ATI RN Adult Medical-Surgical 2026 | NGN-Aligned Proctored Exam | 100 Questions
ATI RN Adult Medical-Surgical 2026
NGN-Aligned Proctored Exam
100 Questions with Answers and Rationales
Instructions: Read each question carefully. For standard multiple-choice questions, select the one best answer. For
Format: Single-answer and Select All That Apply (SATA)
questions marked Select All That Apply select all correct answers. Each question is followed by the correct
answer(s) and a detailed rationale to support your learning.
items | Study Guide Edition
Question 1
A nurse is assessing a client who has heart failure and is receiving furosemide
(Lasix). Which of the following findings should the nurse identify as an adverse
effect of this medication?
A. Bradycardia
B. Hypokalemia
C. Hypernatremia
D. Increased blood pressure
Correct Answer (s): B
Rationale: Furosemide is a loop diuretic that increases the excretion of sodium,
chloride, potassium, and water by the kidneys. Hypokalemia (low potassium) is
a common and potentially dangerous adverse effect because it can lead to
cardiac dysrhythmias. The nurse should monitor serum potassium levels and
assess for signs of hypokalemia such as muscle weakness, fatigue, and
irregular heartbeat. The nurse should also encourage potassium-rich foods or
administer potassium supplements as prescribed. Bradycardia is not expected;
furosemide tends to cause hypovolemia which may actually trigger tachycardia.
Hypernatremia would not occur because furosemide promotes sodium
excretion. Blood pressure typically decreases due to volume depletion.
Question 2
A nurse is caring for a client who has just undergone a cardiac catheterization.
Page 1
, ATI RN Adult Medical-Surgical 2026 | NGN-Aligned Proctored Exam | 100 Questions
Which of the following interventions should the nurse implement?
A. Keep the client on bed rest with the affected extremity straight for 4 to 8 hours
B. Apply a warm compress to the insertion site to promote circulation
C. Encourage the client to ambulate within 1 hour of the procedure
D. Elevate the head of the bed to 45 degrees immediately after the procedure
Correct Answer (s): A
Rationale: Following cardiac catheterization, the client must remain on bed rest
with the affected extremity kept straight for 4 to 8 hours to prevent bleeding from
the arterial or venous insertion site. The nurse should frequently assess the
insertion site for bleeding, hematoma formation, and signs of infection. Distal
pulses, skin temperature, and color of the affected extremity should be checked
regularly. Warm compresses are contraindicated because heat can promote
bleeding. Early ambulation is prohibited due to the risk of hemorrhage.
Elevating the head of the bed beyond 30 degrees may increase pressure at the
insertion site.
Page 2
, ATI RN Adult Medical-Surgical 2026 | NGN-Aligned Proctored Exam | 100 Questions
Question 3 (Select All That Apply)
A nurse is providing discharge teaching to a client who has a new prescription
for warfarin (Coumadin). Which of the following statements by the client
indicates an understanding of the teaching?
A. 'I will eat a consistent amount of foods rich in vitamin K each day.'
B. 'I will take aspirin for headaches instead of acetaminophen.'
C. 'I will double my dose if I miss one.'
D. 'I will use an electric razor instead of a straight razor.'
Correct Answer (s): A, D
Rationale: Clients on warfarin should maintain a consistent intake of vitamin K-
rich foods (such as leafy green vegetables) because vitamin K is essential for
the synthesis of clotting factors and can interfere with warfarin's therapeutic
effect. Sudden increases or decreases in vitamin K consumption can alter the
INR and increase the risk of bleeding or thrombosis. The client should also use
an electric razor instead of a straight razor to minimize the risk of bleeding from
cuts. Aspirin should be avoided because it increases bleeding risk when
combined with warfarin; acetaminophen is the preferred analgesic. The client
should never double a dose of warfarin if one is missed, as this can lead to
dangerous bleeding.
Question 4
A nurse is monitoring a client who is receiving heparin therapy for a deep vein
thrombosis. The nurse should identify that which of the following laboratory
values provides the most critical information about the effectiveness of heparin
therapy?
A. Prothrombin time (PT)
B. International Normalized Ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Platelet count
Correct Answer (s): C
Rationale: The activated partial thromboplastin time (aPTT) is the primary
laboratory value used to monitor the therapeutic effectiveness of heparin
therapy. For heparin to be effective in treating DVT, the aPTT should be 1.5 to
Page 3
, ATI RN Adult Medical-Surgical 2026 | NGN-Aligned Proctored Exam | 100 Questions
2.5 times the control value, which corresponds to a therapeutic range that
prevents clot extension without causing excessive bleeding. PT and INR are
used to monitor warfarin therapy, not heparin. While the platelet count should
be monitored to detect
heparin-induced thrombocytopenia (HIT), it does not assess the anticoagulant
effectiveness of heparin. The nurse should ensure aPTT is drawn at the
prescribed intervals and report values outside the therapeutic range promptly.
Question 5
A nurse is assessing a client who has a history of hypertension and is
experiencing a severe headache, nausea, and vomiting. The client's blood
pressure is 210/120 mm Hg. Which of the following actions should the nurse take
first?
A. Administer an antiemetic as prescribed
B. Obtain a STAT electrocardiogram
C. Lower the head of the bed to a flat position
D. Initiate IV access and prepare to administer antihypertensive medication
Correct Answer (s): D
Rationale: This client is presenting with signs and symptoms of a hypertensive
crisis, which is a medical emergency requiring immediate intervention. The
nurse should first establish IV access and prepare to administer IV
antihypertensive medication as prescribed to rapidly and safely lower the blood
pressure. Hypertensive crisis can lead to target organ damage including stroke,
myocardial infarction, and renal failure. The blood pressure should be reduced
gradually (not more than 25% in the first hour) to prevent cerebral
hypoperfusion. While antiemetics may be needed later, the priority is blood
pressure reduction. An ECG may be obtained but is not the first priority. The
head of the bed should be elevated, not lowered, to reduce intracranial
pressure.
Page 4
ATI RN Adult Medical-Surgical 2026
NGN-Aligned Proctored Exam
100 Questions with Answers and Rationales
Instructions: Read each question carefully. For standard multiple-choice questions, select the one best answer. For
Format: Single-answer and Select All That Apply (SATA)
questions marked Select All That Apply select all correct answers. Each question is followed by the correct
answer(s) and a detailed rationale to support your learning.
items | Study Guide Edition
Question 1
A nurse is assessing a client who has heart failure and is receiving furosemide
(Lasix). Which of the following findings should the nurse identify as an adverse
effect of this medication?
A. Bradycardia
B. Hypokalemia
C. Hypernatremia
D. Increased blood pressure
Correct Answer (s): B
Rationale: Furosemide is a loop diuretic that increases the excretion of sodium,
chloride, potassium, and water by the kidneys. Hypokalemia (low potassium) is
a common and potentially dangerous adverse effect because it can lead to
cardiac dysrhythmias. The nurse should monitor serum potassium levels and
assess for signs of hypokalemia such as muscle weakness, fatigue, and
irregular heartbeat. The nurse should also encourage potassium-rich foods or
administer potassium supplements as prescribed. Bradycardia is not expected;
furosemide tends to cause hypovolemia which may actually trigger tachycardia.
Hypernatremia would not occur because furosemide promotes sodium
excretion. Blood pressure typically decreases due to volume depletion.
Question 2
A nurse is caring for a client who has just undergone a cardiac catheterization.
Page 1
, ATI RN Adult Medical-Surgical 2026 | NGN-Aligned Proctored Exam | 100 Questions
Which of the following interventions should the nurse implement?
A. Keep the client on bed rest with the affected extremity straight for 4 to 8 hours
B. Apply a warm compress to the insertion site to promote circulation
C. Encourage the client to ambulate within 1 hour of the procedure
D. Elevate the head of the bed to 45 degrees immediately after the procedure
Correct Answer (s): A
Rationale: Following cardiac catheterization, the client must remain on bed rest
with the affected extremity kept straight for 4 to 8 hours to prevent bleeding from
the arterial or venous insertion site. The nurse should frequently assess the
insertion site for bleeding, hematoma formation, and signs of infection. Distal
pulses, skin temperature, and color of the affected extremity should be checked
regularly. Warm compresses are contraindicated because heat can promote
bleeding. Early ambulation is prohibited due to the risk of hemorrhage.
Elevating the head of the bed beyond 30 degrees may increase pressure at the
insertion site.
Page 2
, ATI RN Adult Medical-Surgical 2026 | NGN-Aligned Proctored Exam | 100 Questions
Question 3 (Select All That Apply)
A nurse is providing discharge teaching to a client who has a new prescription
for warfarin (Coumadin). Which of the following statements by the client
indicates an understanding of the teaching?
A. 'I will eat a consistent amount of foods rich in vitamin K each day.'
B. 'I will take aspirin for headaches instead of acetaminophen.'
C. 'I will double my dose if I miss one.'
D. 'I will use an electric razor instead of a straight razor.'
Correct Answer (s): A, D
Rationale: Clients on warfarin should maintain a consistent intake of vitamin K-
rich foods (such as leafy green vegetables) because vitamin K is essential for
the synthesis of clotting factors and can interfere with warfarin's therapeutic
effect. Sudden increases or decreases in vitamin K consumption can alter the
INR and increase the risk of bleeding or thrombosis. The client should also use
an electric razor instead of a straight razor to minimize the risk of bleeding from
cuts. Aspirin should be avoided because it increases bleeding risk when
combined with warfarin; acetaminophen is the preferred analgesic. The client
should never double a dose of warfarin if one is missed, as this can lead to
dangerous bleeding.
Question 4
A nurse is monitoring a client who is receiving heparin therapy for a deep vein
thrombosis. The nurse should identify that which of the following laboratory
values provides the most critical information about the effectiveness of heparin
therapy?
A. Prothrombin time (PT)
B. International Normalized Ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Platelet count
Correct Answer (s): C
Rationale: The activated partial thromboplastin time (aPTT) is the primary
laboratory value used to monitor the therapeutic effectiveness of heparin
therapy. For heparin to be effective in treating DVT, the aPTT should be 1.5 to
Page 3
, ATI RN Adult Medical-Surgical 2026 | NGN-Aligned Proctored Exam | 100 Questions
2.5 times the control value, which corresponds to a therapeutic range that
prevents clot extension without causing excessive bleeding. PT and INR are
used to monitor warfarin therapy, not heparin. While the platelet count should
be monitored to detect
heparin-induced thrombocytopenia (HIT), it does not assess the anticoagulant
effectiveness of heparin. The nurse should ensure aPTT is drawn at the
prescribed intervals and report values outside the therapeutic range promptly.
Question 5
A nurse is assessing a client who has a history of hypertension and is
experiencing a severe headache, nausea, and vomiting. The client's blood
pressure is 210/120 mm Hg. Which of the following actions should the nurse take
first?
A. Administer an antiemetic as prescribed
B. Obtain a STAT electrocardiogram
C. Lower the head of the bed to a flat position
D. Initiate IV access and prepare to administer antihypertensive medication
Correct Answer (s): D
Rationale: This client is presenting with signs and symptoms of a hypertensive
crisis, which is a medical emergency requiring immediate intervention. The
nurse should first establish IV access and prepare to administer IV
antihypertensive medication as prescribed to rapidly and safely lower the blood
pressure. Hypertensive crisis can lead to target organ damage including stroke,
myocardial infarction, and renal failure. The blood pressure should be reduced
gradually (not more than 25% in the first hour) to prevent cerebral
hypoperfusion. While antiemetics may be needed later, the priority is blood
pressure reduction. An ECG may be obtained but is not the first priority. The
head of the bed should be elevated, not lowered, to reduce intracranial
pressure.
Page 4
