ATI RN Med-Surg Proctored Exam |
2025/2026 Real Clinical Questions
and 100% Correct Answers
A 58-year-old man arrives at the ED with sudden chest “tearing” pain radiating to the
back. BP 180/110 mm Hg, HR 98, SpO₂ 94 %. Which action is priority?
A. Obtain 12-lead ECG in 10 min
🔵
B. Start high-flow O₂ by non-rebreather
C. Insert two large-bore IVs and keep SBP < 120 mm Hg with esmolol
📖
D. Administer aspirin 325 mg chewed
Rationale: Tearing pain + elevated BP = probable aortic dissection; immediate BP and
heart-rate control with short-acting beta blocker limits shear stress .
The nurse is titrating nitroprusside for a client in hypertensive emergency. Which lab
must be monitored every 24 h?
🔵
A. Serum magnesium
B. Cyanide level
C. Serum calcium
📖
D. Serum acetone
Nitroprusside metabolizes to cyanide; accumulation causes metabolic acidosis and
altered mental status .
Post-MI client will receive tissue plasminogen activator (tPA). Which history is an
absolute contraindication?
🔵
A. Peptic ulcer disease 5 yr ago
B. Hemorrhagic stroke 18 months ago
C. Blood pressure 175/100 at admission
📖
D. Total cholesterol 310 mg/dL
Prior hemorrhagic stroke = absolute exclusion because of re-bleed risk .
A patient with newly diagnosed dilated cardiomyopathy asks why an ACE inhibitor was
prescribed. The nurse replies:
🔵
A. “It speeds up your heart to improve output.”
B. “It blunts neurohormonal activation that remodels the heart.”
C. “It helps you excrete extra fluid.”
📖
D. “It prevents clots inside the ventricle.”
ACE-I reduces afterload and blocks RAAS-mediated cardiac remodeling .
, The provider orders diltiazem 0.25 mg/kg IV push for rapid AF (HR 160). Prior to
administration the nurse should:
🔵
A. Place transcutaneous pacer pads
B. Verify blood pressure ≥ 90 mm Hg systolic
C. Obtain stool guaiac
📖
D. Administer O₂ 2 L via cannula
Non-DHP CCBs can drop BP; ensure patient is not hypotensive .
A 70 kg patient in acute decompensated HF receives furosemide 80 mg IV. Which
assessment best indicates effective diuresis?
🔵
A. Weight ↓ 0.5 kg in 6 h
B. Output 500 mL more than intake within 6 h
C. BNP unchanged
📖
D. CVP ↑ 2 mm Hg
Goal is negative fluid balance; accurate I&O is primary bedside indicator .
A client with infective endocarditis on vancomycin develops flushed neck and itching 30
min into infusion. What should the nurse do first?
🔵
A. Stop infusion & call provider
B. Slow infusion rate and pre-medicate with diphenhydramine
C. Switch to cefazolin immediately
📖
D. Draw peak & trough now
“Red-man” syndrome is rate-related; slow infusion + antihistamine usually resolves .
A patient with HTN and left-ventricular hypertrophy is started on losartan. Teaching
priority is:
🔵
A. “Check pulse daily.”
B. “Call if you become pregnant.”
C. “Avoid all dairy products.”
📖
D. “Take with grapefruit juice.”
ARBs are teratogenic; counsel all women of child-bearing age .
Immediately after synchronized cardioversion the nurse notes ventricular tachycardia on
monitor. First action?
🔵
A. Resume synch cardioversion
B. Defibrillate at 200 J (unsynchronized)
C. Give adenosine 6 mg rapid push
📖
D. Check carotid pulse for 20 s
Any pulseless wide-complex rhythm = defibrillation; sync mode delays shock .
A patient with STEMI receives heparin 4000 units IV. Which lab value requires
immediate notification?
2025/2026 Real Clinical Questions
and 100% Correct Answers
A 58-year-old man arrives at the ED with sudden chest “tearing” pain radiating to the
back. BP 180/110 mm Hg, HR 98, SpO₂ 94 %. Which action is priority?
A. Obtain 12-lead ECG in 10 min
🔵
B. Start high-flow O₂ by non-rebreather
C. Insert two large-bore IVs and keep SBP < 120 mm Hg with esmolol
📖
D. Administer aspirin 325 mg chewed
Rationale: Tearing pain + elevated BP = probable aortic dissection; immediate BP and
heart-rate control with short-acting beta blocker limits shear stress .
The nurse is titrating nitroprusside for a client in hypertensive emergency. Which lab
must be monitored every 24 h?
🔵
A. Serum magnesium
B. Cyanide level
C. Serum calcium
📖
D. Serum acetone
Nitroprusside metabolizes to cyanide; accumulation causes metabolic acidosis and
altered mental status .
Post-MI client will receive tissue plasminogen activator (tPA). Which history is an
absolute contraindication?
🔵
A. Peptic ulcer disease 5 yr ago
B. Hemorrhagic stroke 18 months ago
C. Blood pressure 175/100 at admission
📖
D. Total cholesterol 310 mg/dL
Prior hemorrhagic stroke = absolute exclusion because of re-bleed risk .
A patient with newly diagnosed dilated cardiomyopathy asks why an ACE inhibitor was
prescribed. The nurse replies:
🔵
A. “It speeds up your heart to improve output.”
B. “It blunts neurohormonal activation that remodels the heart.”
C. “It helps you excrete extra fluid.”
📖
D. “It prevents clots inside the ventricle.”
ACE-I reduces afterload and blocks RAAS-mediated cardiac remodeling .
, The provider orders diltiazem 0.25 mg/kg IV push for rapid AF (HR 160). Prior to
administration the nurse should:
🔵
A. Place transcutaneous pacer pads
B. Verify blood pressure ≥ 90 mm Hg systolic
C. Obtain stool guaiac
📖
D. Administer O₂ 2 L via cannula
Non-DHP CCBs can drop BP; ensure patient is not hypotensive .
A 70 kg patient in acute decompensated HF receives furosemide 80 mg IV. Which
assessment best indicates effective diuresis?
🔵
A. Weight ↓ 0.5 kg in 6 h
B. Output 500 mL more than intake within 6 h
C. BNP unchanged
📖
D. CVP ↑ 2 mm Hg
Goal is negative fluid balance; accurate I&O is primary bedside indicator .
A client with infective endocarditis on vancomycin develops flushed neck and itching 30
min into infusion. What should the nurse do first?
🔵
A. Stop infusion & call provider
B. Slow infusion rate and pre-medicate with diphenhydramine
C. Switch to cefazolin immediately
📖
D. Draw peak & trough now
“Red-man” syndrome is rate-related; slow infusion + antihistamine usually resolves .
A patient with HTN and left-ventricular hypertrophy is started on losartan. Teaching
priority is:
🔵
A. “Check pulse daily.”
B. “Call if you become pregnant.”
C. “Avoid all dairy products.”
📖
D. “Take with grapefruit juice.”
ARBs are teratogenic; counsel all women of child-bearing age .
Immediately after synchronized cardioversion the nurse notes ventricular tachycardia on
monitor. First action?
🔵
A. Resume synch cardioversion
B. Defibrillate at 200 J (unsynchronized)
C. Give adenosine 6 mg rapid push
📖
D. Check carotid pulse for 20 s
Any pulseless wide-complex rhythm = defibrillation; sync mode delays shock .
A patient with STEMI receives heparin 4000 units IV. Which lab value requires
immediate notification?
