ATI Medical-Surgical CMS Actual Exam –
Assessment Technologies Institute (ATI) –
2026/2027 Academic Year – Verified
Questions and Answers
SECTION 1: CARDIOVASCULAR AND HEMATOLOGY
DISORDERS (Questions 1-30)
1. Q: A nurse is reviewing the medical record of a client admitted with left-sided
heart failure. Which finding should the nurse identify as an expected
manifestation?
A) Crackles in the lung fields
B) Peripheral edema
C) Jugular venous distention
D) Hepatomegaly
Answer: A
Rationale: Left-sided heart failure impairs the left ventricle's ability to pump blood
forward, causing blood to back up into the pulmonary circulation. This pulmonary
congestion leads to crackles auscultated in the lung fields, dyspnea, orthopnea, and a
productive cough. Peripheral edema, JVD, and hepatomegaly are signs of right-sided
heart failure .
2. Q: A client with a new permanent pacemaker is being discharged. Which
statement indicates understanding of the teaching?
A) "I should check my heart rate every day."
B) "I can hold my cellular phone up to my ear on the same side as the pacemaker."
C) "I should avoid using a microwave oven."
D) "I can stand near antitheft devices in store doorways."
Answer: A
Rationale: Clients with permanent pacemakers should monitor their heart rate daily.
Cellular phones should be held on the opposite side; microwave ovens are safe with
modern pacemakers. Clients should not linger near antitheft devices in store doorways .
,3. Q: A client is 1-day post-cardiac catheterization. The nurse notes the client's
affected extremity is cool, pale, and the distal pulse is weak. Which action
should the nurse take first?
A) Document the findings and continue to monitor
B) Apply a warm compress to the extremity
C) Notify the healthcare provider immediately
D) Elevate the affected extremity
Answer: C
Rationale: Cool, pale extremity with a weak distal pulse indicates possible arterial
occlusion, a serious complication of cardiac catheterization. The healthcare provider
should be notified immediately to prevent tissue ischemia. Documentation alone is
insufficient; this is a critical finding requiring prompt intervention .
4. Q: A client with chronic kidney disease stage 4 has a potassium level of 6.8
mEq/L and peaked T waves on ECG. The provider has prescribed calcium
gluconate, insulin with dextrose, and albuterol. Which finding indicates
immediate life threat has been resolved?
A) Potassium level drops to 5.5 mEq/L in 30 minutes
B) ECG T-wave normalizes
C) Urine output of 40 mL/hr
D) Blood glucose of 250 mg/dL
Answer: B
Rationale: Calcium gluconate stabilizes the myocardium within minutes; ECG
normalization confirms cardiac protection. Potassium lowering takes hours, and urine
output and glucose levels are secondary indicators. The priority is preventing lethal
cardiac dysrhythmias from hyperkalemia .
5. Q: A client prescribed digoxin has a new finding of nausea, vomiting, and
yellow halos around lights. The apical pulse is 48 bpm. Which action should the
nurse take?
,A) Administer the digoxin as scheduled
B) Hold the digoxin and notify the healthcare provider
C) Administer potassium supplement
D) Increase the client's fluid intake
Answer: B
Rationale: Nausea, vomiting, visual disturbances (yellow halos), and bradycardia
(apical pulse below 60 bpm) are classic signs of digoxin toxicity. The medication should
be withheld and the provider notified immediately. Digoxin toxicity can cause life-
threatening dysrhythmias .
6. Q: A client is receiving IV heparin therapy. The aPTT result is 98 seconds
(normal 25-35). The client has no signs of bleeding. Which action should the
nurse take?
A) Continue the infusion and recheck in 6 hours
B) Increase the infusion rate
C) Decrease the rate by 2 units/kg/hr and notify the provider
D) Stop the infusion immediately
Answer: C
Rationale: Therapeutic aPTT for heparin is typically 60-85 seconds. An aPTT of 98
seconds is supratherapeutic. The rate should be decreased and the provider notified.
Stopping abruptly can cause rebound thrombosis .
7. Q: A client with a new prescription for sublingual nitroglycerin asks the nurse
how to take the medication. Which response is correct?
A) "Place one tablet under your tongue at the onset of chest pain."
B) "Swallow the tablet whole with a full glass of water."
C) "Chew the tablet before swallowing."
D) "Place the tablet between your cheek and gum."
Answer: A
Rationale: Sublingual nitroglycerin must dissolve under the tongue for rapid
absorption. It should not be chewed, swallowed, or placed buccally unless specifically
prescribed. Clients can repeat every 5 minutes up to 3 doses. The client should lie down
when taking it to prevent orthostatic hypotension .
, 8. Q: A client with acute coronary syndrome on heparin has an aPTT of 98
seconds. Which action should the nurse take?
A) Continue current infusion rate
B) Increase the infusion rate
C) Decrease the rate and notify the provider
D) Discontinue heparin and administer protamine
Answer: C
Rationale: A supratherapeutic aPTT requires dose reduction and provider notification.
The infusion should not be stopped abruptly due to risk of rebound thrombosis .
9. Q: A client with heart failure receiving furosemide has which finding
indicating the medication is achieving the desired therapeutic effect?
A) Decreased urine output
B) Clear breath sounds and weight loss of 1 kg in 24 hours
C) Elevated jugular venous pressure
D) 3+ pitting edema
Answer: B
Rationale: Desired effects of furosemide in heart failure include diuresis, resulting in
weight loss and improvement in respiratory status. Clear breath sounds indicate
pulmonary congestion is resolving .
10. Q: The nurse is reviewing discharge teaching with a client who has a new
prescription for warfarin. Which statement by the client indicates
understanding?
A) "I will avoid all green leafy vegetables."
B) "I will maintain a consistent intake of vitamin K-rich foods."
C) "I can take ibuprofen for headaches."
D) "I will have my INR checked weekly."
Answer: B
Rationale: Clients taking warfarin should maintain consistent intake of vitamin K-rich
Assessment Technologies Institute (ATI) –
2026/2027 Academic Year – Verified
Questions and Answers
SECTION 1: CARDIOVASCULAR AND HEMATOLOGY
DISORDERS (Questions 1-30)
1. Q: A nurse is reviewing the medical record of a client admitted with left-sided
heart failure. Which finding should the nurse identify as an expected
manifestation?
A) Crackles in the lung fields
B) Peripheral edema
C) Jugular venous distention
D) Hepatomegaly
Answer: A
Rationale: Left-sided heart failure impairs the left ventricle's ability to pump blood
forward, causing blood to back up into the pulmonary circulation. This pulmonary
congestion leads to crackles auscultated in the lung fields, dyspnea, orthopnea, and a
productive cough. Peripheral edema, JVD, and hepatomegaly are signs of right-sided
heart failure .
2. Q: A client with a new permanent pacemaker is being discharged. Which
statement indicates understanding of the teaching?
A) "I should check my heart rate every day."
B) "I can hold my cellular phone up to my ear on the same side as the pacemaker."
C) "I should avoid using a microwave oven."
D) "I can stand near antitheft devices in store doorways."
Answer: A
Rationale: Clients with permanent pacemakers should monitor their heart rate daily.
Cellular phones should be held on the opposite side; microwave ovens are safe with
modern pacemakers. Clients should not linger near antitheft devices in store doorways .
,3. Q: A client is 1-day post-cardiac catheterization. The nurse notes the client's
affected extremity is cool, pale, and the distal pulse is weak. Which action
should the nurse take first?
A) Document the findings and continue to monitor
B) Apply a warm compress to the extremity
C) Notify the healthcare provider immediately
D) Elevate the affected extremity
Answer: C
Rationale: Cool, pale extremity with a weak distal pulse indicates possible arterial
occlusion, a serious complication of cardiac catheterization. The healthcare provider
should be notified immediately to prevent tissue ischemia. Documentation alone is
insufficient; this is a critical finding requiring prompt intervention .
4. Q: A client with chronic kidney disease stage 4 has a potassium level of 6.8
mEq/L and peaked T waves on ECG. The provider has prescribed calcium
gluconate, insulin with dextrose, and albuterol. Which finding indicates
immediate life threat has been resolved?
A) Potassium level drops to 5.5 mEq/L in 30 minutes
B) ECG T-wave normalizes
C) Urine output of 40 mL/hr
D) Blood glucose of 250 mg/dL
Answer: B
Rationale: Calcium gluconate stabilizes the myocardium within minutes; ECG
normalization confirms cardiac protection. Potassium lowering takes hours, and urine
output and glucose levels are secondary indicators. The priority is preventing lethal
cardiac dysrhythmias from hyperkalemia .
5. Q: A client prescribed digoxin has a new finding of nausea, vomiting, and
yellow halos around lights. The apical pulse is 48 bpm. Which action should the
nurse take?
,A) Administer the digoxin as scheduled
B) Hold the digoxin and notify the healthcare provider
C) Administer potassium supplement
D) Increase the client's fluid intake
Answer: B
Rationale: Nausea, vomiting, visual disturbances (yellow halos), and bradycardia
(apical pulse below 60 bpm) are classic signs of digoxin toxicity. The medication should
be withheld and the provider notified immediately. Digoxin toxicity can cause life-
threatening dysrhythmias .
6. Q: A client is receiving IV heparin therapy. The aPTT result is 98 seconds
(normal 25-35). The client has no signs of bleeding. Which action should the
nurse take?
A) Continue the infusion and recheck in 6 hours
B) Increase the infusion rate
C) Decrease the rate by 2 units/kg/hr and notify the provider
D) Stop the infusion immediately
Answer: C
Rationale: Therapeutic aPTT for heparin is typically 60-85 seconds. An aPTT of 98
seconds is supratherapeutic. The rate should be decreased and the provider notified.
Stopping abruptly can cause rebound thrombosis .
7. Q: A client with a new prescription for sublingual nitroglycerin asks the nurse
how to take the medication. Which response is correct?
A) "Place one tablet under your tongue at the onset of chest pain."
B) "Swallow the tablet whole with a full glass of water."
C) "Chew the tablet before swallowing."
D) "Place the tablet between your cheek and gum."
Answer: A
Rationale: Sublingual nitroglycerin must dissolve under the tongue for rapid
absorption. It should not be chewed, swallowed, or placed buccally unless specifically
prescribed. Clients can repeat every 5 minutes up to 3 doses. The client should lie down
when taking it to prevent orthostatic hypotension .
, 8. Q: A client with acute coronary syndrome on heparin has an aPTT of 98
seconds. Which action should the nurse take?
A) Continue current infusion rate
B) Increase the infusion rate
C) Decrease the rate and notify the provider
D) Discontinue heparin and administer protamine
Answer: C
Rationale: A supratherapeutic aPTT requires dose reduction and provider notification.
The infusion should not be stopped abruptly due to risk of rebound thrombosis .
9. Q: A client with heart failure receiving furosemide has which finding
indicating the medication is achieving the desired therapeutic effect?
A) Decreased urine output
B) Clear breath sounds and weight loss of 1 kg in 24 hours
C) Elevated jugular venous pressure
D) 3+ pitting edema
Answer: B
Rationale: Desired effects of furosemide in heart failure include diuresis, resulting in
weight loss and improvement in respiratory status. Clear breath sounds indicate
pulmonary congestion is resolving .
10. Q: The nurse is reviewing discharge teaching with a client who has a new
prescription for warfarin. Which statement by the client indicates
understanding?
A) "I will avoid all green leafy vegetables."
B) "I will maintain a consistent intake of vitamin K-rich foods."
C) "I can take ibuprofen for headaches."
D) "I will have my INR checked weekly."
Answer: B
Rationale: Clients taking warfarin should maintain consistent intake of vitamin K-rich
