ATI MED-SURG CMS PROCTORED EXAM
2026 | VERSIONS A, B & C | PRACTICE
QUESTIONS, VERIFIED CORRECT ANSWERS
& DETAILED RATIONALES | COMPLETE MED-
SURG STUDY GUIDE | JUST RELEASED PDF
ATI MED-SURG CMS PROCTORED EXAM 2026 | VERSIONS A, B & C
PRACTICE QUESTIONS, VERIFIED CORRECT ANSWERS & DETAILED RATIONALES
DOCUMENT OVERVIEW
• Complete Study Resource: This document contains 200 comprehensive multiple-
choice practice questions designed to prepare you for the ATI Medical-Surgical
Nursing Proctored Exam, mirroring the actual exam format and difficulty level.
• Strategic Study Approach: Use these questions to identify knowledge gaps,
reinforce understanding of critical concepts, review detailed rationales to deepen
comprehension, and build test-taking confidence through repeated practice and
self-assessment.
QUESTION 1
A client with acute myocardial infarction (MI) is experiencing chest pain.
Which of the following medications should the nurse expect to administer
first?
A) Metoprolol
B) Lisinopril
C) Morphine
D) Aspirin
E) Nitroglycerin
✓ CORRECT ANSWER: C) Morphine
,RATIONALE: In acute MI, morphine is administered first as a primary intervention
because it provides immediate pain relief, reduces anxiety, decreases cardiac
workload by reducing heart rate and contractility, and causes vasodilation to
improve coronary blood flow. While aspirin and nitroglycerin are also given,
morphine addresses the acute pain crisis first and stabilizes the client's
hemodynamic status. Beta-blockers and ACE inhibitors follow as part of long-term
management but are not the initial priority in acute pain management.
QUESTION 2
A nurse is caring for a client post-myocardial infarction who is receiving
heparin therapy. Which laboratory value would indicate therapeutic
anticoagulation?
A) Prothrombin time (PT) of 18 seconds
B) International Normalized Ratio (INR) of 2-3
C) Activated partial thromboplastin time (aPTT) of 1.5-2.5 times the control value
D) Platelet count of 250,000/mm³
E) Hemoglobin of 14 g/dL
✓ CORRECT ANSWER: C) Activated partial thromboplastin time (aPTT) of 1.5-2.5
times the control value
RATIONALE: Heparin therapy is monitored using the aPTT, with therapeutic levels
ranging from 1.5 to 2.5 times the control value. PT and INR are used to monitor
warfarin therapy, not heparin. A platelet count of 250,000/mm³ is within normal
range and does not indicate anticoagulation status. Hemoglobin levels are
unrelated to heparin monitoring. Proper aPTT monitoring ensures adequate
anticoagulation while minimizing bleeding risk.
,QUESTION 3
A client is scheduled for coronary artery bypass graft (CABG) surgery. Which
preoperative teaching point is most important for the nurse to emphasize?
A) The client will be able to resume driving immediately after discharge
B) Coughing and deep breathing exercises will help prevent postoperative
complications
C) Pain medication will not be necessary after the first 24 hours
D) The client should avoid any activity for 6 weeks postoperatively
E) Antibiotics will be prescribed for 1 year after surgery
✓ CORRECT ANSWER: B) Coughing and deep breathing exercises will help
prevent postoperative complications
RATIONALE: Coughing and deep breathing are essential postoperative nursing
interventions that prevent atelectasis (lung collapse) and pneumonia by promoting
lung expansion and clearance of secretions. This is a critical teaching point that
directly impacts postoperative outcomes. Clients can resume driving with
restrictions (typically 4-6 weeks), pain management is needed beyond 24 hours,
activity restrictions vary based on recovery progress, and antibiotics are not
typically prescribed for a full year. Deep breathing and coughing are evidence-
based interventions that reduce morbidity.
QUESTION 4
A nurse is assessing a client with congestive heart failure (CHF). Which finding
would indicate worsening heart failure?
A) Increased urine output with normal specific gravity
B) Weight gain of 3 pounds in 1 week
C) Blood pressure of 130/85 mmHg
, D) Heart rate of 70 beats per minute
E) Respiratory rate of 16 breaths per minute
✓ CORRECT ANSWER: B) Weight gain of 3 pounds in 1 week
RATIONALE: Rapid weight gain (more than 2-3 pounds in 1-2 days or 5 pounds in a
week) indicates fluid retention and worsening heart failure. This is a cardinal sign of
decompensation. Increased urine output with normal specific gravity suggests
adequate kidney function and fluid balance. A blood pressure of 130/85 is elevated
but not necessarily indicative of worsening CHF. Heart rate of 70 and respiratory
rate of 16 are within normal ranges. Weight monitoring is the single most important
indicator clients and nurses should track in CHF management.
QUESTION 5
A client with hypertension is prescribed lisinopril, an ACE inhibitor. The nurse
should monitor the client for which expected side effect?
A) Hypoglycemia
B) Dry persistent cough
C) Hyperkalemia requiring treatment
D) Fluid retention and weight gain
E) Severe hypotension requiring hospitalization
✓ CORRECT ANSWER: B) Dry persistent cough
RATIONALE: A dry persistent cough occurs in 10-20% of clients taking ACE
inhibitors due to accumulation of bradykinin in the lungs. This is not dangerous but
is bothersome and may lead to medication discontinuation. Clients should be
counseled about this expected side effect. ACE inhibitors do not cause
hypoglycemia, though hyperkalemia can occur and requires monitoring (not severe
treatment in most cases). While fluid retention is not typical of ACE inhibitors,
2026 | VERSIONS A, B & C | PRACTICE
QUESTIONS, VERIFIED CORRECT ANSWERS
& DETAILED RATIONALES | COMPLETE MED-
SURG STUDY GUIDE | JUST RELEASED PDF
ATI MED-SURG CMS PROCTORED EXAM 2026 | VERSIONS A, B & C
PRACTICE QUESTIONS, VERIFIED CORRECT ANSWERS & DETAILED RATIONALES
DOCUMENT OVERVIEW
• Complete Study Resource: This document contains 200 comprehensive multiple-
choice practice questions designed to prepare you for the ATI Medical-Surgical
Nursing Proctored Exam, mirroring the actual exam format and difficulty level.
• Strategic Study Approach: Use these questions to identify knowledge gaps,
reinforce understanding of critical concepts, review detailed rationales to deepen
comprehension, and build test-taking confidence through repeated practice and
self-assessment.
QUESTION 1
A client with acute myocardial infarction (MI) is experiencing chest pain.
Which of the following medications should the nurse expect to administer
first?
A) Metoprolol
B) Lisinopril
C) Morphine
D) Aspirin
E) Nitroglycerin
✓ CORRECT ANSWER: C) Morphine
,RATIONALE: In acute MI, morphine is administered first as a primary intervention
because it provides immediate pain relief, reduces anxiety, decreases cardiac
workload by reducing heart rate and contractility, and causes vasodilation to
improve coronary blood flow. While aspirin and nitroglycerin are also given,
morphine addresses the acute pain crisis first and stabilizes the client's
hemodynamic status. Beta-blockers and ACE inhibitors follow as part of long-term
management but are not the initial priority in acute pain management.
QUESTION 2
A nurse is caring for a client post-myocardial infarction who is receiving
heparin therapy. Which laboratory value would indicate therapeutic
anticoagulation?
A) Prothrombin time (PT) of 18 seconds
B) International Normalized Ratio (INR) of 2-3
C) Activated partial thromboplastin time (aPTT) of 1.5-2.5 times the control value
D) Platelet count of 250,000/mm³
E) Hemoglobin of 14 g/dL
✓ CORRECT ANSWER: C) Activated partial thromboplastin time (aPTT) of 1.5-2.5
times the control value
RATIONALE: Heparin therapy is monitored using the aPTT, with therapeutic levels
ranging from 1.5 to 2.5 times the control value. PT and INR are used to monitor
warfarin therapy, not heparin. A platelet count of 250,000/mm³ is within normal
range and does not indicate anticoagulation status. Hemoglobin levels are
unrelated to heparin monitoring. Proper aPTT monitoring ensures adequate
anticoagulation while minimizing bleeding risk.
,QUESTION 3
A client is scheduled for coronary artery bypass graft (CABG) surgery. Which
preoperative teaching point is most important for the nurse to emphasize?
A) The client will be able to resume driving immediately after discharge
B) Coughing and deep breathing exercises will help prevent postoperative
complications
C) Pain medication will not be necessary after the first 24 hours
D) The client should avoid any activity for 6 weeks postoperatively
E) Antibiotics will be prescribed for 1 year after surgery
✓ CORRECT ANSWER: B) Coughing and deep breathing exercises will help
prevent postoperative complications
RATIONALE: Coughing and deep breathing are essential postoperative nursing
interventions that prevent atelectasis (lung collapse) and pneumonia by promoting
lung expansion and clearance of secretions. This is a critical teaching point that
directly impacts postoperative outcomes. Clients can resume driving with
restrictions (typically 4-6 weeks), pain management is needed beyond 24 hours,
activity restrictions vary based on recovery progress, and antibiotics are not
typically prescribed for a full year. Deep breathing and coughing are evidence-
based interventions that reduce morbidity.
QUESTION 4
A nurse is assessing a client with congestive heart failure (CHF). Which finding
would indicate worsening heart failure?
A) Increased urine output with normal specific gravity
B) Weight gain of 3 pounds in 1 week
C) Blood pressure of 130/85 mmHg
, D) Heart rate of 70 beats per minute
E) Respiratory rate of 16 breaths per minute
✓ CORRECT ANSWER: B) Weight gain of 3 pounds in 1 week
RATIONALE: Rapid weight gain (more than 2-3 pounds in 1-2 days or 5 pounds in a
week) indicates fluid retention and worsening heart failure. This is a cardinal sign of
decompensation. Increased urine output with normal specific gravity suggests
adequate kidney function and fluid balance. A blood pressure of 130/85 is elevated
but not necessarily indicative of worsening CHF. Heart rate of 70 and respiratory
rate of 16 are within normal ranges. Weight monitoring is the single most important
indicator clients and nurses should track in CHF management.
QUESTION 5
A client with hypertension is prescribed lisinopril, an ACE inhibitor. The nurse
should monitor the client for which expected side effect?
A) Hypoglycemia
B) Dry persistent cough
C) Hyperkalemia requiring treatment
D) Fluid retention and weight gain
E) Severe hypotension requiring hospitalization
✓ CORRECT ANSWER: B) Dry persistent cough
RATIONALE: A dry persistent cough occurs in 10-20% of clients taking ACE
inhibitors due to accumulation of bradykinin in the lungs. This is not dangerous but
is bothersome and may lead to medication discontinuation. Clients should be
counseled about this expected side effect. ACE inhibitors do not cause
hypoglycemia, though hyperkalemia can occur and requires monitoring (not severe
treatment in most cases). While fluid retention is not typical of ACE inhibitors,
