ATI RN Medical-Surgical (Med-Surg) Proctored Exam | NGN Practice
Questions with Answers & Rationales | Comprehensive Study Guide
2026
QUESTION 1
A 72-year-old woman with known systolic heart failure (EF 25%) is admitted with severe
dyspnea, bilateral crackles, and SpO₂ 86% on room air. She is cool and diaphoretic. BP
170/98, HR 110. Which intervention should the nurse implement first?
A) Administer high-flow IV furosemide (bolus) and position upright
B) Give a 1-liter IV bolus of normal saline rapidly
C) Start dobutamine drip immediately without further assessment
D) Apply warmed blankets and restrict oxygen
ANSWER: A) Administer high-flow IV furosemide (bolus) and position upright
Rationale: Acute pulmonary edema from fluid overload is treated emergently with IV loop
diuretics and upright positioning to reduce venous return and improve ventilation. Oxygen
and noninvasive ventilation (CPAP/BiPAP) may be needed. Rapid IV fluid bolus is
contraindicated in cardiogenic pulmonary edema.
QUESTION 2
A 64-year-old man arrives with chest pressure, diaphoresis, and an ECG showing ST
depressions in V2–V4. He is alert, SpO₂ 98% on room air, BP 142/86, HR 96. Which initial
action should the nurse perform first?
,A) Administer supplemental oxygen by nasal cannula at 4 L/min
B) Give chewable aspirin (162–325 mg) immediately unless contraindicated
C) Administer sublingual nitroglycerin without assessing blood pressure
D) Start an IV infusion of heparin prior to confirming diagnosis
ANSWER: B) Give chewable aspirin (162–325 mg) immediately unless
contraindicated
Rationale: Early aspirin reduces mortality in suspected acute coronary syndrome and is
part of initial management unless there's a contraindication (e.g., aspirin allergy). Routine
supplemental oxygen is not recommended for normoxic patients (SpO₂ ≥ 90–94%); give
O₂ only if hypoxemic.
QUESTION 3
A nurse is providing discharge teaching to a patient who has a new prescription for
sublingual nitroglycerin. Which statement by the patient indicates understanding of the
teaching?
A) "I can keep my medication 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"
ANSWER: B) "I should lie down when I take this medication"
,Rationale: Sublingual nitroglycerin can cause orthostatic hypotension. Patients should lie
down before taking the medication to prevent dizziness and falls. Nitroglycerin should be
replaced every 6 months. Headache is an expected side effect. The regimen is one tablet
every 5 minutes for up to 3 doses.
QUESTION 4
A nurse is providing discharge teaching to an older adult patient following a left total
hip arthroplasty. Which instruction should the nurse include?
A) Clean the incision daily with hydrogen peroxide
B) You can cross your legs at the ankles when sitting down
C) You should use an incentive spirometer every 8 hours
D) Install a raised toilet seat in your bathroom
ANSWER: D) Install a raised toilet seat in your bathroom
Rationale: After hip arthroplasty, patients must avoid flexion >90 degrees and crossing
legs to prevent dislocation. A raised toilet seat helps maintain hip precautions by reducing
hip flexion. Incisions should be cleaned with mild soap and water, not hydrogen peroxide.
Incentive spirometry is encouraged every 1-2 hours.
QUESTION 5
A 58-year-old patient with type 2 diabetes and peripheral neuropathy reports persistent
tingling and burning in both feet. Which medication is commonly used for neuropathic
pain?
, A) Acetaminophen
B) Ibuprofen
C) Duloxetine
D) Morphine
ANSWER: C) Duloxetine
Rationale: Duloxetine (Cymbalta) is an SNRI indicated for diabetic peripheral neuropathy.
Gabapentin and pregabalin are also first-line medications for neuropathic pain.
Acetaminophen and ibuprofen are less effective for neuropathic pain. Opioids are not first-
line due to risks.
QUESTION 6
A patient with chronic kidney disease has a serum potassium of 6.2 mEq/L. Which ECG
finding would the nurse expect?
A) Peaked T waves
B) U waves
C) ST depression
D) Prolonged QT interval
ANSWER: A) Peaked T waves
Questions with Answers & Rationales | Comprehensive Study Guide
2026
QUESTION 1
A 72-year-old woman with known systolic heart failure (EF 25%) is admitted with severe
dyspnea, bilateral crackles, and SpO₂ 86% on room air. She is cool and diaphoretic. BP
170/98, HR 110. Which intervention should the nurse implement first?
A) Administer high-flow IV furosemide (bolus) and position upright
B) Give a 1-liter IV bolus of normal saline rapidly
C) Start dobutamine drip immediately without further assessment
D) Apply warmed blankets and restrict oxygen
ANSWER: A) Administer high-flow IV furosemide (bolus) and position upright
Rationale: Acute pulmonary edema from fluid overload is treated emergently with IV loop
diuretics and upright positioning to reduce venous return and improve ventilation. Oxygen
and noninvasive ventilation (CPAP/BiPAP) may be needed. Rapid IV fluid bolus is
contraindicated in cardiogenic pulmonary edema.
QUESTION 2
A 64-year-old man arrives with chest pressure, diaphoresis, and an ECG showing ST
depressions in V2–V4. He is alert, SpO₂ 98% on room air, BP 142/86, HR 96. Which initial
action should the nurse perform first?
,A) Administer supplemental oxygen by nasal cannula at 4 L/min
B) Give chewable aspirin (162–325 mg) immediately unless contraindicated
C) Administer sublingual nitroglycerin without assessing blood pressure
D) Start an IV infusion of heparin prior to confirming diagnosis
ANSWER: B) Give chewable aspirin (162–325 mg) immediately unless
contraindicated
Rationale: Early aspirin reduces mortality in suspected acute coronary syndrome and is
part of initial management unless there's a contraindication (e.g., aspirin allergy). Routine
supplemental oxygen is not recommended for normoxic patients (SpO₂ ≥ 90–94%); give
O₂ only if hypoxemic.
QUESTION 3
A nurse is providing discharge teaching to a patient who has a new prescription for
sublingual nitroglycerin. Which statement by the patient indicates understanding of the
teaching?
A) "I can keep my medication 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"
ANSWER: B) "I should lie down when I take this medication"
,Rationale: Sublingual nitroglycerin can cause orthostatic hypotension. Patients should lie
down before taking the medication to prevent dizziness and falls. Nitroglycerin should be
replaced every 6 months. Headache is an expected side effect. The regimen is one tablet
every 5 minutes for up to 3 doses.
QUESTION 4
A nurse is providing discharge teaching to an older adult patient following a left total
hip arthroplasty. Which instruction should the nurse include?
A) Clean the incision daily with hydrogen peroxide
B) You can cross your legs at the ankles when sitting down
C) You should use an incentive spirometer every 8 hours
D) Install a raised toilet seat in your bathroom
ANSWER: D) Install a raised toilet seat in your bathroom
Rationale: After hip arthroplasty, patients must avoid flexion >90 degrees and crossing
legs to prevent dislocation. A raised toilet seat helps maintain hip precautions by reducing
hip flexion. Incisions should be cleaned with mild soap and water, not hydrogen peroxide.
Incentive spirometry is encouraged every 1-2 hours.
QUESTION 5
A 58-year-old patient with type 2 diabetes and peripheral neuropathy reports persistent
tingling and burning in both feet. Which medication is commonly used for neuropathic
pain?
, A) Acetaminophen
B) Ibuprofen
C) Duloxetine
D) Morphine
ANSWER: C) Duloxetine
Rationale: Duloxetine (Cymbalta) is an SNRI indicated for diabetic peripheral neuropathy.
Gabapentin and pregabalin are also first-line medications for neuropathic pain.
Acetaminophen and ibuprofen are less effective for neuropathic pain. Opioids are not first-
line due to risks.
QUESTION 6
A patient with chronic kidney disease has a serum potassium of 6.2 mEq/L. Which ECG
finding would the nurse expect?
A) Peaked T waves
B) U waves
C) ST depression
D) Prolonged QT interval
ANSWER: A) Peaked T waves
