ATI PN MEDICAL-SURGICAL FINAL EXAM
2026/2027 STUDY GUIDE | VERIFIED
QUESTIONS & ANSWERS | NCLEX-PN
ALIGNED | CONTENT MASTERY 12.0
ATI PN MEDICAL-SURGICAL FINAL EXAM 2026/2027 STUDY GUIDE | VERIFIED
QUESTIONS & ANSWERS | NCLEX-PN ALIGNED | CONTENT MASTERY 12.0
====================================================================
============
OVERVIEW
• This study guide contains carefully crafted multiple-choice questions designed to
assess your mastery of core medical-surgical nursing concepts, clinical judgment,
and NCLEX-PN aligned content with detailed rationales for every answer
• Use this material by practicing 20-30 questions daily, reviewing rationales
thoroughly, and identifying weak areas to prioritize deeper study and clinical
application
====================================================================
============
CARDIOVASCULAR SYSTEM DISORDERS (Questions 1-25)
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============
1. A 65-year-old male client is admitted with acute myocardial infarction
(AMI). Which assessment finding should the PN prioritize as the most critical
indicator of cardiac compromise?
A) Elevated blood pressure of 160/95 mmHg
B) Irregular heart rhythm with a heart rate of 48 bpm
C) Diaphoresis and chest pain not relieved by rest
D) Pale skin with cool, clammy extremities
E) Complaint of dyspnea with a respiratory rate of 20
CORRECT ANSWER: B) Irregular heart rhythm with a heart rate of 48 bpm
,Rationale: A heart rate of 48 bpm (bradycardia) with an irregular rhythm following
an MI indicates a conduction disturbance or arrhythmia, which is life-threatening
and requires immediate intervention. While diaphoresis and chest pain are
concerning, a bradyarrhythmia can lead to decreased cardiac output and
cardiogenic shock. Elevated blood pressure may be a compensatory response, and
dyspnea at a rate of 20 is less immediately critical than the arrhythmia. The PN
must prioritize the rhythm disturbance and notify the provider immediately.
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============
2. A 58-year-old female client with heart failure is prescribed digoxin. Which
therapeutic serum level range should the PN verify before administration?
A) 0.5–1.0 ng/mL
B) 1.0–2.0 ng/mL
C) 2.0–3.0 ng/mL
D) 3.0–4.0 ng/mL
E) 4.0–5.0 ng/mL
CORRECT ANSWER: B) 1.0–2.0 ng/mL
Rationale: The therapeutic serum level for digoxin is 0.8–2.0 ng/mL (with 1.0–2.0
ng/mL being the most commonly referenced therapeutic range). Levels below 0.8
ng/mL are subtherapeutic, and levels above 2.4 ng/mL are toxic, increasing the risk
of digoxin toxicity manifested by nausea, vomiting, visual disturbances, and cardiac
arrhythmias. The PN must verify the level is within this range before administration.
====================================================================
============
3. A PN is caring for a client on continuous cardiac monitoring following an
acute coronary event. The monitor shows a rhythm with no P waves, irregular
ventricular rhythm, and a rate of 120 bpm. Which rhythm should the PN
identify?
A) Atrial fibrillation
,B) Atrial flutter
C) Ventricular tachycardia
D) Sinus tachycardia
E) Supraventricular tachycardia
CORRECT ANSWER: A) Atrial fibrillation
Rationale: Atrial fibrillation is characterized by the absence of P waves, an
irregularly irregular ventricular rhythm, and a rapid rate (typically 100–150 bpm or
higher). The disorganized atrial activity creates fine or coarse fibrillatory waves
instead of distinct P waves. Atrial flutter would show "saw-tooth" flutter waves;
ventricular tachycardia would show wide QRS complexes; and sinus tachycardia
would show regular P waves and regular rhythm. Atrial fibrillation increases
thrombus formation and requires anticoagulation therapy.
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============
4. A 72-year-old client with chronic heart failure is on furosemide 40 mg daily
and lisinopril. The PN notes laboratory values: K+ 3.2 mEq/L and Na+ 132
mEq/L. Which intervention should the PN implement first?
A) Administer a potassium supplement immediately
B) Notify the provider of abnormal electrolytes and hold the furosemide
C) Encourage the client to increase dietary sodium intake
D) Administer normal saline IV bolus
E) Schedule a stat EKG for the client
CORRECT ANSWER: B) Notify the provider of abnormal electrolytes and hold
the furosemide
Rationale: Furosemide causes hypokalemia (K+ 3.2 mEq/L is low; normal is 3.5–5.0
mEq/L) and hyponatremia (Na+ 132 mEq/L is low; normal is 135–145 mEq/L). The
PN must notify the provider before giving the next dose of furosemide, as
continuing the diuretic will worsen electrolyte imbalances. The provider may order
, potassium supplementation and electrolyte monitoring. While an EKG is warranted,
notifying the provider and holding the furosemide is the priority intervention to
prevent further electrolyte depletion.
====================================================================
============
5. A client with hypertension is prescribed losartan (Cozaar). Which teaching
point should the PN emphasize regarding this medication?
A) Take the medication with food to enhance absorption
B) Expect a temporary increase in potassium levels, which is normal
C) Change positions slowly to prevent orthostatic hypotension
D) Avoid high-potassium foods because losartan increases potassium retention
E) Schedule blood work monthly to monitor creatinine levels
CORRECT ANSWER: D) Avoid high-potassium foods because losartan increases
potassium retention
Rationale: Losartan is an angiotensin II receptor blocker (ARB) that decreases
aldosterone secretion, leading to potassium retention and increased serum K+
levels. Clients must restrict dietary potassium intake and avoid potassium-sparing
diuretics to prevent hyperkalemia. Options A is incorrect (losartan can be taken
with or without food); Option C is a general antihypertensive precaution but not
specific to losartan; Option E is not required routinely; Option B is incorrect as
losartan causes hyperkalemia, not normalization of levels.
====================================================================
============
6. A 55-year-old client recovering from bypass surgery reports substernal
chest pain rated 7/10. Blood pressure is 165/92 mmHg, and heart rate is 102
bpm. Which action should the PN take immediately?
A) Administer oxygen at 2 L/min via nasal cannula
B) Notify the provider and obtain a 12-lead EKG before administering analgesia
2026/2027 STUDY GUIDE | VERIFIED
QUESTIONS & ANSWERS | NCLEX-PN
ALIGNED | CONTENT MASTERY 12.0
ATI PN MEDICAL-SURGICAL FINAL EXAM 2026/2027 STUDY GUIDE | VERIFIED
QUESTIONS & ANSWERS | NCLEX-PN ALIGNED | CONTENT MASTERY 12.0
====================================================================
============
OVERVIEW
• This study guide contains carefully crafted multiple-choice questions designed to
assess your mastery of core medical-surgical nursing concepts, clinical judgment,
and NCLEX-PN aligned content with detailed rationales for every answer
• Use this material by practicing 20-30 questions daily, reviewing rationales
thoroughly, and identifying weak areas to prioritize deeper study and clinical
application
====================================================================
============
CARDIOVASCULAR SYSTEM DISORDERS (Questions 1-25)
====================================================================
============
1. A 65-year-old male client is admitted with acute myocardial infarction
(AMI). Which assessment finding should the PN prioritize as the most critical
indicator of cardiac compromise?
A) Elevated blood pressure of 160/95 mmHg
B) Irregular heart rhythm with a heart rate of 48 bpm
C) Diaphoresis and chest pain not relieved by rest
D) Pale skin with cool, clammy extremities
E) Complaint of dyspnea with a respiratory rate of 20
CORRECT ANSWER: B) Irregular heart rhythm with a heart rate of 48 bpm
,Rationale: A heart rate of 48 bpm (bradycardia) with an irregular rhythm following
an MI indicates a conduction disturbance or arrhythmia, which is life-threatening
and requires immediate intervention. While diaphoresis and chest pain are
concerning, a bradyarrhythmia can lead to decreased cardiac output and
cardiogenic shock. Elevated blood pressure may be a compensatory response, and
dyspnea at a rate of 20 is less immediately critical than the arrhythmia. The PN
must prioritize the rhythm disturbance and notify the provider immediately.
====================================================================
============
2. A 58-year-old female client with heart failure is prescribed digoxin. Which
therapeutic serum level range should the PN verify before administration?
A) 0.5–1.0 ng/mL
B) 1.0–2.0 ng/mL
C) 2.0–3.0 ng/mL
D) 3.0–4.0 ng/mL
E) 4.0–5.0 ng/mL
CORRECT ANSWER: B) 1.0–2.0 ng/mL
Rationale: The therapeutic serum level for digoxin is 0.8–2.0 ng/mL (with 1.0–2.0
ng/mL being the most commonly referenced therapeutic range). Levels below 0.8
ng/mL are subtherapeutic, and levels above 2.4 ng/mL are toxic, increasing the risk
of digoxin toxicity manifested by nausea, vomiting, visual disturbances, and cardiac
arrhythmias. The PN must verify the level is within this range before administration.
====================================================================
============
3. A PN is caring for a client on continuous cardiac monitoring following an
acute coronary event. The monitor shows a rhythm with no P waves, irregular
ventricular rhythm, and a rate of 120 bpm. Which rhythm should the PN
identify?
A) Atrial fibrillation
,B) Atrial flutter
C) Ventricular tachycardia
D) Sinus tachycardia
E) Supraventricular tachycardia
CORRECT ANSWER: A) Atrial fibrillation
Rationale: Atrial fibrillation is characterized by the absence of P waves, an
irregularly irregular ventricular rhythm, and a rapid rate (typically 100–150 bpm or
higher). The disorganized atrial activity creates fine or coarse fibrillatory waves
instead of distinct P waves. Atrial flutter would show "saw-tooth" flutter waves;
ventricular tachycardia would show wide QRS complexes; and sinus tachycardia
would show regular P waves and regular rhythm. Atrial fibrillation increases
thrombus formation and requires anticoagulation therapy.
====================================================================
============
4. A 72-year-old client with chronic heart failure is on furosemide 40 mg daily
and lisinopril. The PN notes laboratory values: K+ 3.2 mEq/L and Na+ 132
mEq/L. Which intervention should the PN implement first?
A) Administer a potassium supplement immediately
B) Notify the provider of abnormal electrolytes and hold the furosemide
C) Encourage the client to increase dietary sodium intake
D) Administer normal saline IV bolus
E) Schedule a stat EKG for the client
CORRECT ANSWER: B) Notify the provider of abnormal electrolytes and hold
the furosemide
Rationale: Furosemide causes hypokalemia (K+ 3.2 mEq/L is low; normal is 3.5–5.0
mEq/L) and hyponatremia (Na+ 132 mEq/L is low; normal is 135–145 mEq/L). The
PN must notify the provider before giving the next dose of furosemide, as
continuing the diuretic will worsen electrolyte imbalances. The provider may order
, potassium supplementation and electrolyte monitoring. While an EKG is warranted,
notifying the provider and holding the furosemide is the priority intervention to
prevent further electrolyte depletion.
====================================================================
============
5. A client with hypertension is prescribed losartan (Cozaar). Which teaching
point should the PN emphasize regarding this medication?
A) Take the medication with food to enhance absorption
B) Expect a temporary increase in potassium levels, which is normal
C) Change positions slowly to prevent orthostatic hypotension
D) Avoid high-potassium foods because losartan increases potassium retention
E) Schedule blood work monthly to monitor creatinine levels
CORRECT ANSWER: D) Avoid high-potassium foods because losartan increases
potassium retention
Rationale: Losartan is an angiotensin II receptor blocker (ARB) that decreases
aldosterone secretion, leading to potassium retention and increased serum K+
levels. Clients must restrict dietary potassium intake and avoid potassium-sparing
diuretics to prevent hyperkalemia. Options A is incorrect (losartan can be taken
with or without food); Option C is a general antihypertensive precaution but not
specific to losartan; Option E is not required routinely; Option B is incorrect as
losartan causes hyperkalemia, not normalization of levels.
====================================================================
============
6. A 55-year-old client recovering from bypass surgery reports substernal
chest pain rated 7/10. Blood pressure is 165/92 mmHg, and heart rate is 102
bpm. Which action should the PN take immediately?
A) Administer oxygen at 2 L/min via nasal cannula
B) Notify the provider and obtain a 12-lead EKG before administering analgesia
