ATI RN Med-Surg 2 Proctored Exam | 2026 Updated | NGN Standards Page 1
ATI RN MEDICAL-SURGICAL NURSING
PROCTORED EXAMINATION 2
ACTUAL EXAM WITH NGN QUESTIONS AND ANSWERS
2026 UPDATED
Total Questions: 100 | Exam Type: Proctored - NCLEX-RN Aligned
Standard: Next Generation NCLEX (NGN) 2026 | Format: Multiple Choice (4 Options, 1 Correct)
Cognitive Levels: 25% Recall, 50% Application, 25% Analysis
Sections: Cardiovascular (Q1-18) | Respiratory (Q19-30) | Neurological (Q31-42) | GI (Q43-54) | Renal (Q55-62) | Endocrine
(Q63-72) | Musculoskeletal (Q73-78) | Hematologic (Q79-86) | Oncology (Q87-92) | Emergency (Q93-96) | NGN Clinical Judgment
(Q97-100)
ATI RN Medical-Surgical Nursing Proctored Examination 2026
,ATI RN Med-Surg 2 Proctored Exam | 2026 Updated | NGN Standards Page 2
SECTION 1: CARDIOVASCULAR DISORDERS (Q1-18)
ACS, Heart Failure, Dysrhythmias, Hypertension, Peripheral Vascular Disease, and Post-Cardiac Surgery
Q1: A client arrives at the emergency department complaining of substernal chest pain that radiates to
the left jaw and arm. The pain began 30 minutes ago and is unrelieved by rest or nitroglycerin. The ECG
shows ST-segment elevation in leads II, III, and aVF. Which of the following interventions should the
nurse anticipate FIRST?
A. Administering oxygen at 2 L/min via nasal cannula
B. Obtaining a 12-lead ECG
C. Preparing the client for percutaneous coronary intervention (PCI) [CORRECT]
D. Administering aspirin 325 mg chewable
Correct Answer: C
Rationale: The client presents with an acute inferior wall MI (ST elevation in II, III, aVF) and is within the reperfusion
window. PCI is the preferred reperfusion strategy when available within 90 minutes of first medical contact because it
directly opens the occluded artery. While oxygen, ECG confirmation, and aspirin are important components of the MONA
protocol, the definitive TIME-SENSITIVE intervention is PCI, which takes priority as the nurse anticipates the next critical
step in care.
Q2: A nurse is reviewing the laboratory results of a client admitted with suspected acute coronary
syndrome (ACS). Which of the following cardiac biomarkers is MOST specific to myocardial injury and
should be the PRIORITY finding to confirm the diagnosis?
A. Creatine kinase-MB (CK-MB)
B. Troponin I [CORRECT]
C. Myoglobin
D. B-type natriuretic peptide (BNP)
Correct Answer: B
Rationale: Troponin I is the most specific and sensitive biomarker for myocardial injury because it is found almost
exclusively in cardiac muscle. Troponin levels rise within 2-4 hours, peak at 12-24 hours, and remain elevated for 7-10
days, making it the gold standard for MI diagnosis. CK-MB is less specific (also found in skeletal muscle). Myoglobin is
sensitive but not specific. BNP is used for heart failure assessment, not acute myocardial injury detection.
Q3: A client with heart failure has bilateral crackles in the lungs, jugular venous distention (JVD), and 3+
pitting edema in the lower extremities. Which of the following nursing interventions is the PRIORITY?
A. Restricting sodium intake to 2 g/day
B. Administering furosemide IV as prescribed [CORRECT]
C. Placing the client in high-Fowler's position
D. Monitoring daily weights
Correct Answer: B
Rationale: The client exhibits signs of acute fluid overload (pulmonary crackles, JVD, edema). Administering IV furosemide
is the PRIORITY because it promotes rapid diuresis to reduce pulmonary congestion and improve oxygenation.
High-Fowler's position assists breathing but does not address the underlying fluid volume excess. Sodium restriction and
daily weights are important ongoing management strategies but are not the immediate priority for an acutely
decompensated state.
Q4: A nurse is caring for a client with heart failure who is receiving digoxin. Which of the following
findings should the nurse recognize as an early sign of digoxin toxicity and REPORT to the provider
immediately?
A. Weight gain of 1 kg in 24 hours
B. Visual disturbances such as halos around lights [CORRECT]
C. Irregular pulse rate of 58 bpm
ATI RN Medical-Surgical Nursing Proctored Examination 2026
, ATI RN Med-Surg 2 Proctored Exam | 2026 Updated | NGN Standards Page 3
D. Dry, nonproductive cough
Correct Answer: B
Rationale: Visual disturbances including halos around lights, yellow-green color vision, and blurred vision are classic early
signs of digoxin toxicity. Digoxin has a narrow therapeutic index, and toxicity can lead to life-threatening dysrhythmias. The
nurse should withhold the next dose and report immediately. Weight gain suggests fluid retention. Bradycardia can indicate
toxicity but visual changes are more specific to digoxin. A dry cough is associated with ACE inhibitors, not digoxin.
Q5: A client's ECG rhythm strip shows an irregularly irregular rhythm with absent P waves and a heart
rate of 110 bpm. The nurse identifies this as atrial fibrillation. Which of the following complications is the
GREATEST risk for this client?
A. Pulmonary embolism
B. Cardiogenic shock
C. Stroke [CORRECT]
D. Acute kidney injury
Correct Answer: C
Rationale: Atrial fibrillation creates stasis of blood in the atria, leading to thrombus formation. If a thrombus dislodges, it can
travel to the brain causing an ischemic stroke. AF increases stroke risk by 4-5 times, making stroke the GREATEST risk.
Anticoagulation therapy (warfarin, DOACs) is the cornerstone of AF management to prevent stroke. While PE, cardiogenic
shock, and AKI can occur, stroke prevention is the primary concern.
Q6: A nurse is monitoring a client on a cardiac telemetry unit and notes a wide-complex tachycardia at a
rate of 180 bpm with a regular rhythm. The client is alert but reports feeling lightheaded. Which of the
following is the PRIORITY nursing action?
A. Preparing for synchronized cardioversion [CORRECT]
B. Administering amiodarone IV as prescribed
C. Initiating CPR
D. Performing carotid sinus massage
Correct Answer: A
Rationale: Wide-complex tachycardia at 180 bpm (ventricular tachycardia) in a client who is alert but symptomatic
(lightheaded) requires IMMEDIATE synchronized cardioversion. This represents an unstable rhythm with signs of
decreased perfusion. Synchronized cardioversion delivers a shock timed to the R wave to prevent R-on-T phenomenon.
Amiodarone is for stable VT. CPR is for pulseless VT/VF. Carotid sinus massage is for supraventricular tachycardia.
Q7: A client with a history of hypertension presents to the emergency department with a blood pressure
of 210/130 mmHg, severe headache, confusion, and blurred vision. Which of the following nursing
interventions is the PRIORITY?
A. Administering an antihypertensive PO medication
B. Preparing for IV antihypertensive therapy with continuous monitoring [CORRECT]
C. Encouraging the client to rest in a quiet, darkened room
D. Applying a cool compress to the forehead
Correct Answer: B
Rationale: This client is experiencing a hypertensive crisis with evidence of target organ damage (neurologic symptoms). IV
antihypertensive medications (labetalol, nicardipine) are the PRIORITY because they provide rapid, controlled BP
reduction. BP should be lowered gradually, not more than 25% in the first hour, to prevent cerebral hypoperfusion. PO
medications take too long. Rest and cool compresses do not address the life-threatening hypertension.
Q8: A nurse is providing discharge teaching to a client with hypertension. Which of the following
statements by the client indicates an understanding of the DASH diet?
A. I will limit my sodium intake to 5 g per day.
B. I will increase my intake of fruits, vegetables, and low-fat dairy products. [CORRECT]
C. I will avoid all protein sources including lean meats and fish.
D. I will replace table salt with sea salt only.
ATI RN Medical-Surgical Nursing Proctored Examination 2026
ATI RN MEDICAL-SURGICAL NURSING
PROCTORED EXAMINATION 2
ACTUAL EXAM WITH NGN QUESTIONS AND ANSWERS
2026 UPDATED
Total Questions: 100 | Exam Type: Proctored - NCLEX-RN Aligned
Standard: Next Generation NCLEX (NGN) 2026 | Format: Multiple Choice (4 Options, 1 Correct)
Cognitive Levels: 25% Recall, 50% Application, 25% Analysis
Sections: Cardiovascular (Q1-18) | Respiratory (Q19-30) | Neurological (Q31-42) | GI (Q43-54) | Renal (Q55-62) | Endocrine
(Q63-72) | Musculoskeletal (Q73-78) | Hematologic (Q79-86) | Oncology (Q87-92) | Emergency (Q93-96) | NGN Clinical Judgment
(Q97-100)
ATI RN Medical-Surgical Nursing Proctored Examination 2026
,ATI RN Med-Surg 2 Proctored Exam | 2026 Updated | NGN Standards Page 2
SECTION 1: CARDIOVASCULAR DISORDERS (Q1-18)
ACS, Heart Failure, Dysrhythmias, Hypertension, Peripheral Vascular Disease, and Post-Cardiac Surgery
Q1: A client arrives at the emergency department complaining of substernal chest pain that radiates to
the left jaw and arm. The pain began 30 minutes ago and is unrelieved by rest or nitroglycerin. The ECG
shows ST-segment elevation in leads II, III, and aVF. Which of the following interventions should the
nurse anticipate FIRST?
A. Administering oxygen at 2 L/min via nasal cannula
B. Obtaining a 12-lead ECG
C. Preparing the client for percutaneous coronary intervention (PCI) [CORRECT]
D. Administering aspirin 325 mg chewable
Correct Answer: C
Rationale: The client presents with an acute inferior wall MI (ST elevation in II, III, aVF) and is within the reperfusion
window. PCI is the preferred reperfusion strategy when available within 90 minutes of first medical contact because it
directly opens the occluded artery. While oxygen, ECG confirmation, and aspirin are important components of the MONA
protocol, the definitive TIME-SENSITIVE intervention is PCI, which takes priority as the nurse anticipates the next critical
step in care.
Q2: A nurse is reviewing the laboratory results of a client admitted with suspected acute coronary
syndrome (ACS). Which of the following cardiac biomarkers is MOST specific to myocardial injury and
should be the PRIORITY finding to confirm the diagnosis?
A. Creatine kinase-MB (CK-MB)
B. Troponin I [CORRECT]
C. Myoglobin
D. B-type natriuretic peptide (BNP)
Correct Answer: B
Rationale: Troponin I is the most specific and sensitive biomarker for myocardial injury because it is found almost
exclusively in cardiac muscle. Troponin levels rise within 2-4 hours, peak at 12-24 hours, and remain elevated for 7-10
days, making it the gold standard for MI diagnosis. CK-MB is less specific (also found in skeletal muscle). Myoglobin is
sensitive but not specific. BNP is used for heart failure assessment, not acute myocardial injury detection.
Q3: A client with heart failure has bilateral crackles in the lungs, jugular venous distention (JVD), and 3+
pitting edema in the lower extremities. Which of the following nursing interventions is the PRIORITY?
A. Restricting sodium intake to 2 g/day
B. Administering furosemide IV as prescribed [CORRECT]
C. Placing the client in high-Fowler's position
D. Monitoring daily weights
Correct Answer: B
Rationale: The client exhibits signs of acute fluid overload (pulmonary crackles, JVD, edema). Administering IV furosemide
is the PRIORITY because it promotes rapid diuresis to reduce pulmonary congestion and improve oxygenation.
High-Fowler's position assists breathing but does not address the underlying fluid volume excess. Sodium restriction and
daily weights are important ongoing management strategies but are not the immediate priority for an acutely
decompensated state.
Q4: A nurse is caring for a client with heart failure who is receiving digoxin. Which of the following
findings should the nurse recognize as an early sign of digoxin toxicity and REPORT to the provider
immediately?
A. Weight gain of 1 kg in 24 hours
B. Visual disturbances such as halos around lights [CORRECT]
C. Irregular pulse rate of 58 bpm
ATI RN Medical-Surgical Nursing Proctored Examination 2026
, ATI RN Med-Surg 2 Proctored Exam | 2026 Updated | NGN Standards Page 3
D. Dry, nonproductive cough
Correct Answer: B
Rationale: Visual disturbances including halos around lights, yellow-green color vision, and blurred vision are classic early
signs of digoxin toxicity. Digoxin has a narrow therapeutic index, and toxicity can lead to life-threatening dysrhythmias. The
nurse should withhold the next dose and report immediately. Weight gain suggests fluid retention. Bradycardia can indicate
toxicity but visual changes are more specific to digoxin. A dry cough is associated with ACE inhibitors, not digoxin.
Q5: A client's ECG rhythm strip shows an irregularly irregular rhythm with absent P waves and a heart
rate of 110 bpm. The nurse identifies this as atrial fibrillation. Which of the following complications is the
GREATEST risk for this client?
A. Pulmonary embolism
B. Cardiogenic shock
C. Stroke [CORRECT]
D. Acute kidney injury
Correct Answer: C
Rationale: Atrial fibrillation creates stasis of blood in the atria, leading to thrombus formation. If a thrombus dislodges, it can
travel to the brain causing an ischemic stroke. AF increases stroke risk by 4-5 times, making stroke the GREATEST risk.
Anticoagulation therapy (warfarin, DOACs) is the cornerstone of AF management to prevent stroke. While PE, cardiogenic
shock, and AKI can occur, stroke prevention is the primary concern.
Q6: A nurse is monitoring a client on a cardiac telemetry unit and notes a wide-complex tachycardia at a
rate of 180 bpm with a regular rhythm. The client is alert but reports feeling lightheaded. Which of the
following is the PRIORITY nursing action?
A. Preparing for synchronized cardioversion [CORRECT]
B. Administering amiodarone IV as prescribed
C. Initiating CPR
D. Performing carotid sinus massage
Correct Answer: A
Rationale: Wide-complex tachycardia at 180 bpm (ventricular tachycardia) in a client who is alert but symptomatic
(lightheaded) requires IMMEDIATE synchronized cardioversion. This represents an unstable rhythm with signs of
decreased perfusion. Synchronized cardioversion delivers a shock timed to the R wave to prevent R-on-T phenomenon.
Amiodarone is for stable VT. CPR is for pulseless VT/VF. Carotid sinus massage is for supraventricular tachycardia.
Q7: A client with a history of hypertension presents to the emergency department with a blood pressure
of 210/130 mmHg, severe headache, confusion, and blurred vision. Which of the following nursing
interventions is the PRIORITY?
A. Administering an antihypertensive PO medication
B. Preparing for IV antihypertensive therapy with continuous monitoring [CORRECT]
C. Encouraging the client to rest in a quiet, darkened room
D. Applying a cool compress to the forehead
Correct Answer: B
Rationale: This client is experiencing a hypertensive crisis with evidence of target organ damage (neurologic symptoms). IV
antihypertensive medications (labetalol, nicardipine) are the PRIORITY because they provide rapid, controlled BP
reduction. BP should be lowered gradually, not more than 25% in the first hour, to prevent cerebral hypoperfusion. PO
medications take too long. Rest and cool compresses do not address the life-threatening hypertension.
Q8: A nurse is providing discharge teaching to a client with hypertension. Which of the following
statements by the client indicates an understanding of the DASH diet?
A. I will limit my sodium intake to 5 g per day.
B. I will increase my intake of fruits, vegetables, and low-fat dairy products. [CORRECT]
C. I will avoid all protein sources including lean meats and fish.
D. I will replace table salt with sea salt only.
ATI RN Medical-Surgical Nursing Proctored Examination 2026
