ATI PN Adult Medical Surgical (Adult Med-
Surg) 2026 Level 3 Proctored Exam
Assessment | NGN Screenshots Featuring
100 Questions
Section 1: Cardiovascular and Hematologic Disorders (Questions 1–25)
1. A nurse is caring for a patient admitted with acute decompensated heart
failure. Which assessment finding requires the most immediate intervention?
A. Bilateral crackles in the lung bases
B. Distended jugular veins
C. Reports of orthopnea requiring three pillows
D. Pink, frothy sputum with severe dyspnea
Correct Answer: D
Rationale: Pink, frothy sputum accompanied by severe dyspnea indicates
pulmonary edema, a life-threatening condition requiring immediate intervention
to prevent respiratory failure. This finding reflects fluid accumulation in the alveoli
and represents an acute deterioration. Bilateral crackles, distended neck veins,
and orthopnea are expected findings in heart failure requiring prompt
management but do not constitute an immediately life-threatening crisis like
fulminant pulmonary edema.
2. 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
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).
3. 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."
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.
4. A nurse is caring for a client who has heart failure and is taking furosemide.
Which of the following findings indicates a therapeutic response to the
medication?
A. Weight gain of 2 kg in 24 hours
B. Decreased urine output
,C. Clear lung sounds bilaterally
D. Increased peripheral edema
Correct Answer: C
Rationale: Furosemide is a loop diuretic used to reduce fluid overload in heart
failure. Clear lung sounds indicate a reduction in pulmonary congestion, which is a
therapeutic response.
5. A nurse is caring for a client who has a new prescription for warfarin. Which of
the following laboratory values should the nurse monitor to evaluate the
effectiveness of the medication?
A. aPTT
B. INR
C. Platelet count
D. Hemoglobin
Correct Answer: B
Rationale: Warfarin is an anticoagulant that affects the extrinsic pathway. The
INR is the standard laboratory test used to monitor warfarin therapy and adjust
dosage.
6. A nurse is assessing a client who has been admitted with acute exacerbation of
chronic obstructive pulmonary disease (COPD). Which of the following assessment
findings should the nurse expect?
A. Decreased respiratory rate
B. Increased anteroposterior chest diameter
C. Clear breath sounds bilaterally
D. Elevated oxygen saturation of 98%
Correct Answer: B
, Rationale: Clients with COPD often develop a barrel-shaped chest due to
hyperinflation of the lungs, which increases the anteroposterior diameter. This is a
classic physical assessment finding in chronic COPD.
7. A nurse is caring for a client who is receiving total parenteral nutrition (TPN)
through a central line. The nurse notes the solution bag is nearly empty, and the
next bag is not yet available from the pharmacy. Which of the following solutions
should the nurse infuse to prevent hypoglycemia?
A. 0.9% sodium chloride
B. Lactated Ringer's solution
C. 10% dextrose in water
D. 0.45% sodium chloride
Correct Answer: C
Rationale: If TPN is interrupted, the nurse should infuse 10% dextrose in
water to prevent hypoglycemia, as the client's pancreas has been producing
insulin in response to the high glucose content of TPN.
8. A nurse is assessing a client who has an abdominal aortic aneurysm. Which of
the following manifestations should the nurse expect?
A. Lower back discomfort
B. Substernal chest pain
C. Left arm pain
D. Right upper quadrant pain
Correct Answer: A
Rationale: Abdominal aortic aneurysm involves a widening, stretching, or
ballooning of the aorta. Back and abdominal pain indicate that the aneurysm is
extending downward and pressing on lumbar spinal nerve roots, causing pain.
Surg) 2026 Level 3 Proctored Exam
Assessment | NGN Screenshots Featuring
100 Questions
Section 1: Cardiovascular and Hematologic Disorders (Questions 1–25)
1. A nurse is caring for a patient admitted with acute decompensated heart
failure. Which assessment finding requires the most immediate intervention?
A. Bilateral crackles in the lung bases
B. Distended jugular veins
C. Reports of orthopnea requiring three pillows
D. Pink, frothy sputum with severe dyspnea
Correct Answer: D
Rationale: Pink, frothy sputum accompanied by severe dyspnea indicates
pulmonary edema, a life-threatening condition requiring immediate intervention
to prevent respiratory failure. This finding reflects fluid accumulation in the alveoli
and represents an acute deterioration. Bilateral crackles, distended neck veins,
and orthopnea are expected findings in heart failure requiring prompt
management but do not constitute an immediately life-threatening crisis like
fulminant pulmonary edema.
2. 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
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).
3. 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."
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.
4. A nurse is caring for a client who has heart failure and is taking furosemide.
Which of the following findings indicates a therapeutic response to the
medication?
A. Weight gain of 2 kg in 24 hours
B. Decreased urine output
,C. Clear lung sounds bilaterally
D. Increased peripheral edema
Correct Answer: C
Rationale: Furosemide is a loop diuretic used to reduce fluid overload in heart
failure. Clear lung sounds indicate a reduction in pulmonary congestion, which is a
therapeutic response.
5. A nurse is caring for a client who has a new prescription for warfarin. Which of
the following laboratory values should the nurse monitor to evaluate the
effectiveness of the medication?
A. aPTT
B. INR
C. Platelet count
D. Hemoglobin
Correct Answer: B
Rationale: Warfarin is an anticoagulant that affects the extrinsic pathway. The
INR is the standard laboratory test used to monitor warfarin therapy and adjust
dosage.
6. A nurse is assessing a client who has been admitted with acute exacerbation of
chronic obstructive pulmonary disease (COPD). Which of the following assessment
findings should the nurse expect?
A. Decreased respiratory rate
B. Increased anteroposterior chest diameter
C. Clear breath sounds bilaterally
D. Elevated oxygen saturation of 98%
Correct Answer: B
, Rationale: Clients with COPD often develop a barrel-shaped chest due to
hyperinflation of the lungs, which increases the anteroposterior diameter. This is a
classic physical assessment finding in chronic COPD.
7. A nurse is caring for a client who is receiving total parenteral nutrition (TPN)
through a central line. The nurse notes the solution bag is nearly empty, and the
next bag is not yet available from the pharmacy. Which of the following solutions
should the nurse infuse to prevent hypoglycemia?
A. 0.9% sodium chloride
B. Lactated Ringer's solution
C. 10% dextrose in water
D. 0.45% sodium chloride
Correct Answer: C
Rationale: If TPN is interrupted, the nurse should infuse 10% dextrose in
water to prevent hypoglycemia, as the client's pancreas has been producing
insulin in response to the high glucose content of TPN.
8. A nurse is assessing a client who has an abdominal aortic aneurysm. Which of
the following manifestations should the nurse expect?
A. Lower back discomfort
B. Substernal chest pain
C. Left arm pain
D. Right upper quadrant pain
Correct Answer: A
Rationale: Abdominal aortic aneurysm involves a widening, stretching, or
ballooning of the aorta. Back and abdominal pain indicate that the aneurysm is
extending downward and pressing on lumbar spinal nerve roots, causing pain.
