PN ADULT MEDICAL-SURGICAL NURSING — EDITION 12.0
VERIFIED QUESTIONS AND CORRECT ANSWERS
2026/2027 Academic Year
Aligned with the ATI PN Adult Medical-Surgical Nursing Content Mastery Series, NCLEX-PN Test Plan, and Evidence-Based
Medical-Surgical Nursing Practice Standards (2026/2027 Edition).
120 Questions | 11 Sections | Cognitive Mix: 20% Recall, 50% Application, 30% Analysis | Includes Prioritization, Pharmacology,
and Assessment Items
Section 1: Cardiovascular System Disorders
Q1: A 58-year-old male with a 10-year history of essential hypertension is being discharged on hydrochlorothiazide
25 mg daily. Which statement by the patient indicates the discharge teaching has been effective?
A. I will take the medication at bedtime to prevent dizziness during the day.
B. I should eat a diet high in potassium-rich foods such as bananas and oranges. [CORRECT]
C. I will restrict my fluid intake to less than 1,000 mL per day to prevent fluid overload.
D. I should stop taking the medication if my blood pressure returns to normal.
Correct Answer: B
Rationale: Hydrochlorothiazide is a thiazide diuretic that causes potassium loss, so patients must increase dietary potassium
intake (bananas, oranges, spinach) to prevent hypokalemia. Taking the medication at bedtime causes nocturia and sleep
disruption (should be taken in the morning). Fluid restriction is unnecessary and contraindicated. Antihypertensives must be
continued even when BP normalizes because the medication is controlling the condition (ATI PN Adult Medical-Surgical,
NCLEX-PN pharmacology standard).
Q2: The nurse is caring for four patients with heart failure. Which patient should the nurse assess FIRST?
A. A patient who gained 1 lb (0.5 kg) over the past 24 hours and reports mild fatigue.
B. A patient with dyspnea at rest, bilateral crackles halfway up the posterior chest, and a respiratory rate of
32/min. [CORRECT]
C. A patient who reports a 2-lb (0.9 kg) weekly weight gain and 1+ pitting edema of the ankles.
D. A patient receiving furosemide who voided 500 mL in the last 4 hours and reports feeling slightly weak.
Correct Answer: B
Rationale: Dyspnea at rest, bilateral crackles to mid-chest, and tachypnea (RR 32) indicate acute pulmonary edema and
severe decompensated heart failure requiring immediate intervention (priority ABC framework - airway/breathing first). The
other patients exhibit expected or mild symptoms of HF. A 1-lb daily weight gain warrants monitoring but is not acute; 2-lb
weekly gain with 1+ edema is stable CHF; the patient on furosemide is responding to therapy (ATI PN prioritization,
Maslow's physiological priority).
ATI PN Adult Medical-Surgical Nursing Content Mastery Series | NCLEX-PN Test Plan Aligned
,PN Adult Medical-Surgical Nursing - Edition 12.0 - 2026/2027 Academic Year Page 2
Q3: A patient with coronary artery disease is prescribed a low-dose aspirin (81 mg) daily. The nurse understands the
primary purpose of this medication is to:
A. Reduce the workload of the heart by lowering blood pressure.
B. Prevent platelet aggregation and reduce the risk of thrombus formation. [CORRECT]
C. Dissolve existing clots in the coronary arteries.
D. Decrease serum cholesterol levels to slow atherosclerosis.
Correct Answer: B
Rationale: Low-dose aspirin (81 mg) irreversibly inhibits cyclooxygenase-1 in platelets, preventing thromboxane A2
formation and thereby inhibiting platelet aggregation - reducing the risk of arterial thrombus formation in CAD. Aspirin does
not lower BP, dissolve existing clots (thrombolytics do), or reduce cholesterol (statins do). This is a secondary prevention
strategy in CAD per ATI PN Adult Medical-Surgical and American Heart Association guidelines.
Q4: A patient is admitted with chest pain suggestive of acute myocardial infarction. Which laboratory finding is MOST
specific for myocardial injury and would the nurse expect to monitor?
A. Creatine kinase-MB (CK-MB) elevated within 2-4 hours.
B. Troponin I elevated above 0.04 ng/mL. [CORRECT]
C. Myoglobin elevated within 1-2 hours.
D. LDH-1 greater than LDH-2 (flipped ratio).
Correct Answer: B
Rationale: Cardiac troponin I (and troponin T) is the gold-standard biomarker for myocardial injury because it is highly
specific to cardiac muscle, rises within 3-4 hours, peaks at 10-24 hours, and remains elevated for 7-10 days. CK-MB rises in
4-6 hours but is less specific (also found in skeletal muscle). Myoglobin rises earliest but is nonspecific. LDH is no longer
routinely used due to low specificity. ATI PN Adult Medical-Surgical curriculum emphasizes troponin as the priority cardiac
biomarker.
Q5: A patient with stable angina is instructed to use sublingual nitroglycerin 0.4 mg PRN for chest pain. Which
sequence of actions should the nurse teach the patient to follow when chest pain occurs?
A. Take one tablet, lie down, and call 911 if pain is not relieved in 30 minutes.
B. Stop activity, sit down, take one tablet; if pain is unrelieved in 5 minutes, call 911 and may repeat dose up to
two more times 5 minutes apart. [CORRECT]
C. Take three tablets at once and rest quietly for 15 minutes before calling for help.
D. Take one tablet every 10 minutes up to six doses, then seek emergency care if pain persists.
Correct Answer: B
Rationale: Per ATI PN and American Heart Association guidelines: stop activity, sit or lie down (prevents syncope from
vasodilation), take one SL nitroglycerin tablet. If pain is unrelieved in 5 minutes, call 911 immediately and may take
additional doses at 5-minute intervals up to a total of three tablets. Taking multiple tablets simultaneously risks severe
hypotension. Waiting 30 minutes before calling 911 delays critical thrombolytic therapy in evolving MI.
ATI PN Adult Medical-Surgical Nursing Content Mastery Series | NCLEX-PN Test Plan Aligned
,PN Adult Medical-Surgical Nursing - Edition 12.0 - 2026/2027 Academic Year Page 3
Q6: A 65-year-old patient with peripheral arterial disease (PAD) reports calf pain that occurs after walking two blocks
and is relieved by rest. The nurse identifies this symptom as:
A. Venous stasis ulceration requiring compression therapy.
B. Intermittent claudication indicating arterial insufficiency. [CORRECT]
C. Deep vein thrombosis requiring immediate anticoagulation.
D. Peripheral neuropathy associated with diabetes mellitus.
Correct Answer: B
Rationale: Intermittent claudication - reproducible calf/buttock pain with activity that is relieved by rest - is the hallmark
symptom of PAD caused by inadequate arterial blood flow during exertion. This is different from DVT (unilateral edema,
warmth, pain at rest), venous stasis ulcers (medial malleolus, edema, brown pigmentation), or neuropathy (burning, tingling,
often bilateral). ATI PN Adult Medical-Surgical curriculum identifies intermittent claudication as the priority assessment
finding for PAD.
Q7: The nurse is reviewing the electrocardiogram (ECG) of a patient admitted with chest pain and identifies an
ST-segment elevation in leads II, III, and aVF. The nurse recognizes this finding indicates an acute injury in which area
of the heart?
A. Anterior wall of the left ventricle.
B. Lateral wall of the left ventricle.
C. Inferior wall of the left ventricle. [CORRECT]
D. Septal wall of the left ventricle.
Correct Answer: C
Rationale: ST-segment elevation in leads II, III, and aVF indicates an acute inferior wall myocardial infarction, typically
caused by occlusion of the right coronary artery (RCA). Anterior wall MI shows ST elevation in V1-V4 (left anterior
descending artery); lateral wall MI in I, aVL, V5-V6 (circumflex); septal MI in V1-V2. ATI PN Adult Medical-Surgical
content includes basic ECG lead correlation with myocardial anatomy.
Q8: A patient is scheduled for an exercise stress test. Which instruction should the nurse include in the
pre-procedure teaching?
A. Eat a full meal 1 hour before the test to maintain energy.
B. Wear comfortable clothing and rubber-soled walking shoes. [CORRECT]
C. Discontinue all prescribed cardiac medications 3 days prior to the test.
D. Consume at least 2 liters of caffeine-containing fluids to enhance exercise tolerance.
Correct Answer: B
Rationale: Patients should wear comfortable, loose-fitting clothing and rubber-soled shoes for the treadmill. They should be
NPO for at least 2-4 hours (or per facility protocol) before the test. Caffeine should be avoided for 12-24 hours because it can
interfere with test results if a pharmacologic agent such as regadenoson is used. Cardiac medications are held only on
specific provider order. ATI PN Adult Medical-Surgical nursing emphasizes patient preparation for diagnostic procedures.
ATI PN Adult Medical-Surgical Nursing Content Mastery Series | NCLEX-PN Test Plan Aligned
, PN Adult Medical-Surgical Nursing - Edition 12.0 - 2026/2027 Academic Year Page 4
Q9: A patient admitted with acute decompensated heart failure has a pulmonary artery catheter in place. The nurse
notes a pulmonary artery wedge pressure (PAWP) of 24 mm Hg. The nurse understands this value indicates:
A. Hypovolemia requiring fluid administration.
B. Normal left ventricular filling pressure.
C. Elevated left ventricular preload consistent with fluid overload. [CORRECT]
D. Acute right ventricular failure requiring inotropic support.
Correct Answer: C
Rationale: Normal PAWP ranges from 4-12 mm Hg and reflects left ventricular end-diastolic pressure (preload). A PAWP
of 24 mm Hg is significantly elevated, indicating increased left ventricular filling pressure and fluid overload - classic for
acute decompensated heart failure. Treatment includes diuresis and afterload reduction. PAWP less than 4 indicates
hypovolemia; PAWP 18-20 represents mild elevation. ATI PN Adult Medical-Surgical includes hemodynamic monitoring
principles.
Q10: A patient receives alteplase (tPA) for an acute ST-elevation myocardial infarction. Which finding would require
the nurse to STOP the infusion immediately?
A. Blood pressure decrease from 138/82 to 118/72 mm Hg.
B. Heart rate increase from 78 to 92 beats/min.
C. Sudden onset of severe headache with altered level of consciousness. [CORRECT]
D. Decrease in ST-segment elevation on the ECG monitor.
Correct Answer: C
Rationale: A sudden severe headache with altered level of consciousness suggests intracranial hemorrhage - the most
life-threatening complication of thrombolytic therapy. The infusion must be stopped immediately, the provider notified, and
a STAT non-contrast CT of the head obtained. Mild BP drop and slight HR increase are common. ST-segment resolution
indicates successful reperfusion (desired effect). ATI PN Adult Medical-Surgical content specifies bleeding precautions
during thrombolytic therapy.
Q11: A patient receiving a continuous heparin infusion for a deep vein thrombosis has an activated partial
thromboplastin time (aPTT) of 110 seconds (control 30 seconds). The provider orders protamine sulfate. The nurse
should:
A. Administer protamine sulfate IV push rapidly over 1 minute to reverse anticoagulation.
B. Administer protamine sulfate by slow IV infusion over 10 minutes, as ordered, monitoring for hypotension
and bradycardia. [CORRECT]
C. Hold the heparin infusion only and recheck aPTT in 4 hours before giving protamine.
D. Discontinue the heparin infusion and administer vitamin K intramuscularly.
Correct Answer: B
Rationale: Protamine sulfate is the specific antagonist for heparin and must be administered by very slow IV infusion (over
1-10 minutes depending on dose) to avoid severe hypotension, bradycardia, and anaphylaxis. The aPTT of 110 seconds is
significantly above therapeutic range (1.5-2.5 times control, or approximately 45-80 seconds). Rapid IV push is
contraindicated. Vitamin K reverses warfarin, not heparin. ATI PN Adult Medical-Surgical pharmacology standards
emphasize safe heparin reversal.
ATI PN Adult Medical-Surgical Nursing Content Mastery Series | NCLEX-PN Test Plan Aligned
VERIFIED QUESTIONS AND CORRECT ANSWERS
2026/2027 Academic Year
Aligned with the ATI PN Adult Medical-Surgical Nursing Content Mastery Series, NCLEX-PN Test Plan, and Evidence-Based
Medical-Surgical Nursing Practice Standards (2026/2027 Edition).
120 Questions | 11 Sections | Cognitive Mix: 20% Recall, 50% Application, 30% Analysis | Includes Prioritization, Pharmacology,
and Assessment Items
Section 1: Cardiovascular System Disorders
Q1: A 58-year-old male with a 10-year history of essential hypertension is being discharged on hydrochlorothiazide
25 mg daily. Which statement by the patient indicates the discharge teaching has been effective?
A. I will take the medication at bedtime to prevent dizziness during the day.
B. I should eat a diet high in potassium-rich foods such as bananas and oranges. [CORRECT]
C. I will restrict my fluid intake to less than 1,000 mL per day to prevent fluid overload.
D. I should stop taking the medication if my blood pressure returns to normal.
Correct Answer: B
Rationale: Hydrochlorothiazide is a thiazide diuretic that causes potassium loss, so patients must increase dietary potassium
intake (bananas, oranges, spinach) to prevent hypokalemia. Taking the medication at bedtime causes nocturia and sleep
disruption (should be taken in the morning). Fluid restriction is unnecessary and contraindicated. Antihypertensives must be
continued even when BP normalizes because the medication is controlling the condition (ATI PN Adult Medical-Surgical,
NCLEX-PN pharmacology standard).
Q2: The nurse is caring for four patients with heart failure. Which patient should the nurse assess FIRST?
A. A patient who gained 1 lb (0.5 kg) over the past 24 hours and reports mild fatigue.
B. A patient with dyspnea at rest, bilateral crackles halfway up the posterior chest, and a respiratory rate of
32/min. [CORRECT]
C. A patient who reports a 2-lb (0.9 kg) weekly weight gain and 1+ pitting edema of the ankles.
D. A patient receiving furosemide who voided 500 mL in the last 4 hours and reports feeling slightly weak.
Correct Answer: B
Rationale: Dyspnea at rest, bilateral crackles to mid-chest, and tachypnea (RR 32) indicate acute pulmonary edema and
severe decompensated heart failure requiring immediate intervention (priority ABC framework - airway/breathing first). The
other patients exhibit expected or mild symptoms of HF. A 1-lb daily weight gain warrants monitoring but is not acute; 2-lb
weekly gain with 1+ edema is stable CHF; the patient on furosemide is responding to therapy (ATI PN prioritization,
Maslow's physiological priority).
ATI PN Adult Medical-Surgical Nursing Content Mastery Series | NCLEX-PN Test Plan Aligned
,PN Adult Medical-Surgical Nursing - Edition 12.0 - 2026/2027 Academic Year Page 2
Q3: A patient with coronary artery disease is prescribed a low-dose aspirin (81 mg) daily. The nurse understands the
primary purpose of this medication is to:
A. Reduce the workload of the heart by lowering blood pressure.
B. Prevent platelet aggregation and reduce the risk of thrombus formation. [CORRECT]
C. Dissolve existing clots in the coronary arteries.
D. Decrease serum cholesterol levels to slow atherosclerosis.
Correct Answer: B
Rationale: Low-dose aspirin (81 mg) irreversibly inhibits cyclooxygenase-1 in platelets, preventing thromboxane A2
formation and thereby inhibiting platelet aggregation - reducing the risk of arterial thrombus formation in CAD. Aspirin does
not lower BP, dissolve existing clots (thrombolytics do), or reduce cholesterol (statins do). This is a secondary prevention
strategy in CAD per ATI PN Adult Medical-Surgical and American Heart Association guidelines.
Q4: A patient is admitted with chest pain suggestive of acute myocardial infarction. Which laboratory finding is MOST
specific for myocardial injury and would the nurse expect to monitor?
A. Creatine kinase-MB (CK-MB) elevated within 2-4 hours.
B. Troponin I elevated above 0.04 ng/mL. [CORRECT]
C. Myoglobin elevated within 1-2 hours.
D. LDH-1 greater than LDH-2 (flipped ratio).
Correct Answer: B
Rationale: Cardiac troponin I (and troponin T) is the gold-standard biomarker for myocardial injury because it is highly
specific to cardiac muscle, rises within 3-4 hours, peaks at 10-24 hours, and remains elevated for 7-10 days. CK-MB rises in
4-6 hours but is less specific (also found in skeletal muscle). Myoglobin rises earliest but is nonspecific. LDH is no longer
routinely used due to low specificity. ATI PN Adult Medical-Surgical curriculum emphasizes troponin as the priority cardiac
biomarker.
Q5: A patient with stable angina is instructed to use sublingual nitroglycerin 0.4 mg PRN for chest pain. Which
sequence of actions should the nurse teach the patient to follow when chest pain occurs?
A. Take one tablet, lie down, and call 911 if pain is not relieved in 30 minutes.
B. Stop activity, sit down, take one tablet; if pain is unrelieved in 5 minutes, call 911 and may repeat dose up to
two more times 5 minutes apart. [CORRECT]
C. Take three tablets at once and rest quietly for 15 minutes before calling for help.
D. Take one tablet every 10 minutes up to six doses, then seek emergency care if pain persists.
Correct Answer: B
Rationale: Per ATI PN and American Heart Association guidelines: stop activity, sit or lie down (prevents syncope from
vasodilation), take one SL nitroglycerin tablet. If pain is unrelieved in 5 minutes, call 911 immediately and may take
additional doses at 5-minute intervals up to a total of three tablets. Taking multiple tablets simultaneously risks severe
hypotension. Waiting 30 minutes before calling 911 delays critical thrombolytic therapy in evolving MI.
ATI PN Adult Medical-Surgical Nursing Content Mastery Series | NCLEX-PN Test Plan Aligned
,PN Adult Medical-Surgical Nursing - Edition 12.0 - 2026/2027 Academic Year Page 3
Q6: A 65-year-old patient with peripheral arterial disease (PAD) reports calf pain that occurs after walking two blocks
and is relieved by rest. The nurse identifies this symptom as:
A. Venous stasis ulceration requiring compression therapy.
B. Intermittent claudication indicating arterial insufficiency. [CORRECT]
C. Deep vein thrombosis requiring immediate anticoagulation.
D. Peripheral neuropathy associated with diabetes mellitus.
Correct Answer: B
Rationale: Intermittent claudication - reproducible calf/buttock pain with activity that is relieved by rest - is the hallmark
symptom of PAD caused by inadequate arterial blood flow during exertion. This is different from DVT (unilateral edema,
warmth, pain at rest), venous stasis ulcers (medial malleolus, edema, brown pigmentation), or neuropathy (burning, tingling,
often bilateral). ATI PN Adult Medical-Surgical curriculum identifies intermittent claudication as the priority assessment
finding for PAD.
Q7: The nurse is reviewing the electrocardiogram (ECG) of a patient admitted with chest pain and identifies an
ST-segment elevation in leads II, III, and aVF. The nurse recognizes this finding indicates an acute injury in which area
of the heart?
A. Anterior wall of the left ventricle.
B. Lateral wall of the left ventricle.
C. Inferior wall of the left ventricle. [CORRECT]
D. Septal wall of the left ventricle.
Correct Answer: C
Rationale: ST-segment elevation in leads II, III, and aVF indicates an acute inferior wall myocardial infarction, typically
caused by occlusion of the right coronary artery (RCA). Anterior wall MI shows ST elevation in V1-V4 (left anterior
descending artery); lateral wall MI in I, aVL, V5-V6 (circumflex); septal MI in V1-V2. ATI PN Adult Medical-Surgical
content includes basic ECG lead correlation with myocardial anatomy.
Q8: A patient is scheduled for an exercise stress test. Which instruction should the nurse include in the
pre-procedure teaching?
A. Eat a full meal 1 hour before the test to maintain energy.
B. Wear comfortable clothing and rubber-soled walking shoes. [CORRECT]
C. Discontinue all prescribed cardiac medications 3 days prior to the test.
D. Consume at least 2 liters of caffeine-containing fluids to enhance exercise tolerance.
Correct Answer: B
Rationale: Patients should wear comfortable, loose-fitting clothing and rubber-soled shoes for the treadmill. They should be
NPO for at least 2-4 hours (or per facility protocol) before the test. Caffeine should be avoided for 12-24 hours because it can
interfere with test results if a pharmacologic agent such as regadenoson is used. Cardiac medications are held only on
specific provider order. ATI PN Adult Medical-Surgical nursing emphasizes patient preparation for diagnostic procedures.
ATI PN Adult Medical-Surgical Nursing Content Mastery Series | NCLEX-PN Test Plan Aligned
, PN Adult Medical-Surgical Nursing - Edition 12.0 - 2026/2027 Academic Year Page 4
Q9: A patient admitted with acute decompensated heart failure has a pulmonary artery catheter in place. The nurse
notes a pulmonary artery wedge pressure (PAWP) of 24 mm Hg. The nurse understands this value indicates:
A. Hypovolemia requiring fluid administration.
B. Normal left ventricular filling pressure.
C. Elevated left ventricular preload consistent with fluid overload. [CORRECT]
D. Acute right ventricular failure requiring inotropic support.
Correct Answer: C
Rationale: Normal PAWP ranges from 4-12 mm Hg and reflects left ventricular end-diastolic pressure (preload). A PAWP
of 24 mm Hg is significantly elevated, indicating increased left ventricular filling pressure and fluid overload - classic for
acute decompensated heart failure. Treatment includes diuresis and afterload reduction. PAWP less than 4 indicates
hypovolemia; PAWP 18-20 represents mild elevation. ATI PN Adult Medical-Surgical includes hemodynamic monitoring
principles.
Q10: A patient receives alteplase (tPA) for an acute ST-elevation myocardial infarction. Which finding would require
the nurse to STOP the infusion immediately?
A. Blood pressure decrease from 138/82 to 118/72 mm Hg.
B. Heart rate increase from 78 to 92 beats/min.
C. Sudden onset of severe headache with altered level of consciousness. [CORRECT]
D. Decrease in ST-segment elevation on the ECG monitor.
Correct Answer: C
Rationale: A sudden severe headache with altered level of consciousness suggests intracranial hemorrhage - the most
life-threatening complication of thrombolytic therapy. The infusion must be stopped immediately, the provider notified, and
a STAT non-contrast CT of the head obtained. Mild BP drop and slight HR increase are common. ST-segment resolution
indicates successful reperfusion (desired effect). ATI PN Adult Medical-Surgical content specifies bleeding precautions
during thrombolytic therapy.
Q11: A patient receiving a continuous heparin infusion for a deep vein thrombosis has an activated partial
thromboplastin time (aPTT) of 110 seconds (control 30 seconds). The provider orders protamine sulfate. The nurse
should:
A. Administer protamine sulfate IV push rapidly over 1 minute to reverse anticoagulation.
B. Administer protamine sulfate by slow IV infusion over 10 minutes, as ordered, monitoring for hypotension
and bradycardia. [CORRECT]
C. Hold the heparin infusion only and recheck aPTT in 4 hours before giving protamine.
D. Discontinue the heparin infusion and administer vitamin K intramuscularly.
Correct Answer: B
Rationale: Protamine sulfate is the specific antagonist for heparin and must be administered by very slow IV infusion (over
1-10 minutes depending on dose) to avoid severe hypotension, bradycardia, and anaphylaxis. The aPTT of 110 seconds is
significantly above therapeutic range (1.5-2.5 times control, or approximately 45-80 seconds). Rapid IV push is
contraindicated. Vitamin K reverses warfarin, not heparin. ATI PN Adult Medical-Surgical pharmacology standards
emphasize safe heparin reversal.
ATI PN Adult Medical-Surgical Nursing Content Mastery Series | NCLEX-PN Test Plan Aligned
