Verified ATI RN Adult Medical-Surgical (Med-Surg) 2026 NGN
Proctored Examination
Version 2.0 - Comprehensive 100-Question Practice Exam
Exam Title: ATI RN Adult Medical-Surgical Proctored Examination 2026 – Next Generation NCLEX
(NGN) Clinical Judgment and Prioritization Assessment: Advanced Evaluation of Multisystem Disorders,
Pharmacology, Emergency Interventions, and Evidence-Based Nursing Management Across the Adult
Lifespan in Acute and Chronic Care Settings
Difficulty Level: Advanced / Hard
Target Audience: Pre-licensure RN students, graduating nursing students, NCLEX-RN candidates
Format: Multiple-choice with single best answer; NGN-style clinical judgment integration
Total Questions: 100
Time Limit: 3 hours (simulated)
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–15)
Question 1
A 68-year-old client with a history of hypertension and type 2 diabetes presents to the emergency
department with substernal chest pressure radiating to the jaw, diaphoresis, and nausea. The 12-lead
ECG shows ST-segment elevation in leads V1–V4. The client's blood pressure is 98/62 mm Hg, heart
rate 104 bpm, and oxygen saturation 92% on room air. Which intervention should the nurse anticipate
implementing FIRST?
A. Administer sublingual nitroglycerin 0.4 mg
B. Prepare the client for immediate percutaneous coronary intervention (PCI)
C. Administer IV morphine sulfate 2 mg
D. Apply supplemental oxygen at 2 L/min via nasal cannula
,Correct Answer: B
Rationale: ST-segment elevation in leads V1–V4 indicates an anterior wall ST-elevation myocardial
infarction (STEMI). For STEMI, the priority is rapid reperfusion therapy, with PCI being the preferred
method if available within 90 minutes of arrival. The client's hypotension (BP 98/62) suggests possible
cardiogenic shock or right ventricular involvement. Nitroglycerin is contraindicated or should be used
cautiously in inferior/posterior MI with hypotension as it can further reduce preload. Oxygen is
indicated for SpO₂ <90%, and morphine may be given for pain but not before reperfusion planning.
Question 2
A client with chronic heart failure (HF) has been prescribed sacubitril/valsartan (Entresto). The nurse
should monitor which laboratory value most closely after initiating this medication?
A. Serum potassium
B. Serum creatinine and BUN
C. Serum sodium
D. Serum magnesium
Correct Answer: A
Rationale: Sacubitril/valsartan is a combination angiotensin receptor-neprilysin inhibitor (ARNI) that
can cause hyperkalemia, especially in clients with renal impairment. Serum potassium should be
monitored before initiating therapy and periodically thereafter. Creatinine and BUN should also be
monitored, but hyperkalemia is the more immediate and potentially life-threatening electrolyte
abnormality.
Question 3
A client is 12 hours post-cardiac catheterization via the right femoral artery. The nurse notes the
client's right foot is pale, cool to touch, and capillary refill is >5 seconds. The right pedal pulse is
palpable but diminished compared to the left. What is the nurse's PRIORITY action?
A. Apply warm blankets to the right foot
B. Elevate the right leg on pillows
C. Notify the healthcare provider immediately
D. Document the finding and continue to monitor
,Correct Answer: C
Rationale: Pale, cool extremity with delayed capillary refill and diminished pulses after cardiac
catheterization suggests arterial insufficiency, possibly from a thrombus or hematoma at the access
site. This is a critical finding requiring immediate provider notification for possible vascular
intervention. Warm blankets and elevation do not address the underlying arterial compromise.
Delaying notification could result in limb ischemia and tissue loss.
Question 4
A client with aortic regurgitation is being evaluated for valve replacement surgery. Which assessment
finding is MOST indicative of chronic, severe aortic regurgitation?
A. Bounding peripheral pulses and wide pulse pressure
B. Narrow pulse pressure and weak peripheral pulses
C. S4 gallop and jugular venous distention
D. Diminished carotid upstroke
Correct Answer: A
Rationale: Chronic severe aortic regurgitation results in a large stroke volume and rapid runoff of
blood back into the left ventricle during diastole, causing bounding peripheral pulses (water-hammer
pulse), wide pulse pressure, and a hyperdynamic circulation. Narrow pulse pressure and diminished
carotid upstroke are associated with aortic stenosis. JVD and S4 may occur in later stages but are not
the classic hallmark findings.
Question 5
A client with a permanent pacemaker is admitted with syncope. The ECG shows intermittent failure to
capture with pacing spikes not followed by QRS complexes. The nurse should first assess which factor?
A. Battery life of the pacemaker
B. Lead dislodgement or fracture
C. Medication interactions
D. The client's electrolyte levels
Correct Answer: B
Rationale: Failure to capture (pacing spike without subsequent QRS) is most commonly caused by lead
, dislodgement, lead fracture, or an exit block. While battery depletion, medication interactions, and
electrolyte imbalances can affect capture, lead-related issues are the most common and should be
assessed first, typically via chest X-ray.
Question 6
A client is receiving IV amiodarone for ventricular tachycardia. The nurse should monitor for which
adverse effect that requires immediate intervention?
A. Hypotension
B. Nausea
C. Pulmonary toxicity
D. Corneal microdeposits
Correct Answer: A
Rationale: IV amiodarone can cause significant hypotension due to its vasodilatory effects and the
solvent used in the IV formulation. This requires immediate intervention (slowing the infusion, IV fluids,
or vasopressors). Pulmonary toxicity and corneal microdeposits are associated with chronic oral
amiodarone use. Nausea is a less serious side effect.
Question 7
A client with infective endocarditis has a history of intravenous drug use. Which nursing intervention is
MOST important to prevent further complications?
A. Daily blood cultures
B. Strict aseptic technique for all invasive procedures
C. Encouraging oral fluid intake
D. Monitoring for signs of heart failure
Correct Answer: B
Rationale: Clients with infective endocarditis are at high risk for bacteremia and further embolic
events. Strict aseptic technique for all invasive procedures (IV insertion, blood draws, catheter care) is
essential to prevent additional infection and vegetation formation. While daily blood cultures and
monitoring for heart failure are important, infection prevention is the priority in this population.
Proctored Examination
Version 2.0 - Comprehensive 100-Question Practice Exam
Exam Title: ATI RN Adult Medical-Surgical Proctored Examination 2026 – Next Generation NCLEX
(NGN) Clinical Judgment and Prioritization Assessment: Advanced Evaluation of Multisystem Disorders,
Pharmacology, Emergency Interventions, and Evidence-Based Nursing Management Across the Adult
Lifespan in Acute and Chronic Care Settings
Difficulty Level: Advanced / Hard
Target Audience: Pre-licensure RN students, graduating nursing students, NCLEX-RN candidates
Format: Multiple-choice with single best answer; NGN-style clinical judgment integration
Total Questions: 100
Time Limit: 3 hours (simulated)
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–15)
Question 1
A 68-year-old client with a history of hypertension and type 2 diabetes presents to the emergency
department with substernal chest pressure radiating to the jaw, diaphoresis, and nausea. The 12-lead
ECG shows ST-segment elevation in leads V1–V4. The client's blood pressure is 98/62 mm Hg, heart
rate 104 bpm, and oxygen saturation 92% on room air. Which intervention should the nurse anticipate
implementing FIRST?
A. Administer sublingual nitroglycerin 0.4 mg
B. Prepare the client for immediate percutaneous coronary intervention (PCI)
C. Administer IV morphine sulfate 2 mg
D. Apply supplemental oxygen at 2 L/min via nasal cannula
,Correct Answer: B
Rationale: ST-segment elevation in leads V1–V4 indicates an anterior wall ST-elevation myocardial
infarction (STEMI). For STEMI, the priority is rapid reperfusion therapy, with PCI being the preferred
method if available within 90 minutes of arrival. The client's hypotension (BP 98/62) suggests possible
cardiogenic shock or right ventricular involvement. Nitroglycerin is contraindicated or should be used
cautiously in inferior/posterior MI with hypotension as it can further reduce preload. Oxygen is
indicated for SpO₂ <90%, and morphine may be given for pain but not before reperfusion planning.
Question 2
A client with chronic heart failure (HF) has been prescribed sacubitril/valsartan (Entresto). The nurse
should monitor which laboratory value most closely after initiating this medication?
A. Serum potassium
B. Serum creatinine and BUN
C. Serum sodium
D. Serum magnesium
Correct Answer: A
Rationale: Sacubitril/valsartan is a combination angiotensin receptor-neprilysin inhibitor (ARNI) that
can cause hyperkalemia, especially in clients with renal impairment. Serum potassium should be
monitored before initiating therapy and periodically thereafter. Creatinine and BUN should also be
monitored, but hyperkalemia is the more immediate and potentially life-threatening electrolyte
abnormality.
Question 3
A client is 12 hours post-cardiac catheterization via the right femoral artery. The nurse notes the
client's right foot is pale, cool to touch, and capillary refill is >5 seconds. The right pedal pulse is
palpable but diminished compared to the left. What is the nurse's PRIORITY action?
A. Apply warm blankets to the right foot
B. Elevate the right leg on pillows
C. Notify the healthcare provider immediately
D. Document the finding and continue to monitor
,Correct Answer: C
Rationale: Pale, cool extremity with delayed capillary refill and diminished pulses after cardiac
catheterization suggests arterial insufficiency, possibly from a thrombus or hematoma at the access
site. This is a critical finding requiring immediate provider notification for possible vascular
intervention. Warm blankets and elevation do not address the underlying arterial compromise.
Delaying notification could result in limb ischemia and tissue loss.
Question 4
A client with aortic regurgitation is being evaluated for valve replacement surgery. Which assessment
finding is MOST indicative of chronic, severe aortic regurgitation?
A. Bounding peripheral pulses and wide pulse pressure
B. Narrow pulse pressure and weak peripheral pulses
C. S4 gallop and jugular venous distention
D. Diminished carotid upstroke
Correct Answer: A
Rationale: Chronic severe aortic regurgitation results in a large stroke volume and rapid runoff of
blood back into the left ventricle during diastole, causing bounding peripheral pulses (water-hammer
pulse), wide pulse pressure, and a hyperdynamic circulation. Narrow pulse pressure and diminished
carotid upstroke are associated with aortic stenosis. JVD and S4 may occur in later stages but are not
the classic hallmark findings.
Question 5
A client with a permanent pacemaker is admitted with syncope. The ECG shows intermittent failure to
capture with pacing spikes not followed by QRS complexes. The nurse should first assess which factor?
A. Battery life of the pacemaker
B. Lead dislodgement or fracture
C. Medication interactions
D. The client's electrolyte levels
Correct Answer: B
Rationale: Failure to capture (pacing spike without subsequent QRS) is most commonly caused by lead
, dislodgement, lead fracture, or an exit block. While battery depletion, medication interactions, and
electrolyte imbalances can affect capture, lead-related issues are the most common and should be
assessed first, typically via chest X-ray.
Question 6
A client is receiving IV amiodarone for ventricular tachycardia. The nurse should monitor for which
adverse effect that requires immediate intervention?
A. Hypotension
B. Nausea
C. Pulmonary toxicity
D. Corneal microdeposits
Correct Answer: A
Rationale: IV amiodarone can cause significant hypotension due to its vasodilatory effects and the
solvent used in the IV formulation. This requires immediate intervention (slowing the infusion, IV fluids,
or vasopressors). Pulmonary toxicity and corneal microdeposits are associated with chronic oral
amiodarone use. Nausea is a less serious side effect.
Question 7
A client with infective endocarditis has a history of intravenous drug use. Which nursing intervention is
MOST important to prevent further complications?
A. Daily blood cultures
B. Strict aseptic technique for all invasive procedures
C. Encouraging oral fluid intake
D. Monitoring for signs of heart failure
Correct Answer: B
Rationale: Clients with infective endocarditis are at high risk for bacteremia and further embolic
events. Strict aseptic technique for all invasive procedures (IV insertion, blood draws, catheter care) is
essential to prevent additional infection and vegetation formation. While daily blood cultures and
monitoring for heart failure are important, infection prevention is the priority in this population.
