RN Adult Medical Surgical Proctored Exam
2026 A / RN Adult Medical Surgical
Proctored Exam 2026 A: Latest
SECTION I: CARDIOVASCULAR & HEMATOLOGIC
1. A nurse is assessing a client who has heart failure and is taking furosemide.
Which of the following findings indicates an adverse effect of the medication?
A. Heart rate 68/min
B. Serum potassium 3.1 mEq/L
C. Urine output 1,200 mL/day
D. Weight loss of 0.9 kg (2 lb) in 24 hr
Rationale: Furosemide is a loop diuretic that causes potassium loss. A serum
potassium of 3.1 mEq/L is below the expected reference range (3.5–5.0 mEq/L)
and indicates hypokalemia, a serious adverse effect that can precipitate
dysrhythmias. The other findings are expected therapeutic responses.
Correct Answer: B
2. A nurse is caring for a client who is 6 hr postoperative following a coronary
artery bypass graft (CABG). Which of the following findings should the nurse
report to the provider immediately?
A. Temperature 37.4° C (99.3° F)
B. Serosanguineous chest tube drainage of 40 mL/hr
C. Urine output of 20 mL/hr for the past 2 hr
D. Incisional pain rated 5 on a scale of 0 to 10
Rationale: Urine output less than 30 mL/hr indicates decreased renal
perfusion, which can signal hypovolemia, decreased cardiac output, or impending
cardiogenic shock following CABG. This finding requires immediate reporting.
Serosanguineous drainage up to 100–150 mL/hr is expected initially. Low-grade
fever and incisional pain are expected postoperative findings.
,Correct Answer: C
3. A nurse is teaching a client who has atrial fibrillation and a new
prescription for warfarin. Which of the following statements by the client
indicates understanding of the teaching?
A. "I will take aspirin for headaches while taking this medication."
B. "I will increase my intake of green leafy vegetables."
C. "I will use an electric razor when shaving."
D. "I will double my dose if I miss one."
Rationale: Warfarin is an anticoagulant that increases bleeding risk. Using an
electric razor reduces the risk of cuts and bleeding. Aspirin increases bleeding risk
and should be avoided. Green leafy vegetables contain vitamin K, which
antagonizes warfarin; intake should be consistent, not increased. Missed doses
should not be doubled.
Correct Answer: C
4. A nurse is assessing a client who has a new onset of atrial fibrillation. Which
of the following findings should the nurse expect?
A. Blood pressure 168/94 mm Hg
B. Heart rate 52/min and regular
C. Irregular radial pulse
D. Jugular vein distention
Rationale: Atrial fibrillation is characterized by an irregularly irregular rhythm
due to chaotic atrial electrical activity. The radial pulse is irregular in rate and
rhythm. Blood pressure may be normal or low, and the ventricular rate is typically
rapid (100–160/min) rather than bradycardic.
Correct Answer: C
,5. A nurse is caring for a client who is receiving heparin by continuous IV
infusion. Which of the following laboratory values should the nurse monitor to
evaluate the effectiveness of the therapy?
A. PT
B. INR
C. aPTT
D. Platelet count
Rationale: The aPTT is used to monitor the effectiveness of unfractionated
heparin therapy. The therapeutic goal is typically 1.5 to 2.5 times the control value.
PT and INR are used to monitor warfarin. Platelet count monitors for heparin-
induced thrombocytopenia, an adverse effect, not effectiveness.
Correct Answer: C
6. A nurse is assessing a client who has pericarditis. Which of the following
findings should the nurse expect?
A. Bradycardia
B. Pleuritic chest pain that worsens with deep inspiration
C. Decreased ESR
D. Pain that radiates to the left arm
Rationale: Pericarditis causes pleuritic chest pain that worsens with deep
inspiration, coughing, or lying flat, and improves when sitting upright and leaning
forward. Tachycardia, not bradycardia, is common. ESR is typically elevated.
Radiating arm pain is more characteristic of myocardial infarction.
Correct Answer: B
7. A nurse is caring for a client who has a blood pressure of 78/42 mm Hg and
is experiencing dizziness. Which of the following actions should the nurse take
first?
, A. Administer a prescribed IV bolus of 0.9% sodium chloride.
B. Place the client in a supine position with legs elevated.
C. Obtain a 12-lead ECG.
D. Notify the provider.
Rationale: Using the nursing process and priority-setting framework, the nurse
should first implement a safety intervention that does not require a prescription.
Positioning the client supine with the legs elevated promotes venous return and
perfusion to vital organs. This is an independent nursing action that should precede
obtaining an ECG, notifying the provider, or administering a prescribed bolus.
Correct Answer: B
8. A nurse is reviewing the laboratory results of a client who has an elevated
INR of 6.2 while taking warfarin. Which of the following medications should
the nurse anticipate administering?
A. Protamine sulfate
B. Vitamin K (phytonadione)
C. Naloxone
D. Acetylcysteine
Rationale: Vitamin K is the antidote for warfarin overdose. Protamine sulfate
reverses heparin. Naloxone reverses opioids. Acetylcysteine is the antidote for
acetaminophen toxicity.
Correct Answer: B
9. A nurse is assessing a client who has deep vein thrombosis (DVT) in the left
calf. Which of the following findings should the nurse expect?
A. Dependent rubor of the left foot
B. Unilateral calf swelling and warmth
C. Bilateral pitting edema
D. Absent dorsalis pedis pulse
2026 A / RN Adult Medical Surgical
Proctored Exam 2026 A: Latest
SECTION I: CARDIOVASCULAR & HEMATOLOGIC
1. A nurse is assessing a client who has heart failure and is taking furosemide.
Which of the following findings indicates an adverse effect of the medication?
A. Heart rate 68/min
B. Serum potassium 3.1 mEq/L
C. Urine output 1,200 mL/day
D. Weight loss of 0.9 kg (2 lb) in 24 hr
Rationale: Furosemide is a loop diuretic that causes potassium loss. A serum
potassium of 3.1 mEq/L is below the expected reference range (3.5–5.0 mEq/L)
and indicates hypokalemia, a serious adverse effect that can precipitate
dysrhythmias. The other findings are expected therapeutic responses.
Correct Answer: B
2. A nurse is caring for a client who is 6 hr postoperative following a coronary
artery bypass graft (CABG). Which of the following findings should the nurse
report to the provider immediately?
A. Temperature 37.4° C (99.3° F)
B. Serosanguineous chest tube drainage of 40 mL/hr
C. Urine output of 20 mL/hr for the past 2 hr
D. Incisional pain rated 5 on a scale of 0 to 10
Rationale: Urine output less than 30 mL/hr indicates decreased renal
perfusion, which can signal hypovolemia, decreased cardiac output, or impending
cardiogenic shock following CABG. This finding requires immediate reporting.
Serosanguineous drainage up to 100–150 mL/hr is expected initially. Low-grade
fever and incisional pain are expected postoperative findings.
,Correct Answer: C
3. A nurse is teaching a client who has atrial fibrillation and a new
prescription for warfarin. Which of the following statements by the client
indicates understanding of the teaching?
A. "I will take aspirin for headaches while taking this medication."
B. "I will increase my intake of green leafy vegetables."
C. "I will use an electric razor when shaving."
D. "I will double my dose if I miss one."
Rationale: Warfarin is an anticoagulant that increases bleeding risk. Using an
electric razor reduces the risk of cuts and bleeding. Aspirin increases bleeding risk
and should be avoided. Green leafy vegetables contain vitamin K, which
antagonizes warfarin; intake should be consistent, not increased. Missed doses
should not be doubled.
Correct Answer: C
4. A nurse is assessing a client who has a new onset of atrial fibrillation. Which
of the following findings should the nurse expect?
A. Blood pressure 168/94 mm Hg
B. Heart rate 52/min and regular
C. Irregular radial pulse
D. Jugular vein distention
Rationale: Atrial fibrillation is characterized by an irregularly irregular rhythm
due to chaotic atrial electrical activity. The radial pulse is irregular in rate and
rhythm. Blood pressure may be normal or low, and the ventricular rate is typically
rapid (100–160/min) rather than bradycardic.
Correct Answer: C
,5. A nurse is caring for a client who is receiving heparin by continuous IV
infusion. Which of the following laboratory values should the nurse monitor to
evaluate the effectiveness of the therapy?
A. PT
B. INR
C. aPTT
D. Platelet count
Rationale: The aPTT is used to monitor the effectiveness of unfractionated
heparin therapy. The therapeutic goal is typically 1.5 to 2.5 times the control value.
PT and INR are used to monitor warfarin. Platelet count monitors for heparin-
induced thrombocytopenia, an adverse effect, not effectiveness.
Correct Answer: C
6. A nurse is assessing a client who has pericarditis. Which of the following
findings should the nurse expect?
A. Bradycardia
B. Pleuritic chest pain that worsens with deep inspiration
C. Decreased ESR
D. Pain that radiates to the left arm
Rationale: Pericarditis causes pleuritic chest pain that worsens with deep
inspiration, coughing, or lying flat, and improves when sitting upright and leaning
forward. Tachycardia, not bradycardia, is common. ESR is typically elevated.
Radiating arm pain is more characteristic of myocardial infarction.
Correct Answer: B
7. A nurse is caring for a client who has a blood pressure of 78/42 mm Hg and
is experiencing dizziness. Which of the following actions should the nurse take
first?
, A. Administer a prescribed IV bolus of 0.9% sodium chloride.
B. Place the client in a supine position with legs elevated.
C. Obtain a 12-lead ECG.
D. Notify the provider.
Rationale: Using the nursing process and priority-setting framework, the nurse
should first implement a safety intervention that does not require a prescription.
Positioning the client supine with the legs elevated promotes venous return and
perfusion to vital organs. This is an independent nursing action that should precede
obtaining an ECG, notifying the provider, or administering a prescribed bolus.
Correct Answer: B
8. A nurse is reviewing the laboratory results of a client who has an elevated
INR of 6.2 while taking warfarin. Which of the following medications should
the nurse anticipate administering?
A. Protamine sulfate
B. Vitamin K (phytonadione)
C. Naloxone
D. Acetylcysteine
Rationale: Vitamin K is the antidote for warfarin overdose. Protamine sulfate
reverses heparin. Naloxone reverses opioids. Acetylcysteine is the antidote for
acetaminophen toxicity.
Correct Answer: B
9. A nurse is assessing a client who has deep vein thrombosis (DVT) in the left
calf. Which of the following findings should the nurse expect?
A. Dependent rubor of the left foot
B. Unilateral calf swelling and warmth
C. Bilateral pitting edema
D. Absent dorsalis pedis pulse
