ATI Medical-Surgical Nursing Part A Practice Exam
- 2026 Simulation | Complete Solution Guide |
Clinical Judgment Assessment
Directions: Choose the best answer(s) for each item. SATA = Select All That Apply.
Assume every client is adult, alert, and on a medical floor unless otherwise stated.
CARDIOVASCULAR & HEMATOLOGY (Q 1-20)
1. (Prioritization) The nurse receives morning report on four clients. Which client
requires immediate assessment?
A. 58 y/o 2 days post-MI whose 0600 troponin I has decreased from 8→3 ng/mL.
B. 70 y/o with new-onset atrial fibrillation whose apical pulse is 92 and irregular.
C. 64 y/o on a heparin drip; aPTT 96 seconds (control 30).
D. 55 y/o with HF whose 1 kg weight gain since yesterday.
Answer: C
Rationale: aPTT > 2½–3 × control = bleeding risk—an immediate safety threat
(Circulation). A = expected downtrend; B = rate controlled; D = 1 kg (1 L) gain is
important but not emergent.
2. (SATA) A client with acute anterior-wall ST-elevation MI is receiving alteplase
(tPA). Which findings require the nurse to stop the infusion? (Select all that
apply.)
A. Sudden severe headache
B. IV site ecchymosis 2 cm
C. Blood pressure 180/100 mmHg
D. Gross blood in Foley catheter
E. Epistaxis lasting 5 min
Answer: A, D
Rationale: A = hallmark of intracranial bleed—absolute contraindication; D =
, genitourinary bleed may be major. B = minor oozing—apply pressure; C = treat
HTN but continue if no bleed; E = minor—pack/nasal spray.
3. (Delegation) The nurse is caring for a client on continuous cardiac monitoring.
Which task can be safely delegated to an unlicensed assistive personnel (UAP)?
A. Document heart rate every hour from monitor.
B. Interpret rhythm changes.
C. Obtain 12-lead ECG.
D. Initiate synchronized cardioversion.
Answer: A
Rationale: UAPs may collect data; interpretation & invasive actions require
licensed nurse.
4. A client with hypertensive crisis (BP 220/130) is started on nicardipine 5 mg/hr
IV. Two minutes after initiation the BP is 218/128. What is the nurse’s best
action?
A. Increase drip to 7.5 mg/hr.
B. Notify provider immediately.
C. Recheck BP in 5 min using same cuff.
D. Place client in Trendelenburg.
Answer: C
Rationale: Rapid-acting vasodilators require 5–15 min for full effect; recheck per
protocol before titration. Trendelenburg worsens cerebral perfusion.
5. (Medication) A client is discharged on warfarin 5 mg daily. Which statement
indicates correct understanding?
A. “I will take aspirin if I have chest pain.”
B. “I should eat a spinach salad every day.”
C. “I will check my INR every month.”
D. “I will use an electric razor.”
Answer: D
Rationale: Electric razor prevents bleeding injury. Daily spinach (vitamin K) would
destabilize INR; aspirin ↑ bleed risk; INR weekly to monthly once stable, not
necessarily monthly.
6. (EKG) The monitor shows PR 0.28 s, regular RR, QRS 0.08 s. The nurse interprets
this as:
A. First-degree AV block
B. Type I second-degree AV block
C. Normal sinus rhythm
D. Sinus bradycardia
Answer: A
Rationale: Prolonged PR (>0.20 s) with consistent conduction = first-degree.
, 7. (Calculation) Heparin 12,000 units in 250 mL D5W is running at 18 mL/hr. How
many units/hour is the client receiving?
Answer: 864 units/hr
Rationale: (12,000 ÷ 250) = 48 units/mL × 18 mL = 864 units/hr.
8. (SATA) The nurse is discharging a client with chronic HF. Which topics are priority
for teach-back? (Select all that apply.)
A. Daily weights
B. When to withhold digoxin if pulse <60
C. Limiting alcohol to 2 drinks/day
D. Using an ACE inhibitor as prescribed
E. Increasing sodium if thirsty
Answer: A, B, D
Rationale: Daily weights detect fluid gain early; digoxin hold protects bradycardia;
ACE ↓ mortality. Alcohol is discouraged; sodium restriction is lifelong.
9. A client in hypovolemic shock has these parameters: BP 78/50, MAP 46, urine 15
mL/hr, lactate 5.2 mmol/L. The provider orders norepinephrine 4 mcg/min IV.
Before starting the drug, the nurse’s priority is to:
A. Place high-flow nasal cannula at 6 L.
B. Ensure a proximal (central) line is in place.
C. Raise head of bed to 45°.
D. Start norepinephrine via peripheral IV.
Answer: B
Rationale: Vasopressors can cause tissue necrosis if extravasated—central line
required unless emergent short-term peripheral use with close monitoring.
10. (SATA) A 72 y/o with severe aortic stenosis is scheduled for cardiac
catheterization. Which pre-cath data increase this client’s risk for complications?
(Select all that apply.)
A. Hgb 9.8 g/dL
B. Creatinine 1.9 mg/dL
C. BP 88/60 mmHg
D. Heart rate 110 bpm
E. INR 1.1
Answer: A, B, C
Rationale: Anemia (↓ O2 carry), kidney injury (↑ contrast risk), hypotension (↓
coronary perfusion) are high-risk. HR 110 = compensatory and tolerated; INR 1.1
is normal.
11. After cardiac catheterization via right femoral artery, the client reports “popping”
and new 3 cm hard lump at site. BP 100/60, HR 110. The nurse’s first action is to:
A. Remove dressing and apply pressure.
- 2026 Simulation | Complete Solution Guide |
Clinical Judgment Assessment
Directions: Choose the best answer(s) for each item. SATA = Select All That Apply.
Assume every client is adult, alert, and on a medical floor unless otherwise stated.
CARDIOVASCULAR & HEMATOLOGY (Q 1-20)
1. (Prioritization) The nurse receives morning report on four clients. Which client
requires immediate assessment?
A. 58 y/o 2 days post-MI whose 0600 troponin I has decreased from 8→3 ng/mL.
B. 70 y/o with new-onset atrial fibrillation whose apical pulse is 92 and irregular.
C. 64 y/o on a heparin drip; aPTT 96 seconds (control 30).
D. 55 y/o with HF whose 1 kg weight gain since yesterday.
Answer: C
Rationale: aPTT > 2½–3 × control = bleeding risk—an immediate safety threat
(Circulation). A = expected downtrend; B = rate controlled; D = 1 kg (1 L) gain is
important but not emergent.
2. (SATA) A client with acute anterior-wall ST-elevation MI is receiving alteplase
(tPA). Which findings require the nurse to stop the infusion? (Select all that
apply.)
A. Sudden severe headache
B. IV site ecchymosis 2 cm
C. Blood pressure 180/100 mmHg
D. Gross blood in Foley catheter
E. Epistaxis lasting 5 min
Answer: A, D
Rationale: A = hallmark of intracranial bleed—absolute contraindication; D =
, genitourinary bleed may be major. B = minor oozing—apply pressure; C = treat
HTN but continue if no bleed; E = minor—pack/nasal spray.
3. (Delegation) The nurse is caring for a client on continuous cardiac monitoring.
Which task can be safely delegated to an unlicensed assistive personnel (UAP)?
A. Document heart rate every hour from monitor.
B. Interpret rhythm changes.
C. Obtain 12-lead ECG.
D. Initiate synchronized cardioversion.
Answer: A
Rationale: UAPs may collect data; interpretation & invasive actions require
licensed nurse.
4. A client with hypertensive crisis (BP 220/130) is started on nicardipine 5 mg/hr
IV. Two minutes after initiation the BP is 218/128. What is the nurse’s best
action?
A. Increase drip to 7.5 mg/hr.
B. Notify provider immediately.
C. Recheck BP in 5 min using same cuff.
D. Place client in Trendelenburg.
Answer: C
Rationale: Rapid-acting vasodilators require 5–15 min for full effect; recheck per
protocol before titration. Trendelenburg worsens cerebral perfusion.
5. (Medication) A client is discharged on warfarin 5 mg daily. Which statement
indicates correct understanding?
A. “I will take aspirin if I have chest pain.”
B. “I should eat a spinach salad every day.”
C. “I will check my INR every month.”
D. “I will use an electric razor.”
Answer: D
Rationale: Electric razor prevents bleeding injury. Daily spinach (vitamin K) would
destabilize INR; aspirin ↑ bleed risk; INR weekly to monthly once stable, not
necessarily monthly.
6. (EKG) The monitor shows PR 0.28 s, regular RR, QRS 0.08 s. The nurse interprets
this as:
A. First-degree AV block
B. Type I second-degree AV block
C. Normal sinus rhythm
D. Sinus bradycardia
Answer: A
Rationale: Prolonged PR (>0.20 s) with consistent conduction = first-degree.
, 7. (Calculation) Heparin 12,000 units in 250 mL D5W is running at 18 mL/hr. How
many units/hour is the client receiving?
Answer: 864 units/hr
Rationale: (12,000 ÷ 250) = 48 units/mL × 18 mL = 864 units/hr.
8. (SATA) The nurse is discharging a client with chronic HF. Which topics are priority
for teach-back? (Select all that apply.)
A. Daily weights
B. When to withhold digoxin if pulse <60
C. Limiting alcohol to 2 drinks/day
D. Using an ACE inhibitor as prescribed
E. Increasing sodium if thirsty
Answer: A, B, D
Rationale: Daily weights detect fluid gain early; digoxin hold protects bradycardia;
ACE ↓ mortality. Alcohol is discouraged; sodium restriction is lifelong.
9. A client in hypovolemic shock has these parameters: BP 78/50, MAP 46, urine 15
mL/hr, lactate 5.2 mmol/L. The provider orders norepinephrine 4 mcg/min IV.
Before starting the drug, the nurse’s priority is to:
A. Place high-flow nasal cannula at 6 L.
B. Ensure a proximal (central) line is in place.
C. Raise head of bed to 45°.
D. Start norepinephrine via peripheral IV.
Answer: B
Rationale: Vasopressors can cause tissue necrosis if extravasated—central line
required unless emergent short-term peripheral use with close monitoring.
10. (SATA) A 72 y/o with severe aortic stenosis is scheduled for cardiac
catheterization. Which pre-cath data increase this client’s risk for complications?
(Select all that apply.)
A. Hgb 9.8 g/dL
B. Creatinine 1.9 mg/dL
C. BP 88/60 mmHg
D. Heart rate 110 bpm
E. INR 1.1
Answer: A, B, C
Rationale: Anemia (↓ O2 carry), kidney injury (↑ contrast risk), hypotension (↓
coronary perfusion) are high-risk. HR 110 = compensatory and tolerated; INR 1.1
is normal.
11. After cardiac catheterization via right femoral artery, the client reports “popping”
and new 3 cm hard lump at site. BP 100/60, HR 110. The nurse’s first action is to:
A. Remove dressing and apply pressure.
