ATI MEDICAL SURGICAL PROCTORED EXAM 2026 WITH
NGN
Cardiovascular
1. A patient with heart failure has crackles in both lungs, JVD, and 3+ pitting
edema. Which medication does the nurse expect to administer first?
• A) Digoxin
• B) Furosemide
• C) Metoprolol
• D) Spironolactone
Answer: B) Furosemide
Rationale: Furosemide is a loop diuretic that rapidly reduces preload, relieving
pulmonary congestion and edema. Digoxin and metoprolol are chronic
management; spironolactone is slower.
2. Post-cardiac catheterization via the femoral artery, the patient reports severe
groin pain and a rapidly expanding hematoma. What is the priority action?
• A) Apply ice to the groin
• B) Elevate the HOB to 45 degrees
• C) Apply firm pressure above the insertion site
• D) Administer morphine sulfate
Answer: C) Apply firm pressure above the insertion site
Rationale: This indicates bleeding/retroperitoneal hematoma. Direct pressure is
needed to stop bleeding. Ice and morphine are secondary; HOB elevation is
contraindicated (keep flat).
3. A patient with unstable angina is prescribed nitroglycerin sublingual. The
patient reports a headache after the first dose. What should the nurse do?
• A) Withhold the next dose
• B) Administer acetaminophen as ordered
• C) Notify the provider immediately
, • D) Reassure that this is expected and treat the headache
Answer: D) Reassure that this is expected and treat the headache
Rationale: Headache is a common side effect due to vasodilation. It usually
subsides with continued use. Acetaminophen can be given, but education is key.
4. Which lab value is most critical to monitor in a patient taking warfarin?
• A) aPTT
• B) INR
• C) Platelet count
• D) Hemoglobin
Answer: B) INR
Rationale: INR monitors warfarin’s anticoagulant effect. Therapeutic range is 2-3
for most indications. aPTT monitors heparin.
5. A patient with peripheral artery disease (PAD) reports leg pain when walking
that stops with rest. What is the best nursing intervention?
• A) Encourage bed rest
• B) Apply heat to the legs
• C) Develop a supervised walking program
• D) Elevate the legs above heart level
Answer: C) Develop a supervised walking program
Rationale: Intermittent claudication improves with gradual exercise that promotes
collateral circulation. Elevation worsens PAD pain; heat can cause injury due to
reduced sensation.
Respiratory
6. A COPD patient with an SpO2 of 88% on room air is placed on 4 L/min oxygen
via nasal cannula. Thirty minutes later, the patient is lethargic and breathing
shallowly. What is the priority action?
• A) Increase oxygen to 6 L/min
• B) Prepare for intubation
• C) Decrease oxygen to 2 L/min
, • D) Draw ABGs immediately
Answer: C) Decrease oxygen to 2 L/min
Rationale: COPD patients may rely on hypoxic drive. High oxygen can decrease
respiratory drive, leading to CO2 retention. Target SpO2 88-92%.
7. A patient with pneumonia has a fever of 39.4°C (103°F), productive cough, and
RR 28. Which intervention should the nurse perform first?
• A) Administer antipyretic
• B) Collect sputum culture
• C) Encourage oral fluids
• D) Apply oxygen via nasal cannula
Answer: D) Apply oxygen via nasal cannula
Rationale: Airway and breathing come first. Tachypnea indicates hypoxemia.
Oxygen is priority, then antipyretics, fluids, and sputum collection.
8. Following a total laryngectomy, which finding requires immediate intervention?
• A) The patient uses a pad and paper to communicate
• B) The stoma is moist and pink
• C) The patient has copious mucus from the stoma
• D) The tracheostomy tube is dislodged
Answer: D) The tracheostomy tube is dislodged
Rationale: Dislodgement can cause airway loss. This is an emergency. Moist pink
stoma and mucus are expected. Communication aids are fine.
9. A patient with a pulmonary embolism is on heparin drip. Which assessment
finding indicates the therapy is effective?
• A) aPTT 70 seconds (normal 25-35)
• B) INR 3.0
• C) Platelets 50,000/mm³
• D) Respiratory rate 22
Answer: A) aPTT 70 seconds
Rationale: Heparin therapeutic aPTT is 1.5-2.5x normal (about 60-80 sec). INR
monitors warfarin. Low platelets indicate HIT.
10. A patient with a chest tube to water seal after a lobectomy has continuous
bubbling in the water seal chamber. What should the nurse do?
NGN
Cardiovascular
1. A patient with heart failure has crackles in both lungs, JVD, and 3+ pitting
edema. Which medication does the nurse expect to administer first?
• A) Digoxin
• B) Furosemide
• C) Metoprolol
• D) Spironolactone
Answer: B) Furosemide
Rationale: Furosemide is a loop diuretic that rapidly reduces preload, relieving
pulmonary congestion and edema. Digoxin and metoprolol are chronic
management; spironolactone is slower.
2. Post-cardiac catheterization via the femoral artery, the patient reports severe
groin pain and a rapidly expanding hematoma. What is the priority action?
• A) Apply ice to the groin
• B) Elevate the HOB to 45 degrees
• C) Apply firm pressure above the insertion site
• D) Administer morphine sulfate
Answer: C) Apply firm pressure above the insertion site
Rationale: This indicates bleeding/retroperitoneal hematoma. Direct pressure is
needed to stop bleeding. Ice and morphine are secondary; HOB elevation is
contraindicated (keep flat).
3. A patient with unstable angina is prescribed nitroglycerin sublingual. The
patient reports a headache after the first dose. What should the nurse do?
• A) Withhold the next dose
• B) Administer acetaminophen as ordered
• C) Notify the provider immediately
, • D) Reassure that this is expected and treat the headache
Answer: D) Reassure that this is expected and treat the headache
Rationale: Headache is a common side effect due to vasodilation. It usually
subsides with continued use. Acetaminophen can be given, but education is key.
4. Which lab value is most critical to monitor in a patient taking warfarin?
• A) aPTT
• B) INR
• C) Platelet count
• D) Hemoglobin
Answer: B) INR
Rationale: INR monitors warfarin’s anticoagulant effect. Therapeutic range is 2-3
for most indications. aPTT monitors heparin.
5. A patient with peripheral artery disease (PAD) reports leg pain when walking
that stops with rest. What is the best nursing intervention?
• A) Encourage bed rest
• B) Apply heat to the legs
• C) Develop a supervised walking program
• D) Elevate the legs above heart level
Answer: C) Develop a supervised walking program
Rationale: Intermittent claudication improves with gradual exercise that promotes
collateral circulation. Elevation worsens PAD pain; heat can cause injury due to
reduced sensation.
Respiratory
6. A COPD patient with an SpO2 of 88% on room air is placed on 4 L/min oxygen
via nasal cannula. Thirty minutes later, the patient is lethargic and breathing
shallowly. What is the priority action?
• A) Increase oxygen to 6 L/min
• B) Prepare for intubation
• C) Decrease oxygen to 2 L/min
, • D) Draw ABGs immediately
Answer: C) Decrease oxygen to 2 L/min
Rationale: COPD patients may rely on hypoxic drive. High oxygen can decrease
respiratory drive, leading to CO2 retention. Target SpO2 88-92%.
7. A patient with pneumonia has a fever of 39.4°C (103°F), productive cough, and
RR 28. Which intervention should the nurse perform first?
• A) Administer antipyretic
• B) Collect sputum culture
• C) Encourage oral fluids
• D) Apply oxygen via nasal cannula
Answer: D) Apply oxygen via nasal cannula
Rationale: Airway and breathing come first. Tachypnea indicates hypoxemia.
Oxygen is priority, then antipyretics, fluids, and sputum collection.
8. Following a total laryngectomy, which finding requires immediate intervention?
• A) The patient uses a pad and paper to communicate
• B) The stoma is moist and pink
• C) The patient has copious mucus from the stoma
• D) The tracheostomy tube is dislodged
Answer: D) The tracheostomy tube is dislodged
Rationale: Dislodgement can cause airway loss. This is an emergency. Moist pink
stoma and mucus are expected. Communication aids are fine.
9. A patient with a pulmonary embolism is on heparin drip. Which assessment
finding indicates the therapy is effective?
• A) aPTT 70 seconds (normal 25-35)
• B) INR 3.0
• C) Platelets 50,000/mm³
• D) Respiratory rate 22
Answer: A) aPTT 70 seconds
Rationale: Heparin therapeutic aPTT is 1.5-2.5x normal (about 60-80 sec). INR
monitors warfarin. Low platelets indicate HIT.
10. A patient with a chest tube to water seal after a lobectomy has continuous
bubbling in the water seal chamber. What should the nurse do?
