ATI RN Adult Medical-Surgical Proctored Exam
2026/2027 Study Guide | ATI RN Adult Med-Surg
Practice Questions & Answers, Detailed Rationales,
Clinical Judgment, NGN-Style Case Studies & NCLEX-
RN Exam Prep
Question 1: A nurse is assessing a client who has right-sided heart
failure. Which of the following findings should the nurse expect?
A. Crackles in the lung bases
B. Paroxysmal nocturnal dyspnea
C. Jugular venous distension
D. Frothy sputum
CORRECT ANSWER: C. Jugular venous distension
Rationale: Right-sided heart failure results in fluid backup into the systemic
venous system, leading to jugular venous distension, peripheral edema,
hepatomegaly, and ascites. Crackles, paroxysmal nocturnal dyspnea, and
frothy sputum are manifestations of left-sided heart failure due to
pulmonary congestion .
Question 2: A nurse is caring for a client who is receiving digoxin
for heart failure. Which of the following findings indicates digoxin
toxicity?
A. Heart rate of 72 beats per minute
B. Anorexia, nausea, and blurred yellow vision
C. Blood pressure of 120/80 mm Hg
D. Potassium level of 4.0 mEq/L
CORRECT ANSWER: B. Anorexia, nausea, and blurred yellow
vision
Rationale: Digoxin toxicity manifests with gastrointestinal symptoms
(anorexia, nausea, vomiting), visual disturbances (yellow-green halos,
blurred vision), and cardiac dysrhythmias. Hypokalemia increases the risk
of toxicity .
Question 3: A nurse is preparing to administer digoxin to a client.
The apical pulse is 52 beats per minute. Which action should the
nurse take?
,A. Administer the medication as prescribed
B. Hold the medication and notify the provider
C. Administer the medication and recheck the pulse in 30 minutes
D. Administer the medication and then notify the provider
CORRECT ANSWER: B. Hold the medication and notify the provider
Rationale: The standard hold parameter for digoxin is an apical pulse less
than 60 beats per minute in adults. A pulse of 52 indicates bradycardia that
could worsen with digoxin administration, requiring the nurse to withhold
the medication and contact the provider .
Question 4: A client with heart failure is prescribed lisinopril.
Which adverse effect requires immediate notification of the
provider?
A. Dry cough
B. Angioedema
C. Headache
D. Fatigue
CORRECT ANSWER: B. Angioedema
Rationale: Angioedema is a life-threatening adverse effect of ACE inhibitors
characterized by swelling of the lips, tongue, or throat that can compromise
the airway. It requires immediate emergency intervention. Dry cough is a
common but not immediately dangerous side effect .
Question 5: A nurse is teaching a client who has heart failure about
daily weight monitoring. Which instruction should the nurse
include?
A. "Weigh yourself weekly."
B. "Weigh yourself only if you feel short of breath."
C. "Weigh yourself daily and report a gain of 2 to 3 pounds in 24
hours."
D. "Weigh yourself daily and report a gain of 10 pounds in one week."
CORRECT ANSWER: C. "Weigh yourself daily and report a gain of 2
to 3 pounds in 24 hours."
Rationale: Daily weight monitoring is essential in heart failure management.
A weight gain of 2 to 3 pounds in 24 hours or 5 pounds in one week
,indicates fluid retention and worsening heart failure requiring prompt
intervention .
Question 6: A nurse is assessing a client who has pericarditis.
Which of the following manifestations should the nurse expect?
A. Bradycardia with ST-segment depression
B. Relief of chest pain with deep inspiration
C. Dyspnea with hiccups
D. Chest pain that increases when sitting upright
CORRECT ANSWER: C. Dyspnea with hiccups
Rationale: Pericarditis can cause dyspnea, hiccups, and a nonproductive
cough due to pericardial compression. Chest pain is typically relieved by
sitting upright and leaning forward, and worsens with inspiration .
Question 7: A nurse is collecting data from a client prior to
administering hydrochlorothiazide. Which finding is a
contraindication to administering the medication?
A. 2+ pedal edema
B. Potassium 2.8 mEq/L
C. Allergy to shellfish
D. History of GERD
CORRECT ANSWER: B. Potassium 2.8 mEq/L
Rationale: Hydrochlorothiazide is a thiazide diuretic that can cause
hypokalemia. A potassium level of 2.8 mEq/L is below the normal range
(3.5-5.0 mEq/L) and is a contraindication. The nurse should hold the
medication and notify the provider .
Question 8: A nurse is caring for a client in the emergency
department who has acute angina. Which action should the nurse
take first?
A. Administer sublingual nitroglycerin
B. Obtain a 12-lead ECG
C. Administer oxygen
D. Assess pain level
CORRECT ANSWER: A. Administer sublingual nitroglycerin
, Rationale: For acute angina, the priority is to relieve chest pain and
myocardial ischemia. Sublingual nitroglycerin should be administered first
to vasodilate coronary arteries and improve blood flow to the myocardium .
Question 9: A nurse is caring for a client receiving morphine IV for
chest pain. Which adverse effect should the nurse monitor?
A. Hypertension
B. Tachycardia
C. Respiratory depression
D. Hyperglycemia
CORRECT ANSWER: C. Respiratory depression
Rationale: Morphine is an opioid analgesic that can cause respiratory
depression, especially in older adults or those with compromised
respiratory function. The nurse should monitor respiratory rate and depth
closely .
Question 10: A client has a new prescription for digoxin. Which
finding requires withholding the medication?
A. Heart rate 110 bpm
B. Apical pulse 56 bpm
C. Blood pressure 130/80 mm Hg
D. Respiratory rate 20/min
CORRECT ANSWER: B. Apical pulse 56 bpm
Rationale: Digoxin should be withheld if the apical pulse is less than 60
beats per minute in adults. A pulse of 56 indicates bradycardia that could be
worsened by digoxin administration .
Question 11: A nurse is collecting data from a client with an acute
myocardial infarction. Which pain characteristic is most indicative
of cardiac origin?
A. Sharp, stabbing pain relieved by deep breathing
B. Crushing chest pain radiating to the left arm
C. Burning epigastric pain
D. Sharp pain worsened by movement
CORRECT ANSWER: B. Crushing chest pain radiating to the left
arm
2026/2027 Study Guide | ATI RN Adult Med-Surg
Practice Questions & Answers, Detailed Rationales,
Clinical Judgment, NGN-Style Case Studies & NCLEX-
RN Exam Prep
Question 1: A nurse is assessing a client who has right-sided heart
failure. Which of the following findings should the nurse expect?
A. Crackles in the lung bases
B. Paroxysmal nocturnal dyspnea
C. Jugular venous distension
D. Frothy sputum
CORRECT ANSWER: C. Jugular venous distension
Rationale: Right-sided heart failure results in fluid backup into the systemic
venous system, leading to jugular venous distension, peripheral edema,
hepatomegaly, and ascites. Crackles, paroxysmal nocturnal dyspnea, and
frothy sputum are manifestations of left-sided heart failure due to
pulmonary congestion .
Question 2: A nurse is caring for a client who is receiving digoxin
for heart failure. Which of the following findings indicates digoxin
toxicity?
A. Heart rate of 72 beats per minute
B. Anorexia, nausea, and blurred yellow vision
C. Blood pressure of 120/80 mm Hg
D. Potassium level of 4.0 mEq/L
CORRECT ANSWER: B. Anorexia, nausea, and blurred yellow
vision
Rationale: Digoxin toxicity manifests with gastrointestinal symptoms
(anorexia, nausea, vomiting), visual disturbances (yellow-green halos,
blurred vision), and cardiac dysrhythmias. Hypokalemia increases the risk
of toxicity .
Question 3: A nurse is preparing to administer digoxin to a client.
The apical pulse is 52 beats per minute. Which action should the
nurse take?
,A. Administer the medication as prescribed
B. Hold the medication and notify the provider
C. Administer the medication and recheck the pulse in 30 minutes
D. Administer the medication and then notify the provider
CORRECT ANSWER: B. Hold the medication and notify the provider
Rationale: The standard hold parameter for digoxin is an apical pulse less
than 60 beats per minute in adults. A pulse of 52 indicates bradycardia that
could worsen with digoxin administration, requiring the nurse to withhold
the medication and contact the provider .
Question 4: A client with heart failure is prescribed lisinopril.
Which adverse effect requires immediate notification of the
provider?
A. Dry cough
B. Angioedema
C. Headache
D. Fatigue
CORRECT ANSWER: B. Angioedema
Rationale: Angioedema is a life-threatening adverse effect of ACE inhibitors
characterized by swelling of the lips, tongue, or throat that can compromise
the airway. It requires immediate emergency intervention. Dry cough is a
common but not immediately dangerous side effect .
Question 5: A nurse is teaching a client who has heart failure about
daily weight monitoring. Which instruction should the nurse
include?
A. "Weigh yourself weekly."
B. "Weigh yourself only if you feel short of breath."
C. "Weigh yourself daily and report a gain of 2 to 3 pounds in 24
hours."
D. "Weigh yourself daily and report a gain of 10 pounds in one week."
CORRECT ANSWER: C. "Weigh yourself daily and report a gain of 2
to 3 pounds in 24 hours."
Rationale: Daily weight monitoring is essential in heart failure management.
A weight gain of 2 to 3 pounds in 24 hours or 5 pounds in one week
,indicates fluid retention and worsening heart failure requiring prompt
intervention .
Question 6: A nurse is assessing a client who has pericarditis.
Which of the following manifestations should the nurse expect?
A. Bradycardia with ST-segment depression
B. Relief of chest pain with deep inspiration
C. Dyspnea with hiccups
D. Chest pain that increases when sitting upright
CORRECT ANSWER: C. Dyspnea with hiccups
Rationale: Pericarditis can cause dyspnea, hiccups, and a nonproductive
cough due to pericardial compression. Chest pain is typically relieved by
sitting upright and leaning forward, and worsens with inspiration .
Question 7: A nurse is collecting data from a client prior to
administering hydrochlorothiazide. Which finding is a
contraindication to administering the medication?
A. 2+ pedal edema
B. Potassium 2.8 mEq/L
C. Allergy to shellfish
D. History of GERD
CORRECT ANSWER: B. Potassium 2.8 mEq/L
Rationale: Hydrochlorothiazide is a thiazide diuretic that can cause
hypokalemia. A potassium level of 2.8 mEq/L is below the normal range
(3.5-5.0 mEq/L) and is a contraindication. The nurse should hold the
medication and notify the provider .
Question 8: A nurse is caring for a client in the emergency
department who has acute angina. Which action should the nurse
take first?
A. Administer sublingual nitroglycerin
B. Obtain a 12-lead ECG
C. Administer oxygen
D. Assess pain level
CORRECT ANSWER: A. Administer sublingual nitroglycerin
, Rationale: For acute angina, the priority is to relieve chest pain and
myocardial ischemia. Sublingual nitroglycerin should be administered first
to vasodilate coronary arteries and improve blood flow to the myocardium .
Question 9: A nurse is caring for a client receiving morphine IV for
chest pain. Which adverse effect should the nurse monitor?
A. Hypertension
B. Tachycardia
C. Respiratory depression
D. Hyperglycemia
CORRECT ANSWER: C. Respiratory depression
Rationale: Morphine is an opioid analgesic that can cause respiratory
depression, especially in older adults or those with compromised
respiratory function. The nurse should monitor respiratory rate and depth
closely .
Question 10: A client has a new prescription for digoxin. Which
finding requires withholding the medication?
A. Heart rate 110 bpm
B. Apical pulse 56 bpm
C. Blood pressure 130/80 mm Hg
D. Respiratory rate 20/min
CORRECT ANSWER: B. Apical pulse 56 bpm
Rationale: Digoxin should be withheld if the apical pulse is less than 60
beats per minute in adults. A pulse of 56 indicates bradycardia that could be
worsened by digoxin administration .
Question 11: A nurse is collecting data from a client with an acute
myocardial infarction. Which pain characteristic is most indicative
of cardiac origin?
A. Sharp, stabbing pain relieved by deep breathing
B. Crushing chest pain radiating to the left arm
C. Burning epigastric pain
D. Sharp pain worsened by movement
CORRECT ANSWER: B. Crushing chest pain radiating to the left
arm
