ATI CMS RN MEDICAL-SURGICAL
70 Actual NGN Questions and Answers
100% Correct | 2026/2027 Updated | Ed. 12.0 Standards
ATI RN Adult Medical-Surgical Nursing Content Mastery Series
Next Generation NCLEX (NGN) Style with Comprehensive Clinical Judgment Frameworks
Domain 1: Cardiovascular Disorders (Q1-Q15)
Q1: A nurse is caring for a client with heart failure who is prescribed furosemide (Lasix) 40 mg IV. The client has a
serum potassium level of 3.0 mEq/L. Which of the following actions should the nurse take first?
A. Administer the furosemide as prescribed
B. Hold the medication and notify the provider [CORRECT]
C. Give the furosemide and add a potassium supplement
D. Request a repeat potassium level to confirm the result
Correct Answer: B
Rationale: Furosemide is a loop diuretic that promotes potassium excretion, placing the client at risk for further hypokalemia. A serum
potassium level of 3.0 mEq/L is below the normal range of 3.5-5.0 mEq/L and increases the risk of fatal cardiac dysrhythmias. The priority
action is to hold the medication and notify the provider before administration. The nurse should not administer the diuretic with an already
critically low potassium level, as this could precipitate life-threatening arrhythmias. ATI RN Med-Surg Ed. 12.0 emphasizes that hypokalemia is
a critical finding to report before administering potassium-wasting diuretics.
Q2: A nurse is assessing a client receiving digoxin (Lanoxin) 0.25 mg PO daily for heart failure. Which of the
following findings should the nurse identify as an early sign of digoxin toxicity?
A. Hypertension and tachycardia
B. Nausea, vomiting, and anorexia [CORRECT]
C. Hyperactive deep tendon reflexes
D. Increased urine output and thirst
Correct Answer: B
Rationale: Early signs of digoxin toxicity include gastrointestinal manifestations such as nausea, vomiting, and anorexia. These occur because
digoxin has a direct effect on the chemoreceptor trigger zone in the medulla. As toxicity progresses, visual disturbances such as yellow-green
halos and blurred vision may occur, along with cardiac dysrhythmias. The priority action upon recognizing these findings is to hold the
medication and notify the provider. ATI RN Med-Surg Ed. 12.0 highlights that GI symptoms are often the earliest manifestation of digoxin
toxicity and should not be overlooked.
Q3: A client admitted with an inferior STEMI reports chest pain and is found to have ST-segment elevation in leads
II, III, and aVF. The nurse should anticipate which of the following as the priority complication to monitor for?
A. Left ventricular systolic dysfunction and pulmonary edema
B. Bradycardia, hypotension, and right ventricular failure [CORRECT]
C. Atrial fibrillation and systemic embolization
D. Papillary muscle rupture and acute mitral regurgitation
Correct Answer: B
Rationale: An inferior STEMI involves the right coronary artery, which supplies the right ventricle and the sinoatrial (SA) and atrioventricular
(AV) nodes. The priority complications include bradycardia, hypotension, and right ventricular failure due to compromised right-sided cardiac
ATI CMS RN Med-Surg Exam | 70 NGN Questions | Page 1
,output. Nitrates should be avoided in inferior MI because they can precipitate profound hypotension; instead, preload should be maintained
with IV fluids. ATI RN Med-Surg Ed. 12.0 identifies right coronary artery involvement as the hallmark of inferior STEMI with distinct
management priorities compared to anterior MI.
Q4: A nurse is providing discharge teaching to a client following a myocardial infarction. Which of the following
statements by the client indicates an understanding of the teaching?
A. I will take nitroglycerin every day to prevent chest pain
B. I should report chest pain that is unrelieved by rest or nitroglycerin [CORRECT]
C. I will avoid all physical activity for at least 6 months
D. I can stop taking my aspirin if I have no chest pain
Correct Answer: B
Rationale: The client should be taught to report chest pain that is unrelieved by rest or sublingual nitroglycerin, as this may indicate extension of
the MI, recurrent ischemia, or other complications requiring immediate evaluation. Aspirin should be taken daily as prescribed for antiplatelet
therapy, and the client should participate in a cardiac rehabilitation program that includes progressive physical activity. Nitroglycerin is a PRN
medication for acute anginal episodes, not a daily preventive medication. ATI RN Med-Surg Ed. 12.0 emphasizes that discharge teaching after
MI should focus on recognizing warning signs, medication adherence, and lifestyle modification.
Q5: A nurse is instructing a client with angina on the administration of sublingual nitroglycerin. Which of the
following statements by the client indicates a need for further teaching?
A. I should lie down when I take the medication
B. I can take up to 3 tablets 5 minutes apart for chest pain
C. I will replace my nitroglycerin supply every 6 months
D. If I develop a headache after taking it, I should stop using it [CORRECT]
Correct Answer: D
Rationale: Headache is a common and expected side effect of sublingual nitroglycerin due to its vasodilatory effects on cerebral blood vessels.
The client should be informed that headaches are expected and should NOT discontinue the medication for this reason. The client should lie
down during administration to minimize the risk of hypotension and falls. The correct dosing is one tablet every 5 minutes for up to 3 doses,
and the medication supply should be replaced every 6 months because nitroglycerin loses potency over time. ATI RN Med-Surg Ed. 12.0
identifies headache as the most common side effect and emphasizes it does not warrant discontinuation of therapy.
Q6: A nurse is assessing a client with suspected pericarditis. Which of the following findings should the nurse expect
to auscultate?
A. A harsh systolic murmur at the right upper sternal border
B. A pericardial friction rub best heard at the left sternal border [CORRECT]
C. Crackles in the bilateral lung bases
D. A third heart sound (S3) at the apex
Correct Answer: B
Rationale: Pericarditis is inflammation of the pericardial sac surrounding the heart. The classic auscultatory finding is a pericardial friction
rub, which is a grating or scratching sound best heard at the left sternal border with the diaphragm of the stethoscope while the client is sitting
upright and leaning forward. This sound is often heard during both systole and diastole because the inflamed pericardial layers rub against
each other throughout the cardiac cycle. An S3 gallop is associated with heart failure, and crackles indicate pulmonary edema. ATI RN
Med-Surg Ed. 12.0 identifies the pericardial friction rub as the hallmark auscultatory finding of pericarditis.
Q7: A client with atrial fibrillation is started on warfarin (Coumadin) therapy. Which of the following laboratory
values should the nurse monitor to evaluate the therapeutic effect of this medication?
A. Activated partial thromboplastin time (aPTT)
B. Prothrombin time (PT) and International Normalized Ratio (INR) [CORRECT]
C. Platelet count and bleeding time
D. D-dimer and fibrinogen levels
Correct Answer: B
ATI CMS RN Med-Surg Exam | 70 NGN Questions | Page 2
, Rationale: Warfarin is a vitamin K antagonist anticoagulant used to prevent thromboembolic complications in atrial fibrillation. The
therapeutic effect is monitored using the prothrombin time (PT), which is standardized as the International Normalized Ratio (INR). For atrial
fibrillation, the target INR is typically 2.0-3.0. The aPTT is used to monitor heparin therapy, not warfarin. D-dimer is a marker of fibrin
degradation used to evaluate suspected thromboembolic disease, not anticoagulant efficacy. ATI RN Med-Surg Ed. 12.0 emphasizes that INR is
the gold standard for monitoring warfarin therapy in clients with atrial fibrillation.
Q8: A nurse is reviewing the laboratory results for a client receiving digoxin (Lanoxin). Which of the following
laboratory findings increases the risk of digoxin toxicity?
A. Serum sodium 142 mEq/L
B. Serum potassium 3.1 mEq/L [CORRECT]
C. Serum calcium 9.2 mg/dL
D. Serum magnesium 2.1 mEq/L
Correct Answer: B
Rationale: Hypokalemia (serum potassium below 3.5 mEq/L) increases the risk of digoxin toxicity because potassium competes with digoxin for
binding sites at the sodium-potassium ATPase pump. When potassium levels are low, more digoxin binds to the pump, intensifying its effects
and increasing the risk of toxicity. The nurse should monitor potassium levels closely in clients receiving digoxin, especially those also taking
potassium-wasting diuretics like furosemide. The sodium, calcium, and magnesium values listed are within normal ranges and do not increase
digoxin toxicity risk. ATI RN Med-Surg Ed. 12.0 identifies the digoxin-hypokalemia interaction as a high-priority medication safety concern.
Q9: [NGN Bow-Tie] A client with heart failure is receiving furosemide (Lasix) 80 mg IV twice daily and digoxin
(Lanoxin) 0.25 mg PO daily. Which of the following findings should the nurse identify as the priority to report to the
provider? Select the finding and the corresponding rationale.
A. Serum potassium 3.2 mEq/L — Hypokalemia increases the risk of digoxin toxicity and cardiac dysrhythmias
[CORRECT]
B. Weight gain of 0.5 kg in 24 hours — Indicates fluid retention requiring diuretic dose adjustment
C. Occasional dizziness when standing — Suggests orthostatic hypotension from diuretic therapy
D. Serum sodium 136 mEq/L — Indicates mild hyponatremia that requires dietary sodium increase
Correct Answer: A
Rationale: The priority finding to report is the serum potassium of 3.2 mEq/L because this client is receiving both furosemide (a
potassium-wasting diuretic) and digoxin. Hypokalemia potentiates digoxin toxicity by increasing myocardial sensitivity to digoxin, which can
lead to life-threatening dysrhythmias. The combination of a potassium-wasting diuretic and digoxin creates a dangerous synergy that requires
vigilant electrolyte monitoring. Weight gain, occasional dizziness, and a sodium of 136 mEq/L (within normal range) are less critical compared
to the risk of digoxin-induced cardiac arrest. ATI RN Med-Surg Ed. 12.0 identifies this drug-drug-electrolyte interaction as a critical safety
priority.
Q10: A nurse is caring for a client with heart failure who is experiencing acute dyspnea and orthopnea. Which of the
following positions should the nurse place the client in to promote maximal ventilatory effort?
A. Supine with legs elevated
B. High Fowler position with legs dependent [CORRECT]
C. Side-lying position on the left side
D. Trendelenburg position
Correct Answer: B
Rationale: The high Fowler position (head of bed elevated to 45-60 degrees or higher) with legs dependent promotes maximal ventilatory
effort by reducing venous return to the heart, thereby decreasing pulmonary congestion. This position uses gravity to reduce preload, alleviating
the pulmonary edema that causes dyspnea and orthopnea in heart failure. The Trendelenburg position would increase venous return and
worsen pulmonary congestion. The supine position with elevated legs would similarly increase preload and exacerbate dyspnea. ATI RN
Med-Surg Ed. 12.0 identifies high Fowler position as the first-line nonpharmacological intervention for acute dyspnea in heart failure.
Q11: A client with atrial fibrillation has an INR of 4.2. The nurse should anticipate which of the following provider
prescriptions?
A. Increase the warfarin dose
ATI CMS RN Med-Surg Exam | 70 NGN Questions | Page 3
70 Actual NGN Questions and Answers
100% Correct | 2026/2027 Updated | Ed. 12.0 Standards
ATI RN Adult Medical-Surgical Nursing Content Mastery Series
Next Generation NCLEX (NGN) Style with Comprehensive Clinical Judgment Frameworks
Domain 1: Cardiovascular Disorders (Q1-Q15)
Q1: A nurse is caring for a client with heart failure who is prescribed furosemide (Lasix) 40 mg IV. The client has a
serum potassium level of 3.0 mEq/L. Which of the following actions should the nurse take first?
A. Administer the furosemide as prescribed
B. Hold the medication and notify the provider [CORRECT]
C. Give the furosemide and add a potassium supplement
D. Request a repeat potassium level to confirm the result
Correct Answer: B
Rationale: Furosemide is a loop diuretic that promotes potassium excretion, placing the client at risk for further hypokalemia. A serum
potassium level of 3.0 mEq/L is below the normal range of 3.5-5.0 mEq/L and increases the risk of fatal cardiac dysrhythmias. The priority
action is to hold the medication and notify the provider before administration. The nurse should not administer the diuretic with an already
critically low potassium level, as this could precipitate life-threatening arrhythmias. ATI RN Med-Surg Ed. 12.0 emphasizes that hypokalemia is
a critical finding to report before administering potassium-wasting diuretics.
Q2: A nurse is assessing a client receiving digoxin (Lanoxin) 0.25 mg PO daily for heart failure. Which of the
following findings should the nurse identify as an early sign of digoxin toxicity?
A. Hypertension and tachycardia
B. Nausea, vomiting, and anorexia [CORRECT]
C. Hyperactive deep tendon reflexes
D. Increased urine output and thirst
Correct Answer: B
Rationale: Early signs of digoxin toxicity include gastrointestinal manifestations such as nausea, vomiting, and anorexia. These occur because
digoxin has a direct effect on the chemoreceptor trigger zone in the medulla. As toxicity progresses, visual disturbances such as yellow-green
halos and blurred vision may occur, along with cardiac dysrhythmias. The priority action upon recognizing these findings is to hold the
medication and notify the provider. ATI RN Med-Surg Ed. 12.0 highlights that GI symptoms are often the earliest manifestation of digoxin
toxicity and should not be overlooked.
Q3: A client admitted with an inferior STEMI reports chest pain and is found to have ST-segment elevation in leads
II, III, and aVF. The nurse should anticipate which of the following as the priority complication to monitor for?
A. Left ventricular systolic dysfunction and pulmonary edema
B. Bradycardia, hypotension, and right ventricular failure [CORRECT]
C. Atrial fibrillation and systemic embolization
D. Papillary muscle rupture and acute mitral regurgitation
Correct Answer: B
Rationale: An inferior STEMI involves the right coronary artery, which supplies the right ventricle and the sinoatrial (SA) and atrioventricular
(AV) nodes. The priority complications include bradycardia, hypotension, and right ventricular failure due to compromised right-sided cardiac
ATI CMS RN Med-Surg Exam | 70 NGN Questions | Page 1
,output. Nitrates should be avoided in inferior MI because they can precipitate profound hypotension; instead, preload should be maintained
with IV fluids. ATI RN Med-Surg Ed. 12.0 identifies right coronary artery involvement as the hallmark of inferior STEMI with distinct
management priorities compared to anterior MI.
Q4: A nurse is providing discharge teaching to a client following a myocardial infarction. Which of the following
statements by the client indicates an understanding of the teaching?
A. I will take nitroglycerin every day to prevent chest pain
B. I should report chest pain that is unrelieved by rest or nitroglycerin [CORRECT]
C. I will avoid all physical activity for at least 6 months
D. I can stop taking my aspirin if I have no chest pain
Correct Answer: B
Rationale: The client should be taught to report chest pain that is unrelieved by rest or sublingual nitroglycerin, as this may indicate extension of
the MI, recurrent ischemia, or other complications requiring immediate evaluation. Aspirin should be taken daily as prescribed for antiplatelet
therapy, and the client should participate in a cardiac rehabilitation program that includes progressive physical activity. Nitroglycerin is a PRN
medication for acute anginal episodes, not a daily preventive medication. ATI RN Med-Surg Ed. 12.0 emphasizes that discharge teaching after
MI should focus on recognizing warning signs, medication adherence, and lifestyle modification.
Q5: A nurse is instructing a client with angina on the administration of sublingual nitroglycerin. Which of the
following statements by the client indicates a need for further teaching?
A. I should lie down when I take the medication
B. I can take up to 3 tablets 5 minutes apart for chest pain
C. I will replace my nitroglycerin supply every 6 months
D. If I develop a headache after taking it, I should stop using it [CORRECT]
Correct Answer: D
Rationale: Headache is a common and expected side effect of sublingual nitroglycerin due to its vasodilatory effects on cerebral blood vessels.
The client should be informed that headaches are expected and should NOT discontinue the medication for this reason. The client should lie
down during administration to minimize the risk of hypotension and falls. The correct dosing is one tablet every 5 minutes for up to 3 doses,
and the medication supply should be replaced every 6 months because nitroglycerin loses potency over time. ATI RN Med-Surg Ed. 12.0
identifies headache as the most common side effect and emphasizes it does not warrant discontinuation of therapy.
Q6: A nurse is assessing a client with suspected pericarditis. Which of the following findings should the nurse expect
to auscultate?
A. A harsh systolic murmur at the right upper sternal border
B. A pericardial friction rub best heard at the left sternal border [CORRECT]
C. Crackles in the bilateral lung bases
D. A third heart sound (S3) at the apex
Correct Answer: B
Rationale: Pericarditis is inflammation of the pericardial sac surrounding the heart. The classic auscultatory finding is a pericardial friction
rub, which is a grating or scratching sound best heard at the left sternal border with the diaphragm of the stethoscope while the client is sitting
upright and leaning forward. This sound is often heard during both systole and diastole because the inflamed pericardial layers rub against
each other throughout the cardiac cycle. An S3 gallop is associated with heart failure, and crackles indicate pulmonary edema. ATI RN
Med-Surg Ed. 12.0 identifies the pericardial friction rub as the hallmark auscultatory finding of pericarditis.
Q7: A client with atrial fibrillation is started on warfarin (Coumadin) therapy. Which of the following laboratory
values should the nurse monitor to evaluate the therapeutic effect of this medication?
A. Activated partial thromboplastin time (aPTT)
B. Prothrombin time (PT) and International Normalized Ratio (INR) [CORRECT]
C. Platelet count and bleeding time
D. D-dimer and fibrinogen levels
Correct Answer: B
ATI CMS RN Med-Surg Exam | 70 NGN Questions | Page 2
, Rationale: Warfarin is a vitamin K antagonist anticoagulant used to prevent thromboembolic complications in atrial fibrillation. The
therapeutic effect is monitored using the prothrombin time (PT), which is standardized as the International Normalized Ratio (INR). For atrial
fibrillation, the target INR is typically 2.0-3.0. The aPTT is used to monitor heparin therapy, not warfarin. D-dimer is a marker of fibrin
degradation used to evaluate suspected thromboembolic disease, not anticoagulant efficacy. ATI RN Med-Surg Ed. 12.0 emphasizes that INR is
the gold standard for monitoring warfarin therapy in clients with atrial fibrillation.
Q8: A nurse is reviewing the laboratory results for a client receiving digoxin (Lanoxin). Which of the following
laboratory findings increases the risk of digoxin toxicity?
A. Serum sodium 142 mEq/L
B. Serum potassium 3.1 mEq/L [CORRECT]
C. Serum calcium 9.2 mg/dL
D. Serum magnesium 2.1 mEq/L
Correct Answer: B
Rationale: Hypokalemia (serum potassium below 3.5 mEq/L) increases the risk of digoxin toxicity because potassium competes with digoxin for
binding sites at the sodium-potassium ATPase pump. When potassium levels are low, more digoxin binds to the pump, intensifying its effects
and increasing the risk of toxicity. The nurse should monitor potassium levels closely in clients receiving digoxin, especially those also taking
potassium-wasting diuretics like furosemide. The sodium, calcium, and magnesium values listed are within normal ranges and do not increase
digoxin toxicity risk. ATI RN Med-Surg Ed. 12.0 identifies the digoxin-hypokalemia interaction as a high-priority medication safety concern.
Q9: [NGN Bow-Tie] A client with heart failure is receiving furosemide (Lasix) 80 mg IV twice daily and digoxin
(Lanoxin) 0.25 mg PO daily. Which of the following findings should the nurse identify as the priority to report to the
provider? Select the finding and the corresponding rationale.
A. Serum potassium 3.2 mEq/L — Hypokalemia increases the risk of digoxin toxicity and cardiac dysrhythmias
[CORRECT]
B. Weight gain of 0.5 kg in 24 hours — Indicates fluid retention requiring diuretic dose adjustment
C. Occasional dizziness when standing — Suggests orthostatic hypotension from diuretic therapy
D. Serum sodium 136 mEq/L — Indicates mild hyponatremia that requires dietary sodium increase
Correct Answer: A
Rationale: The priority finding to report is the serum potassium of 3.2 mEq/L because this client is receiving both furosemide (a
potassium-wasting diuretic) and digoxin. Hypokalemia potentiates digoxin toxicity by increasing myocardial sensitivity to digoxin, which can
lead to life-threatening dysrhythmias. The combination of a potassium-wasting diuretic and digoxin creates a dangerous synergy that requires
vigilant electrolyte monitoring. Weight gain, occasional dizziness, and a sodium of 136 mEq/L (within normal range) are less critical compared
to the risk of digoxin-induced cardiac arrest. ATI RN Med-Surg Ed. 12.0 identifies this drug-drug-electrolyte interaction as a critical safety
priority.
Q10: A nurse is caring for a client with heart failure who is experiencing acute dyspnea and orthopnea. Which of the
following positions should the nurse place the client in to promote maximal ventilatory effort?
A. Supine with legs elevated
B. High Fowler position with legs dependent [CORRECT]
C. Side-lying position on the left side
D. Trendelenburg position
Correct Answer: B
Rationale: The high Fowler position (head of bed elevated to 45-60 degrees or higher) with legs dependent promotes maximal ventilatory
effort by reducing venous return to the heart, thereby decreasing pulmonary congestion. This position uses gravity to reduce preload, alleviating
the pulmonary edema that causes dyspnea and orthopnea in heart failure. The Trendelenburg position would increase venous return and
worsen pulmonary congestion. The supine position with elevated legs would similarly increase preload and exacerbate dyspnea. ATI RN
Med-Surg Ed. 12.0 identifies high Fowler position as the first-line nonpharmacological intervention for acute dyspnea in heart failure.
Q11: A client with atrial fibrillation has an INR of 4.2. The nurse should anticipate which of the following provider
prescriptions?
A. Increase the warfarin dose
ATI CMS RN Med-Surg Exam | 70 NGN Questions | Page 3
