2022-2023 ATI RN Medical Surgical Exam with Answers (269 Solved Questions)

Name: 2022-2023 ATI RN Medical Surgical Exam with Answers (269 Solved Questions)
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2022-2023 RN MEDICAL SURGICAL ATI
EXAM/MEDICAL SURGICAL ATI EXAM 2022-
2023 QUESTIONS AND ANSWERS |ALREADY
GRADED A | BRAND NEW!!
1. CORONARY ARTERY DISEASE AND ACUTE CORONARY SYNDROME
2. The nurse is developing a teaching plan for a 64-year-old patient with coronary artery disease
(CAD). Which factor should the nurse focus on during the teaching sessionx?
a. Family history of coronary artery disease
b. Elevated low-density lipoprotein (LDL) level
c. Greater risk associated with the patient’s gender
d. Increased risk of cardiovascular disease with aging
ANS: B RN should focus on the pt’s LDL level. ↓ LDL will help ↓ the pt’s risk for developing CAD.
3. Which nursing intervention is likely to be most effective when assisting the pt w/ CAD to make
appropriate dietary ∆?
a. Inform the patient about a diet containing no saturated fat and minimal salt.
b. Emphasize the increased cardiac risk unless the patient makes dietary changes.
c. Help the patient modify favorite high-fat recipes by using monounsaturated oils.
d. Give the patient a list of low-sodium, low-cholesterol foods to include in the diet.
ANS: C Lifestyle changes are more likely to be successful when consideration is given to the patient’s
values and preferences. The highest percentage of calories from fat should come from monounsaturated
or polyunsaturated fats.
4. The nurse is admitting a patient who has chest pain. Which assessment data suggest that the
pain is from an acute MI?
a. The pain increases with deep breathing.
b. The pain has lasted longer than 30 minutes.
c. The pain is relieved after the patient takes nitroglycerin.
d. The pain is reproducible when the patient raises the arms.
ANS: B
5. Which info from a pt helps the nurse confirm the previous dx of chronic stable angina?
a. “The pain wakes me up at night.”
b. “The pain is level 3 to 5 (0 to 10 scale).”
c. “The pain has gotten worse over the last week.”
d. “The pain goes away after a nitroglycerin tablet.”
ANS: D Chronic stable angina is typically relieved by rest or nitroglycerin
6. Which pt statement indicates that the RN’s teaching about subling nitroglycerin (Nitrostat) has
been effective?
a. “I can expect nausea as a side effect of nitroglycerin.”

b. “I should only take nitroglycerin when I have chest pain.”
c. “Nitroglycerin helps prevent a clot from forming and blocking blood flow to my heart.”
d. “I will call an ambulance if I have pain after taking 3 nitroglycerin 5 minutes apart.”
ANS: D

7. Which statement made by a pt w/ CAD after the nurse has completed teaching about the thx
lifestyle changes (TLC) diet indicates that further teaching is needed?
a. “I will switch from whole milk to 1% milk.”
b. “I like salmon and I will plan to eat it more often.”
c. “I can have a glass of wine with dinner if I want one.”
d. “I will miss being able to eat peanut butter sandwiches.”
ANS: D
8. Which pt statement indicates that the nurse’s teaching about carvedilol (Coreg) for preventing
anginal episodes has been effective?
a. “Carvedilol will help my heart muscle work harder.”
b. “It is important not to suddenly stop taking the carvedilol.”
c. “I can expect to feel short of breath when taking carvedilol.”
d. “Carvedilol will increase the blood flow to my heart muscle.”
ANS: B Can develop intense and frequent angina if the medication is suddenly DC’d
9. A pt who has had chest pain for several hours is admitted with a diagnosis of rule out AMI.
Which laboratory test is most specific for the nurse to monitor in determining whether the
patient has had an AMI?
a. Myoglobin
b. Homocysteine
c. C-reactive protein
d. Cardiac-specific troponin
ANS: D Troponin levels ↑about 4-6 hrs after the onset of myocardial infarction (MI) and are highly
specific indicators for MI. Myoglobin is released within 2 hours of MI, but it lacks specificity and its use is
limited. The other laboratory data are useful in determining the patient’s risk for developing coronary
artery disease but are not helpful in determining whether an acute MI is in progress.
10. Diltiazem (Cardizem) is Rx for a pt w/ newly dx Prinzmetal’s (variant) angina. Which action of
diltiazem is accurate for the nurse to include in the teaching plan?
a. Reduces heart palpitations.
b. Prevents coronary artery plaque.
c. Decreases coronary artery spasms.
d. Increases contractile force of the heart.
ANS: C Prinzmetal’s angina is caused by coronary artery spasm. Calcium channel blockers (e.g., diltiazem,
amlodipine [Norvasc]) are a first-line therapy for this

d. Heart monitor shows normal sinus rhythm.
ANS: C
12. Nadolol (Corgard) Rx for a patient with chronic stable angina and left ventricular dysfunction.
What data would indicate to the nurse that the drug is effective?
a. Decreased blood pressure and heart rate
b. Improvement in the strength of the distal pulses
c. Fewer complaints of having cold hands and feet
d. Participation in daily activities without chest pain
e. ANS: D
13. Heparin is ordered for a pt with a non–ST-segment-elevation myocardial infarction (NSTEMI).
How should the nurse explain the purpose of the heparin to the patient?
a. “Heparin enhances platelet aggregation at the plaque site.”
b. “Heparin decreases the size of the coronary artery plaque.”
c. “Heparin prevents the development of new clots in the coronary arteries.”
d. “Heparin dissolves clots that are blocking blood flow in the coronary arteries.”
ANS:
14. Which action will nurse take to evaluate the effectiveness of IV nitroglycerin for a pt w/ MI?
a. Monitor heart rate.
b. Ask about chest pain.
c. Check blood pressure.
d. Observe for dysrhythmias.
ANS: B
15. A patient with ST-segment elevation in 3 contiguous ECG leads is admitted to ED & dx as having
ST-segment-elevation MI (STEMI). Which q should the nurse ask to determine whether the pt is a
candidate for thrombolytic therapy?
a. “Do you have any allergies?”
b. “Do you take aspirin daily?”
c. “What time did your pain begin?”
d. “Can you rate the pain on a 0 to 10 scale?”
ANS: C Thrombolytic therapy should be started within 6 hours of the onset of MIDIF: Cognitive Level:
Apply (application)
16. A pt who has recently had an acute MI (AMI) ambulates in the hospital hallway. Which data
would indicate to the nurse that the patient should stop and rest?
a. O2 saturation drops from 99% to 95%.
b. Heart rate increases from 66 to 98 beats/min.
c. Respiratory rate goes from 14 to 20 breaths/min.
d. Blood pressure (BP) changes from 118/60 to 126/68 mm Hg.
ANS: B

17. The nurse is administering a thrombolytic agent to a patient with an AMI. What patient data
indicates that the nurse should stop the drug infusion?
a. Bleeding from the gums
b. An increase in blood pressure
c. Decreased level of consciousness
d. A nonsustained episode of ventricular tachycardia
ANS: C patient may be experiencing intracranial bleeding
18. A pt recovering from MI develops chest pain on day 3 that ↑ when taking a deep breath and is
relieved by leaning forward. Which action should nurse take as focused follow-up on this
symptom?
a. Assess both feet for pedal edema.
b. Palpate the radial pulses bilaterally.
c. Auscultate for a pericardial friction rub.
d. Check the heart monitor for dysrhythmias.
ANS: C The patient’s symptoms are consistent with the development of pericarditis, a possible
complication of MI.
19. In preparation for DC, nurse teaches a pt w/ chronic stable angina how to use the Rx short-acting
and long-acting nitrates. Which pt statement indicates that the teaching has been effective?
a. “I will sit down before I put the nitroglycerin under my tongue.”
b. “I will check my pulse rate before I take any nitroglycerin tablets.”
c. “I will put the nitroglycerin patch on as soon as I get any chest pain.”
d. “I will remove the nitroglycerin patch before taking sublingual nitroglycerin.”
ANS: A
20. The nurse is caring for a patient who is recovering from a sudden cardiac death (SCD) event and
has no evidence of AMI. What should the nurse anticipate teaching the patient?
a. Sudden cardiac death events rarely reoccur.
b. Additional diagnostic testing will be required.
c. Long-term anticoagulation therapy will be needed.
d. Limiting physical activity will prevent future SCD events.

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22. After having MI and successful percutaneous coronary intervention, pt states, “It was just a little
chest pain. As soon as I get out of here, I’m going for my vacation as planned.” Which reply
would be most appropriate for the nurse to make?
a. “What do you think caused your chest pain?”
b. “Where are you planning to go for your vacation?”
c. “Sometimes plans need to change after a heart attack.”
d. “Recovery from a heart attack takes at least a few weeks.”
ANS: A pt experiencing denial, test reality
23. The nurse is evaluating the effectiveness of preoperative teaching with a patient scheduled for
coronary artery bypass graft (CABG) surgery using the internal mammary artery. Which patient
statement indicates that additional teaching is needed?
a. “They will circulate my blood with a machine during surgery.”
b. “I will have incisions in my leg where they will remove the vein.”
c. “They will use an artery near my heart to go around the area that is blocked.”
d. “I will need to take aspirin every day after the surgery to keep the graft open.”
ANS: B
24. A pt who is recovering from an AMI asks the nurse about safely resuming

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a. Generalized muscle aches and pains
b. Dizziness with rapid position changes
c. Nausea when taking the drugs before meals
d. Flushing and pruritus after taking the drugs
ANS: A m aches and pains may indicate myopathy and rhabdomyolysis, which have cz acute kidney injury
and death in some patients who have taken the statin medications. Thesesymptoms indicate that the
pravastatin may need to be discontinued.
28. A patient who is being admitted to the ED with intermittent chest pain gives the following list of
daily medications to the nurse. Which medication has the most immediate implications for the
patient’s care?
a. Tadalafil (Cialas)
b. Furosemide (Lasix)
c. c. Warfarin (Coumadin)
d. d. Diltiazem (Cardizem)
ANS: A The nurse will need to avoid giving nitrates to the patient because nitrate administration is
contraindicated in patients who are using tadalafil because of the risk of severe hypotension caused by
vasodilation.
29. Which assessment finding in a patient who has had coronary artery bypass grafting using a right
radial artery graft is most important for the nurse to communicate to the health care provider?
a. Complaints of incisional chest pain
b. Pallor and weakness of the right hand
c. Fine crackles heard at both lung bases
d. Redness on both sides of the sternal incision
ANS: B The ∆ in the right hand indicate compromised blood flow, which requires immediate evaluation
and actions, such as prescribed calcium channel blockers or surgery.
30. The nurse is caring for a pt who has just arrived on the telemetry unit after having cardiac
(LPN/VN)?
a. Teach the patient about the postprocedure plan of care.
b. Give the scheduled aspirin and lipid-lowering medication.
c. Perform the initial assessment of the catheter insertion site.
d. Titrate the heparin infusion according to the agency protocol.
ANS: B
31. Which (ECG) ∆ by a pt w/ chest pain is most important for RN to report rapidly to

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32. A patient with acute coronary syndrome has returned to the coronary care unit after having
angioplasty with stent placement. Which assessment data indicate the need for immediate
action by the nurse?
a. Report of chest pain
b. Heart rate 102 beats/min
c. Pedal pulses 1+ bilaterally
d. Blood pressure 103/54 mm Hg
ANS: C The patient’s chest pain indicates that restenosis of the coronary artery may be occurring and
requires immediate actions, such as administration of oxygen and nitroglycerin, by the nurse.
33. A patient admitted to the coronary care unit (CCU) with an ST-segment-elevation MI (STEMI) is
restless and anxious. The BP is 86/40 mm Hg, and HR is 132 beats/min. Based on this
information, which patient problem is the priority?
a. Anxiety
b. Acute pain
c. Stress management
d. Decreased cardiac output
ANS: D The hypotension and tachycardia indicate ↓CO & shock from then damaged myocardium.
34. When admitting a patient with a non–ST-segment-elevation MI (NSTEMI) to the ICU, which
action should the nurse perform first?
a. Attach the heart monitor.
b. Obtain the blood pressure.
c. Assess the peripheral pulses.
d. d. Auscultate the breath sounds.
ANS: A
35. Which information about a patient receiving thrombolytic therapy for an AMI is most important
for the nurse to communicate to the health care provider?
a. An increase in troponin levels from baseline
b. A large bruise at the patient’s IV insertion site
c. No change in the patient’s reported level of chest pain
d. A decrease

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ANS: C The crackles indicate that the patient may be developing heart failure, a possible complication of
myocardial infarction (MI). The health care provider may need to order medications such as diuretics or
angiotensin-converting enzyme inhibitors for the patient.
37. A patient had a NSTEMI 3 days ago. Which nursing intervention is appropriate for the registered
nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/VN)?
a. Reinforcement of teaching about the prescribed medications
b. Evaluation of the patient’s response to walking in the hallway
c. Completion of the referral form for a home health nurse follow-up
d. Education of the patient about the pathophysiology of heart disease
ANS: A
38. A patient who has chest pain is admitted to the ED , and all of the following items are
prescribed. Which one should the nurse arrange to be completed first?
a. Chest x-ray
b. Troponin level
c. Electrocardiogram (ECG)
d. Insertion of a peripheral IV
ANS: C
39. After receiving change-of-shift report about the following four patients on the cardiac care unit,
which patient should the nurse assess first?
a. 39-year-old patient with pericarditis who is complaining of sharp, stabbing chest pain.
b. A 56-year-old patient with variant angina who is scheduled to receive nifedipine
c. A 65-year-old patient who had a myocardial infarction (MI) 4 days ago and is anxious
about today’s planned discharge.
d. A 59-year-old patient with

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41. Which patient at the cardiovascular clinic requires the most immediate action by the nurse?
a. Patient with type 2 diabetes whose current blood glucose level is 145 mg/dL.
b. Patient with stable angina whose chest pain has recently increased in frequency.
c. Patient with familial hypercholesterolemia and a total cholesterol of 465 mg/dL.
d. Patient with chronic hypertension whose blood pressure today is 172/98 mm Hg.
ANS: B
42. The nurse reviews information shown in the accompanying figure from the medical records of a
43-year-old patient. Which risk factor modification for coronary artery disease should the nurse
include in patient teaching?
a. Importance of daily physical activity
b. Effect of weight loss on blood pressure
c. Dietary changes to improve lipid levels
d. Cardiac risk associated with previous tobacco use
ANS: C The patient has an elevated low-density lipoprotein cholesterol and low high-density lipoprotein
cholesterol, which will increase the risk of coronary artery disease.
43. After reviewing a patient’s history, vital signs, physical assessment, and laboratory data, which
information shown in the accompanying figure is most important for the nurse to communicate
to the HCP?
a. Hyperglycemia
b. Bilateral crackles
c. Q waves on ECG
d. Elevated troponin
ANS: B Pulmonary congestion suggests that the patient may be developing heart failure
2. HEART FAILURE
1. While assessing an older adult patient, the nurse notes jugular venous distention (JVD) with the
head of the patient’s bed

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d. Patient denies experiencing chest pain or chest pressure
ANS: C Because pt’s major clinical manifestation of ADHF is orthopnea (caused by the presence of fluid in
the alveoli), the best indicator that the medications are effective is a decrease in dyspnea with the head
of the bed at 30 degrees.
3. Which topic will RN plan to include in DC teaching for pt w/HF reduced ejection fraction (HFrEF)?
a. Need to begin an aerobic exercise program several times weekly
b. Benefits and effects of angiotensin-converting enzyme (ACE) inhibitors
c. Use of salt substitutes to replace table salt when cooking and at the table
d. Importance of making an annual appointment with the health care provider
ANS: B The core measures for tx of HF indicate that pts w/ an ejection fraction below 40% should receive
an ACE inhibitor to ↓ progression of HF.
4. IV Na+ nitroprusside is ordered for pt w/ acute pulmonary edema. Which reassessment finding
during 1st hrs of admin indicates that RN should ↓ the rate of nitroprusside infusion?
a. Ventricular ectopy
b. Dry, hacking cough
c. Systolic BP below 90 mm Hg
d. Heart rate below 50 beats/min
ANS: C Na+ nitroprusside is a potent vasodilator and the major adverse effect is severe hypotension.
5. A pt who has chronic HF tells the nurse, “I was fine when I went to bed, but I woke up in the
middle of the night feeling like I was suffocating!” How should the nurse document this finding?
a. Orthopnea
b. Pulsus alternans
c. Paroxysmal nocturnal dyspnea
d. Acute bilateral pleural effusion

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c. Yogurt and milk products
d. Fresh or frozen vegetables
ANS: C Yogurt and milk products (e.g., cheese) naturally contain a significant amount of Na+
8. The nurse plans DC teaching for pt w/ chronic HF who has Rx for digoxin (Lanoxin) and
hydrochlorothiazide. Which instruction should the nurse include?
a. Limit dietary sources of potassium.
b. Take the hydrochlorothiazide at bedtime.
c. Notify the health care provider if nausea develops.
d. Take the digoxin if the pulse is below 60 beats/min.
ANS: C Nausea is a symptom of digoxin toxicity and should be reported so that the provider can assess
the patient for toxicity and adjust the digoxin dose, if necessary.
9. While admitting 82yo w/ acute decompensated HF to the hospital, RN learns that pt lives alone
& sometimes confuses “water pill” w/ “<3 pill.” What should RN include in DC plan?
a. Consult with a psychologist.
b. Transfer to a long-term care facility.
c. Referral to a home health care agency.
d. Arrangements for around-the-clock care.
ANS: C
10. Following an AMI, a previously healthy 60yo develops HF. What med topic should RN anticipate
including in discharge teaching?
a. -Adrenergic blockers
b. Calcium channel blockers

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d. 12-lead electrocardiogram
ANS: C (BNP is secreted when ventricular pressures ↑, as they do w/ HF. ↑ BNP indicates a probable or
very probable dx of HF. A 12-lead ECG, ABG, and troponin may also be used in determining the causes or
effects of HF but are not as clearly dx of HF as BNP.
13. Which action should the nurse include in POC for a pt admitted with acute decompensated heart
failure (ADHF) who is receiving nesiritide (Natrecor)?
a. Monitor blood pressure frequently.
b. Encourage patient to ambulate in room.
c. Teach patient to drink at least 3 liters of fluid daily.
d. Titrate nesiritide dose down slowly before stopping.
ANS: A Nesiritide is a potent arterial and venous dilator, and the major adverse effect is hypotension.
Because the pt is likely to have orthostatic hypotension, the pt should not be encouraged to ambulate.
Nesiritide does not require titration. Excessive hydration could exacerbate ADHF.
14. Pt w/ chronic HF has a new order for captopril 12.5mg PO. After giving the 1st dose & teaching
pt about the drug, which statement by pt indicates that teaching has been effective?
a. “I plan to take the medication with food.”
b. “I should eat more potassium-rich foods.”
c. “I will call for help

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17. A pt w/ chronic HF who is taking a diuretic and an ACE inhibitor and who is on a ↓-Na+ diet tells
home health nurse about a 5lb wt ↑ in past 3 days. Priority action?
a. Teach the patient about restricting dietary sodium.
b. Assess the patient for manifestations of acute heart failure.
c. Ask the patient about the use of the prescribed medications.
d. Have the patient recall the dietary intake for the past 3 days.
ANS: B 5lb wt ↑ over 3 days indicates that pt’s chronic HF may be worsening. It’s important that pt be
assessed immediately for other clinical manifestations of decompensation, such as lung crackles.
18. A pt in the intensive care unit who has acute decompensated HF (ADHF) reports severe dyspnea
and is anxious, tachypneic, and tachycardic. Several drugs have been

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d. Weight increase from 120 pounds to 122 pounds over 3 days
ANS: C dysrhythmias and potentiate the actions of digoxin. Hypokalemia also ↑ risk for digoxin toxicity
22. An out pt who has chronic HF returns to the clinic after 2 weeks of therapy with metoprolol
(Toprol XL). Which assessment finding is most important for the nurse to report to the HCP?
a. 2+ bilateral pedal edema
b. Heart rate of 52 beats/min
c. Report of increased fatigue
d. Blood pressure (BP) of 88/42 mm Hg
ANS: D The pt’s BP indicates that the dose of metoprolol may need to be ↓ because of hypotension.
Bradycardia is a frequent adverse effect of -adrenergic blockade, though it may need to be monitored
23. A pt who is receiving dobutamine for the tx of acute decompensated HF (ADHF) has the
following nursing interventions included in the POC. Which action will be most appropriate for
the RN to delegate to an LPN?
a. Teach the patient the reasons for remaining on bed rest.
b. Change the peripheral IV site according to agency policy.
c. Monitor the patient’s blood pressure and heart rate every hour.
d. Titrate the dobutamine to keep the systolic blood pressure >90 mm Hg.
ANS: C

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