ATI RN ADULT MEDICAL-SURGICAL PROCTORED
EXAMINATION
2026/2027 | High-Fidelity NGN Study Bank
Assessment Technologies Institute (ATI) | Next Generation NCLEX (NGN) Core
Competencies
150 Questions | Comprehensive 3-Batch Professional Certification Examination
Introduction
This comprehensive practice bank is meticulously engineered to mirror the blueprint,
difficulty, and clinical reasoning expectations of the ATI RN Adult Medical-Surgical
Proctored Examination (2026). The contents are structured around the Next Generation
NCLEX (NGN) clinical judgment model, testing your ability to recognize cues, analyze cues,
prioritize hypotheses, generate solutions, take actions, and evaluate outcomes.
This exam is arranged into three sequential batches of 50 questions each, covering core
physiological systems, critical care, and perioperative nursing management.
Batch 1 (Questions 1–50): Cardiovascular, Respiratory, and Renal/Urinary Systems
Batch 2 (Questions 51–100): Gastrointestinal, Endocrine, Metabolic, and Neurological
Systems
Batch 3 (Questions 101–150): Immune, Musculoskeletal, Hematological, Oncology, and
Perioperative Care
Batch 1: Cardiovascular, Respiratory, and Renal/Urinary Systems (Questions 1–50)
Domain: Cardiovascular Disorders & Critical Care
, 1. A nurse is assessing a client who is 12 hr postoperative following an abdominal
aortic aneurysm (AAA) repair. Which of the following findings should the nurse
report to the provider immediately?
A. Absent bowel sounds in all four quadrants
B. Serosanguineous drainage on the abdominal dressing
C. Diminished pedal pulses with a cool lower extremity
D. Urine output of 45 mL over the past hour
Explanation: Diminished pedal pulses and a cool extremity indicate graft occlusion or
arterial thrombosis, a life-threatening complication of AAA repair requiring immediate
surgical intervention. Absent bowel sounds are expected due to paralytic ileus at 12 hr.
2. A nurse in the emergency department is caring for a client who reports crushing
chest pain radiating to the left jaw. The client's ECG shows ST-segment elevation in
leads V1 through V4. Which of the following actions should the nurse take first?
A. Administer morphine sulfate 2 mg IV bolus.
B. Obtain a stat sample for cardiac troponin levels.
C. Administer chewable aspirin 325 mg.
D. Prepare the client for transport to the cardiac catheterization lab.
Explanation: In an acute STEMI, administering chewable aspirin is the highest priority action
to inhibit further platelet aggregation and thrombus growth. While the other actions are
correct, antiplatelet therapy takes priority to preserve myocardial tissue.
, 3. A nurse is reviewing the laboratory results of a client who is receiving a
continuous heparin infusion for a deep-vein thrombosis (DVT). The client's activated
partial thromboplastin time (aPTT) is 98 seconds. Which of the following actions
should the nurse take?
A. Increase the heparin infusion rate by 100 units/hr.
B. Maintain the current infusion rate and repeat the test in 2 hr.
C. Stop the heparin infusion and prepare protamine sulfate if ordered.
D. Administer vitamin K₁ intramuscularly immediately.
Explanation: The therapeutic range for aPTT during heparin therapy is 1.5 to 2.5 times the
control value (typically 60 to 80 seconds). An aPTT of 98 seconds is dangerously
prolonged, indicating a high risk of hemorrhage. The infusion must be stopped. Protamine
sulfate is the antidote for heparin.
4. A nurse is assessing a client who has chronic heart failure and is taking digoxin
0.25 mg daily. The client reports nausea, blurred vision, and seeing yellow halos
around lights. Which of the following laboratory values should the nurse review
immediately?
A. Serum calcium
B. Serum potassium
C. Blood urea nitrogen (BUN)
D. Serum sodium
, Explanation: The client is exhibiting classic manifestations of digoxin toxicity. Hypokalemia
increases the risk of digoxin toxicity, making the serum potassium level the most critical
value to check.
5. A nurse is caring for a client who is in the compensatory stage of hypovolemic
shock. Which of the following clinical manifestations should the nurse expect?
A. Bradycardia and bounding peripheral pulses
B. Respiratory depression and respiratory acidosis
C. Tachycardia and narrowed pulse pressure
D. Flushed skin and hyperactive bowel sounds
Explanation: In the compensatory stage of shock, the sympathetic nervous system triggers
vasoconstriction and tachycardia to maintain cardiac output, causing a narrowed pulse
pressure and cool, pale skin.
6. A nurse is monitoring a client who has a permanent pacemaker inserted 4 hr ago.
The nurse notes pacemaker spikes on the cardiac monitor that are not followed by a
QRS complex. The nurse should document this finding as which of the following
pacemaker malfunctions?
A. Failure to pace
B. Failure to sense
C. Failure to capture
D. Oversensing
EXAMINATION
2026/2027 | High-Fidelity NGN Study Bank
Assessment Technologies Institute (ATI) | Next Generation NCLEX (NGN) Core
Competencies
150 Questions | Comprehensive 3-Batch Professional Certification Examination
Introduction
This comprehensive practice bank is meticulously engineered to mirror the blueprint,
difficulty, and clinical reasoning expectations of the ATI RN Adult Medical-Surgical
Proctored Examination (2026). The contents are structured around the Next Generation
NCLEX (NGN) clinical judgment model, testing your ability to recognize cues, analyze cues,
prioritize hypotheses, generate solutions, take actions, and evaluate outcomes.
This exam is arranged into three sequential batches of 50 questions each, covering core
physiological systems, critical care, and perioperative nursing management.
Batch 1 (Questions 1–50): Cardiovascular, Respiratory, and Renal/Urinary Systems
Batch 2 (Questions 51–100): Gastrointestinal, Endocrine, Metabolic, and Neurological
Systems
Batch 3 (Questions 101–150): Immune, Musculoskeletal, Hematological, Oncology, and
Perioperative Care
Batch 1: Cardiovascular, Respiratory, and Renal/Urinary Systems (Questions 1–50)
Domain: Cardiovascular Disorders & Critical Care
, 1. A nurse is assessing a client who is 12 hr postoperative following an abdominal
aortic aneurysm (AAA) repair. Which of the following findings should the nurse
report to the provider immediately?
A. Absent bowel sounds in all four quadrants
B. Serosanguineous drainage on the abdominal dressing
C. Diminished pedal pulses with a cool lower extremity
D. Urine output of 45 mL over the past hour
Explanation: Diminished pedal pulses and a cool extremity indicate graft occlusion or
arterial thrombosis, a life-threatening complication of AAA repair requiring immediate
surgical intervention. Absent bowel sounds are expected due to paralytic ileus at 12 hr.
2. A nurse in the emergency department is caring for a client who reports crushing
chest pain radiating to the left jaw. The client's ECG shows ST-segment elevation in
leads V1 through V4. Which of the following actions should the nurse take first?
A. Administer morphine sulfate 2 mg IV bolus.
B. Obtain a stat sample for cardiac troponin levels.
C. Administer chewable aspirin 325 mg.
D. Prepare the client for transport to the cardiac catheterization lab.
Explanation: In an acute STEMI, administering chewable aspirin is the highest priority action
to inhibit further platelet aggregation and thrombus growth. While the other actions are
correct, antiplatelet therapy takes priority to preserve myocardial tissue.
, 3. A nurse is reviewing the laboratory results of a client who is receiving a
continuous heparin infusion for a deep-vein thrombosis (DVT). The client's activated
partial thromboplastin time (aPTT) is 98 seconds. Which of the following actions
should the nurse take?
A. Increase the heparin infusion rate by 100 units/hr.
B. Maintain the current infusion rate and repeat the test in 2 hr.
C. Stop the heparin infusion and prepare protamine sulfate if ordered.
D. Administer vitamin K₁ intramuscularly immediately.
Explanation: The therapeutic range for aPTT during heparin therapy is 1.5 to 2.5 times the
control value (typically 60 to 80 seconds). An aPTT of 98 seconds is dangerously
prolonged, indicating a high risk of hemorrhage. The infusion must be stopped. Protamine
sulfate is the antidote for heparin.
4. A nurse is assessing a client who has chronic heart failure and is taking digoxin
0.25 mg daily. The client reports nausea, blurred vision, and seeing yellow halos
around lights. Which of the following laboratory values should the nurse review
immediately?
A. Serum calcium
B. Serum potassium
C. Blood urea nitrogen (BUN)
D. Serum sodium
, Explanation: The client is exhibiting classic manifestations of digoxin toxicity. Hypokalemia
increases the risk of digoxin toxicity, making the serum potassium level the most critical
value to check.
5. A nurse is caring for a client who is in the compensatory stage of hypovolemic
shock. Which of the following clinical manifestations should the nurse expect?
A. Bradycardia and bounding peripheral pulses
B. Respiratory depression and respiratory acidosis
C. Tachycardia and narrowed pulse pressure
D. Flushed skin and hyperactive bowel sounds
Explanation: In the compensatory stage of shock, the sympathetic nervous system triggers
vasoconstriction and tachycardia to maintain cardiac output, causing a narrowed pulse
pressure and cool, pale skin.
6. A nurse is monitoring a client who has a permanent pacemaker inserted 4 hr ago.
The nurse notes pacemaker spikes on the cardiac monitor that are not followed by a
QRS complex. The nurse should document this finding as which of the following
pacemaker malfunctions?
A. Failure to pace
B. Failure to sense
C. Failure to capture
D. Oversensing
