ATI RN Adult Medical-Surgical Nursing NGN Proctored Exam Review
2026 Updated Version | Complete Study Guide Covering
Cardiovascular, Respiratory, Neurological, Gastrointestinal, Renal,
Endocrine, Oncology & Perioperative Nursing Concepts with Answers
and Rationales
Cardiovascular System
1. A nurse is assessing a client with left-sided heart failure. Which of the
following findings should the nurse expect?
• A) Jugular venous distention
• B) Peripheral edema
• C) Crackles in the lung bases
• D) Hepatomegaly
Answer: C) Crackles in the lung bases
Rationale: Left-sided heart failure causes blood to back up into the pulmonary
circulation, leading to pulmonary congestion. Crackles (rales) in the lung bases are
a hallmark sign. Jugular venous distention, peripheral edema, and hepatomegaly
are signs of right-sided heart failure.
2. A nurse is caring for a client prescribed digoxin for heart failure. Which of the
following findings indicates digoxin toxicity?
• A) Heart rate of 72 bpm
• B) Blood pressure of 130/80 mmHg
• C) Visual disturbances (yellow-green halos)
• D) Increased urine output
Answer: C) Visual disturbances (yellow-green halos)
,Rationale: Digoxin toxicity presents with gastrointestinal symptoms (nausea,
vomiting), cardiac dysrhythmias, and visual disturbances such as yellow-green
halos or blurred vision. A heart rate of 72 bpm is within normal range.
3. A client with atrial fibrillation is prescribed warfarin. Which laboratory value
should the nurse monitor to evaluate therapeutic effectiveness?
• A) aPTT
• B) INR
• C) Platelet count
• D) PT
Answer: B) INR
Rationale: Warfarin therapy is monitored using the International Normalized
Ratio (INR). The therapeutic INR range for atrial fibrillation is typically 2.0–3.0.
aPTT is used for heparin monitoring.
4. A nurse is providing discharge teaching to a client with hypertension. Which
dietary modification should the nurse recommend?
• A) Increase sodium intake to 3,000 mg/day
• B) Follow the DASH eating plan
• C) Restrict potassium-rich foods
• D) Increase saturated fat consumption
Answer: B) Follow the DASH eating plan
Rationale: The DASH (Dietary Approaches to Stop Hypertension) eating plan
emphasizes fruits, vegetables, whole grains, and low-fat dairy while reducing
sodium and saturated fat. Sodium should be limited to less than 2,300 mg/day.
,5. A client with angina is prescribed sublingual nitroglycerin. Which instruction
should the nurse include?
• A) "Chew the tablet for faster absorption."
• B) "Take up to three tablets 5 minutes apart if pain persists."
• C) "Swallow the tablet with a full glass of water."
• D) "Store the tablets in the refrigerator."
Answer: B) "Take up to three tablets 5 minutes apart if pain persists."
Rationale: Sublingual nitroglycerin should be placed under the tongue and
allowed to dissolve. If pain is not relieved after the first tablet, the client may take
a second tablet 5 minutes later, and a third tablet 5 minutes after that. If pain
persists after three tablets, emergency care is needed.
6. A nurse is assessing a client with peripheral arterial disease (PAD). Which
finding is most characteristic?
• A) Bilateral lower extremity edema
• B) Diminished or absent peripheral pulses
• C) Warm, pink skin on the lower extremities
• D) Distended neck veins
Answer: B) Diminished or absent peripheral pulses
Rationale: PAD results from atherosclerosis causing reduced blood flow to the
extremities. Diminished or absent pulses, cool skin, and pallor with elevation are
characteristic findings. Edema and warm skin are more typical of venous
insufficiency.
7. A client with heart failure is prescribed furosemide. Which electrolyte
imbalance should the nurse monitor most closely?
• A) Hyperkalemia
, • B) Hypokalemia
• C) Hypernatremia
• D) Hypermagnesemia
Answer: B) Hypokalemia
Rationale: Furosemide is a loop diuretic that causes potassium excretion in the
urine, leading to hypokalemia. The nurse should monitor serum potassium levels
and assess for signs of hypokalemia such as muscle weakness and cardiac
dysrhythmias.
8. A nurse is caring for a client 2 hours after a cardiac catheterization via the
femoral artery. Which assessment finding requires immediate intervention?
• A) Pulse rate of 78 bpm
• B) Blood pressure of 110/70 mmHg
• C) Pallor and coolness of the affected extremity
• D) Small amount of serous drainage at the insertion site
Answer: C) Pallor and coolness of the affected extremity
Rationale: Pallor and coolness of the extremity indicate possible arterial occlusion
or thromboembolism, which requires immediate intervention to prevent tissue
ischemia and loss of the limb.
9. A client with infective endocarditis is at risk for which complication?
• A) Pulmonary embolism
• B) Systemic embolization
• C) Deep vein thrombosis
• D) Myocardial infarction
Answer: B) Systemic embolization
2026 Updated Version | Complete Study Guide Covering
Cardiovascular, Respiratory, Neurological, Gastrointestinal, Renal,
Endocrine, Oncology & Perioperative Nursing Concepts with Answers
and Rationales
Cardiovascular System
1. A nurse is assessing a client with left-sided heart failure. Which of the
following findings should the nurse expect?
• A) Jugular venous distention
• B) Peripheral edema
• C) Crackles in the lung bases
• D) Hepatomegaly
Answer: C) Crackles in the lung bases
Rationale: Left-sided heart failure causes blood to back up into the pulmonary
circulation, leading to pulmonary congestion. Crackles (rales) in the lung bases are
a hallmark sign. Jugular venous distention, peripheral edema, and hepatomegaly
are signs of right-sided heart failure.
2. A nurse is caring for a client prescribed digoxin for heart failure. Which of the
following findings indicates digoxin toxicity?
• A) Heart rate of 72 bpm
• B) Blood pressure of 130/80 mmHg
• C) Visual disturbances (yellow-green halos)
• D) Increased urine output
Answer: C) Visual disturbances (yellow-green halos)
,Rationale: Digoxin toxicity presents with gastrointestinal symptoms (nausea,
vomiting), cardiac dysrhythmias, and visual disturbances such as yellow-green
halos or blurred vision. A heart rate of 72 bpm is within normal range.
3. A client with atrial fibrillation is prescribed warfarin. Which laboratory value
should the nurse monitor to evaluate therapeutic effectiveness?
• A) aPTT
• B) INR
• C) Platelet count
• D) PT
Answer: B) INR
Rationale: Warfarin therapy is monitored using the International Normalized
Ratio (INR). The therapeutic INR range for atrial fibrillation is typically 2.0–3.0.
aPTT is used for heparin monitoring.
4. A nurse is providing discharge teaching to a client with hypertension. Which
dietary modification should the nurse recommend?
• A) Increase sodium intake to 3,000 mg/day
• B) Follow the DASH eating plan
• C) Restrict potassium-rich foods
• D) Increase saturated fat consumption
Answer: B) Follow the DASH eating plan
Rationale: The DASH (Dietary Approaches to Stop Hypertension) eating plan
emphasizes fruits, vegetables, whole grains, and low-fat dairy while reducing
sodium and saturated fat. Sodium should be limited to less than 2,300 mg/day.
,5. A client with angina is prescribed sublingual nitroglycerin. Which instruction
should the nurse include?
• A) "Chew the tablet for faster absorption."
• B) "Take up to three tablets 5 minutes apart if pain persists."
• C) "Swallow the tablet with a full glass of water."
• D) "Store the tablets in the refrigerator."
Answer: B) "Take up to three tablets 5 minutes apart if pain persists."
Rationale: Sublingual nitroglycerin should be placed under the tongue and
allowed to dissolve. If pain is not relieved after the first tablet, the client may take
a second tablet 5 minutes later, and a third tablet 5 minutes after that. If pain
persists after three tablets, emergency care is needed.
6. A nurse is assessing a client with peripheral arterial disease (PAD). Which
finding is most characteristic?
• A) Bilateral lower extremity edema
• B) Diminished or absent peripheral pulses
• C) Warm, pink skin on the lower extremities
• D) Distended neck veins
Answer: B) Diminished or absent peripheral pulses
Rationale: PAD results from atherosclerosis causing reduced blood flow to the
extremities. Diminished or absent pulses, cool skin, and pallor with elevation are
characteristic findings. Edema and warm skin are more typical of venous
insufficiency.
7. A client with heart failure is prescribed furosemide. Which electrolyte
imbalance should the nurse monitor most closely?
• A) Hyperkalemia
, • B) Hypokalemia
• C) Hypernatremia
• D) Hypermagnesemia
Answer: B) Hypokalemia
Rationale: Furosemide is a loop diuretic that causes potassium excretion in the
urine, leading to hypokalemia. The nurse should monitor serum potassium levels
and assess for signs of hypokalemia such as muscle weakness and cardiac
dysrhythmias.
8. A nurse is caring for a client 2 hours after a cardiac catheterization via the
femoral artery. Which assessment finding requires immediate intervention?
• A) Pulse rate of 78 bpm
• B) Blood pressure of 110/70 mmHg
• C) Pallor and coolness of the affected extremity
• D) Small amount of serous drainage at the insertion site
Answer: C) Pallor and coolness of the affected extremity
Rationale: Pallor and coolness of the extremity indicate possible arterial occlusion
or thromboembolism, which requires immediate intervention to prevent tissue
ischemia and loss of the limb.
9. A client with infective endocarditis is at risk for which complication?
• A) Pulmonary embolism
• B) Systemic embolization
• C) Deep vein thrombosis
• D) Myocardial infarction
Answer: B) Systemic embolization
