ATI RN Adult Medical-Surgical (Med-Surg) 2026 Proctored
Examination with NGN - Version 2.0
Advanced Clinical Judgment Assessment: A Comprehensive 100-
Question Examination Covering Cardiovascular, Respiratory,
Neurological, Gastrointestinal, Renal, Endocrine, Musculoskeletal,
Hematological, Oncological, and Critical Care Nursing Concepts with
Next Generation NCLEX-Style Application Questions for Senior
Nursing Students and Graduate Nurses
Instructions:
Each question has one correct answer unless otherwise specified.
Select the best answer based on current evidence-based practice and ATI testing standards.
Questions incorporate Next Generation NCLEX (NGN) clinical judgment frameworks.
Some questions may require prioritization, delegation, or clinical reasoning.
Cardiovascular Disorders
Question 1
A nurse is caring for a client with acute decompensated heart failure (ADHF) who is receiving IV
furosemide. Which assessment finding indicates the medication is having the desired therapeutic
effect?
A. Increased heart rate from 88 to 102 bpm
B. Decreased blood pressure from 142/90 to 128/78 mm Hg
C. Urine output of 250 mL over the past 2 hours
D. Respiratory rate decreasing from 28 to 20 breaths/min
Correct Answer: D. Respiratory rate decreasing from 28 to 20 breaths/min
,Rationale: In ADHF, the therapeutic goal of furosemide is to reduce fluid volume, decrease preload,
and improve pulmonary congestion. A decreasing respiratory rate indicates improvement in
pulmonary edema and respiratory status. While increased urine output is desired, the clinical
improvement in respiratory status is the best indicator of therapeutic effect. Decreased blood pressure
may occur but is not the primary therapeutic goal. Tachycardia would indicate worsening or a
complication.
Question 2
A client with a history of myocardial infarction (MI) is prescribed clopidogrel. The nurse should monitor
the client for which adverse effect?
A. Hepatotoxicity
B. Bleeding
C. Nephrotoxicity
D. Hyperglycemia
Correct Answer: B. Bleeding
Rationale: Clopidogrel is a P2Y12 platelet inhibitor that prevents platelet aggregation. The primary
adverse effect is bleeding, including gastrointestinal bleeding, intracranial hemorrhage, and prolonged
bleeding from minor injuries. Hepatotoxicity, nephrotoxicity, and hyperglycemia are not typical
adverse effects of clopidogrel.
Question 3
A nurse is assessing a client with pericarditis who reports sharp chest pain that worsens with
inspiration and improves when leaning forward. Which additional finding would the nurse expect?
A. Pericardial friction rub on auscultation
B. Distended jugular veins
C. Muffled heart sounds
D. Hypotension with narrowed pulse pressure
Correct Answer: A. Pericardial friction rub on auscultation
,Rationale: Pericarditis is characterized by sharp, pleuritic chest pain that worsens with inspiration and
improves when leaning forward. A pericardial friction rub is a classic auscultatory finding. Distended
jugular veins, muffled heart sounds, and hypotension with narrowed pulse pressure are signs of
cardiac tamponade, a complication of pericarditis.
Question 4
A client with atrial fibrillation is prescribed warfarin. The nurse notes the client's INR is 3.8. Which
action should the nurse take?
A. Administer the prescribed dose of warfarin
B. Hold the warfarin and notify the healthcare provider
C. Administer vitamin K as prescribed
D. Increase the warfarin dose as prescribed
Correct Answer: B. Hold the warfarin and notify the healthcare provider
Rationale: The therapeutic INR range for atrial fibrillation is typically 2.0-3.0. An INR of 3.8 is elevated
and increases the risk of bleeding. The nurse should hold the warfarin and notify the healthcare
provider for further instructions. Vitamin K may be indicated for significant bleeding or very high INR
(>5.0) but is not the first action. Increasing the dose would be contraindicated.
Question 5
A client is admitted with acute coronary syndrome (ACS). Which laboratory value is most specific for
myocardial injury?
A. Creatine kinase-MB (CK-MB)
B. Troponin I
C. Myoglobin
D. C-reactive protein (CRP)
Correct Answer: B. Troponin I
, Rationale: Troponin I and troponin T are the most specific and sensitive cardiac biomarkers for
myocardial injury. Troponin levels begin to rise within 3-4 hours of MI and remain elevated for up to
10-14 days. CK-MB is less specific and myoglobin is less sensitive. CRP is a marker of inflammation but
is not specific for myocardial injury.
Question 6
A nurse is caring for a client with a temporary pacemaker. Which finding indicates proper pacemaker
function?
A. The pacemaker spikes are followed by a QRS complex on the ECG
B. The pacemaker spikes are not followed by a QRS complex
C. The heart rate is 48 bpm with a regular rhythm
D. The client reports palpitations and dizziness
Correct Answer: A. The pacemaker spikes are followed by a QRS complex on the ECG
Rationale: Proper pacemaker function is indicated by a pacer spike followed by a QRS complex
(ventricular capture). If spikes are not followed by QRS complexes, capture failure is occurring. A heart
rate of 48 bpm with regular rhythm may indicate the pacemaker is not firing at the set rate.
Palpitations and dizziness suggest improper function or underlying arrhythmia.
Question 7
A client with hypertension is prescribed amlodipine. The nurse should instruct the client to report
which adverse effect?
A. Dry cough
B. Peripheral edema
C. Hyperkalemia
D. Weight gain
Correct Answer: B. Peripheral edema
Examination with NGN - Version 2.0
Advanced Clinical Judgment Assessment: A Comprehensive 100-
Question Examination Covering Cardiovascular, Respiratory,
Neurological, Gastrointestinal, Renal, Endocrine, Musculoskeletal,
Hematological, Oncological, and Critical Care Nursing Concepts with
Next Generation NCLEX-Style Application Questions for Senior
Nursing Students and Graduate Nurses
Instructions:
Each question has one correct answer unless otherwise specified.
Select the best answer based on current evidence-based practice and ATI testing standards.
Questions incorporate Next Generation NCLEX (NGN) clinical judgment frameworks.
Some questions may require prioritization, delegation, or clinical reasoning.
Cardiovascular Disorders
Question 1
A nurse is caring for a client with acute decompensated heart failure (ADHF) who is receiving IV
furosemide. Which assessment finding indicates the medication is having the desired therapeutic
effect?
A. Increased heart rate from 88 to 102 bpm
B. Decreased blood pressure from 142/90 to 128/78 mm Hg
C. Urine output of 250 mL over the past 2 hours
D. Respiratory rate decreasing from 28 to 20 breaths/min
Correct Answer: D. Respiratory rate decreasing from 28 to 20 breaths/min
,Rationale: In ADHF, the therapeutic goal of furosemide is to reduce fluid volume, decrease preload,
and improve pulmonary congestion. A decreasing respiratory rate indicates improvement in
pulmonary edema and respiratory status. While increased urine output is desired, the clinical
improvement in respiratory status is the best indicator of therapeutic effect. Decreased blood pressure
may occur but is not the primary therapeutic goal. Tachycardia would indicate worsening or a
complication.
Question 2
A client with a history of myocardial infarction (MI) is prescribed clopidogrel. The nurse should monitor
the client for which adverse effect?
A. Hepatotoxicity
B. Bleeding
C. Nephrotoxicity
D. Hyperglycemia
Correct Answer: B. Bleeding
Rationale: Clopidogrel is a P2Y12 platelet inhibitor that prevents platelet aggregation. The primary
adverse effect is bleeding, including gastrointestinal bleeding, intracranial hemorrhage, and prolonged
bleeding from minor injuries. Hepatotoxicity, nephrotoxicity, and hyperglycemia are not typical
adverse effects of clopidogrel.
Question 3
A nurse is assessing a client with pericarditis who reports sharp chest pain that worsens with
inspiration and improves when leaning forward. Which additional finding would the nurse expect?
A. Pericardial friction rub on auscultation
B. Distended jugular veins
C. Muffled heart sounds
D. Hypotension with narrowed pulse pressure
Correct Answer: A. Pericardial friction rub on auscultation
,Rationale: Pericarditis is characterized by sharp, pleuritic chest pain that worsens with inspiration and
improves when leaning forward. A pericardial friction rub is a classic auscultatory finding. Distended
jugular veins, muffled heart sounds, and hypotension with narrowed pulse pressure are signs of
cardiac tamponade, a complication of pericarditis.
Question 4
A client with atrial fibrillation is prescribed warfarin. The nurse notes the client's INR is 3.8. Which
action should the nurse take?
A. Administer the prescribed dose of warfarin
B. Hold the warfarin and notify the healthcare provider
C. Administer vitamin K as prescribed
D. Increase the warfarin dose as prescribed
Correct Answer: B. Hold the warfarin and notify the healthcare provider
Rationale: The therapeutic INR range for atrial fibrillation is typically 2.0-3.0. An INR of 3.8 is elevated
and increases the risk of bleeding. The nurse should hold the warfarin and notify the healthcare
provider for further instructions. Vitamin K may be indicated for significant bleeding or very high INR
(>5.0) but is not the first action. Increasing the dose would be contraindicated.
Question 5
A client is admitted with acute coronary syndrome (ACS). Which laboratory value is most specific for
myocardial injury?
A. Creatine kinase-MB (CK-MB)
B. Troponin I
C. Myoglobin
D. C-reactive protein (CRP)
Correct Answer: B. Troponin I
, Rationale: Troponin I and troponin T are the most specific and sensitive cardiac biomarkers for
myocardial injury. Troponin levels begin to rise within 3-4 hours of MI and remain elevated for up to
10-14 days. CK-MB is less specific and myoglobin is less sensitive. CRP is a marker of inflammation but
is not specific for myocardial injury.
Question 6
A nurse is caring for a client with a temporary pacemaker. Which finding indicates proper pacemaker
function?
A. The pacemaker spikes are followed by a QRS complex on the ECG
B. The pacemaker spikes are not followed by a QRS complex
C. The heart rate is 48 bpm with a regular rhythm
D. The client reports palpitations and dizziness
Correct Answer: A. The pacemaker spikes are followed by a QRS complex on the ECG
Rationale: Proper pacemaker function is indicated by a pacer spike followed by a QRS complex
(ventricular capture). If spikes are not followed by QRS complexes, capture failure is occurring. A heart
rate of 48 bpm with regular rhythm may indicate the pacemaker is not firing at the set rate.
Palpitations and dizziness suggest improper function or underlying arrhythmia.
Question 7
A client with hypertension is prescribed amlodipine. The nurse should instruct the client to report
which adverse effect?
A. Dry cough
B. Peripheral edema
C. Hyperkalemia
D. Weight gain
Correct Answer: B. Peripheral edema
