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 1-25) |
| Section 2: Respiratory Disorders (Questions 26-45) |
| Section 3: Gastrointestinal Disorders (Questions 46-65) |
| Section 4: Renal/Urinary Disorders (Questions 66-80) |
| Section 5: Endocrine Disorders (Questions 81-100) |
| Section 6: Neurological Disorders (Questions 101-120) |
| Section 7: Musculoskeletal/Integumentary (Questions 121-135) |
| Section 8: Multisystem & Emergencies (Questions 136-150) |
[SECTION 1: Cardiovascular Disorders (Questions 1-25)]
Q1: A patient with acute coronary syndrome reports severe chest pain unrelieved by rest. Which
diagnostic test is priority to confirm myocardial infarction?
A. Cardiac enzymes
B. 12-lead ECG
C. Echocardiogram
D. Chest X-ray
B. 12-lead ECG [CORRECT]
Correct Answer: B
Rationale: A 12-lead ECG is the immediate priority to detect ST-segment elevation (STEMI) or
ischemia, guiding urgent interventions like PCI or thrombolytics. Cardiac enzymes (A) confirm
infarction but take hours to elevate. Echocardiogram (C) assesses wall motion but is not
immediate. Chest X-ray (D) rules out other causes but does not diagnose MI. Current AHA
guidelines emphasize ECG within 10 minutes of arrival.
Q2: A patient with heart failure has a BNP level of 900 pg/mL. What does this indicate?
A. Normal cardiac function
B. Mild heart failure
C. Moderate to severe heart failure
D. Acute myocardial infarction
C. Moderate to severe heart failure [CORRECT]
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Correct Answer: C
Rationale: BNP > 400 pg/mL typically indicates moderate to severe heart failure, as levels
correlate with ventricular stretch and pressure overload. Normal BNP is < 100 pg/mL (A). Mild
HF may show BNP 100-400 pg/mL (B). BNP elevation is not specific to MI (D), which requires
troponin elevation.
Q3: Which medication is contraindicated in a patient with cardiogenic shock?
A. Dobutamine
B. Nitroprusside
C. Furosemide
D. Metoprolol
D. Metoprolol [CORRECT]
Correct Answer: D
Rationale: Beta-blockers like metoprolol reduce heart rate and contractility, worsening
cardiogenic shock. Dobutamine (A) is an inotrope used to support cardiac output. Nitroprusside
(B) reduces afterload in acute HF. Furosemide (C) manages fluid overload. Beta-blockers are
avoided in shock due to negative inotropic effects.
Q4: A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4. What is the recommended
anticoagulation?
A. Aspirin
B. Warfarin
C. Direct oral anticoagulant (DOAC)
D. No anticoagulation
C. Direct oral anticoagulant (DOAC) [CORRECT]
Correct Answer: C
Rationale: CHA₂DS₂-VASc ≥ 2 in men or ≥ 3 in women indicates high stroke risk, requiring
anticoagulation. DOACs (e.g., apixaban) are preferred over warfarin (B) due to fewer
interactions and predictable dosing. Aspirin (A) is insufficient for high-risk patients. No
anticoagulation (D) is inappropriate for score ≥ 2.
Q5: Which assessment finding suggests pericardial tamponade in a post-cardiac surgery patient?
A. Muffled heart sounds, hypotension, distended neck veins
B. Sharp chest pain, friction rub, fever
C. Tachycardia, hypertension, bounding pulses
D. Bradycardia, hypertension, jugular venous distension
A. Muffled heart sounds, hypotension, distended neck veins [CORRECT]
Correct Answer: A
Rationale: Beck’s triad (hypotension, JVD, muffled heart sounds) is classic for tamponade,
requiring immediate pericardiocentesis. Friction rub (B) suggests pericarditis, not tamponade.
Hypertension (C, D) contradicts tamponade’s hypotension. Tamponade reduces cardiac output,
causing narrow pulse pressure.
,3
Q6: A patient with hypertension is prescribed lisinopril. Which side effect should the nurse
monitor?
A. Dry cough
B. Hyperkalemia
C. Angioedema
D. All of the above
D. All of the above [CORRECT]
Correct Answer: D
Rationale: ACE inhibitors like lisinopril commonly cause dry cough (A) due to bradykinin
accumulation, hyperkalemia (B) from aldosterone suppression, and rare but life-threatening
angioedema (C). Patients must be educated on these risks.
Q7: Which intervention is priority for a patient with deep vein thrombosis (DVT)?
A. Ambulate frequently
B. Apply warm compresses
C. Administer enoxaparin
D. Elevate legs above heart level
C. Administer enoxaparin [CORRECT]
Correct Answer: C
Rationale: Anticoagulation (e.g., enoxaparin) prevents clot extension and embolism. Ambulation
(A) is encouraged but not priority. Warm compresses (B) increase inflammation. Leg elevation
(D) aids venous return but does not treat the clot.
Q8: A patient with aortic stenosis reports syncope. What is the primary cause?
A. Reduced cerebral perfusion during exertion
B. Arrhythmia from left ventricular hypertrophy
C. Hypovolemia from diuretic use
D. Sepsis from endocarditis
A. Reduced cerebral perfusion during exertion [CORRECT]
Correct Answer: A
Rationale: Aortic stenosis limits cardiac output during exertion, causing cerebral hypoperfusion
and syncope. Arrhythmias (B) are possible but less common. Hypovolemia (C) and sepsis (D)
are unrelated to the valvular pathology.
Q9: Which lab value indicates effective heparin therapy?
A. aPTT 1.5-2.5 times control
B. INR 2-3
C. Platelet count > 150,000/mm³
D. PT 11-13 seconds
A. aPTT 1.5-2.5 times control [CORRECT]
Correct Answer: A
Rationale: Heparin’s therapeutic effect is monitored via aPTT, which should be 1.5-2.5 times the
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baseline. INR (B) measures warfarin effect. Platelets (C) monitor for heparin-induced
thrombocytopenia. PT (D) assesses extrinsic pathway, not heparin.
Q10: A patient with infective endocarditis has a temperature of 103°F. Which action is priority?
A. Obtain blood cultures
B. Administer acetaminophen
C. Start vancomycin
D. Perform echocardiogram
A. Obtain blood cultures [CORRECT]
Correct Answer: A
Rationale: Blood cultures drawn before antibiotics identify the causative organism.
Acetaminophen (B) reduces fever but does not address infection. Vancomycin (C) is started after
cultures. Echocardiogram (D) confirms vegetations but is not immediate.
Q11: Which diet is recommended for a patient with hyperlipidemia?
A. High saturated fat, low fiber
B. Low saturated fat, high soluble fiber
C. High cholesterol, low carbohydrates
D. Low protein, high trans fats
B. Low saturated fat, high soluble fiber [CORRECT]
Correct Answer: B
Rationale: Saturated fats raise LDL cholesterol; soluble fiber (e.g., oats) lowers it. High saturated
fat (A) worsens hyperlipidemia. High cholesterol (C) and trans fats (D) are contraindicated.
Q12: A patient with a pacemaker has a heart rate of 60 bpm but reports dizziness. What is the
likely issue?
A. Pacemaker malfunction
B. Atrial fibrillation
C. Ventricular tachycardia
D. Normal pacemaker function
A. Pacemaker malfunction [CORRECT]
Correct Answer: A
Rationale: Dizziness with a set rate of 60 bpm suggests failure to capture or sense, requiring
evaluation. Atrial fibrillation (B) would cause irregular rhythm. Ventricular tachycardia (C) is
rapid. Normal function (D) would not cause symptoms.
Q13: Which medication is used to reverse warfarin-induced bleeding?
A. Protamine sulfate
B. Vitamin K
C. Flumazenil
D. Naloxone
B. Vitamin K [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 1-25) |
| Section 2: Respiratory Disorders (Questions 26-45) |
| Section 3: Gastrointestinal Disorders (Questions 46-65) |
| Section 4: Renal/Urinary Disorders (Questions 66-80) |
| Section 5: Endocrine Disorders (Questions 81-100) |
| Section 6: Neurological Disorders (Questions 101-120) |
| Section 7: Musculoskeletal/Integumentary (Questions 121-135) |
| Section 8: Multisystem & Emergencies (Questions 136-150) |
[SECTION 1: Cardiovascular Disorders (Questions 1-25)]
Q1: A patient with acute coronary syndrome reports severe chest pain unrelieved by rest. Which
diagnostic test is priority to confirm myocardial infarction?
A. Cardiac enzymes
B. 12-lead ECG
C. Echocardiogram
D. Chest X-ray
B. 12-lead ECG [CORRECT]
Correct Answer: B
Rationale: A 12-lead ECG is the immediate priority to detect ST-segment elevation (STEMI) or
ischemia, guiding urgent interventions like PCI or thrombolytics. Cardiac enzymes (A) confirm
infarction but take hours to elevate. Echocardiogram (C) assesses wall motion but is not
immediate. Chest X-ray (D) rules out other causes but does not diagnose MI. Current AHA
guidelines emphasize ECG within 10 minutes of arrival.
Q2: A patient with heart failure has a BNP level of 900 pg/mL. What does this indicate?
A. Normal cardiac function
B. Mild heart failure
C. Moderate to severe heart failure
D. Acute myocardial infarction
C. Moderate to severe heart failure [CORRECT]
,2
Correct Answer: C
Rationale: BNP > 400 pg/mL typically indicates moderate to severe heart failure, as levels
correlate with ventricular stretch and pressure overload. Normal BNP is < 100 pg/mL (A). Mild
HF may show BNP 100-400 pg/mL (B). BNP elevation is not specific to MI (D), which requires
troponin elevation.
Q3: Which medication is contraindicated in a patient with cardiogenic shock?
A. Dobutamine
B. Nitroprusside
C. Furosemide
D. Metoprolol
D. Metoprolol [CORRECT]
Correct Answer: D
Rationale: Beta-blockers like metoprolol reduce heart rate and contractility, worsening
cardiogenic shock. Dobutamine (A) is an inotrope used to support cardiac output. Nitroprusside
(B) reduces afterload in acute HF. Furosemide (C) manages fluid overload. Beta-blockers are
avoided in shock due to negative inotropic effects.
Q4: A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4. What is the recommended
anticoagulation?
A. Aspirin
B. Warfarin
C. Direct oral anticoagulant (DOAC)
D. No anticoagulation
C. Direct oral anticoagulant (DOAC) [CORRECT]
Correct Answer: C
Rationale: CHA₂DS₂-VASc ≥ 2 in men or ≥ 3 in women indicates high stroke risk, requiring
anticoagulation. DOACs (e.g., apixaban) are preferred over warfarin (B) due to fewer
interactions and predictable dosing. Aspirin (A) is insufficient for high-risk patients. No
anticoagulation (D) is inappropriate for score ≥ 2.
Q5: Which assessment finding suggests pericardial tamponade in a post-cardiac surgery patient?
A. Muffled heart sounds, hypotension, distended neck veins
B. Sharp chest pain, friction rub, fever
C. Tachycardia, hypertension, bounding pulses
D. Bradycardia, hypertension, jugular venous distension
A. Muffled heart sounds, hypotension, distended neck veins [CORRECT]
Correct Answer: A
Rationale: Beck’s triad (hypotension, JVD, muffled heart sounds) is classic for tamponade,
requiring immediate pericardiocentesis. Friction rub (B) suggests pericarditis, not tamponade.
Hypertension (C, D) contradicts tamponade’s hypotension. Tamponade reduces cardiac output,
causing narrow pulse pressure.
,3
Q6: A patient with hypertension is prescribed lisinopril. Which side effect should the nurse
monitor?
A. Dry cough
B. Hyperkalemia
C. Angioedema
D. All of the above
D. All of the above [CORRECT]
Correct Answer: D
Rationale: ACE inhibitors like lisinopril commonly cause dry cough (A) due to bradykinin
accumulation, hyperkalemia (B) from aldosterone suppression, and rare but life-threatening
angioedema (C). Patients must be educated on these risks.
Q7: Which intervention is priority for a patient with deep vein thrombosis (DVT)?
A. Ambulate frequently
B. Apply warm compresses
C. Administer enoxaparin
D. Elevate legs above heart level
C. Administer enoxaparin [CORRECT]
Correct Answer: C
Rationale: Anticoagulation (e.g., enoxaparin) prevents clot extension and embolism. Ambulation
(A) is encouraged but not priority. Warm compresses (B) increase inflammation. Leg elevation
(D) aids venous return but does not treat the clot.
Q8: A patient with aortic stenosis reports syncope. What is the primary cause?
A. Reduced cerebral perfusion during exertion
B. Arrhythmia from left ventricular hypertrophy
C. Hypovolemia from diuretic use
D. Sepsis from endocarditis
A. Reduced cerebral perfusion during exertion [CORRECT]
Correct Answer: A
Rationale: Aortic stenosis limits cardiac output during exertion, causing cerebral hypoperfusion
and syncope. Arrhythmias (B) are possible but less common. Hypovolemia (C) and sepsis (D)
are unrelated to the valvular pathology.
Q9: Which lab value indicates effective heparin therapy?
A. aPTT 1.5-2.5 times control
B. INR 2-3
C. Platelet count > 150,000/mm³
D. PT 11-13 seconds
A. aPTT 1.5-2.5 times control [CORRECT]
Correct Answer: A
Rationale: Heparin’s therapeutic effect is monitored via aPTT, which should be 1.5-2.5 times the
, 4
baseline. INR (B) measures warfarin effect. Platelets (C) monitor for heparin-induced
thrombocytopenia. PT (D) assesses extrinsic pathway, not heparin.
Q10: A patient with infective endocarditis has a temperature of 103°F. Which action is priority?
A. Obtain blood cultures
B. Administer acetaminophen
C. Start vancomycin
D. Perform echocardiogram
A. Obtain blood cultures [CORRECT]
Correct Answer: A
Rationale: Blood cultures drawn before antibiotics identify the causative organism.
Acetaminophen (B) reduces fever but does not address infection. Vancomycin (C) is started after
cultures. Echocardiogram (D) confirms vegetations but is not immediate.
Q11: Which diet is recommended for a patient with hyperlipidemia?
A. High saturated fat, low fiber
B. Low saturated fat, high soluble fiber
C. High cholesterol, low carbohydrates
D. Low protein, high trans fats
B. Low saturated fat, high soluble fiber [CORRECT]
Correct Answer: B
Rationale: Saturated fats raise LDL cholesterol; soluble fiber (e.g., oats) lowers it. High saturated
fat (A) worsens hyperlipidemia. High cholesterol (C) and trans fats (D) are contraindicated.
Q12: A patient with a pacemaker has a heart rate of 60 bpm but reports dizziness. What is the
likely issue?
A. Pacemaker malfunction
B. Atrial fibrillation
C. Ventricular tachycardia
D. Normal pacemaker function
A. Pacemaker malfunction [CORRECT]
Correct Answer: A
Rationale: Dizziness with a set rate of 60 bpm suggests failure to capture or sense, requiring
evaluation. Atrial fibrillation (B) would cause irregular rhythm. Ventricular tachycardia (C) is
rapid. Normal function (D) would not cause symptoms.
Q13: Which medication is used to reverse warfarin-induced bleeding?
A. Protamine sulfate
B. Vitamin K
C. Flumazenil
D. Naloxone
B. Vitamin K [CORRECT]
