1
RN ATI MedSurg Exam Actual Exam
2026/2027 – Complete Exam-Style Questions
with Detailed Rationales | 100% Verified –
Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
| Section 1: Cardiovascular Disorders (Questions 1-30) |
| Section 2: Respiratory Disorders (Questions 31-52) |
| Section 3: Gastrointestinal Disorders (Questions 53-70) |
| Section 4: Neurological Disorders (Questions 71-88) |
| Section 5: Renal/Urinary Disorders (Questions 89-100) |
| Section 6: Endocrine Disorders (Questions 101-115) |
| Section 7: Musculoskeletal Disorders (Questions 116-127) |
| Section 8: Immunological/Hematological Disorders (Questions 128-139) |
| Section 9: Perioperative Care (Questions 140-147) |
| Section 10: Infectious Diseases & Emergency Response (Questions 148-150) |
[SECTION 1: Questions 1-30]
Q1: A 58-year-old male with hypertension and smoking history presents with sudden "tearing"
chest pain radiating to the back, BP 180/110 mmHg (right arm) vs. 150/90 mmHg (left arm).
What is the most likely diagnosis?
A. Acute myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Unstable angina
B. Aortic dissection [CORRECT]
Correct Answer: B
Rationale: Aortic dissection is characterized by sudden, severe tearing pain radiating to the back
and a systolic BP difference >20 mmHg between arms. Hypertension and smoking are key risk
factors. Acute MI typically presents with crushing pain, not tearing, and lacks BP discrepancies.
Pulmonary embolism often causes dyspnea/hypoxia, not BP asymmetry. Unstable angina is a
precursor to MI without these specific signs. Immediate CT angiography is required for
confirmation.
Q2: A patient with HFrEF is prescribed carvedilol. What is its primary mechanism in managing
HFrEF?
,2
A. Selective beta-1 adrenergic blockade
B. Non-selective beta-adrenergic blockade with alpha-1 blockade
C. Calcium channel blockade
D. Angiotensin-converting enzyme inhibition
B. Non-selective beta-adrenergic blockade with alpha-1 blockade [CORRECT]
Correct Answer: B
Rationale: Carvedilol blocks beta-1, beta-2, and alpha-1 receptors, reducing heart rate,
myocardial contractility, and systemic vascular resistance. This improves ejection fraction and
survival in HFrEF. Selective beta-1 blockers (e.g., metoprolol) lack alpha-1 blockade. Calcium
channel blockers are avoided in HFrEF due to negative inotropy. ACE inhibitors (e.g., lisinopril)
act via the renin-angiotensin system, not adrenergic blockade.
Q3: A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4. What is the recommended
anticoagulation therapy?
A. Aspirin 81 mg daily
B. Warfarin with INR goal 2-3
C. Direct oral anticoagulant (e.g., apixaban)
D. No anticoagulation needed
C. Direct oral anticoagulant (e.g., apixaban) [CORRECT]
Correct Answer: C
Rationale: CHA₂DS₂-VASc ≥2 (male) or ≥3 (female) indicates high stroke risk, requiring
anticoagulation. DOACs (e.g., apixaban) are preferred over warfarin due to fewer interactions
and predictable dosing. Aspirin is insufficient for high-risk patients. Warfarin requires frequent
INR monitoring and has dietary restrictions. Guidelines (ACC/AHA/ESC) recommend DOACs
as first-line for non-valvular AF.
Q4: A patient with acute coronary syndrome (ACS) receives nitroglycerin. What is the priority
assessment before administration?
A. Serum potassium level
B. Blood pressure
C. Respiratory rate
D. Urine output
B. Blood pressure [CORRECT]
Correct Answer: B
Rationale: Nitroglycerin causes vasodilation, which can precipitate hypotension, especially in
patients with low baseline BP (SBP <90 mmHg). Assessing BP prevents adverse events like
syncope or reduced coronary perfusion. Potassium, respiratory rate, and urine output are less
critical for nitroglycerin safety. Guidelines emphasize BP monitoring before each dose.
Q5: A patient with deep vein thrombosis (DVT) is prescribed enoxaparin. What is the antidote
for enoxaparin overdose?
A. Protamine sulfate
,3
B. Vitamin K
C. Andexanet alfa
D. Idarucizumab
A. Protamine sulfate [CORRECT]
Correct Answer: A
Rationale: Protamine sulfate reverses unfractionated heparin and low-molecular-weight heparin
(e.g., enoxaparin) by binding to their anionic sites. Vitamin K reverses warfarin, not heparin.
Andexanet alfa is for factor Xa inhibitors (e.g., rivaroxaban). Idarucizumab reverses dabigatran.
Immediate reversal is critical in bleeding emergencies.
Q6: A patient with heart failure develops crackles, JVD, and pitting edema. What is the priority
nursing intervention?
A. Administer IV furosemide
B. Restrict sodium intake to 2 g/day
C. Elevate head of bed to 45 degrees
D. Monitor daily weights
A. Administer IV furosemide [CORRECT]
Correct Answer: A
Rationale: Crackles, JVD, and edema indicate fluid overload in acute decompensated heart
failure. IV furosemide promotes rapid diuresis, reducing preload and relieving symptoms.
Sodium restriction and daily weights are long-term strategies. Elevating the head of bed aids
breathing but doesn't address fluid overload. Immediate diuresis is critical to prevent respiratory
compromise.
Q7: A patient with hypertension is prescribed lisinopril. What is the most common adverse
effect?
A. Dry cough
B. Hyperkalemia
C. Angioedema
D. Hypotension
A. Dry cough [CORRECT]
Correct Answer: A
Rationale: ACE inhibitors (e.g., lisinopril) cause bradykinin accumulation, leading to a dry,
persistent cough in 10-20% of patients. Hyperkalemia and angioedema are less common but
serious. Hypotension may occur initially but is not the most frequent. Guidelines recommend
switching to ARBs (e.g., losartan) if cough is intolerable.
Q8: A patient with myocardial infarction (MI) has ST-segment elevation in leads V1-V4. Which
coronary artery is likely occluded?
A. Left anterior descending (LAD)
B. Left circumflex (LCx)
C. Right coronary artery (RCA)
, 4
D. Left main coronary artery
A. Left anterior descending (LAD) [CORRECT]
Correct Answer: A
Rationale: ST elevation in V1-V4 indicates anterior wall MI, typically caused by LAD occlusion.
The LAD supplies the anterior left ventricle. LCx occlusion affects lateral leads (I, aVL, V5-V6).
RCA occlusion causes inferior MI (II, III, aVF). Left main occlusion is rare and presents with
widespread ST changes. Immediate reperfusion (PCI or thrombolytics) is critical.
Q9: A patient with infective endocarditis has a new murmur and petechiae. What is the priority
diagnostic test?
A. Blood cultures x3 sets
B. Transesophageal echocardiogram (TEE)
C. Complete blood count (CBC)
D. Chest X-ray
A. Blood cultures x3 sets [CORRECT]
Correct Answer: A
Rationale: Blood cultures (3 sets from different sites) are essential to identify the causative
organism (e.g., Staphylococcus aureus) and guide antibiotic therapy. TEE is more sensitive than
TTE for vegetations but is not the initial test. CBC may show leukocytosis but is non-specific.
Chest X-ray may show cardiomegaly but is not diagnostic. Guidelines emphasize blood cultures
before antibiotics.
Q10: A patient with peripheral artery disease (PAD) has an ankle-brachial index (ABI) of 0.6.
What does this indicate?
A. Normal arterial flow
B. Mild arterial insufficiency
C. Moderate arterial insufficiency
D. Severe arterial insufficiency
C. Moderate arterial insufficiency [CORRECT]
Correct Answer: C
Rationale: ABI 0.4-0.7 indicates moderate PAD, with claudication during moderate activity. ABI
>0.9 is normal, 0.8-0.9 is mild, and <0.4 is severe (rest pain/gangrene). This patient requires
smoking cessation, exercise, and antiplatelet therapy. Severe PAD (ABI <0.4) may need
revascularization.
Q11: A patient with cardiogenic shock has a cardiac index of 1.8 L/min/m². What is the goal of
therapy?
A. Increase cardiac index to >2.2 L/min/m²
B. Decrease systemic vascular resistance (SVR)
C. Maintain pulmonary artery wedge pressure (PAWP) <18 mmHg
D. Achieve mean arterial pressure (MAP) >65 mmHg
A. Increase cardiac index to >2.2 L/min/m² [CORRECT]
RN ATI MedSurg Exam Actual Exam
2026/2027 – Complete Exam-Style Questions
with Detailed Rationales | 100% Verified –
Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
| Section 1: Cardiovascular Disorders (Questions 1-30) |
| Section 2: Respiratory Disorders (Questions 31-52) |
| Section 3: Gastrointestinal Disorders (Questions 53-70) |
| Section 4: Neurological Disorders (Questions 71-88) |
| Section 5: Renal/Urinary Disorders (Questions 89-100) |
| Section 6: Endocrine Disorders (Questions 101-115) |
| Section 7: Musculoskeletal Disorders (Questions 116-127) |
| Section 8: Immunological/Hematological Disorders (Questions 128-139) |
| Section 9: Perioperative Care (Questions 140-147) |
| Section 10: Infectious Diseases & Emergency Response (Questions 148-150) |
[SECTION 1: Questions 1-30]
Q1: A 58-year-old male with hypertension and smoking history presents with sudden "tearing"
chest pain radiating to the back, BP 180/110 mmHg (right arm) vs. 150/90 mmHg (left arm).
What is the most likely diagnosis?
A. Acute myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Unstable angina
B. Aortic dissection [CORRECT]
Correct Answer: B
Rationale: Aortic dissection is characterized by sudden, severe tearing pain radiating to the back
and a systolic BP difference >20 mmHg between arms. Hypertension and smoking are key risk
factors. Acute MI typically presents with crushing pain, not tearing, and lacks BP discrepancies.
Pulmonary embolism often causes dyspnea/hypoxia, not BP asymmetry. Unstable angina is a
precursor to MI without these specific signs. Immediate CT angiography is required for
confirmation.
Q2: A patient with HFrEF is prescribed carvedilol. What is its primary mechanism in managing
HFrEF?
,2
A. Selective beta-1 adrenergic blockade
B. Non-selective beta-adrenergic blockade with alpha-1 blockade
C. Calcium channel blockade
D. Angiotensin-converting enzyme inhibition
B. Non-selective beta-adrenergic blockade with alpha-1 blockade [CORRECT]
Correct Answer: B
Rationale: Carvedilol blocks beta-1, beta-2, and alpha-1 receptors, reducing heart rate,
myocardial contractility, and systemic vascular resistance. This improves ejection fraction and
survival in HFrEF. Selective beta-1 blockers (e.g., metoprolol) lack alpha-1 blockade. Calcium
channel blockers are avoided in HFrEF due to negative inotropy. ACE inhibitors (e.g., lisinopril)
act via the renin-angiotensin system, not adrenergic blockade.
Q3: A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4. What is the recommended
anticoagulation therapy?
A. Aspirin 81 mg daily
B. Warfarin with INR goal 2-3
C. Direct oral anticoagulant (e.g., apixaban)
D. No anticoagulation needed
C. Direct oral anticoagulant (e.g., apixaban) [CORRECT]
Correct Answer: C
Rationale: CHA₂DS₂-VASc ≥2 (male) or ≥3 (female) indicates high stroke risk, requiring
anticoagulation. DOACs (e.g., apixaban) are preferred over warfarin due to fewer interactions
and predictable dosing. Aspirin is insufficient for high-risk patients. Warfarin requires frequent
INR monitoring and has dietary restrictions. Guidelines (ACC/AHA/ESC) recommend DOACs
as first-line for non-valvular AF.
Q4: A patient with acute coronary syndrome (ACS) receives nitroglycerin. What is the priority
assessment before administration?
A. Serum potassium level
B. Blood pressure
C. Respiratory rate
D. Urine output
B. Blood pressure [CORRECT]
Correct Answer: B
Rationale: Nitroglycerin causes vasodilation, which can precipitate hypotension, especially in
patients with low baseline BP (SBP <90 mmHg). Assessing BP prevents adverse events like
syncope or reduced coronary perfusion. Potassium, respiratory rate, and urine output are less
critical for nitroglycerin safety. Guidelines emphasize BP monitoring before each dose.
Q5: A patient with deep vein thrombosis (DVT) is prescribed enoxaparin. What is the antidote
for enoxaparin overdose?
A. Protamine sulfate
,3
B. Vitamin K
C. Andexanet alfa
D. Idarucizumab
A. Protamine sulfate [CORRECT]
Correct Answer: A
Rationale: Protamine sulfate reverses unfractionated heparin and low-molecular-weight heparin
(e.g., enoxaparin) by binding to their anionic sites. Vitamin K reverses warfarin, not heparin.
Andexanet alfa is for factor Xa inhibitors (e.g., rivaroxaban). Idarucizumab reverses dabigatran.
Immediate reversal is critical in bleeding emergencies.
Q6: A patient with heart failure develops crackles, JVD, and pitting edema. What is the priority
nursing intervention?
A. Administer IV furosemide
B. Restrict sodium intake to 2 g/day
C. Elevate head of bed to 45 degrees
D. Monitor daily weights
A. Administer IV furosemide [CORRECT]
Correct Answer: A
Rationale: Crackles, JVD, and edema indicate fluid overload in acute decompensated heart
failure. IV furosemide promotes rapid diuresis, reducing preload and relieving symptoms.
Sodium restriction and daily weights are long-term strategies. Elevating the head of bed aids
breathing but doesn't address fluid overload. Immediate diuresis is critical to prevent respiratory
compromise.
Q7: A patient with hypertension is prescribed lisinopril. What is the most common adverse
effect?
A. Dry cough
B. Hyperkalemia
C. Angioedema
D. Hypotension
A. Dry cough [CORRECT]
Correct Answer: A
Rationale: ACE inhibitors (e.g., lisinopril) cause bradykinin accumulation, leading to a dry,
persistent cough in 10-20% of patients. Hyperkalemia and angioedema are less common but
serious. Hypotension may occur initially but is not the most frequent. Guidelines recommend
switching to ARBs (e.g., losartan) if cough is intolerable.
Q8: A patient with myocardial infarction (MI) has ST-segment elevation in leads V1-V4. Which
coronary artery is likely occluded?
A. Left anterior descending (LAD)
B. Left circumflex (LCx)
C. Right coronary artery (RCA)
, 4
D. Left main coronary artery
A. Left anterior descending (LAD) [CORRECT]
Correct Answer: A
Rationale: ST elevation in V1-V4 indicates anterior wall MI, typically caused by LAD occlusion.
The LAD supplies the anterior left ventricle. LCx occlusion affects lateral leads (I, aVL, V5-V6).
RCA occlusion causes inferior MI (II, III, aVF). Left main occlusion is rare and presents with
widespread ST changes. Immediate reperfusion (PCI or thrombolytics) is critical.
Q9: A patient with infective endocarditis has a new murmur and petechiae. What is the priority
diagnostic test?
A. Blood cultures x3 sets
B. Transesophageal echocardiogram (TEE)
C. Complete blood count (CBC)
D. Chest X-ray
A. Blood cultures x3 sets [CORRECT]
Correct Answer: A
Rationale: Blood cultures (3 sets from different sites) are essential to identify the causative
organism (e.g., Staphylococcus aureus) and guide antibiotic therapy. TEE is more sensitive than
TTE for vegetations but is not the initial test. CBC may show leukocytosis but is non-specific.
Chest X-ray may show cardiomegaly but is not diagnostic. Guidelines emphasize blood cultures
before antibiotics.
Q10: A patient with peripheral artery disease (PAD) has an ankle-brachial index (ABI) of 0.6.
What does this indicate?
A. Normal arterial flow
B. Mild arterial insufficiency
C. Moderate arterial insufficiency
D. Severe arterial insufficiency
C. Moderate arterial insufficiency [CORRECT]
Correct Answer: C
Rationale: ABI 0.4-0.7 indicates moderate PAD, with claudication during moderate activity. ABI
>0.9 is normal, 0.8-0.9 is mild, and <0.4 is severe (rest pain/gangrene). This patient requires
smoking cessation, exercise, and antiplatelet therapy. Severe PAD (ABI <0.4) may need
revascularization.
Q11: A patient with cardiogenic shock has a cardiac index of 1.8 L/min/m². What is the goal of
therapy?
A. Increase cardiac index to >2.2 L/min/m²
B. Decrease systemic vascular resistance (SVR)
C. Maintain pulmonary artery wedge pressure (PAWP) <18 mmHg
D. Achieve mean arterial pressure (MAP) >65 mmHg
A. Increase cardiac index to >2.2 L/min/m² [CORRECT]
