ATI PN Medical-Surgical Nursing Final Exam 2026/2027 (VERIFIED VERSION) Page 1
ATI PN Medical-Surgical Nursing Final Exam
2026/2027 (VERIFIED VERSION)
100 Multiple-Choice Questions | PN/LPN Scope of Practice
Total Items Cognitive Distribution Time Allotted Passing Score
100 25% Recall / 55% Application / 20% Analysis 150 minutes Provider-defined
Instructions: Select the ONE best answer for each question. Read each stem carefully and consider all four options before
selecting your response. Each question is weighted equally. Rationales are provided after each question for self-review and
remediation. Content domains align with the ATI PN Medical-Surgical nursing blueprint, including cardiovascular,
respiratory, gastrointestinal, renal, endocrine, neurological, musculoskeletal, integumentary, immunologic, and
perioperative/emergency care. Question formats emphasize prioritization (ABC, Maslow's hierarchy), delegation (RN vs.
LPN/LVN vs. UAP scope of practice), nursing process application (ADPIE), pharmacologic management, patient
education, complication recognition, and evidence-based practice aligned with 2026-2027 updates.
Section 1: Cardiovascular System Disorders
Hypertension, CAD, Heart Failure, Peripheral Vascular Disease, & Cardiac Emergencies (Q1-Q18)
Q1. A 58-year-old client with newly diagnosed stage 1 hypertension asks the practical nurse (PN) what
lifestyle modification is most effective for lowering blood pressure. Which response by the PN is most
appropriate?
A. Limit fluid intake to 1 liter per day.
B. Adopt the DASH diet and reduce dietary sodium to less than 2,300 mg/day. [CORRECT]
C. Increase consumption of red meat and full-fat dairy for protein.
D. Avoid all physical activity to prevent cardiac strain.
Correct Answer: B
Rationale: The DASH (Dietary Approaches to Stop Hypertension) diet, rich in fruits, vegetables, and low-fat dairy,
combined with sodium restriction, is the most evidence-based nonpharmacologic intervention for lowering blood pressure.
Fluid restriction is not indicated in uncomplicated hypertension, red meat and full-fat dairy increase saturated fat intake (a
cardiovascular risk), and aerobic activity (e.g., 150 min/week) is recommended to reduce blood pressure and improve
cardiovascular fitness.
CONFIDENTIAL — PN Medical-Surgical Final Examination | 100 Items
,ATI PN Medical-Surgical Nursing Final Exam 2026/2027 (VERIFIED VERSION) Page 2
Q2. A client prescribed lisinopril 10 mg daily for hypertension reports a persistent dry, hacking cough for the
past 2 weeks. Which action should the PN take first?
A. Reassure the client that the cough is unrelated to the medication and continue therapy.
B. Instruct the client to take an over-the-counter cough suppressant.
C. Notify the registered nurse (RN) or provider, as the cough may indicate an ACE inhibitor side effect requiring
medication change. [CORRECT]
D. Discontinue the lisinopril immediately and document the reaction.
Correct Answer: C
Rationale: A persistent dry cough occurs in up to 20% of clients taking ACE inhibitors like lisinopril, due to bradykinin
accumulation in the lungs. The PN must report this finding promptly so the provider can switch the client to an angiotensin II
receptor blocker (ARB), which does not cause bradykinin buildup. The PN cannot independently discontinue prescribed
medication, and cough suppressants do not address the underlying cause. Option A is incorrect because the cough is a
known side effect.
Q3. A 65-year-old client with coronary artery disease (CAD) is admitted with chest pain rated 8/10,
diaphoresis, and nausea. Which nursing action should the PN prioritize using the ABC framework?
A. Obtain a 12-lead ECG.
B. Administer sublingual nitroglycerin 0.4 mg as prescribed.
C. Assess vital signs and oxygen saturation. [CORRECT]
D. Draw cardiac enzymes and troponin.
Correct Answer: C
Rationale: Using the ABC (Airway, Breathing, Circulation) framework, the PN must first assess vital signs and oxygen
saturation to evaluate perfusion and respiratory status before any interventions. Once stability is confirmed, an ECG and
nitroglycerin administration follow per chest pain protocol. Cardiac enzymes are diagnostic but do not take priority over
airway/breathing/circulation assessment. Premature nitroglycerin administration without baseline blood pressure could
precipitate dangerous hypotension.
Q4. A client with chronic stable angina is being discharged with a prescription for sublingual nitroglycerin
tablets. Which client statement indicates correct understanding of discharge teaching?
A. "I will store the tablets in a clear plastic pill organizer on my countertop."
B. "I should take one tablet every 5 minutes up to three doses; if pain continues, I should call 911." [CORRECT]
C. "I will swallow the tablet whole with a full glass of water."
D. "I can take nitroglycerin only when I am resting in bed."
Correct Answer: B
Rationale: Sublingual nitroglycerin should be taken at the first sign of chest pain: one tablet every 5 minutes for up to three
doses, calling 911 if pain is unrelieved after the first dose or after three doses total. Tablets must be stored in their original
dark, glass container because light degrades the medication; they must be taken sublingually (not swallowed) for rapid
absorption, and clients should sit down before administration to prevent syncope from orthostatic hypotension.
CONFIDENTIAL — PN Medical-Surgical Final Examination | 100 Items
,ATI PN Medical-Surgical Nursing Final Exam 2026/2027 (VERIFIED VERSION) Page 3
Q5. A client with heart failure (HF) has crackles bilaterally in the lung bases, jugular venous distention, and
2+ pitting edema of the lower extremities. Which nursing intervention is the priority?
A. Place the client in a high-Fowler's position. [CORRECT]
B. Restrict all oral fluids immediately.
C. Administer a beta-blocker as prescribed.
D. Encourage ambulation to promote circulation.
Correct Answer: A
Rationale: The client is demonstrating pulmonary congestion and fluid overload (hypervolemia). The priority intervention is
placing the client in a high-Fowler's position to maximize lung expansion and reduce venous return to the heart, easing
dyspnea. The PN should then notify the RN/provider for diuretic administration (e.g., furosemide). Complete fluid restriction
requires a provider order; beta-blockers are typically held during acute decompensation; ambulation is contraindicated in
acute fluid overload.
Q6. Which statement by a client with heart failure indicates that discharge teaching about daily weights has
been effective?
A. "I will weigh myself once a week before breakfast."
B. "I should weigh myself every morning after voiding, before eating or drinking, wearing similar clothing."
[CORRECT]
C. "A weight gain of 3 pounds in one day is expected and not concerning."
D. "I only need to weigh myself if I feel short of breath."
Correct Answer: B
Rationale: Clients with heart failure must weigh themselves daily at the same time (morning, after voiding, before
eating/drinking, with similar clothing) to detect fluid retention early. A weight gain of 2 pounds in one day or 3-5 pounds in
one week signals fluid overload and should be reported to the provider immediately. Weekly weights are insufficient;
symptom-triggered weighing is unreliable because fluid accumulation may precede symptoms.
Q7. A client with heart failure is receiving furosemide 40 mg IV push. The PN notes the client's most recent
potassium level is 3.1 mEq/L. Which finding requires immediate intervention?
A. Serum sodium of 138 mEq/L
B. Cardiac rhythm showing U waves and premature ventricular contractions (PVCs) [CORRECT]
C. Blood pressure of 116/74 mmHg
D. Respiratory rate of 18 breaths/min
Correct Answer: B
Rationale: Hypokalemia (K+ < 3.5 mEq/L) from loop diuretic therapy predisposes the client to life-threatening
dysrhythmias. U waves on ECG and PVCs are hallmark signs of hypokalemia and require immediate intervention with
potassium replacement and provider notification. The other findings are within normal limits or expected with diuresis. The
PN should hold the next furosemide dose pending provider guidance and monitor cardiac rhythm continuously.
CONFIDENTIAL — PN Medical-Surgical Final Examination | 100 Items
, ATI PN Medical-Surgical Nursing Final Exam 2026/2027 (VERIFIED VERSION) Page 4
Q8. The PN is teaching a client with heart failure about a 2-gram sodium diet. Which food selection by the
client indicates teaching has been effective?
A. Canned vegetable soup with saltine crackers
B. Fresh apple, grilled chicken breast, and steamed rice [CORRECT]
C. Ham sandwich with mustard and a pickle
D. Frozen lasagna with garlic bread
Correct Answer: B
Rationale: A 2-gram sodium diet limits processed, cured, canned, and frozen prepared foods. Fresh fruits (apple), fresh lean
proteins (grilled chicken), and unprocessed starches (steamed rice) are appropriate. Canned soup, saltines, ham, pickles,
mustard, and frozen prepared meals are all high-sodium foods that must be avoided. Teaching should also emphasize
reading nutrition labels for sodium content and avoiding added salt during cooking or at the table.
Q9. A client with suspected peripheral arterial disease (PAD) reports calf pain that occurs after walking two
blocks and is relieved by rest. How should the PN document this finding?
A. Rest pain
B. Intermittent claudication [CORRECT]
C. Neuropathic pain
D. Deep vein thrombosis
Correct Answer: B
Rationale: Intermittent claudication is the hallmark symptom of PAD, characterized by reproducible ischemic muscle pain
precipitated by activity and relieved by rest within 10 minutes. It results from inadequate arterial blood supply during
exertion. Rest pain occurs at night without activity and indicates severe ischemia; neuropathic pain is burning/tingling
unrelated to activity; DVT presents with calf tenderness, edema, and warmth, not exercise-relieved pain.
Q10. The PN is caring for a client with arterial insufficiency of the lower extremities. Which intervention
should the PN include in the plan of care?
A. Apply elastic compression stockings before ambulation.
B. Keep the legs in a dependent position when sitting. [CORRECT]
C. Encourage the client to soak the feet in hot water nightly.
D. Position the legs above the level of the heart when in bed.
Correct Answer: B
Rationale: Arterial insufficiency benefits from a dependent leg position, which uses gravity to enhance arterial perfusion to
ischemic tissues. Elastic stockings, used for venous disease, worsen arterial flow. Hot water soaks are contraindicated
because decreased sensation increases burn risk. Elevating legs above the heart worsens ischemic pain in arterial disease
(opposite of venous disease management, where elevation reduces edema).
CONFIDENTIAL — PN Medical-Surgical Final Examination | 100 Items
ATI PN Medical-Surgical Nursing Final Exam
2026/2027 (VERIFIED VERSION)
100 Multiple-Choice Questions | PN/LPN Scope of Practice
Total Items Cognitive Distribution Time Allotted Passing Score
100 25% Recall / 55% Application / 20% Analysis 150 minutes Provider-defined
Instructions: Select the ONE best answer for each question. Read each stem carefully and consider all four options before
selecting your response. Each question is weighted equally. Rationales are provided after each question for self-review and
remediation. Content domains align with the ATI PN Medical-Surgical nursing blueprint, including cardiovascular,
respiratory, gastrointestinal, renal, endocrine, neurological, musculoskeletal, integumentary, immunologic, and
perioperative/emergency care. Question formats emphasize prioritization (ABC, Maslow's hierarchy), delegation (RN vs.
LPN/LVN vs. UAP scope of practice), nursing process application (ADPIE), pharmacologic management, patient
education, complication recognition, and evidence-based practice aligned with 2026-2027 updates.
Section 1: Cardiovascular System Disorders
Hypertension, CAD, Heart Failure, Peripheral Vascular Disease, & Cardiac Emergencies (Q1-Q18)
Q1. A 58-year-old client with newly diagnosed stage 1 hypertension asks the practical nurse (PN) what
lifestyle modification is most effective for lowering blood pressure. Which response by the PN is most
appropriate?
A. Limit fluid intake to 1 liter per day.
B. Adopt the DASH diet and reduce dietary sodium to less than 2,300 mg/day. [CORRECT]
C. Increase consumption of red meat and full-fat dairy for protein.
D. Avoid all physical activity to prevent cardiac strain.
Correct Answer: B
Rationale: The DASH (Dietary Approaches to Stop Hypertension) diet, rich in fruits, vegetables, and low-fat dairy,
combined with sodium restriction, is the most evidence-based nonpharmacologic intervention for lowering blood pressure.
Fluid restriction is not indicated in uncomplicated hypertension, red meat and full-fat dairy increase saturated fat intake (a
cardiovascular risk), and aerobic activity (e.g., 150 min/week) is recommended to reduce blood pressure and improve
cardiovascular fitness.
CONFIDENTIAL — PN Medical-Surgical Final Examination | 100 Items
,ATI PN Medical-Surgical Nursing Final Exam 2026/2027 (VERIFIED VERSION) Page 2
Q2. A client prescribed lisinopril 10 mg daily for hypertension reports a persistent dry, hacking cough for the
past 2 weeks. Which action should the PN take first?
A. Reassure the client that the cough is unrelated to the medication and continue therapy.
B. Instruct the client to take an over-the-counter cough suppressant.
C. Notify the registered nurse (RN) or provider, as the cough may indicate an ACE inhibitor side effect requiring
medication change. [CORRECT]
D. Discontinue the lisinopril immediately and document the reaction.
Correct Answer: C
Rationale: A persistent dry cough occurs in up to 20% of clients taking ACE inhibitors like lisinopril, due to bradykinin
accumulation in the lungs. The PN must report this finding promptly so the provider can switch the client to an angiotensin II
receptor blocker (ARB), which does not cause bradykinin buildup. The PN cannot independently discontinue prescribed
medication, and cough suppressants do not address the underlying cause. Option A is incorrect because the cough is a
known side effect.
Q3. A 65-year-old client with coronary artery disease (CAD) is admitted with chest pain rated 8/10,
diaphoresis, and nausea. Which nursing action should the PN prioritize using the ABC framework?
A. Obtain a 12-lead ECG.
B. Administer sublingual nitroglycerin 0.4 mg as prescribed.
C. Assess vital signs and oxygen saturation. [CORRECT]
D. Draw cardiac enzymes and troponin.
Correct Answer: C
Rationale: Using the ABC (Airway, Breathing, Circulation) framework, the PN must first assess vital signs and oxygen
saturation to evaluate perfusion and respiratory status before any interventions. Once stability is confirmed, an ECG and
nitroglycerin administration follow per chest pain protocol. Cardiac enzymes are diagnostic but do not take priority over
airway/breathing/circulation assessment. Premature nitroglycerin administration without baseline blood pressure could
precipitate dangerous hypotension.
Q4. A client with chronic stable angina is being discharged with a prescription for sublingual nitroglycerin
tablets. Which client statement indicates correct understanding of discharge teaching?
A. "I will store the tablets in a clear plastic pill organizer on my countertop."
B. "I should take one tablet every 5 minutes up to three doses; if pain continues, I should call 911." [CORRECT]
C. "I will swallow the tablet whole with a full glass of water."
D. "I can take nitroglycerin only when I am resting in bed."
Correct Answer: B
Rationale: Sublingual nitroglycerin should be taken at the first sign of chest pain: one tablet every 5 minutes for up to three
doses, calling 911 if pain is unrelieved after the first dose or after three doses total. Tablets must be stored in their original
dark, glass container because light degrades the medication; they must be taken sublingually (not swallowed) for rapid
absorption, and clients should sit down before administration to prevent syncope from orthostatic hypotension.
CONFIDENTIAL — PN Medical-Surgical Final Examination | 100 Items
,ATI PN Medical-Surgical Nursing Final Exam 2026/2027 (VERIFIED VERSION) Page 3
Q5. A client with heart failure (HF) has crackles bilaterally in the lung bases, jugular venous distention, and
2+ pitting edema of the lower extremities. Which nursing intervention is the priority?
A. Place the client in a high-Fowler's position. [CORRECT]
B. Restrict all oral fluids immediately.
C. Administer a beta-blocker as prescribed.
D. Encourage ambulation to promote circulation.
Correct Answer: A
Rationale: The client is demonstrating pulmonary congestion and fluid overload (hypervolemia). The priority intervention is
placing the client in a high-Fowler's position to maximize lung expansion and reduce venous return to the heart, easing
dyspnea. The PN should then notify the RN/provider for diuretic administration (e.g., furosemide). Complete fluid restriction
requires a provider order; beta-blockers are typically held during acute decompensation; ambulation is contraindicated in
acute fluid overload.
Q6. Which statement by a client with heart failure indicates that discharge teaching about daily weights has
been effective?
A. "I will weigh myself once a week before breakfast."
B. "I should weigh myself every morning after voiding, before eating or drinking, wearing similar clothing."
[CORRECT]
C. "A weight gain of 3 pounds in one day is expected and not concerning."
D. "I only need to weigh myself if I feel short of breath."
Correct Answer: B
Rationale: Clients with heart failure must weigh themselves daily at the same time (morning, after voiding, before
eating/drinking, with similar clothing) to detect fluid retention early. A weight gain of 2 pounds in one day or 3-5 pounds in
one week signals fluid overload and should be reported to the provider immediately. Weekly weights are insufficient;
symptom-triggered weighing is unreliable because fluid accumulation may precede symptoms.
Q7. A client with heart failure is receiving furosemide 40 mg IV push. The PN notes the client's most recent
potassium level is 3.1 mEq/L. Which finding requires immediate intervention?
A. Serum sodium of 138 mEq/L
B. Cardiac rhythm showing U waves and premature ventricular contractions (PVCs) [CORRECT]
C. Blood pressure of 116/74 mmHg
D. Respiratory rate of 18 breaths/min
Correct Answer: B
Rationale: Hypokalemia (K+ < 3.5 mEq/L) from loop diuretic therapy predisposes the client to life-threatening
dysrhythmias. U waves on ECG and PVCs are hallmark signs of hypokalemia and require immediate intervention with
potassium replacement and provider notification. The other findings are within normal limits or expected with diuresis. The
PN should hold the next furosemide dose pending provider guidance and monitor cardiac rhythm continuously.
CONFIDENTIAL — PN Medical-Surgical Final Examination | 100 Items
, ATI PN Medical-Surgical Nursing Final Exam 2026/2027 (VERIFIED VERSION) Page 4
Q8. The PN is teaching a client with heart failure about a 2-gram sodium diet. Which food selection by the
client indicates teaching has been effective?
A. Canned vegetable soup with saltine crackers
B. Fresh apple, grilled chicken breast, and steamed rice [CORRECT]
C. Ham sandwich with mustard and a pickle
D. Frozen lasagna with garlic bread
Correct Answer: B
Rationale: A 2-gram sodium diet limits processed, cured, canned, and frozen prepared foods. Fresh fruits (apple), fresh lean
proteins (grilled chicken), and unprocessed starches (steamed rice) are appropriate. Canned soup, saltines, ham, pickles,
mustard, and frozen prepared meals are all high-sodium foods that must be avoided. Teaching should also emphasize
reading nutrition labels for sodium content and avoiding added salt during cooking or at the table.
Q9. A client with suspected peripheral arterial disease (PAD) reports calf pain that occurs after walking two
blocks and is relieved by rest. How should the PN document this finding?
A. Rest pain
B. Intermittent claudication [CORRECT]
C. Neuropathic pain
D. Deep vein thrombosis
Correct Answer: B
Rationale: Intermittent claudication is the hallmark symptom of PAD, characterized by reproducible ischemic muscle pain
precipitated by activity and relieved by rest within 10 minutes. It results from inadequate arterial blood supply during
exertion. Rest pain occurs at night without activity and indicates severe ischemia; neuropathic pain is burning/tingling
unrelated to activity; DVT presents with calf tenderness, edema, and warmth, not exercise-relieved pain.
Q10. The PN is caring for a client with arterial insufficiency of the lower extremities. Which intervention
should the PN include in the plan of care?
A. Apply elastic compression stockings before ambulation.
B. Keep the legs in a dependent position when sitting. [CORRECT]
C. Encourage the client to soak the feet in hot water nightly.
D. Position the legs above the level of the heart when in bed.
Correct Answer: B
Rationale: Arterial insufficiency benefits from a dependent leg position, which uses gravity to enhance arterial perfusion to
ischemic tissues. Elastic stockings, used for venous disease, worsen arterial flow. Hot water soaks are contraindicated
because decreased sensation increases burn risk. Elevating legs above the heart worsens ischemic pain in arterial disease
(opposite of venous disease management, where elevation reduces edema).
CONFIDENTIAL — PN Medical-Surgical Final Examination | 100 Items
