ATI Advanced Med Surg Proctored 2019
NGN Exam – Updated Questions, Correct
Answers & Rationales
Cardiovascular System (1–30)
Question 1: A nurse is caring for a client with chest pain for 3 hours. ECG shows ST elevation
in leads V1–V4. What is the priority nursing action?
A) Administer sublingual nitroglycerin
B) Notify the provider for urgent PCI
C) Obtain a 12-lead ECG
D) Start IV heparin
Answer: B) Notify the provider for urgent PCI
Rationale: ST-elevation myocardial infarction (STEMI) requires urgent percutaneous coronary
intervention (PCI) within 90 minutes, per ACC/AHA guidelines. Nitroglycerin is contraindicated
in unstable patients, the ECG is already done, and heparin is adjunctive.
Question 2 (NGN Bow-Tie): A client presents with atrial fibrillation and a heart rate of 120
bpm. CHA2DS2-VASc score is 3. Complete the bow-tie diagram:
Diagnosis: Atrial fibrillation
Action to Take: [Select one]
A) Initiate rate control with metoprolol
B) Administer thrombolytics
C) Perform immediate cardioversion
Parameters to Monitor: [Select two]
A) Heart rate
B) Blood pressure
C) Blood glucose
Potential Complications: [Select two]
A) Stroke
B) Heart failure
C) Hypoglycemia
Answer:
Action: A) Initiate rate control with metoprolol
Parameters: A) Heart rate, B) Blood pressure
Complications: A) Stroke, B) Heart failure
Rationale: Rate control with beta-blockers (e.g., metoprolol) is initial management for
stable atrial fibrillation. Monitor heart rate and blood pressure to assess response. Stroke
and heart failure are risks due to thromboembolism and tachycardia, per AHA/ACC.
,Question 3: Which medications are indicated for heart failure with reduced ejection fraction
(HFrEF, EF 30%)? (Select all that apply.)
A) Carvedilol
B) Lisinopril
C) Furosemide
D) Amlodipine
Answers: A, B, C
Rationale: Carvedilol (beta-blocker), lisinopril (ACE inhibitor), and furosemide (loop diuretic)
improve mortality and symptoms in HFrEF, per ACC/AHA. Amlodipine is not indicated for
HFrEF.
Question 4: A client with hypertension is prescribed lisinopril and develops a dry cough. What is
the nurse’s best action?
A) Continue lisinopril and monitor
B) Switch to losartan
C) Add albuterol
D) Increase lisinopril dose
Answer: B) Switch to losartan
Rationale: Dry cough is a common ACE inhibitor side effect; switching to an ARB like losartan
is recommended, per JNC 8.
Question 5: A nurse is monitoring a client on warfarin for atrial fibrillation. Which lab test
assesses therapeutic effect?
A) Prothrombin time (PT)
B) Platelet count
C) Activated partial thromboplastin time (aPTT)
D) White blood cell count
Answer: A) Prothrombin time (PT)
Rationale: PT (measured as INR) monitors warfarin’s effect on the coagulation cascade, per ATI
guidelines.
Question 6 (NGN Case Study): A 65-year-old male presents with dyspnea and leg edema.
History includes hypertension and CAD. Vital signs: BP 150/90 mmHg, HR 88 bpm, SpO2 92%.
Labs show BNP 600 pg/mL.
Question 6.1: What is the likely diagnosis?
A) Pneumonia
B) Heart failure
C) Pulmonary embolism
D) COPD exacerbation
Answer: B) Heart failure
Rationale: Dyspnea, edema, and elevated BNP suggest heart failure, per ACC/AHA.
Question 6.2: What is the priority nursing intervention?
A) Administer oxygen
B) Start antibiotics
C) Initiate heparin
, D) Order chest X-ray
Answer: A) Administer oxygen
Rationale: Oxygen improves hypoxemia (SpO2 92%) in heart failure, per ATI
guidelines.
Question 6.3: Which medication is first-line?
A) Furosemide
B) Metoprolol
C) Amiodarone
D) Nitroglycerin
Answer: A) Furosemide
Rationale: Loop diuretics like furosemide relieve fluid overload in acute heart failure,
per ACC/AHA.
Question 7: A client with chest pain has a normal ECG and troponin. What is the next step?
A) Discharge with follow-up
B) Order stress test
C) Admit for catheterization
D) Start thrombolytics
Answer: B) Order stress test
Rationale: Normal ECG and troponin suggest low-risk chest pain; a stress test evaluates
ischemia, per ACP.
Question 8: A client with a new pacemaker reports dizziness. What is the nurse’s priority
action?
A) Check blood pressure
B) Administer oxygen
C) Obtain ECG
D) Notify provider
Answer: C) Obtain ECG
Rationale: Dizziness may indicate pacemaker malfunction; an ECG assesses device function,
per AHA.
Question 9: What is the target LDL for a client with CAD and diabetes?
A) <100 mg/dL
B) <70 mg/dL
C) <130 mg/dL
D) <150 mg/dL
Answer: B) <70 mg/dL
Rationale: High-risk patients (CAD + diabetes) require LDL <70 mg/dL, per AHA/ACC.
Question 10: A client with acute pericarditis has chest pain. Which finding is expected on ECG?
A) ST elevation in all leads
B) Q waves in V1–V3
C) T-wave inversion
D) Prolonged QT interval
, Answer: A) ST elevation in all leads
Rationale: Diffuse ST elevation is characteristic of pericarditis, per ACC.
Question 11: A client with heart failure is prescribed spironolactone. What should the nurse
monitor?
A) Serum potassium
B) Blood glucose
C) Platelet count
D) Liver enzymes
Answer: A) Serum potassium
Rationale: Spironolactone can cause hyperkalemia, per ACC/AHA.
Question 12: A client with hypertension is prescribed verapamil. What should the nurse include
in teaching?
A) Take on an empty stomach
B) Take with meals or milk
C) Avoid calcium supplements
D) Monitor for hyperglycemia
Answer: B) Take with meals or milk
Rationale: Verapamil should be taken with food to reduce gastric irritation, per ATI guidelines.
Question 13: A client with a history of MI is prescribed clopidogrel. What is its mechanism?
A) Inhibits platelet aggregation
B) Blocks beta receptors
C) Inhibits ACE
D) Reduces cholesterol
Answer: A) Inhibits platelet aggregation
Rationale: Clopidogrel prevents thrombus formation in CAD, per AHA/ACC.
Question 14: A client with chest pain radiating to the back is suspected to have aortic dissection.
What is the diagnostic test of choice?
A) Chest X-ray
B) CT angiography
C) ECG
D) Echocardiogram
Answer: B) CT angiography
Rationale: CT angiography confirms aortic dissection, per AHA.
Question 15: A client on furosemide reports muscle cramps. What is the likely cause?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypocalcemia
Answer: B) Hypokalemia
Rationale: Loop diuretics like furosemide cause potassium loss, per ACC/AHA.
NGN Exam – Updated Questions, Correct
Answers & Rationales
Cardiovascular System (1–30)
Question 1: A nurse is caring for a client with chest pain for 3 hours. ECG shows ST elevation
in leads V1–V4. What is the priority nursing action?
A) Administer sublingual nitroglycerin
B) Notify the provider for urgent PCI
C) Obtain a 12-lead ECG
D) Start IV heparin
Answer: B) Notify the provider for urgent PCI
Rationale: ST-elevation myocardial infarction (STEMI) requires urgent percutaneous coronary
intervention (PCI) within 90 minutes, per ACC/AHA guidelines. Nitroglycerin is contraindicated
in unstable patients, the ECG is already done, and heparin is adjunctive.
Question 2 (NGN Bow-Tie): A client presents with atrial fibrillation and a heart rate of 120
bpm. CHA2DS2-VASc score is 3. Complete the bow-tie diagram:
Diagnosis: Atrial fibrillation
Action to Take: [Select one]
A) Initiate rate control with metoprolol
B) Administer thrombolytics
C) Perform immediate cardioversion
Parameters to Monitor: [Select two]
A) Heart rate
B) Blood pressure
C) Blood glucose
Potential Complications: [Select two]
A) Stroke
B) Heart failure
C) Hypoglycemia
Answer:
Action: A) Initiate rate control with metoprolol
Parameters: A) Heart rate, B) Blood pressure
Complications: A) Stroke, B) Heart failure
Rationale: Rate control with beta-blockers (e.g., metoprolol) is initial management for
stable atrial fibrillation. Monitor heart rate and blood pressure to assess response. Stroke
and heart failure are risks due to thromboembolism and tachycardia, per AHA/ACC.
,Question 3: Which medications are indicated for heart failure with reduced ejection fraction
(HFrEF, EF 30%)? (Select all that apply.)
A) Carvedilol
B) Lisinopril
C) Furosemide
D) Amlodipine
Answers: A, B, C
Rationale: Carvedilol (beta-blocker), lisinopril (ACE inhibitor), and furosemide (loop diuretic)
improve mortality and symptoms in HFrEF, per ACC/AHA. Amlodipine is not indicated for
HFrEF.
Question 4: A client with hypertension is prescribed lisinopril and develops a dry cough. What is
the nurse’s best action?
A) Continue lisinopril and monitor
B) Switch to losartan
C) Add albuterol
D) Increase lisinopril dose
Answer: B) Switch to losartan
Rationale: Dry cough is a common ACE inhibitor side effect; switching to an ARB like losartan
is recommended, per JNC 8.
Question 5: A nurse is monitoring a client on warfarin for atrial fibrillation. Which lab test
assesses therapeutic effect?
A) Prothrombin time (PT)
B) Platelet count
C) Activated partial thromboplastin time (aPTT)
D) White blood cell count
Answer: A) Prothrombin time (PT)
Rationale: PT (measured as INR) monitors warfarin’s effect on the coagulation cascade, per ATI
guidelines.
Question 6 (NGN Case Study): A 65-year-old male presents with dyspnea and leg edema.
History includes hypertension and CAD. Vital signs: BP 150/90 mmHg, HR 88 bpm, SpO2 92%.
Labs show BNP 600 pg/mL.
Question 6.1: What is the likely diagnosis?
A) Pneumonia
B) Heart failure
C) Pulmonary embolism
D) COPD exacerbation
Answer: B) Heart failure
Rationale: Dyspnea, edema, and elevated BNP suggest heart failure, per ACC/AHA.
Question 6.2: What is the priority nursing intervention?
A) Administer oxygen
B) Start antibiotics
C) Initiate heparin
, D) Order chest X-ray
Answer: A) Administer oxygen
Rationale: Oxygen improves hypoxemia (SpO2 92%) in heart failure, per ATI
guidelines.
Question 6.3: Which medication is first-line?
A) Furosemide
B) Metoprolol
C) Amiodarone
D) Nitroglycerin
Answer: A) Furosemide
Rationale: Loop diuretics like furosemide relieve fluid overload in acute heart failure,
per ACC/AHA.
Question 7: A client with chest pain has a normal ECG and troponin. What is the next step?
A) Discharge with follow-up
B) Order stress test
C) Admit for catheterization
D) Start thrombolytics
Answer: B) Order stress test
Rationale: Normal ECG and troponin suggest low-risk chest pain; a stress test evaluates
ischemia, per ACP.
Question 8: A client with a new pacemaker reports dizziness. What is the nurse’s priority
action?
A) Check blood pressure
B) Administer oxygen
C) Obtain ECG
D) Notify provider
Answer: C) Obtain ECG
Rationale: Dizziness may indicate pacemaker malfunction; an ECG assesses device function,
per AHA.
Question 9: What is the target LDL for a client with CAD and diabetes?
A) <100 mg/dL
B) <70 mg/dL
C) <130 mg/dL
D) <150 mg/dL
Answer: B) <70 mg/dL
Rationale: High-risk patients (CAD + diabetes) require LDL <70 mg/dL, per AHA/ACC.
Question 10: A client with acute pericarditis has chest pain. Which finding is expected on ECG?
A) ST elevation in all leads
B) Q waves in V1–V3
C) T-wave inversion
D) Prolonged QT interval
, Answer: A) ST elevation in all leads
Rationale: Diffuse ST elevation is characteristic of pericarditis, per ACC.
Question 11: A client with heart failure is prescribed spironolactone. What should the nurse
monitor?
A) Serum potassium
B) Blood glucose
C) Platelet count
D) Liver enzymes
Answer: A) Serum potassium
Rationale: Spironolactone can cause hyperkalemia, per ACC/AHA.
Question 12: A client with hypertension is prescribed verapamil. What should the nurse include
in teaching?
A) Take on an empty stomach
B) Take with meals or milk
C) Avoid calcium supplements
D) Monitor for hyperglycemia
Answer: B) Take with meals or milk
Rationale: Verapamil should be taken with food to reduce gastric irritation, per ATI guidelines.
Question 13: A client with a history of MI is prescribed clopidogrel. What is its mechanism?
A) Inhibits platelet aggregation
B) Blocks beta receptors
C) Inhibits ACE
D) Reduces cholesterol
Answer: A) Inhibits platelet aggregation
Rationale: Clopidogrel prevents thrombus formation in CAD, per AHA/ACC.
Question 14: A client with chest pain radiating to the back is suspected to have aortic dissection.
What is the diagnostic test of choice?
A) Chest X-ray
B) CT angiography
C) ECG
D) Echocardiogram
Answer: B) CT angiography
Rationale: CT angiography confirms aortic dissection, per AHA.
Question 15: A client on furosemide reports muscle cramps. What is the likely cause?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypocalcemia
Answer: B) Hypokalemia
Rationale: Loop diuretics like furosemide cause potassium loss, per ACC/AHA.
