hypotension and storing it in amber glass preserves potency,
swallowing the pill is a critical administration error. Remember the sublingual route is
the fastest non-IV route for coronary vasodilation.
Question 4 of 50
A 55-year-old patient is admitted with a suspected acute myocardial infarction. The
patient suddenly develops a regular, wide-complex tachycardia at a rate of 160/min and
becomes unresponsive with no palpable pulse. What is the nurse's immediate action?
. Perform synchronized cardioversion at 100 joules
A
B. Administer intravenous amiodarone 300 mg push
C. Assess the airway and obtain a 12-lead electrocardiogram
D. Defibrillate the patient immediately with 120 to 200 joules
orrect Answer: D
C
Rationale: A pulseless, unresponsive patient in wide-complex tachycardia (pulseless
ventricular tachycardia) requires immediate defibrillation per ACLS guidelines to restore
a perfusing rhythm. Synchronized cardioversion is used for unstable tachycardias with a
pulse, not pulseless rhythms. Know the critical distinction on the ATI exam: defibrillation
is for pulseless rhythms, while cardioversion is for unstable rhythms with a pulse.
, Question 5 of 50
A 34-year-old patient with a mechanical mitral valve replacement is being discharged on
warfarin therapy. The nurse is reviewing dietary instructions with the patient. What
statement by the patient indicates a correct understanding of the teaching?
. I should maintain a consistent intake of vitamin K-rich foods in my daily diet
A
B. I will increase my intake of dark green leafy vegetables to ensure adequate vitamin K
C. I must completely avoid all foods that contain vitamin K to prevent blood clots
D. I will drink a large glass of cranberry juice daily to boost the medication effect
orrect Answer: A
C
Rationale: Patients on warfarin should maintain a consistent intake of vitamin K to
prevent fluctuations in their International Normalized Ratio (INR) and maintain
therapeutic anticoagulation. Increasing or drastically avoiding vitamin K intake will alter
the INR and either negate the drug's effect or increase bleeding risk. ATI exam strategy:
"Consistent" is the key word for diet teaching with warfarin.
Question 6 of 50
A 68-year-old patient with a history of severe anemia presents with extreme fatigue,
pallor, and a hemoglobin level of 6.5 g/dL. The provider prescribes two units of packed
red blood cells. During the first 15 minutes of the transfusion, what is the priority
nursing action?
. Infuse the blood at a rapid rate to correct the anemia quickly
A
B. Stay with the patient and monitor closely for signs of an acute hemolytic reaction
C. Monitor the patient's vital signs every 30 minutes during the transfusion
D. Administer intravenous furosemide between the two units of blood
A
Comprehensive Review Official Practice Exam
Actual Exam 2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
═════════════════════════════════════
═
SECTION 1: CARDIOVASCULAR & HEMATOLOGIC DISORDERS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 58-year-old patient with a history of uncontrolled hypertension presents to the
emergency department with a severe headache, blurred vision, and a blood pressure of
210/120 mm Hg. The nurse anticipates an immediate order for intravenous
antihypertensive therapy. What is the primary nursing goal during the initial hours of
treatment?
. Lower the diastolic pressure to 100 mm Hg within the first two hours
A
B. Reduce the mean arterial pressure by 50% within the first hour
C. Maintain the blood pressure at 120/80 mm Hg to prevent end-organ damage
D. Administer oral beta-blockers to achieve a gradual reduction over 24 hours
orrect Answer: A
C
Rationale: In a hypertensive crisis, the goal is to reduce the mean arterial pressure by no
more than 25% in the first hour, then to around 160/100 over the next 2-6 hours to
prevent cerebral hypoperfusion. Dropping the pressure too rapidly, as in reducing it by
,50%, can cause ischemic stroke or renal failure. Always remember the ATI rule of thumb
for hypertensive crisis: lower slowly to protect the brain.
Question 2 of 50
A 72-year-old patient admitted with acute decompensated heart failure has a pulmonary
artery catheter. The nurse notes a pulmonary artery wedge pressure (PAWP) of 24 mm
Hg and a cardiac output of 3.2 L/min. Based on these hemodynamic parameters, what
is the priority nursing intervention?
. Administer a prescribed intravenous fluid bolus of normal saline
A
B. Administer a prescribed dose of intravenous furosemide
C. Prepare for immediate synchronized cardioversion
D. Apply continuous positive airway pressure (CPAP)
orrect Answer: B
C
Rationale: A PAWP of 24 mm Hg indicates significant fluid overload and increased
preload, requiring immediate diuresis with intravenous furosemide to reduce pulmonary
congestion. Administering a fluid bolus would worsen the heart failure and pulmonary
edema. On the ATI exam, always correlate high PAWP with the need for preload
reduction.
Question 3 of 50
A 65-year-old patient with coronary artery disease is prescribed sublingual nitroglycerin
for exertional angina. The nurse evaluates the patient's understanding of the
medication. What statement by the patient indicates a need for further teaching?
, . I should sit down before taking the medication to prevent dizziness
A
B. I can take up to three tablets five minutes apart if the pain persists
C. I should swallow the tablet whole with a full glass of water
D. I will store the medication in the original amber glass bottle
orrect Answer: C
C
Rationale: Sublingual nitroglycerin must be absorbed through the oral mucosa for rapid
onset, so swallowing it whole renders it ineffective for acute angina. While sitting down
prevents orthostatic hypotension and storing it in amber glass preserves potency,
swallowing the pill is a critical administration error. Remember the sublingual route is
the fastest non-IV route for coronary vasodilation.
Question 4 of 50
A 55-year-old patient is admitted with a suspected acute myocardial infarction. The
patient suddenly develops a regular, wide-complex tachycardia at a rate of 160/min and
becomes unresponsive with no palpable pulse. What is the nurse's immediate action?
. Perform synchronized cardioversion at 100 joules
A
B. Administer intravenous amiodarone 300 mg push
C. Assess the airway and obtain a 12-lead electrocardiogram
D. Defibrillate the patient immediately with 120 to 200 joules
orrect Answer: D
C
Rationale: A pulseless, unresponsive patient in wide-complex tachycardia (pulseless
ventricular tachycardia) requires immediate defibrillation per ACLS guidelines to restore
a perfusing rhythm. Synchronized cardioversion is used for unstable tachycardias with a
pulse, not pulseless rhythms. Know the critical distinction on the ATI exam: defibrillation
is for pulseless rhythms, while cardioversion is for unstable rhythms with a pulse.
, Question 5 of 50
A 34-year-old patient with a mechanical mitral valve replacement is being discharged on
warfarin therapy. The nurse is reviewing dietary instructions with the patient. What
statement by the patient indicates a correct understanding of the teaching?
. I should maintain a consistent intake of vitamin K-rich foods in my daily diet
A
B. I will increase my intake of dark green leafy vegetables to ensure adequate vitamin K
C. I must completely avoid all foods that contain vitamin K to prevent blood clots
D. I will drink a large glass of cranberry juice daily to boost the medication effect
orrect Answer: A
C
Rationale: Patients on warfarin should maintain a consistent intake of vitamin K to
prevent fluctuations in their International Normalized Ratio (INR) and maintain
therapeutic anticoagulation. Increasing or drastically avoiding vitamin K intake will alter
the INR and either negate the drug's effect or increase bleeding risk. ATI exam strategy:
"Consistent" is the key word for diet teaching with warfarin.
Question 6 of 50
A 68-year-old patient with a history of severe anemia presents with extreme fatigue,
pallor, and a hemoglobin level of 6.5 g/dL. The provider prescribes two units of packed
red blood cells. During the first 15 minutes of the transfusion, what is the priority
nursing action?
. Infuse the blood at a rapid rate to correct the anemia quickly
A
B. Stay with the patient and monitor closely for signs of an acute hemolytic reaction
C. Monitor the patient's vital signs every 30 minutes during the transfusion
D. Administer intravenous furosemide between the two units of blood
