ATI MED-SURG PROCTORED EXAM PREP
(2026) NGN-STYLE QUESTIONS &
GRADED A+ RATIONALES
This comprehensive question ATI Medical-Surgical Nursing
practice test bank features Next-Generation NCLEX (NGN)
style case items with instant verified answer keys. Every
scenario integrates high-yield clinical reasoning
frameworks, focusing on fluid/electrolyte dynamics,
pharmacology, advanced prioritization, and multisystem
care management. Perfectly formatted with clear bold
rationales to help nursing students master core
competencies, review rationales, and achieve Level 3
proficiency on proctored assessments .
1. A nurse is assessing a client 2 hours post-percutaneous
coronary intervention (PCI) via the femoral artery. The
nurse notes a hard, painful lump forming proximal to the
puncture site and the client's blood pressure drops from
120/80 to 98/60 mmHg. Which action should the nurse
take first?
A. Apply manual pressure to the groin site.
, B. Obtain an immediate 12-lead ECG.
C. Increase the maintenance IV fluid rate.
D. Check the client’s distal pedal pulses.
• Answer: A
• Rationale: The client is exhibiting signs of a femoral
artery pseudoaneurysm or hematoma with active
bleeding, causing hemodynamic instability. Holding
immediate, firm manual pressure is the priority action to
halt blood loss before addressing fluid resuscitation or
obtaining diagnostics. Checking pulses is vital, but
stopping active hemorrhage takes precedence.
2. A client with a history of heart failure is prescribed
digoxintor daily use. Which of the following clinical findings
should alert the nurse to potential digoxin toxicity?
A. Intermittent muscle cramps in the lower extremities.
B. New onset of green-yellow halos around glowing
objects.
C. A blood pressure reading of 150/90 mmHg.
D. Increased frequency of nocturnal urination.
• Answer: B
• Rationale: Visual disturbances, specifically green, yellow,
or white halos around objects, are classic signs of digoxin
toxicity. Other early symptoms include anorexia, nausea,
, and bradycardia. Muscle cramps are typically linked to
electrolyte shifts rather than direct digitalis toxicity.
3. A nurse is caring for a client in the emergency department
who reports sudden, severe chest pain radiating to the
back between the scapulae, described as a "tearing"
sensation. The nurse notes a blood pressure mismatch of
30 mmHg between the right and left arms. Which
condition should the nurse suspect?
A. Acute Myocardial Infarction
B. Pulmonary Embolism
C. Aortic Dissection
D. Cardiac Tamponade
• Answer: C
• Rationale: A tearing chest pain that radiates to the back
combined with a significant blood pressure differential
between limbs is the hallmark presentation of an acute
aortic dissection. This constitutes a surgical emergency
due to the risk of aortic rupture.
4. A client with chronic atrial fibrillation is prescribed
warfarin. The client’s morning laboratory results show an
International Normalized Ratio (INR) of 5.5. The nurse
notes no active bleeding or bruising. Which action should
the nurse anticipate?
A. Administering protamine sulfate intravenously.
, B. Preparing a platelet transfusion.
C. Withholding the next dose and administering Vitamin K.
D. Continuing the current dose and rechecking the INR in
24 hours.
• Answer: C
• Rationale: An INR of 5.5 is significantly above the typical
therapeutic range (2.0–3.0). For elevated INRs without
severe bleeding, the standard intervention is to hold the
medication and give Vitamin K (the antidote for warfarin)
to safely lower the clotting times. Protamine sulfate is the
antidote for heparin.
5. The nurse is monitoring a client on a telemetry unit who
suddenly develops ventricular tachycardia (VT). The nurse
enters the room and notes the client is alert, talking, and
denying chest pain. Which action should the nurse take
next?
A. Deliver an immediate unsynchronized cardioversion
shock.
B. Initiate continuous cardiopulmonary resuscitation (CPR).
C. Administer amiodarone intravenously as prescribed.
D. Prepare the client for immediate endotracheal
intubation.
• Answer: C
(2026) NGN-STYLE QUESTIONS &
GRADED A+ RATIONALES
This comprehensive question ATI Medical-Surgical Nursing
practice test bank features Next-Generation NCLEX (NGN)
style case items with instant verified answer keys. Every
scenario integrates high-yield clinical reasoning
frameworks, focusing on fluid/electrolyte dynamics,
pharmacology, advanced prioritization, and multisystem
care management. Perfectly formatted with clear bold
rationales to help nursing students master core
competencies, review rationales, and achieve Level 3
proficiency on proctored assessments .
1. A nurse is assessing a client 2 hours post-percutaneous
coronary intervention (PCI) via the femoral artery. The
nurse notes a hard, painful lump forming proximal to the
puncture site and the client's blood pressure drops from
120/80 to 98/60 mmHg. Which action should the nurse
take first?
A. Apply manual pressure to the groin site.
, B. Obtain an immediate 12-lead ECG.
C. Increase the maintenance IV fluid rate.
D. Check the client’s distal pedal pulses.
• Answer: A
• Rationale: The client is exhibiting signs of a femoral
artery pseudoaneurysm or hematoma with active
bleeding, causing hemodynamic instability. Holding
immediate, firm manual pressure is the priority action to
halt blood loss before addressing fluid resuscitation or
obtaining diagnostics. Checking pulses is vital, but
stopping active hemorrhage takes precedence.
2. A client with a history of heart failure is prescribed
digoxintor daily use. Which of the following clinical findings
should alert the nurse to potential digoxin toxicity?
A. Intermittent muscle cramps in the lower extremities.
B. New onset of green-yellow halos around glowing
objects.
C. A blood pressure reading of 150/90 mmHg.
D. Increased frequency of nocturnal urination.
• Answer: B
• Rationale: Visual disturbances, specifically green, yellow,
or white halos around objects, are classic signs of digoxin
toxicity. Other early symptoms include anorexia, nausea,
, and bradycardia. Muscle cramps are typically linked to
electrolyte shifts rather than direct digitalis toxicity.
3. A nurse is caring for a client in the emergency department
who reports sudden, severe chest pain radiating to the
back between the scapulae, described as a "tearing"
sensation. The nurse notes a blood pressure mismatch of
30 mmHg between the right and left arms. Which
condition should the nurse suspect?
A. Acute Myocardial Infarction
B. Pulmonary Embolism
C. Aortic Dissection
D. Cardiac Tamponade
• Answer: C
• Rationale: A tearing chest pain that radiates to the back
combined with a significant blood pressure differential
between limbs is the hallmark presentation of an acute
aortic dissection. This constitutes a surgical emergency
due to the risk of aortic rupture.
4. A client with chronic atrial fibrillation is prescribed
warfarin. The client’s morning laboratory results show an
International Normalized Ratio (INR) of 5.5. The nurse
notes no active bleeding or bruising. Which action should
the nurse anticipate?
A. Administering protamine sulfate intravenously.
, B. Preparing a platelet transfusion.
C. Withholding the next dose and administering Vitamin K.
D. Continuing the current dose and rechecking the INR in
24 hours.
• Answer: C
• Rationale: An INR of 5.5 is significantly above the typical
therapeutic range (2.0–3.0). For elevated INRs without
severe bleeding, the standard intervention is to hold the
medication and give Vitamin K (the antidote for warfarin)
to safely lower the clotting times. Protamine sulfate is the
antidote for heparin.
5. The nurse is monitoring a client on a telemetry unit who
suddenly develops ventricular tachycardia (VT). The nurse
enters the room and notes the client is alert, talking, and
denying chest pain. Which action should the nurse take
next?
A. Deliver an immediate unsynchronized cardioversion
shock.
B. Initiate continuous cardiopulmonary resuscitation (CPR).
C. Administer amiodarone intravenously as prescribed.
D. Prepare the client for immediate endotracheal
intubation.
• Answer: C
