• Updated ATI RN Adult Medical Surgical (Med-
Surg) 2026 NGN Proctored Exam with 100
Questions and Answers | Actual ATI RN Med-
Surg Latest Version Proctored Exam
• EXAM
• C. Hemoglobin 8.2 g/dL
• D. Gastric pH of 3.0
Correct Answer: C. Hemoglobin 8.2 g/dL
Rationale: Normal hemoglobin levels are approximately 13-18 g/dL for males and
12-16 g/dL for females. A level of 8.2 g/dL is significantly low and may indicate
postoperative hemorrhage, which requires immediate reporting to the surgeon.
Absent bowel sounds are expected for the first 24-72 hours post-abdominal
surgery due to anesthesia and manipulation of the bowel.
Q2. A client with heart failure is receiving furosemide (Lasix) and digoxin
(Lanoxin). The nurse notes new-onset nausea, vomiting, and an apical heart rate
of 45 bpm. Which action should the nurse take first?
• A. Administer the digoxin as ordered.
• B. Hold the digoxin and notify the provider.
• C. Administer potassium chloride IV push.
• D. Check the patient's blood pressure.
Correct Answer: B. Hold the digoxin and notify the provider.
Rationale: The patient is showing classic signs of digoxin toxicity (bradycardia and
GI upset). Hypokalemia from furosemide increases this risk. The medication must
be held, and the provider must be notified immediately.
Q3. A nurse is caring for a client who is receiving a blood transfusion. The nurse
observes that the client has bounding peripheral pulses, hypertension, and
distended jugular veins. The nurse should anticipate administering which of the
following prescribed medications?
, • A. Diphenhydramine
• B. Acetaminophen
• C. Pantoprazole
• D. Furosemide
Correct Answer: D. Furosemide
Rationale: The signs and symptoms indicate fluid volume overload, a complication
of rapid or massive blood transfusion. Furosemide, a loop diuretic, is administered
to promote diuresis and reduce preload.
Q4. A client is receiving heparin IV for a deep vein thrombosis (DVT). Which
laboratory test is used to monitor the therapeutic effect of heparin?
• A. PT/INR
• B. aPTT
• C. Platelet count
• D. Hemoglobin A1c
Correct Answer: B. aPTT (Activated Partial Thromboplastin Time)
Rationale: The aPTT is used to monitor unfractionated heparin therapy. The
therapeutic goal is typically 1.5 to 2.5 times the normal control value. PT/INR is
used to monitor warfarin (Coumadin) therapy.
Q5. A client with new-onset atrial fibrillation has a heart rate of 140 bpm and a
blood pressure of 100/60 mmHg. The nurse should prepare for which
intervention?
• A. Synchronized electrical cardioversion
• B. Defibrillation
• C. Pacemaker insertion
• D. Adenosine administration
Correct Answer: A. Synchronized electrical cardioversion
,Rationale: Synchronized cardioversion is indicated for unstable atrial fibrillation
with a rapid ventricular response causing hypotension or other signs of instability.
The shock is synchronized with the QRS complex to avoid precipitating ventricular
fibrillation.
Q6. A client's PT/INR is 4.5 (therapeutic range for atrial fibrillation is 2.0–3.0).
There is no active bleeding. What should the nurse do?
• A. Administer the next warfarin dose as ordered.
• B. Hold the next dose and notify the provider.
• C. Administer vitamin K immediately.
• D. Increase the next warfarin dose.
Correct Answer: B. Hold the next dose and notify the provider.
Rationale: An INR of 4.5 is supratherapeutic and significantly increases bleeding
risk. The nurse should hold the next dose and notify the provider for further
instructions. Vitamin K is reserved for active bleeding or an INR >10.0.
Q7. A nurse is assessing a client with deep vein thrombosis (DVT). Which finding
is expected?
• A. Cool, pale extremity
• B. Bilateral edema
• C. Warm, swollen calf with tenderness
• D. Decreased heart rate
Correct Answer: C. Warm, swollen calf with tenderness
Rationale: Classic signs of DVT include unilateral calf swelling, warmth, erythema,
and tenderness. A cool, pale extremity suggests arterial insufficiency. Bilateral
edema suggests systemic causes (heart failure, kidney disease).
Q8. A nurse is providing discharge teaching to a client who has a new
prescription for sublingual nitroglycerin. Which of the following client
statements indicates an understanding of the teaching?
• A. "I can keep my medications for 1 year before replacing it."
, • B. "I should lie down when I take this medication."
• C. "I should discontinue this medication if I develop a headache."
• D. "I can take up to five tablets in 15 minutes before seeking medical
attention."
Correct Answer: B. I should lie down when I take this medication.
Rationale: Nitroglycerin causes vasodilation, which can lead to hypotension and
dizziness. The client should lie or sit down before taking the medication to
prevent injury from falling. Headaches are a common side effect and do not
warrant discontinuation.
Q9. 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 is inflammation of the pericardial sac. Classic findings
include sharp, pleuritic chest pain that is worse when lying flat and improves by
leaning forward (sitting upright). Dyspnea, hiccups, and a pericardial friction rub
may also be present.
Q10. A nurse is planning care for a client following a cardiac catheterization.
Which of the following actions should the nurse take?
• A. Keep the client on bed rest for 24 hours.
• B. Limit the client's fluid intake to 1 L per day.
• C. Maintain the client's affected extremity in extension.
• D. Change the client's dressing every 8 hours.
Correct Answer: C. Maintain the client's affected extremity in extension.
Surg) 2026 NGN Proctored Exam with 100
Questions and Answers | Actual ATI RN Med-
Surg Latest Version Proctored Exam
• EXAM
• C. Hemoglobin 8.2 g/dL
• D. Gastric pH of 3.0
Correct Answer: C. Hemoglobin 8.2 g/dL
Rationale: Normal hemoglobin levels are approximately 13-18 g/dL for males and
12-16 g/dL for females. A level of 8.2 g/dL is significantly low and may indicate
postoperative hemorrhage, which requires immediate reporting to the surgeon.
Absent bowel sounds are expected for the first 24-72 hours post-abdominal
surgery due to anesthesia and manipulation of the bowel.
Q2. A client with heart failure is receiving furosemide (Lasix) and digoxin
(Lanoxin). The nurse notes new-onset nausea, vomiting, and an apical heart rate
of 45 bpm. Which action should the nurse take first?
• A. Administer the digoxin as ordered.
• B. Hold the digoxin and notify the provider.
• C. Administer potassium chloride IV push.
• D. Check the patient's blood pressure.
Correct Answer: B. Hold the digoxin and notify the provider.
Rationale: The patient is showing classic signs of digoxin toxicity (bradycardia and
GI upset). Hypokalemia from furosemide increases this risk. The medication must
be held, and the provider must be notified immediately.
Q3. A nurse is caring for a client who is receiving a blood transfusion. The nurse
observes that the client has bounding peripheral pulses, hypertension, and
distended jugular veins. The nurse should anticipate administering which of the
following prescribed medications?
, • A. Diphenhydramine
• B. Acetaminophen
• C. Pantoprazole
• D. Furosemide
Correct Answer: D. Furosemide
Rationale: The signs and symptoms indicate fluid volume overload, a complication
of rapid or massive blood transfusion. Furosemide, a loop diuretic, is administered
to promote diuresis and reduce preload.
Q4. A client is receiving heparin IV for a deep vein thrombosis (DVT). Which
laboratory test is used to monitor the therapeutic effect of heparin?
• A. PT/INR
• B. aPTT
• C. Platelet count
• D. Hemoglobin A1c
Correct Answer: B. aPTT (Activated Partial Thromboplastin Time)
Rationale: The aPTT is used to monitor unfractionated heparin therapy. The
therapeutic goal is typically 1.5 to 2.5 times the normal control value. PT/INR is
used to monitor warfarin (Coumadin) therapy.
Q5. A client with new-onset atrial fibrillation has a heart rate of 140 bpm and a
blood pressure of 100/60 mmHg. The nurse should prepare for which
intervention?
• A. Synchronized electrical cardioversion
• B. Defibrillation
• C. Pacemaker insertion
• D. Adenosine administration
Correct Answer: A. Synchronized electrical cardioversion
,Rationale: Synchronized cardioversion is indicated for unstable atrial fibrillation
with a rapid ventricular response causing hypotension or other signs of instability.
The shock is synchronized with the QRS complex to avoid precipitating ventricular
fibrillation.
Q6. A client's PT/INR is 4.5 (therapeutic range for atrial fibrillation is 2.0–3.0).
There is no active bleeding. What should the nurse do?
• A. Administer the next warfarin dose as ordered.
• B. Hold the next dose and notify the provider.
• C. Administer vitamin K immediately.
• D. Increase the next warfarin dose.
Correct Answer: B. Hold the next dose and notify the provider.
Rationale: An INR of 4.5 is supratherapeutic and significantly increases bleeding
risk. The nurse should hold the next dose and notify the provider for further
instructions. Vitamin K is reserved for active bleeding or an INR >10.0.
Q7. A nurse is assessing a client with deep vein thrombosis (DVT). Which finding
is expected?
• A. Cool, pale extremity
• B. Bilateral edema
• C. Warm, swollen calf with tenderness
• D. Decreased heart rate
Correct Answer: C. Warm, swollen calf with tenderness
Rationale: Classic signs of DVT include unilateral calf swelling, warmth, erythema,
and tenderness. A cool, pale extremity suggests arterial insufficiency. Bilateral
edema suggests systemic causes (heart failure, kidney disease).
Q8. A nurse is providing discharge teaching to a client who has a new
prescription for sublingual nitroglycerin. Which of the following client
statements indicates an understanding of the teaching?
• A. "I can keep my medications for 1 year before replacing it."
, • B. "I should lie down when I take this medication."
• C. "I should discontinue this medication if I develop a headache."
• D. "I can take up to five tablets in 15 minutes before seeking medical
attention."
Correct Answer: B. I should lie down when I take this medication.
Rationale: Nitroglycerin causes vasodilation, which can lead to hypotension and
dizziness. The client should lie or sit down before taking the medication to
prevent injury from falling. Headaches are a common side effect and do not
warrant discontinuation.
Q9. 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 is inflammation of the pericardial sac. Classic findings
include sharp, pleuritic chest pain that is worse when lying flat and improves by
leaning forward (sitting upright). Dyspnea, hiccups, and a pericardial friction rub
may also be present.
Q10. A nurse is planning care for a client following a cardiac catheterization.
Which of the following actions should the nurse take?
• A. Keep the client on bed rest for 24 hours.
• B. Limit the client's fluid intake to 1 L per day.
• C. Maintain the client's affected extremity in extension.
• D. Change the client's dressing every 8 hours.
Correct Answer: C. Maintain the client's affected extremity in extension.
