RN
A T I R N M E D I C A L- S U R G I C A L P R O C T O R E D E X A M I N A T I O N
ATI RN
Med-Surg Exam
2026/2027 Edition
180 NGN Exam Questions with Detailed Answer Key.
Aligned with ATI Proctored Examination Content and
Next Generation NCLEX (NGN) Style Preparation.
Evidence-Based Practice | Clinical Judgment Focus
Comprehensive NGN Test Bank
2026/2027 Edition
8 Clinical Domains | Scenario-Based Questions
1 8 0 N G N Q U E S T I ON S | 8 S E C T I ON S
AT I R N M E D I C A L - S U R G I C A L | N G N - S T Y L E P R E P A R AT I O N
, ATI RN Medical-Surgical Proctored Exam | 2026/2027 Edition
180 NGN Questions with Detailed Answer Key | Evidence-Based Practice
Section 1: Cardiovascular System
Acute Coronary Syndromes, Heart Failure, Valvular Disease, Dysrhythmias, Hypertension, Peripheral Vascular Disease, and Hemodynamic
Monitoring
Q1: A nurse in the emergency department is assessing a client who has a history of heart failure. Which of the following
findings should the nurse identify as a priority concern?
A. Dyspnea on exertion and bilateral ankle edema [CORRECT]
B. Weight gain of 0.5 kg (1.1 lb) over the past week
C. Decreased appetite and fatigue
D. Occasional dry cough at night
Correct Answer: A
Rationale: Dyspnea on exertion and bilateral ankle edema are classic signs of fluid volume overload and worsening heart failure, making
this the priority finding. While weight gain, decreased appetite, fatigue, and nocturnal cough are also associated with heart failure, the
presence of both dyspnea and edema indicates a more acute exacerbation requiring immediate intervention. The nurse should prioritize
findings that reflect the greatest threat to the client's oxygenation and hemodynamic stability.
Q2: A nurse is caring for a client admitted with acute decompensated heart failure who has crackles throughout the
lungs, jugular venous distention, and oxygen saturation of 88% on room air. Which of the following medications should
the nurse expect to administer first?
A. Furosemide 40 mg IV push
B. Oxygen 4 L via nasal cannula [CORRECT]
C. Morphine sulfate 2 mg IV
D. Nitroglycerin 0.4 mg sublingual
Correct Answer: B
Rationale: Oxygen should be administered first to address the client's hypoxemia (SpO2 88%), following the ABC (airway, breathing,
circulation) approach to care. While furosemide, morphine, and nitroglycerin are all appropriate medications for acute decompensated heart
failure, oxygenation must be established before administering other therapies. Once the client's oxygenation is stabilized, diuretics,
vasodilators, and analgesics can be given to reduce preload and afterload.
Q3: A nurse is reviewing the medication list for a client who is taking digoxin. Which of the following findings should the
nurse identify as an early indication of digoxin toxicity?
A. Tachycardia and hypertension
B. Hyperactive deep tendon reflexes
C. Nausea, vomiting, and anorexia [CORRECT]
D. Increased urine output and thirst
Correct Answer: C
Rationale: Gastrointestinal symptoms such as nausea, vomiting, and anorexia are often the earliest manifestations of digoxin toxicity and
should prompt the nurse to hold the medication and notify the provider. Digoxin has a narrow therapeutic index, and toxicity can progress to
life-threatening cardiac dysrhythmias if not identified early. Tachycardia, hyperactive reflexes, and increased urine output are not associated
with digoxin toxicity.
Q4: A nurse is preparing to administer digoxin 0.25 mg PO to a client. The client's apical pulse is 52 bpm. Which of the
following actions should the nurse take?
A. Administer the medication and recheck the pulse in 1 hour
B. Administer half the prescribed dose
ATI RN Medical-Surgical Exam | 2026/2027 Edition | 180 NGN Questions | Page 1
, C. Give the medication with a snack to reduce GI upset
D. Withhold the medication and notify the provider [CORRECT]
Correct Answer: D
Rationale: The nurse should withhold the digoxin because the client's apical pulse is below 60 bpm, which is the standard protocol before
administering this medication. Digoxin slows AV node conduction and increases vagal tone, which can lead to severe bradycardia and heart
block. The nurse must notify the provider, who may order a serum digoxin level and potassium level before determining whether to resume
therapy.
Q5: A nurse is reviewing laboratory results for a client who reports chest pain. The troponin I level is 0.8 ng/mL and the
CK-MB is elevated. The ECG shows ST-segment elevation in leads II, III, and aVF. The nurse should recognize that these
findings indicate which of the following?
A. An acute ST-elevation myocardial infarction (STEMI) of the inferior wall [CORRECT]
B. A non-ST-elevation myocardial infarction (NSTEMI)
C. Unstable angina with elevated cardiac biomarkers
D. A previous myocardial infarction with reinfarction
Correct Answer: A
Rationale: The combination of ST-segment elevation on ECG and elevated cardiac biomarkers (troponin I and CK-MB) is diagnostic of an
acute STEMI. The involvement of leads II, III, and aVF localizes the infarction to the inferior wall of the left ventricle. NSTEMI presents
with elevated biomarkers but without ST-segment elevation, and unstable angina typically does not show significant biomarker elevation.
Q6: A nurse is caring for a client following a myocardial infarction. The provider orders serial troponin levels. The nurse
should understand that troponin levels typically peak at which of the following time frames after myocardial injury?
A. 3 to 6 hours
B. 12 to 24 hours [CORRECT]
C. 36 to 48 hours
D. 72 to 96 hours
Correct Answer: B
Rationale: Troponin I and T levels typically peak at 12 to 24 hours after myocardial injury and may remain elevated for 7 to 10 days. This
prolonged elevation makes troponin the most sensitive and specific biomarker for diagnosing myocardial infarction. CK-MB, in contrast,
peaks earlier at 12 to 24 hours but returns to normal within 48 to 72 hours.
Q7: A nurse is providing discharge teaching to a client following a percutaneous coronary intervention (PCI) with stent
placement. Which of the following statements by the client indicates an understanding of the teaching?
A. "I should stop taking clopidogrel after 1 month."
B. "I will avoid walking for at least 2 weeks."
C. "I will take aspirin and clopidogrel exactly as prescribed to prevent stent thrombosis." [CORRECT]
D. "I can resume smoking in moderation since the stent fixed the blockage."
Correct Answer: C
Rationale: Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor such as clopidogrel is essential to prevent stent thrombosis
following PCI. The client's statement about taking both medications as prescribed demonstrates correct understanding. Clopidogrel is
typically continued for at least 6 to 12 months depending on stent type, walking is encouraged after discharge, and smoking cessation is
critical to prevent further coronary artery disease progression.
Q8: A nurse in the emergency department is caring for a client who is being considered for thrombolytic therapy
following an acute myocardial infarction. Which of the following findings in the client's history is a contraindication to
this therapy?
A. History of hypertension controlled with medication
B. Type 2 diabetes mellitus
C. Previous coronary artery bypass graft surgery
D. Recent intracranial surgery within the past 2 months [CORRECT]
ATI RN Medical-Surgical Exam | 2026/2027 Edition | 180 NGN Questions | Page 2
, Correct Answer: D
Rationale: Recent intracranial surgery or trauma is an absolute contraindication to thrombolytic therapy due to the high risk of fatal
intracranial hemorrhage. Thrombolytic agents dissolve clots by activating plasminogen, which can cause severe bleeding at any site.
Controlled hypertension, diabetes mellitus, and prior CABG are not contraindications and do not preclude the use of thrombolytic therapy.
Q9: A nurse is caring for a client receiving a continuous heparin infusion for a pulmonary embolism. The aPTT is 98
seconds and the client has oozing from the IV site. Which of the following actions should the nurse take first?
A. Stop the heparin infusion [CORRECT]
B. Administer protamine sulfate IV
C. Apply a pressure dressing to the IV site
D. Request a repeat aPTT in 4 hours
Correct Answer: A
Rationale: The nurse should first stop the heparin infusion because the aPTT of 98 seconds is significantly above the therapeutic range, and
the client is showing signs of bleeding (oozing from the IV site). Stopping the infusion eliminates the source of the anticoagulant effect.
Protamine sulfate is the antidote for heparin but requires a provider's order before administration. Applying pressure to the IV site is
appropriate but does not address the systemic anticoagulation. Waiting 4 hours for a repeat aPTT would delay necessary intervention.
Q10: A nurse is assessing a client with new-onset atrial fibrillation. The client's heart rate is 148 bpm and blood pressure
is 102/68 mmHg. Which of the following interventions should the nurse anticipate?
A. Immediate synchronized cardioversion
B. Administration of a rate-control medication such as diltiazem [CORRECT]
C. Defibrillation at 200 joules
D. Initiation of cardiopulmonary resuscitation
Correct Answer: B
Rationale: For a stable client with atrial fibrillation who has adequate blood pressure and no signs of hemodynamic instability, the priority
intervention is rate control with medications such as diltiazem, metoprolol, or amiodarone. Synchronized cardioversion is reserved for
hemodynamically unstable clients with hypotension, altered mental status, or ischemic chest pain. Defibrillation is used for pulseless
ventricular fibrillation or pulseless ventricular tachycardia, not for atrial fibrillation. CPR is not indicated for a client who has a pulse.
Q11: A nurse is monitoring a client on a cardiac telemetry unit when the monitor shows ventricular tachycardia. The
client is responsive and reports feeling dizzy. The nurse should take which of the following actions first?
A. Begin chest compressions
B. Administer amiodarone 300 mg IV push
C. Assess the client's pulse and blood pressure [CORRECT]
D. Prepare for immediate defibrillation
Correct Answer: C
Rationale: The nurse should first assess the client's pulse and blood pressure to determine whether the ventricular tachycardia is perfusing
(with a pulse) or non-perfusing (pulseless), as this determines the appropriate intervention. If the client has a pulse and is hemodynamically
unstable, synchronized cardioversion is indicated. If the client is pulseless, defibrillation and CPR are required. The client's dizziness
suggests possible hemodynamic compromise, but a pulse check is essential before initiating any intervention.
Q12: A nurse is reviewing the cardiac rhythm strip of a client and notes frequent premature ventricular contractions
(PVCs). Which of the following findings should the nurse report to the provider immediately?
A. Occasional PVCs occurring every 10 to 12 beats
B. PVCs that are unifocal in appearance
C. A single PVC following each normal QRS complex
D. Multifocal PVCs occurring in runs of three or more [CORRECT]
Correct Answer: D
Rationale: Multifocal PVCs occurring in runs of three or more constitute ventricular tachycardia, which is a life-threatening dysrhythmia
requiring immediate provider notification and intervention. Multifocal PVCs originate from multiple ectopic foci and indicate greater
electrical instability than unifocal PVCs. Occasional unifocal PVCs are relatively common and may not require treatment unless associated
ATI RN Medical-Surgical Exam | 2026/2027 Edition | 180 NGN Questions | Page 3
A T I R N M E D I C A L- S U R G I C A L P R O C T O R E D E X A M I N A T I O N
ATI RN
Med-Surg Exam
2026/2027 Edition
180 NGN Exam Questions with Detailed Answer Key.
Aligned with ATI Proctored Examination Content and
Next Generation NCLEX (NGN) Style Preparation.
Evidence-Based Practice | Clinical Judgment Focus
Comprehensive NGN Test Bank
2026/2027 Edition
8 Clinical Domains | Scenario-Based Questions
1 8 0 N G N Q U E S T I ON S | 8 S E C T I ON S
AT I R N M E D I C A L - S U R G I C A L | N G N - S T Y L E P R E P A R AT I O N
, ATI RN Medical-Surgical Proctored Exam | 2026/2027 Edition
180 NGN Questions with Detailed Answer Key | Evidence-Based Practice
Section 1: Cardiovascular System
Acute Coronary Syndromes, Heart Failure, Valvular Disease, Dysrhythmias, Hypertension, Peripheral Vascular Disease, and Hemodynamic
Monitoring
Q1: A nurse in the emergency department is assessing a client who has a history of heart failure. Which of the following
findings should the nurse identify as a priority concern?
A. Dyspnea on exertion and bilateral ankle edema [CORRECT]
B. Weight gain of 0.5 kg (1.1 lb) over the past week
C. Decreased appetite and fatigue
D. Occasional dry cough at night
Correct Answer: A
Rationale: Dyspnea on exertion and bilateral ankle edema are classic signs of fluid volume overload and worsening heart failure, making
this the priority finding. While weight gain, decreased appetite, fatigue, and nocturnal cough are also associated with heart failure, the
presence of both dyspnea and edema indicates a more acute exacerbation requiring immediate intervention. The nurse should prioritize
findings that reflect the greatest threat to the client's oxygenation and hemodynamic stability.
Q2: A nurse is caring for a client admitted with acute decompensated heart failure who has crackles throughout the
lungs, jugular venous distention, and oxygen saturation of 88% on room air. Which of the following medications should
the nurse expect to administer first?
A. Furosemide 40 mg IV push
B. Oxygen 4 L via nasal cannula [CORRECT]
C. Morphine sulfate 2 mg IV
D. Nitroglycerin 0.4 mg sublingual
Correct Answer: B
Rationale: Oxygen should be administered first to address the client's hypoxemia (SpO2 88%), following the ABC (airway, breathing,
circulation) approach to care. While furosemide, morphine, and nitroglycerin are all appropriate medications for acute decompensated heart
failure, oxygenation must be established before administering other therapies. Once the client's oxygenation is stabilized, diuretics,
vasodilators, and analgesics can be given to reduce preload and afterload.
Q3: A nurse is reviewing the medication list for a client who is taking digoxin. Which of the following findings should the
nurse identify as an early indication of digoxin toxicity?
A. Tachycardia and hypertension
B. Hyperactive deep tendon reflexes
C. Nausea, vomiting, and anorexia [CORRECT]
D. Increased urine output and thirst
Correct Answer: C
Rationale: Gastrointestinal symptoms such as nausea, vomiting, and anorexia are often the earliest manifestations of digoxin toxicity and
should prompt the nurse to hold the medication and notify the provider. Digoxin has a narrow therapeutic index, and toxicity can progress to
life-threatening cardiac dysrhythmias if not identified early. Tachycardia, hyperactive reflexes, and increased urine output are not associated
with digoxin toxicity.
Q4: A nurse is preparing to administer digoxin 0.25 mg PO to a client. The client's apical pulse is 52 bpm. Which of the
following actions should the nurse take?
A. Administer the medication and recheck the pulse in 1 hour
B. Administer half the prescribed dose
ATI RN Medical-Surgical Exam | 2026/2027 Edition | 180 NGN Questions | Page 1
, C. Give the medication with a snack to reduce GI upset
D. Withhold the medication and notify the provider [CORRECT]
Correct Answer: D
Rationale: The nurse should withhold the digoxin because the client's apical pulse is below 60 bpm, which is the standard protocol before
administering this medication. Digoxin slows AV node conduction and increases vagal tone, which can lead to severe bradycardia and heart
block. The nurse must notify the provider, who may order a serum digoxin level and potassium level before determining whether to resume
therapy.
Q5: A nurse is reviewing laboratory results for a client who reports chest pain. The troponin I level is 0.8 ng/mL and the
CK-MB is elevated. The ECG shows ST-segment elevation in leads II, III, and aVF. The nurse should recognize that these
findings indicate which of the following?
A. An acute ST-elevation myocardial infarction (STEMI) of the inferior wall [CORRECT]
B. A non-ST-elevation myocardial infarction (NSTEMI)
C. Unstable angina with elevated cardiac biomarkers
D. A previous myocardial infarction with reinfarction
Correct Answer: A
Rationale: The combination of ST-segment elevation on ECG and elevated cardiac biomarkers (troponin I and CK-MB) is diagnostic of an
acute STEMI. The involvement of leads II, III, and aVF localizes the infarction to the inferior wall of the left ventricle. NSTEMI presents
with elevated biomarkers but without ST-segment elevation, and unstable angina typically does not show significant biomarker elevation.
Q6: A nurse is caring for a client following a myocardial infarction. The provider orders serial troponin levels. The nurse
should understand that troponin levels typically peak at which of the following time frames after myocardial injury?
A. 3 to 6 hours
B. 12 to 24 hours [CORRECT]
C. 36 to 48 hours
D. 72 to 96 hours
Correct Answer: B
Rationale: Troponin I and T levels typically peak at 12 to 24 hours after myocardial injury and may remain elevated for 7 to 10 days. This
prolonged elevation makes troponin the most sensitive and specific biomarker for diagnosing myocardial infarction. CK-MB, in contrast,
peaks earlier at 12 to 24 hours but returns to normal within 48 to 72 hours.
Q7: A nurse is providing discharge teaching to a client following a percutaneous coronary intervention (PCI) with stent
placement. Which of the following statements by the client indicates an understanding of the teaching?
A. "I should stop taking clopidogrel after 1 month."
B. "I will avoid walking for at least 2 weeks."
C. "I will take aspirin and clopidogrel exactly as prescribed to prevent stent thrombosis." [CORRECT]
D. "I can resume smoking in moderation since the stent fixed the blockage."
Correct Answer: C
Rationale: Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor such as clopidogrel is essential to prevent stent thrombosis
following PCI. The client's statement about taking both medications as prescribed demonstrates correct understanding. Clopidogrel is
typically continued for at least 6 to 12 months depending on stent type, walking is encouraged after discharge, and smoking cessation is
critical to prevent further coronary artery disease progression.
Q8: A nurse in the emergency department is caring for a client who is being considered for thrombolytic therapy
following an acute myocardial infarction. Which of the following findings in the client's history is a contraindication to
this therapy?
A. History of hypertension controlled with medication
B. Type 2 diabetes mellitus
C. Previous coronary artery bypass graft surgery
D. Recent intracranial surgery within the past 2 months [CORRECT]
ATI RN Medical-Surgical Exam | 2026/2027 Edition | 180 NGN Questions | Page 2
, Correct Answer: D
Rationale: Recent intracranial surgery or trauma is an absolute contraindication to thrombolytic therapy due to the high risk of fatal
intracranial hemorrhage. Thrombolytic agents dissolve clots by activating plasminogen, which can cause severe bleeding at any site.
Controlled hypertension, diabetes mellitus, and prior CABG are not contraindications and do not preclude the use of thrombolytic therapy.
Q9: A nurse is caring for a client receiving a continuous heparin infusion for a pulmonary embolism. The aPTT is 98
seconds and the client has oozing from the IV site. Which of the following actions should the nurse take first?
A. Stop the heparin infusion [CORRECT]
B. Administer protamine sulfate IV
C. Apply a pressure dressing to the IV site
D. Request a repeat aPTT in 4 hours
Correct Answer: A
Rationale: The nurse should first stop the heparin infusion because the aPTT of 98 seconds is significantly above the therapeutic range, and
the client is showing signs of bleeding (oozing from the IV site). Stopping the infusion eliminates the source of the anticoagulant effect.
Protamine sulfate is the antidote for heparin but requires a provider's order before administration. Applying pressure to the IV site is
appropriate but does not address the systemic anticoagulation. Waiting 4 hours for a repeat aPTT would delay necessary intervention.
Q10: A nurse is assessing a client with new-onset atrial fibrillation. The client's heart rate is 148 bpm and blood pressure
is 102/68 mmHg. Which of the following interventions should the nurse anticipate?
A. Immediate synchronized cardioversion
B. Administration of a rate-control medication such as diltiazem [CORRECT]
C. Defibrillation at 200 joules
D. Initiation of cardiopulmonary resuscitation
Correct Answer: B
Rationale: For a stable client with atrial fibrillation who has adequate blood pressure and no signs of hemodynamic instability, the priority
intervention is rate control with medications such as diltiazem, metoprolol, or amiodarone. Synchronized cardioversion is reserved for
hemodynamically unstable clients with hypotension, altered mental status, or ischemic chest pain. Defibrillation is used for pulseless
ventricular fibrillation or pulseless ventricular tachycardia, not for atrial fibrillation. CPR is not indicated for a client who has a pulse.
Q11: A nurse is monitoring a client on a cardiac telemetry unit when the monitor shows ventricular tachycardia. The
client is responsive and reports feeling dizzy. The nurse should take which of the following actions first?
A. Begin chest compressions
B. Administer amiodarone 300 mg IV push
C. Assess the client's pulse and blood pressure [CORRECT]
D. Prepare for immediate defibrillation
Correct Answer: C
Rationale: The nurse should first assess the client's pulse and blood pressure to determine whether the ventricular tachycardia is perfusing
(with a pulse) or non-perfusing (pulseless), as this determines the appropriate intervention. If the client has a pulse and is hemodynamically
unstable, synchronized cardioversion is indicated. If the client is pulseless, defibrillation and CPR are required. The client's dizziness
suggests possible hemodynamic compromise, but a pulse check is essential before initiating any intervention.
Q12: A nurse is reviewing the cardiac rhythm strip of a client and notes frequent premature ventricular contractions
(PVCs). Which of the following findings should the nurse report to the provider immediately?
A. Occasional PVCs occurring every 10 to 12 beats
B. PVCs that are unifocal in appearance
C. A single PVC following each normal QRS complex
D. Multifocal PVCs occurring in runs of three or more [CORRECT]
Correct Answer: D
Rationale: Multifocal PVCs occurring in runs of three or more constitute ventricular tachycardia, which is a life-threatening dysrhythmia
requiring immediate provider notification and intervention. Multifocal PVCs originate from multiple ectopic foci and indicate greater
electrical instability than unifocal PVCs. Occasional unifocal PVCs are relatively common and may not require treatment unless associated
ATI RN Medical-Surgical Exam | 2026/2027 Edition | 180 NGN Questions | Page 3
