ATI RN Adult Medical-Surgical (Med-Surg) 2026 Proctored
Examination with NGN: A Comprehensive 100-Question
Assessment of Clinical Judgment, Pathophysiology,
Pharmacological Management, and Evidence-Based Nursing
Interventions Across Major Body Systems for Advanced Nursing
Practice
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.
Cardiovascular Disorders
Question 1
A nurse is assessing a client who is 6 hours post-percutaneous coronary intervention (PCI) via the
femoral artery. Which finding requires immediate intervention?
A. Heart rate 88 bpm with occasional premature ventricular contractions
B. Blood pressure 118/72 mm Hg
C. Large, expanding hematoma at the insertion site with diminished distal pulses
D. Urine output of 45 mL over the past hour
Correct Answer: C. Large, expanding hematoma at the insertion site with diminished distal pulses
Rationale: An expanding hematoma at the femoral access site with diminished distal pulses indicates
active bleeding and possible vessel injury or occlusion, which can lead to compartment syndrome or
limb ischemia. This requires immediate intervention including manual pressure, possible reversal of
anticoagulation, and surgical consultation. Options A, B, and D are within acceptable parameters.
,Question 2
A client with heart failure (HF) and New York Heart Association (NYHA) Class III symptoms is prescribed
sacubitril/valsartan. Which laboratory value should the nurse monitor most closely prior to initiating
this medication?
A. Serum potassium
B. Serum sodium
C. BUN and creatinine
D. Hemoglobin and hematocrit
Correct Answer: A. Serum potassium
Rationale: Sacubitril/valsartan is a combination angiotensin receptor-neprilysin inhibitor (ARNI) that
can cause hyperkalemia. Serum potassium should be monitored before initiation and periodically
during therapy. Potassium levels >5.4 mEq/L are a contraindication to starting therapy. Renal function
(BUN/creatinine) should also be monitored, but hyperkalemia poses the most immediate risk.
Question 3
A nurse is caring for a client with infective endocarditis. Which assessment finding is most consistent
with this diagnosis?
A. Splinter hemorrhages and Osler's nodes
B. Clubbing of the fingers and cyanosis
C. Pericardial friction rub and jugular venous distention
D. Wheezing and productive cough
Correct Answer: A. Splinter hemorrhages and Osler's nodes
Rationale: Splinter hemorrhages (linear red/brown streaks under the nails) and Osler's nodes (tender,
red, raised lesions on the fingertips or toes) are classic peripheral manifestations of infective
endocarditis caused by immune complex deposition and microemboli. Other findings may include
Janeway lesions, Roth spots, and new or changing heart murmurs.
,Question 4
A client with unstable angina is receiving continuous IV nitroglycerin. The client reports a sudden,
severe headache. Which action should the nurse take?
A. Discontinue the nitroglycerin immediately
B. Administer acetaminophen as prescribed
C. Decrease the infusion rate by half
D. Notify the healthcare provider stat
Correct Answer: B. Administer acetaminophen as prescribed
Rationale: Headache is a common and expected side effect of nitroglycerin due to vasodilation. It is
not an indication to discontinue therapy. The nurse should administer analgesics as prescribed and
continue to monitor the client. Discontinuing or decreasing the infusion without an order could
compromise the client's cardiac status. The healthcare provider does not need to be notified stat for
this expected side effect.
Question 5
A nurse is preparing to administer digoxin to a client with atrial fibrillation. Which finding indicates the
medication should be withheld?
A. Serum potassium of 4.2 mEq/L
B. Apical heart rate of 54 bpm
C. Blood pressure of 138/86 mm Hg
D. Serum digoxin level of 1.2 ng/mL
Correct Answer: B. Apical heart rate of 54 bpm
Rationale: Digoxin should be withheld if the apical pulse is <60 bpm in adults (or <70 bpm in children)
because bradycardia is a sign of digoxin toxicity. The nurse should reassess the pulse and notify the
healthcare provider. The serum digoxin therapeutic range is 0.8-2.0 ng/mL; 1.2 ng/mL is within normal
limits. Potassium of 4.2 mEq/L is normal.
, Question 6
A client with peripheral arterial disease (PAD) reports leg pain that awakens them at night. Which
intervention should the nurse recommend?
A. Elevate the legs above heart level while sleeping
B. Dangle the legs over the side of the bed
C. Apply warm compresses to the affected extremities
D. Wear compression stockings to bed
Correct Answer: B. Dangle the legs over the side of the bed
Rationale: Rest pain in PAD is caused by inadequate arterial blood flow. Dangling the legs over the
side of the bed uses gravity to increase blood flow to the extremities and relieve ischemic pain.
Elevation worsens ischemia by reducing arterial perfusion. Warm compresses can increase metabolic
demand and worsen ischemia in severe PAD. Compression stockings are contraindicated in PAD as
they further impair arterial flow.
Question 7
A nurse is assessing a client with aortic stenosis. Which finding is most characteristic of this condition?
A. Bounding peripheral pulses
B. Systolic ejection murmur heard best at the right upper sternal border
C. Diastolic murmur heard best at the apex
D. Widened pulse pressure
Correct Answer: B. Systolic ejection murmur heard best at the right upper sternal border
Rationale: Aortic stenosis produces a harsh, crescendo-decrescendo systolic ejection murmur that is
best heard at the right upper sternal border (aortic area). It radiates to the carotids. Bounding pulses
and widened pulse pressure are associated with aortic regurgitation. A diastolic murmur at the apex is
characteristic of mitral stenosis.
Examination with NGN: A Comprehensive 100-Question
Assessment of Clinical Judgment, Pathophysiology,
Pharmacological Management, and Evidence-Based Nursing
Interventions Across Major Body Systems for Advanced Nursing
Practice
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.
Cardiovascular Disorders
Question 1
A nurse is assessing a client who is 6 hours post-percutaneous coronary intervention (PCI) via the
femoral artery. Which finding requires immediate intervention?
A. Heart rate 88 bpm with occasional premature ventricular contractions
B. Blood pressure 118/72 mm Hg
C. Large, expanding hematoma at the insertion site with diminished distal pulses
D. Urine output of 45 mL over the past hour
Correct Answer: C. Large, expanding hematoma at the insertion site with diminished distal pulses
Rationale: An expanding hematoma at the femoral access site with diminished distal pulses indicates
active bleeding and possible vessel injury or occlusion, which can lead to compartment syndrome or
limb ischemia. This requires immediate intervention including manual pressure, possible reversal of
anticoagulation, and surgical consultation. Options A, B, and D are within acceptable parameters.
,Question 2
A client with heart failure (HF) and New York Heart Association (NYHA) Class III symptoms is prescribed
sacubitril/valsartan. Which laboratory value should the nurse monitor most closely prior to initiating
this medication?
A. Serum potassium
B. Serum sodium
C. BUN and creatinine
D. Hemoglobin and hematocrit
Correct Answer: A. Serum potassium
Rationale: Sacubitril/valsartan is a combination angiotensin receptor-neprilysin inhibitor (ARNI) that
can cause hyperkalemia. Serum potassium should be monitored before initiation and periodically
during therapy. Potassium levels >5.4 mEq/L are a contraindication to starting therapy. Renal function
(BUN/creatinine) should also be monitored, but hyperkalemia poses the most immediate risk.
Question 3
A nurse is caring for a client with infective endocarditis. Which assessment finding is most consistent
with this diagnosis?
A. Splinter hemorrhages and Osler's nodes
B. Clubbing of the fingers and cyanosis
C. Pericardial friction rub and jugular venous distention
D. Wheezing and productive cough
Correct Answer: A. Splinter hemorrhages and Osler's nodes
Rationale: Splinter hemorrhages (linear red/brown streaks under the nails) and Osler's nodes (tender,
red, raised lesions on the fingertips or toes) are classic peripheral manifestations of infective
endocarditis caused by immune complex deposition and microemboli. Other findings may include
Janeway lesions, Roth spots, and new or changing heart murmurs.
,Question 4
A client with unstable angina is receiving continuous IV nitroglycerin. The client reports a sudden,
severe headache. Which action should the nurse take?
A. Discontinue the nitroglycerin immediately
B. Administer acetaminophen as prescribed
C. Decrease the infusion rate by half
D. Notify the healthcare provider stat
Correct Answer: B. Administer acetaminophen as prescribed
Rationale: Headache is a common and expected side effect of nitroglycerin due to vasodilation. It is
not an indication to discontinue therapy. The nurse should administer analgesics as prescribed and
continue to monitor the client. Discontinuing or decreasing the infusion without an order could
compromise the client's cardiac status. The healthcare provider does not need to be notified stat for
this expected side effect.
Question 5
A nurse is preparing to administer digoxin to a client with atrial fibrillation. Which finding indicates the
medication should be withheld?
A. Serum potassium of 4.2 mEq/L
B. Apical heart rate of 54 bpm
C. Blood pressure of 138/86 mm Hg
D. Serum digoxin level of 1.2 ng/mL
Correct Answer: B. Apical heart rate of 54 bpm
Rationale: Digoxin should be withheld if the apical pulse is <60 bpm in adults (or <70 bpm in children)
because bradycardia is a sign of digoxin toxicity. The nurse should reassess the pulse and notify the
healthcare provider. The serum digoxin therapeutic range is 0.8-2.0 ng/mL; 1.2 ng/mL is within normal
limits. Potassium of 4.2 mEq/L is normal.
, Question 6
A client with peripheral arterial disease (PAD) reports leg pain that awakens them at night. Which
intervention should the nurse recommend?
A. Elevate the legs above heart level while sleeping
B. Dangle the legs over the side of the bed
C. Apply warm compresses to the affected extremities
D. Wear compression stockings to bed
Correct Answer: B. Dangle the legs over the side of the bed
Rationale: Rest pain in PAD is caused by inadequate arterial blood flow. Dangling the legs over the
side of the bed uses gravity to increase blood flow to the extremities and relieve ischemic pain.
Elevation worsens ischemia by reducing arterial perfusion. Warm compresses can increase metabolic
demand and worsen ischemia in severe PAD. Compression stockings are contraindicated in PAD as
they further impair arterial flow.
Question 7
A nurse is assessing a client with aortic stenosis. Which finding is most characteristic of this condition?
A. Bounding peripheral pulses
B. Systolic ejection murmur heard best at the right upper sternal border
C. Diastolic murmur heard best at the apex
D. Widened pulse pressure
Correct Answer: B. Systolic ejection murmur heard best at the right upper sternal border
Rationale: Aortic stenosis produces a harsh, crescendo-decrescendo systolic ejection murmur that is
best heard at the right upper sternal border (aortic area). It radiates to the carotids. Bounding pulses
and widened pulse pressure are associated with aortic regurgitation. A diastolic murmur at the apex is
characteristic of mitral stenosis.
