ATI Med-Surg Proctored Exam (2026) – NGN-
Style Questions, Case Scenarios & Answers (1-
200)
SECTION 1: CARDIOVASCULAR DISORDERS
1. A nurse is assessing a client who is 6 hours post-angiogram via the
right femoral artery. Which finding requires immediate action?
A) Blood pressure 128/74 mm Hg
B) Heart rate 86 bpm
C) Small amount of bloody drainage on the pressure dressing
D) Palpable, hard lump at the catheter insertion site
*D) Palpable, hard lump at the catheter insertion site *
Rationale: A palpable, hard lump (hematoma) at the insertion site indicates
active bleeding into the tissue and can lead to compromised circulation to the
limb and significant blood loss. The nurse should immediately apply firm
pressure proximal to the site, assess distal pulses, and notify the provider .
2. A client with heart failure reports a sudden weight gain of 2 kg (4.4
lb) in 2 days. What is the nurse's priority action?
A) Encourage ambulation
B) Restrict fluids
C) Notify the provider
D) Administer potassium
,*C) Notify the provider *
Rationale: Rapid weight gain indicates fluid overload and a possible
exacerbation of heart failure, requiring immediate provider intervention for
diuretic adjustment or other medical management .
3. A client is receiving a heparin infusion. Which lab value should the
nurse monitor to evaluate therapeutic effect?
A) INR
B) aPTT
C) Platelet count
D) Hemoglobin
*B) aPTT *
Rationale: The activated partial thromboplastin time (aPTT) is used to
monitor heparin therapy. The therapeutic goal is typically 1.5-2.5 times the
control value .
4. A client with acute decompensated heart failure (ADHF) 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
*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 .
5. 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
*B) Bleeding *
Rationale: Clopidogrel is a P2Y12 platelet inhibitor that prevents platelet
aggregation. The primary adverse effect is bleeding, including gastrointestinal
bleeding and intracranial hemorrhage .
6. 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
*A) Pericardial friction rub on auscultation *
Rationale: A pericardial friction rub is a classic finding in pericarditis, caused
by inflammation of the pericardial layers rubbing against each other.
Distended jugular veins, muffled heart sounds, and hypotension with
narrowed pulse pressure suggest pericardial effusion or cardiac tamponade .
, 7. A client with atrial fibrillation is prescribed warfarin. Which
laboratory value indicates therapy is therapeutic?
A) INR of 2.5
B) aPTT of 60 seconds
C) Platelets of 150,000
D) Hemoglobin of 14 g/dL
*A) INR of 2.5 *
Rationale: For atrial fibrillation, the therapeutic INR range is typically 2.0-3.0.
aPTT is used to monitor heparin therapy .
8. A client receiving IV heparin has a platelet count of 80,000/mm³.
What should the nurse do?
A) Continue therapy and monitor labs
B) Hold heparin and notify the provider
C) Increase heparin dose
D) Administer vitamin K
*B) Hold heparin and notify the provider *
Rationale: Thrombocytopenia may indicate heparin-induced
thrombocytopenia (HIT); heparin must be held and the provider notified
immediately .
9. A nurse is assessing a client with a pleural effusion. Which finding is
most consistent with this diagnosis?
A) Hyperresonance on percussion
B) Bronchial breath sounds over the affected area
Style Questions, Case Scenarios & Answers (1-
200)
SECTION 1: CARDIOVASCULAR DISORDERS
1. A nurse is assessing a client who is 6 hours post-angiogram via the
right femoral artery. Which finding requires immediate action?
A) Blood pressure 128/74 mm Hg
B) Heart rate 86 bpm
C) Small amount of bloody drainage on the pressure dressing
D) Palpable, hard lump at the catheter insertion site
*D) Palpable, hard lump at the catheter insertion site *
Rationale: A palpable, hard lump (hematoma) at the insertion site indicates
active bleeding into the tissue and can lead to compromised circulation to the
limb and significant blood loss. The nurse should immediately apply firm
pressure proximal to the site, assess distal pulses, and notify the provider .
2. A client with heart failure reports a sudden weight gain of 2 kg (4.4
lb) in 2 days. What is the nurse's priority action?
A) Encourage ambulation
B) Restrict fluids
C) Notify the provider
D) Administer potassium
,*C) Notify the provider *
Rationale: Rapid weight gain indicates fluid overload and a possible
exacerbation of heart failure, requiring immediate provider intervention for
diuretic adjustment or other medical management .
3. A client is receiving a heparin infusion. Which lab value should the
nurse monitor to evaluate therapeutic effect?
A) INR
B) aPTT
C) Platelet count
D) Hemoglobin
*B) aPTT *
Rationale: The activated partial thromboplastin time (aPTT) is used to
monitor heparin therapy. The therapeutic goal is typically 1.5-2.5 times the
control value .
4. A client with acute decompensated heart failure (ADHF) 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
*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 .
5. 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
*B) Bleeding *
Rationale: Clopidogrel is a P2Y12 platelet inhibitor that prevents platelet
aggregation. The primary adverse effect is bleeding, including gastrointestinal
bleeding and intracranial hemorrhage .
6. 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
*A) Pericardial friction rub on auscultation *
Rationale: A pericardial friction rub is a classic finding in pericarditis, caused
by inflammation of the pericardial layers rubbing against each other.
Distended jugular veins, muffled heart sounds, and hypotension with
narrowed pulse pressure suggest pericardial effusion or cardiac tamponade .
, 7. A client with atrial fibrillation is prescribed warfarin. Which
laboratory value indicates therapy is therapeutic?
A) INR of 2.5
B) aPTT of 60 seconds
C) Platelets of 150,000
D) Hemoglobin of 14 g/dL
*A) INR of 2.5 *
Rationale: For atrial fibrillation, the therapeutic INR range is typically 2.0-3.0.
aPTT is used to monitor heparin therapy .
8. A client receiving IV heparin has a platelet count of 80,000/mm³.
What should the nurse do?
A) Continue therapy and monitor labs
B) Hold heparin and notify the provider
C) Increase heparin dose
D) Administer vitamin K
*B) Hold heparin and notify the provider *
Rationale: Thrombocytopenia may indicate heparin-induced
thrombocytopenia (HIT); heparin must be held and the provider notified
immediately .
9. A nurse is assessing a client with a pleural effusion. Which finding is
most consistent with this diagnosis?
A) Hyperresonance on percussion
B) Bronchial breath sounds over the affected area
