ADVANCED ATI MED SURG FINAL EXAM WITH NGN (ALL NEW
UPDATED SOLUTIONS 2025)
1. What is the normal range for troponin I, and when do elevated levels first become
detectable after myocardial injury, including their duration?
• Less than 0.1 ng/mL, detectable at 6 hours, lasts 3 days
• Less than 0.03 ng/mL, detectable at 3 hours, lasts 7 to 10 days
• Less than 0.05 ng/mL, detectable at 12 hours, lasts 14 days
• Less than 0.03 ng/mL, detectable at 1 hour, lasts 24 hours
Rationale: Troponin I rises within 3 hours of myocardial injury and remains elevated for
7–10 days, making it a critical marker for diagnosing myocardial infarction (MI).
2. What is the normal range for myoglobin, and when are elevated levels first noticeable
after myocardial injury, including how long they persist?
• Less than 50 mcg/L, detectable at 4 hours, lasts 48 hours
• Less than 90 mcg/L, detectable at 2 hours, lasts 24 hours
• Less than 100 mcg/L, detectable at 6 hours, lasts 72 hours
• Less than 75 mcg/L, detectable at 1 hour, lasts 12 hours
Rationale: Myoglobin elevates within 2 hours and clears within 24 hours, serving as an
early but transient indicator of muscle damage.
3. During an echocardiogram, on which side should the patient lie, and what additional
instruction is provided?
• Right side, breathe deeply
• Left side, remain still
• Supine, move as needed
• Left side, hold breath
Rationale: The left-side position optimizes cardiac imaging, and stillness prevents
motion artifacts.
4. What conditions indicate the need for an echocardiogram?
• Asthma, pneumonia
• Cardiomyopathy, heart failure, angina, myocardial infarction
• Hypertension, diabetes
• Kidney failure, liver disease
Rationale: Echocardiograms assess heart structure and function, indicated for cardiac-
specific conditions.
5. What are the indications for performing a stress test?
• COPD, lung cancer
• Dysrhythmias, heart failure, angina, myocardial infarction
, • Stroke, seizures
• Peripheral artery disease, venous insufficiency
Rationale: Stress tests evaluate cardiac response to exertion, relevant for coronary and
rhythm issues.
6. Which two medications are commonly prescribed for a pharmacological stress test?
• Epinephrine, norepinephrine
• Dobutamine, adenosine
• Atropine, lidocaine
• Verapamil, amiodarone
Rationale: Dobutamine and adenosine simulate exercise effects on the heart for patients
unable to perform physical stress tests.
7. What should a patient avoid 2 to 4 hours prior to a stress test?
• Water, juice
• Tobacco, alcohol, caffeine
• Light meals, exercise
• Medications, rest
Rationale: Tobacco, alcohol, and caffeine can alter heart rate and blood pressure,
skewing stress test results.
8. In hemodynamic monitoring with arterial lines, typically placed in the radial, brachial,
or femoral artery, what should be monitored in the limb?
• Pain, swelling
• Circulation (capillary refill, temperature, color)
• Muscle strength, sensation
• Blood pressure, pulse rate
Rationale: Monitoring circulation ensures the arterial line hasn’t compromised blood
flow to the limb.
9. Are arterial lines used for IV fluid administration in hemodynamic monitoring?
• No
• Yes
• Only in emergencies
• Only with saline
Rationale: Arterial lines are for monitoring pressure, not fluid administration, to avoid
arterial damage.
10. Where is a pulmonary artery (PA) catheter inserted, and what is one of its functions?
• Radial artery, measures blood pressure
• Large vein (e.g., internal jugular), allows IV fluid infusion
, • Femoral artery, samples blood
• Subclavian vein, monitors oxygen levels
Rationale: PA catheters are inserted via large veins and threaded to the pulmonary
artery, enabling IV fluid infusion among other functions.
11. What is the expected reference range for central venous pressure (CVP)?
• 10 to 20 mm Hg
• 1 to 8 mm Hg
• 15 to 30 mm Hg
• 0 to 5 mm Hg
Rationale: CVP of 1–8 mm Hg reflects normal right atrial pressure and fluid status.
12. What is the expected range for pulmonary artery systolic (PAS) pressure?
• 5 to 15 mm Hg
• 15 to 26 mm Hg
• 25 to 35 mm Hg
• 10 to 20 mm Hg
Rationale: PAS of 15–26 mm Hg indicates normal pulmonary artery systolic pressure.
13. What is the expected range for pulmonary artery diastolic (PAD) pressure?
• 15 to 25 mm Hg
• 5 to 15 mm Hg
• 20 to 30 mm Hg
• 0 to 10 mm Hg
Rationale: PAD of 5–15 mm Hg reflects normal pulmonary artery diastolic pressure.
14. What is the expected range for pulmonary artery wedge pressure (PAWP)?
• 10 to 20 mm Hg
• 4 to 12 mm Hg
• 15 to 25 mm Hg
• 1 to 8 mm Hg
Rationale: PAWP of 4–12 mm Hg indicates normal left atrial pressure.
15. What is the expected range for cardiac output?
• 1 to 3 L/min
• 4 to 7 L/min
• 8 to 10 L/min
• 2 to 5 L/min
Rationale: Cardiac output of 4–7 L/min reflects normal heart pumping capacity.
16. What is the expected range for mixed venous oxygen saturation?
, • 40% to 60%
• 60% to 80%
• 80% to 100%
• 20% to 40%
Rationale: Mixed venous oxygen saturation of 60%–80% indicates adequate tissue
oxygenation.
17. When might a nurse expect lower hemodynamic values in a patient?
• In young adults
• In older patients, especially with dehydration
• During exercise
• In pregnant women
Rationale: Aging and dehydration reduce hemodynamic values due to decreased cardiac
reserve and fluid volume.
18. In what position should a patient be placed for hemodynamic monitoring?
• Prone
• Supine or Trendelenburg
• Sitting upright
• Left lateral
Rationale: Supine or Trendelenburg positions ensure accurate pressure readings in
hemodynamic monitoring.
19. What are key post-procedure nursing interventions for hemodynamic monitoring?
• Encourage ambulation, monitor urine output
• Obtain chest X-ray, monitor vitals, document catheter placement
• Administer fluids, assess pain
• Remove catheter, apply pressure dressing
Rationale: Chest X-ray confirms catheter placement, vital monitoring detects
complications, and documentation ensures continuity of care.
20. What are essential pre-procedure nursing actions before an angiography?
• Encourage fluids, assess pain
• NPO for 8 hours, check iodine/shellfish allergy, assess renal function
• Administer sedatives, monitor vitals
• Position patient, obtain X-ray
Rationale: NPO prevents aspiration, allergy checks avoid reactions, and renal assessment
ensures contrast safety.
21. What are critical post-procedure nursing interventions following an angiography?
• Encourage ambulation, monitor pain
UPDATED SOLUTIONS 2025)
1. What is the normal range for troponin I, and when do elevated levels first become
detectable after myocardial injury, including their duration?
• Less than 0.1 ng/mL, detectable at 6 hours, lasts 3 days
• Less than 0.03 ng/mL, detectable at 3 hours, lasts 7 to 10 days
• Less than 0.05 ng/mL, detectable at 12 hours, lasts 14 days
• Less than 0.03 ng/mL, detectable at 1 hour, lasts 24 hours
Rationale: Troponin I rises within 3 hours of myocardial injury and remains elevated for
7–10 days, making it a critical marker for diagnosing myocardial infarction (MI).
2. What is the normal range for myoglobin, and when are elevated levels first noticeable
after myocardial injury, including how long they persist?
• Less than 50 mcg/L, detectable at 4 hours, lasts 48 hours
• Less than 90 mcg/L, detectable at 2 hours, lasts 24 hours
• Less than 100 mcg/L, detectable at 6 hours, lasts 72 hours
• Less than 75 mcg/L, detectable at 1 hour, lasts 12 hours
Rationale: Myoglobin elevates within 2 hours and clears within 24 hours, serving as an
early but transient indicator of muscle damage.
3. During an echocardiogram, on which side should the patient lie, and what additional
instruction is provided?
• Right side, breathe deeply
• Left side, remain still
• Supine, move as needed
• Left side, hold breath
Rationale: The left-side position optimizes cardiac imaging, and stillness prevents
motion artifacts.
4. What conditions indicate the need for an echocardiogram?
• Asthma, pneumonia
• Cardiomyopathy, heart failure, angina, myocardial infarction
• Hypertension, diabetes
• Kidney failure, liver disease
Rationale: Echocardiograms assess heart structure and function, indicated for cardiac-
specific conditions.
5. What are the indications for performing a stress test?
• COPD, lung cancer
• Dysrhythmias, heart failure, angina, myocardial infarction
, • Stroke, seizures
• Peripheral artery disease, venous insufficiency
Rationale: Stress tests evaluate cardiac response to exertion, relevant for coronary and
rhythm issues.
6. Which two medications are commonly prescribed for a pharmacological stress test?
• Epinephrine, norepinephrine
• Dobutamine, adenosine
• Atropine, lidocaine
• Verapamil, amiodarone
Rationale: Dobutamine and adenosine simulate exercise effects on the heart for patients
unable to perform physical stress tests.
7. What should a patient avoid 2 to 4 hours prior to a stress test?
• Water, juice
• Tobacco, alcohol, caffeine
• Light meals, exercise
• Medications, rest
Rationale: Tobacco, alcohol, and caffeine can alter heart rate and blood pressure,
skewing stress test results.
8. In hemodynamic monitoring with arterial lines, typically placed in the radial, brachial,
or femoral artery, what should be monitored in the limb?
• Pain, swelling
• Circulation (capillary refill, temperature, color)
• Muscle strength, sensation
• Blood pressure, pulse rate
Rationale: Monitoring circulation ensures the arterial line hasn’t compromised blood
flow to the limb.
9. Are arterial lines used for IV fluid administration in hemodynamic monitoring?
• No
• Yes
• Only in emergencies
• Only with saline
Rationale: Arterial lines are for monitoring pressure, not fluid administration, to avoid
arterial damage.
10. Where is a pulmonary artery (PA) catheter inserted, and what is one of its functions?
• Radial artery, measures blood pressure
• Large vein (e.g., internal jugular), allows IV fluid infusion
, • Femoral artery, samples blood
• Subclavian vein, monitors oxygen levels
Rationale: PA catheters are inserted via large veins and threaded to the pulmonary
artery, enabling IV fluid infusion among other functions.
11. What is the expected reference range for central venous pressure (CVP)?
• 10 to 20 mm Hg
• 1 to 8 mm Hg
• 15 to 30 mm Hg
• 0 to 5 mm Hg
Rationale: CVP of 1–8 mm Hg reflects normal right atrial pressure and fluid status.
12. What is the expected range for pulmonary artery systolic (PAS) pressure?
• 5 to 15 mm Hg
• 15 to 26 mm Hg
• 25 to 35 mm Hg
• 10 to 20 mm Hg
Rationale: PAS of 15–26 mm Hg indicates normal pulmonary artery systolic pressure.
13. What is the expected range for pulmonary artery diastolic (PAD) pressure?
• 15 to 25 mm Hg
• 5 to 15 mm Hg
• 20 to 30 mm Hg
• 0 to 10 mm Hg
Rationale: PAD of 5–15 mm Hg reflects normal pulmonary artery diastolic pressure.
14. What is the expected range for pulmonary artery wedge pressure (PAWP)?
• 10 to 20 mm Hg
• 4 to 12 mm Hg
• 15 to 25 mm Hg
• 1 to 8 mm Hg
Rationale: PAWP of 4–12 mm Hg indicates normal left atrial pressure.
15. What is the expected range for cardiac output?
• 1 to 3 L/min
• 4 to 7 L/min
• 8 to 10 L/min
• 2 to 5 L/min
Rationale: Cardiac output of 4–7 L/min reflects normal heart pumping capacity.
16. What is the expected range for mixed venous oxygen saturation?
, • 40% to 60%
• 60% to 80%
• 80% to 100%
• 20% to 40%
Rationale: Mixed venous oxygen saturation of 60%–80% indicates adequate tissue
oxygenation.
17. When might a nurse expect lower hemodynamic values in a patient?
• In young adults
• In older patients, especially with dehydration
• During exercise
• In pregnant women
Rationale: Aging and dehydration reduce hemodynamic values due to decreased cardiac
reserve and fluid volume.
18. In what position should a patient be placed for hemodynamic monitoring?
• Prone
• Supine or Trendelenburg
• Sitting upright
• Left lateral
Rationale: Supine or Trendelenburg positions ensure accurate pressure readings in
hemodynamic monitoring.
19. What are key post-procedure nursing interventions for hemodynamic monitoring?
• Encourage ambulation, monitor urine output
• Obtain chest X-ray, monitor vitals, document catheter placement
• Administer fluids, assess pain
• Remove catheter, apply pressure dressing
Rationale: Chest X-ray confirms catheter placement, vital monitoring detects
complications, and documentation ensures continuity of care.
20. What are essential pre-procedure nursing actions before an angiography?
• Encourage fluids, assess pain
• NPO for 8 hours, check iodine/shellfish allergy, assess renal function
• Administer sedatives, monitor vitals
• Position patient, obtain X-ray
Rationale: NPO prevents aspiration, allergy checks avoid reactions, and renal assessment
ensures contrast safety.
21. What are critical post-procedure nursing interventions following an angiography?
• Encourage ambulation, monitor pain
