ATI ADULT MEDICAL SURGICAL NURSING (CMS) EXAM
2026/2027
200 Practice Questions & Detailed Answers | Complete A+
Guide
SECTION 1: CARDIOVASCULAR & HEMATOLOGIC DISORDERS (Questions 1–40)
1. A nurse is assessing a client with leftsided heart failure. Which finding is most expected?
A. Jugular vein distention
B. Peripheral edema
C. Crackles in lung bases
D. Hepatomegaly
Answer: C. Leftsided heart failure causes fluid backup into the lungs (pulmonary congestion), leading to
crackles. JVD, peripheral edema, and hepatomegaly are signs of rightsided failure.
2. A client with heart failure has crackles in all lung fields, jugular venous distention, and 3+ pitting
edema. Which medication should the nurse expect to administer first?
A. Digoxin
B. Furosemide
C. Enalapril
D. Carvedilol
Answer: B. Furosemide (loop diuretic) reduces preload by promoting diuresis, decreasing fluid volume,
and alleviating pulmonary congestion.
,3. A client postMI develops chest pain unrelieved by nitroglycerin. The nurse should first:
A. Administer morphine sulfate
B. Repeat nitroglycerin
C. Obtain an ECG
D. Assess blood pressure
Answer: D. Before administering further nitroglycerin or morphine, assess BP to prevent hypotension.
After assessment, notify provider and obtain ECG.
4. A client with angina is prescribed nitroglycerin sublingual. The nurse instructs the client to take one
tablet every 5 minutes for up to 3 doses. If chest pain is not relieved after 3 doses, the client should:
A. Take two more tablets
B. Call 911 immediately
C. Lie down and rest
D. Take a warm shower
Answer: B. Unrelieved chest pain after 3 nitroglycerin doses (over 15 minutes) warrants emergency
medical attention (potential MI).
5. A client with a history of deep vein thrombosis (DVT) is prescribed enoxaparin. The nurse should
administer this medication via which route?
A. Intravenous push
B. Subcutaneous injection in the abdomen
C. Intramuscular injection
D. Oral
,Answer: B. Enoxaparin (lowmolecularweight heparin) is given subcutaneously in the abdomen; rotate
sites; do not expel air bubble.
6. A client after cardiac catheterization via the femoral artery has a sandbag placed over the insertion
site. Which finding requires immediate nursing action?
A. Small amount of oozing around the site
B. Ecchymosis at the site
C. Expanding hematoma and loss of pulse in the affected leg
D. Mild groin discomfort
Answer: C. Expanding hematoma with loss of distal pulse indicates possible retroperitoneal bleeding or
vessel occlusion; notify provider immediately.
7. A client with chronic heart failure has a prescription for carvedilol. The nurse should monitor for
which therapeutic effect?
A. Increased heart rate
B. Improved left ventricular ejection fraction (LVEF) and reduced mortality
C. Increased blood pressure
D. Decreased urinary output
Answer: B. Carvedilol is a betablocker that reduces mortality, hospitalizations, and improves LVEF in
heart failure with reduced ejection fraction.
, 8. A client with infective endocarditis has petechiae, splinter hemorrhages, and Osler nodes. The nurse
should prioritize:
A. Pain management
B. Obtaining blood cultures before antibiotics
C. Administering antipyretics
D. Restricting fluids
Answer: B. Blood cultures are essential to identify causative organism before initiating antibiotics;
empiric antibiotics are started after cultures are obtained.
9. A client with heart failure is prescribed spironolactone. Which finding indicates a therapeutic effect?
A. Increased urinary output and reduced edema
B. Increased potassium level
C. Decreased blood pressure
D. Decreased heart rate
Answer: A. Spironolactone is a potassiumsparing diuretic that promotes diuresis, reducing fluid volume
and edema. Monitor for hyperkalemia.
10. A client with chronic venous insufficiency (CVI) has lower extremity edema. Which intervention
should the nurse recommend?
A. Elevate legs above heart level and wear compression stockings
B. Apply warm compresses
C. Massage the affected areas
D. Encourage prolonged standing
2026/2027
200 Practice Questions & Detailed Answers | Complete A+
Guide
SECTION 1: CARDIOVASCULAR & HEMATOLOGIC DISORDERS (Questions 1–40)
1. A nurse is assessing a client with leftsided heart failure. Which finding is most expected?
A. Jugular vein distention
B. Peripheral edema
C. Crackles in lung bases
D. Hepatomegaly
Answer: C. Leftsided heart failure causes fluid backup into the lungs (pulmonary congestion), leading to
crackles. JVD, peripheral edema, and hepatomegaly are signs of rightsided failure.
2. A client with heart failure has crackles in all lung fields, jugular venous distention, and 3+ pitting
edema. Which medication should the nurse expect to administer first?
A. Digoxin
B. Furosemide
C. Enalapril
D. Carvedilol
Answer: B. Furosemide (loop diuretic) reduces preload by promoting diuresis, decreasing fluid volume,
and alleviating pulmonary congestion.
,3. A client postMI develops chest pain unrelieved by nitroglycerin. The nurse should first:
A. Administer morphine sulfate
B. Repeat nitroglycerin
C. Obtain an ECG
D. Assess blood pressure
Answer: D. Before administering further nitroglycerin or morphine, assess BP to prevent hypotension.
After assessment, notify provider and obtain ECG.
4. A client with angina is prescribed nitroglycerin sublingual. The nurse instructs the client to take one
tablet every 5 minutes for up to 3 doses. If chest pain is not relieved after 3 doses, the client should:
A. Take two more tablets
B. Call 911 immediately
C. Lie down and rest
D. Take a warm shower
Answer: B. Unrelieved chest pain after 3 nitroglycerin doses (over 15 minutes) warrants emergency
medical attention (potential MI).
5. A client with a history of deep vein thrombosis (DVT) is prescribed enoxaparin. The nurse should
administer this medication via which route?
A. Intravenous push
B. Subcutaneous injection in the abdomen
C. Intramuscular injection
D. Oral
,Answer: B. Enoxaparin (lowmolecularweight heparin) is given subcutaneously in the abdomen; rotate
sites; do not expel air bubble.
6. A client after cardiac catheterization via the femoral artery has a sandbag placed over the insertion
site. Which finding requires immediate nursing action?
A. Small amount of oozing around the site
B. Ecchymosis at the site
C. Expanding hematoma and loss of pulse in the affected leg
D. Mild groin discomfort
Answer: C. Expanding hematoma with loss of distal pulse indicates possible retroperitoneal bleeding or
vessel occlusion; notify provider immediately.
7. A client with chronic heart failure has a prescription for carvedilol. The nurse should monitor for
which therapeutic effect?
A. Increased heart rate
B. Improved left ventricular ejection fraction (LVEF) and reduced mortality
C. Increased blood pressure
D. Decreased urinary output
Answer: B. Carvedilol is a betablocker that reduces mortality, hospitalizations, and improves LVEF in
heart failure with reduced ejection fraction.
, 8. A client with infective endocarditis has petechiae, splinter hemorrhages, and Osler nodes. The nurse
should prioritize:
A. Pain management
B. Obtaining blood cultures before antibiotics
C. Administering antipyretics
D. Restricting fluids
Answer: B. Blood cultures are essential to identify causative organism before initiating antibiotics;
empiric antibiotics are started after cultures are obtained.
9. A client with heart failure is prescribed spironolactone. Which finding indicates a therapeutic effect?
A. Increased urinary output and reduced edema
B. Increased potassium level
C. Decreased blood pressure
D. Decreased heart rate
Answer: A. Spironolactone is a potassiumsparing diuretic that promotes diuresis, reducing fluid volume
and edema. Monitor for hyperkalemia.
10. A client with chronic venous insufficiency (CVI) has lower extremity edema. Which intervention
should the nurse recommend?
A. Elevate legs above heart level and wear compression stockings
B. Apply warm compresses
C. Massage the affected areas
D. Encourage prolonged standing
