ATI RN Adult Medical-Surgical 2026 | NGN Proctored Exam
ATI RN Adult Medical-Surgical Nursing 2026
NGN Proctored Examination with Answer Key
100 Questions | Time Limit: 3 Hours | All Med-Surg Topics
Instructions: Read each question carefully. For standard multiple-choice, select the one best answer. For Select All
That Apply (SATA), select all correct responses (no partial credit). For Ordered Response, place the items in the
correct priority order.
Question 1 [Standard MCQ]
A client with heart failure is receiving furosemide (Lasix) 40 mg IV. Which assessment finding indicates the
medication is effective?
A. Decreased urinary output
B. Weight loss of 2 lbs in 24 hours
C. Increased blood pressure
D. Bradycardia
Question 2 [Standard MCQ]
A nurse is caring for a client with atrial fibrillation who is taking warfarin (Coumadin). The client's INR is
4.2. Which action should the nurse take first?
A. Administer vitamin K as prescribed
B. Hold the next dose of warfarin
C. Prepare for a blood transfusion
D. Increase the heparin drip rate
Question 3 [Select All That Apply]
A nurse is providing discharge teaching to a client with coronary artery disease. Which statements by the
client indicate understanding of the teaching? (Select all that apply.)
A. I will walk 30 minutes daily at a moderate pace
B. I will take my nitroglycerin tablet only when I have chest pain
C. I will eat foods high in saturated fat to keep my energy up
D. I will report any unusual weight gain to my provider
E. I will avoid drinking alcohol while taking my medications
Question 4 [Ordered Response]
A nurse is caring for a client who is experiencing an acute myocardial infarction. In which order should the
nurse implement these interventions?
(Place in correct priority order:)
¡ A. Administer oxygen via nasal cannula â
B. Obtain a 12-lead electrocardiogram
¡ C. Start a peripheral IV access
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, ATI RN Adult Medical-Surgical 2026 | NGN Proctored Exam
¡ D. Assess vital signs and level of consciousness
Question 5 [Standard MCQ]
A client with hypertension is prescribed lisinopril (Zestril). Which instruction should the nurse include in the
discharge teaching?
A. Rise slowly from a sitting or lying position
B. Increase potassium-rich foods in the diet
C. Expect a persistent dry cough
D. Take the medication at bedtime only
Question 6 [Standard MCQ]
A nurse is assessing a client with left-sided heart failure. Which finding is most consistent with this
condition?
A. Jugular vein distention
B. Hepatomegaly
C. Bilateral crackles in the lungs
D. Dependent edema in the lower extremities
Question 7 [Standard MCQ]
A client who had a permanent pacemaker inserted reports dizziness and lightheadedness. The nurse checks
the pacemaker rate and finds it is 40 beats per minute. What is the priority nursing action?
A. Document the finding and reassess in 1 hour
B. Instruct the client to perform Valsalva maneuver
C. Place a magnet over the pacemaker generator
D. Prepare the client for temporary transvenous pacing
Question 8 [Standard MCQ]
A nurse is teaching a client about the DASH diet for hypertension management. Which statement by the
client indicates the teaching has been effective?
A. I will limit my sodium intake to 3,000 mg per day
B. I will eat 4 to 5 servings of fruits and vegetables daily
C. I will replace red meat with poultry and fish twice a week
D. I will drink whole milk instead of skim milk for calcium
Question 9 [Select All That Apply]
A nurse is monitoring a client following a cardiac catheterization via the femoral artery. Which findings
require immediate notification of the provider? (Select all that apply.)
â A. Bleeding or oozing at the insertion site
â B. Capillary refill of the affected foot less than 3 seconds
â C. Loss of pedal pulse in the affected extremity
â D. Temperature of the affected extremity cooler than the other
â E. Urine output of 50 mL per hour
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, ATI RN Adult Medical-Surgical 2026 | NGN Proctored Exam
Question 10 [Ordered Response]
A nurse is preparing to administer digoxin (Lanoxin) to a client with heart failure. In which order should the
nurse implement these actions?
(Place in correct priority order:)
â ¡ A. Check the apical pulse for a full minute
â ¡ B. Review the serum digoxin level
â ¡ C. Compare the current heart rate with the prescribed parameters
â ¡ D. Administer the medication
Question 11 [Standard MCQ]
A client with aortic stenosis is being prepared for surgical valve replacement. Which assessment finding is
most concerning to the nurse?
A. Systolic murmur heard at the right upper sternal border
B. Exertional syncope episodes
C. Blood pressure of 118/76 mmHg
D. Left ventricular hypertrophy on ECG
Question 12 [Standard MCQ]
A nurse is caring for a client with deep vein thrombosis (DVT) who is receiving heparin therapy. The client
asks why they cannot take warfarin (Coumadin) instead. What is the best response by the nurse?
A. Warfarin takes several days to reach a therapeutic effect
B. Warfarin cannot be used for treating blood clots
C. Heparin is more effective than warfarin
D. Warfarin would increase the risk of bleeding
Question 13 [Standard MCQ]
A nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who is receiving oxygen
at 4 L/min via nasal cannula. The client becomes confused and lethargic. What is the priority action?
A. Increase the oxygen flow rate to 6 L/min
B. Obtain an arterial blood gas (ABG) sample
C. Decrease the oxygen flow rate to 2 L/min
D. Prepare for endotracheal intubation
Question 14 [Standard MCQ]
A client with pneumonia has a productive cough with thick, rust-colored sputum. The nurse recognizes this
finding is most characteristic of which type of pneumonia?
A. Viral pneumonia
B. Pneumococcal (streptococcal) pneumonia
C. Mycoplasma pneumonia
D. Pneumocystis jirovecii pneumonia
Question 15 [Select All That Apply]
Page 3
, ATI RN Adult Medical-Surgical 2026 | NGN Proctored Exam
A nurse is caring for a client who is 2 hours post-thoracotomy. Which interventions should the nurse include
in the plan of care? (Select all that apply.)
â A. Encourage the use of the incentive spirometer every 1 to 2 hours
â B. Position the client in high Fowler's position
â C. Assist with ambulation within the first hour postoperatively
â D. Administer prescribed analgesics before respiratory exercises
â E. Monitor the chest tube drainage system for air leaks
Question 16 [Standard MCQ]
A nurse is assessing a client with a pulmonary embolism. Which finding is most commonly associated with
this condition?
A. Productive cough with green sputum
B. Sudden onset of dyspnea and chest pain
C. Bilateral wheezing on auscultation
D. Slowly progressive shortness of breath over weeks
Question 17 [Standard MCQ]
A client with asthma is prescribed a metered-dose inhaler (MDI) with a spacer. Which statement by the
client indicates a need for further teaching?
A. I will shake the inhaler well before each use
B. I will exhale completely before placing my lips around the mouthpiece
C. I will inhale slowly and deeply as I press the canister
D. I will hold my breath for 5 seconds after inhaling the medication
Question 18 [Ordered Response]
A nurse is caring for a client who is having an acute asthma attack. In which order should the nurse
administer these medications?
(Place in correct priority order:)
â ¡ A. Inhaled corticosteroid (fluticasone)
â ¡ B. Short-acting beta-2 agonist (albuterol)
â ¡ C. Systemic corticosteroid (prednisone)
â ¡ D. Oxygen therapy to maintain SpO2 above 90%
Question 19 [Standard MCQ]
A nurse is caring for a client with a chest tube connected to a water-seal drainage system. The nurse
observes continuous bubbling in the water-seal chamber. What does this finding indicate?
A. The system is functioning normally
B. An air leak is present in the system
C. The client has resolving pneumothorax
D. The drainage tube is obstructed
Question 20 [Standard MCQ]
Page 4
ATI RN Adult Medical-Surgical Nursing 2026
NGN Proctored Examination with Answer Key
100 Questions | Time Limit: 3 Hours | All Med-Surg Topics
Instructions: Read each question carefully. For standard multiple-choice, select the one best answer. For Select All
That Apply (SATA), select all correct responses (no partial credit). For Ordered Response, place the items in the
correct priority order.
Question 1 [Standard MCQ]
A client with heart failure is receiving furosemide (Lasix) 40 mg IV. Which assessment finding indicates the
medication is effective?
A. Decreased urinary output
B. Weight loss of 2 lbs in 24 hours
C. Increased blood pressure
D. Bradycardia
Question 2 [Standard MCQ]
A nurse is caring for a client with atrial fibrillation who is taking warfarin (Coumadin). The client's INR is
4.2. Which action should the nurse take first?
A. Administer vitamin K as prescribed
B. Hold the next dose of warfarin
C. Prepare for a blood transfusion
D. Increase the heparin drip rate
Question 3 [Select All That Apply]
A nurse is providing discharge teaching to a client with coronary artery disease. Which statements by the
client indicate understanding of the teaching? (Select all that apply.)
A. I will walk 30 minutes daily at a moderate pace
B. I will take my nitroglycerin tablet only when I have chest pain
C. I will eat foods high in saturated fat to keep my energy up
D. I will report any unusual weight gain to my provider
E. I will avoid drinking alcohol while taking my medications
Question 4 [Ordered Response]
A nurse is caring for a client who is experiencing an acute myocardial infarction. In which order should the
nurse implement these interventions?
(Place in correct priority order:)
¡ A. Administer oxygen via nasal cannula â
B. Obtain a 12-lead electrocardiogram
¡ C. Start a peripheral IV access
Page 1
, ATI RN Adult Medical-Surgical 2026 | NGN Proctored Exam
¡ D. Assess vital signs and level of consciousness
Question 5 [Standard MCQ]
A client with hypertension is prescribed lisinopril (Zestril). Which instruction should the nurse include in the
discharge teaching?
A. Rise slowly from a sitting or lying position
B. Increase potassium-rich foods in the diet
C. Expect a persistent dry cough
D. Take the medication at bedtime only
Question 6 [Standard MCQ]
A nurse is assessing a client with left-sided heart failure. Which finding is most consistent with this
condition?
A. Jugular vein distention
B. Hepatomegaly
C. Bilateral crackles in the lungs
D. Dependent edema in the lower extremities
Question 7 [Standard MCQ]
A client who had a permanent pacemaker inserted reports dizziness and lightheadedness. The nurse checks
the pacemaker rate and finds it is 40 beats per minute. What is the priority nursing action?
A. Document the finding and reassess in 1 hour
B. Instruct the client to perform Valsalva maneuver
C. Place a magnet over the pacemaker generator
D. Prepare the client for temporary transvenous pacing
Question 8 [Standard MCQ]
A nurse is teaching a client about the DASH diet for hypertension management. Which statement by the
client indicates the teaching has been effective?
A. I will limit my sodium intake to 3,000 mg per day
B. I will eat 4 to 5 servings of fruits and vegetables daily
C. I will replace red meat with poultry and fish twice a week
D. I will drink whole milk instead of skim milk for calcium
Question 9 [Select All That Apply]
A nurse is monitoring a client following a cardiac catheterization via the femoral artery. Which findings
require immediate notification of the provider? (Select all that apply.)
â A. Bleeding or oozing at the insertion site
â B. Capillary refill of the affected foot less than 3 seconds
â C. Loss of pedal pulse in the affected extremity
â D. Temperature of the affected extremity cooler than the other
â E. Urine output of 50 mL per hour
Page 2
, ATI RN Adult Medical-Surgical 2026 | NGN Proctored Exam
Question 10 [Ordered Response]
A nurse is preparing to administer digoxin (Lanoxin) to a client with heart failure. In which order should the
nurse implement these actions?
(Place in correct priority order:)
â ¡ A. Check the apical pulse for a full minute
â ¡ B. Review the serum digoxin level
â ¡ C. Compare the current heart rate with the prescribed parameters
â ¡ D. Administer the medication
Question 11 [Standard MCQ]
A client with aortic stenosis is being prepared for surgical valve replacement. Which assessment finding is
most concerning to the nurse?
A. Systolic murmur heard at the right upper sternal border
B. Exertional syncope episodes
C. Blood pressure of 118/76 mmHg
D. Left ventricular hypertrophy on ECG
Question 12 [Standard MCQ]
A nurse is caring for a client with deep vein thrombosis (DVT) who is receiving heparin therapy. The client
asks why they cannot take warfarin (Coumadin) instead. What is the best response by the nurse?
A. Warfarin takes several days to reach a therapeutic effect
B. Warfarin cannot be used for treating blood clots
C. Heparin is more effective than warfarin
D. Warfarin would increase the risk of bleeding
Question 13 [Standard MCQ]
A nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who is receiving oxygen
at 4 L/min via nasal cannula. The client becomes confused and lethargic. What is the priority action?
A. Increase the oxygen flow rate to 6 L/min
B. Obtain an arterial blood gas (ABG) sample
C. Decrease the oxygen flow rate to 2 L/min
D. Prepare for endotracheal intubation
Question 14 [Standard MCQ]
A client with pneumonia has a productive cough with thick, rust-colored sputum. The nurse recognizes this
finding is most characteristic of which type of pneumonia?
A. Viral pneumonia
B. Pneumococcal (streptococcal) pneumonia
C. Mycoplasma pneumonia
D. Pneumocystis jirovecii pneumonia
Question 15 [Select All That Apply]
Page 3
, ATI RN Adult Medical-Surgical 2026 | NGN Proctored Exam
A nurse is caring for a client who is 2 hours post-thoracotomy. Which interventions should the nurse include
in the plan of care? (Select all that apply.)
â A. Encourage the use of the incentive spirometer every 1 to 2 hours
â B. Position the client in high Fowler's position
â C. Assist with ambulation within the first hour postoperatively
â D. Administer prescribed analgesics before respiratory exercises
â E. Monitor the chest tube drainage system for air leaks
Question 16 [Standard MCQ]
A nurse is assessing a client with a pulmonary embolism. Which finding is most commonly associated with
this condition?
A. Productive cough with green sputum
B. Sudden onset of dyspnea and chest pain
C. Bilateral wheezing on auscultation
D. Slowly progressive shortness of breath over weeks
Question 17 [Standard MCQ]
A client with asthma is prescribed a metered-dose inhaler (MDI) with a spacer. Which statement by the
client indicates a need for further teaching?
A. I will shake the inhaler well before each use
B. I will exhale completely before placing my lips around the mouthpiece
C. I will inhale slowly and deeply as I press the canister
D. I will hold my breath for 5 seconds after inhaling the medication
Question 18 [Ordered Response]
A nurse is caring for a client who is having an acute asthma attack. In which order should the nurse
administer these medications?
(Place in correct priority order:)
â ¡ A. Inhaled corticosteroid (fluticasone)
â ¡ B. Short-acting beta-2 agonist (albuterol)
â ¡ C. Systemic corticosteroid (prednisone)
â ¡ D. Oxygen therapy to maintain SpO2 above 90%
Question 19 [Standard MCQ]
A nurse is caring for a client with a chest tube connected to a water-seal drainage system. The nurse
observes continuous bubbling in the water-seal chamber. What does this finding indicate?
A. The system is functioning normally
B. An air leak is present in the system
C. The client has resolving pneumothorax
D. The drainage tube is obstructed
Question 20 [Standard MCQ]
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