Page 1 of 115
ATI MED-SURG PROCTORED EXAM — NGN-STYLE 2026
QUESTIONS WITH VERIFIED QUESTIONS DETAILED RATIONALES
GRADED A+
ATI Med-Surg Proctored Exam — NGN-Style: Questions with Rationales
Summarized 10-Point Exam Coverage
Cardiovascular Disorders — acute myocardial infarction, heart failure, dysrhythmias,
pericarditis, hypertension, vascular disorders.
Respiratory Disorders — COPD, pneumonia, pulmonary embolism, ARDS, tracheostomy care,
chest tubes, mechanical ventilation.
Gastrointestinal Disorders — peptic ulcer disease, inflammatory bowel disease, cirrhosis,
pancreatitis, bowel obstruction, ostomies.
Renal and Urinary Disorders — acute kidney injury, chronic kidney disease, dialysis, urinary
tract infections, renal calculi, TURP.
Endocrine and Metabolic Disorders — diabetes mellitus, DKA, HHS, thyroid disorders, adrenal
disorders, SIADH, diabetes insipidus.
Neurological Disorders — stroke, seizures, traumatic brain injury, spinal cord injury, meningitis,
Guillain-Barré syndrome, myasthenia gravis.
Hematologic and Immunologic Disorders — anemia, leukemia, thrombocytopenia,
neutropenia, transfusion reactions, HIV/AIDS.
Musculoskeletal and Integumentary Disorders — fractures, total joint arthroplasty,
amputations, burns, pressure injuries, wound care.
Fluid, Electrolyte, and Acid-Base Imbalances — dehydration, fluid overload, hyperkalemia,
hypokalemia, metabolic/respiratory acidosis/alkalosis.
,Page 2 of 115
Pain Management, Safety, and Perioperative Care — pain assessment and management,
medication safety, restraint use, preoperative and postoperative nursing care, NGN clinical
judgment.
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–40)
Q1. A nurse is caring for a client with acute myocardial infarction who reports chest pain rated
8/10. Which action should the nurse take FIRST?
A. Document the pain in the client's medical record
B. Administer prescribed nitroglycerin and reassess
C. Notify the client's family members
D. Offer the client a light snack
Correct Answer: B
Rationale: Chest pain in acute myocardial infarction indicates ongoing myocardial ischemia and
is life-threatening. Administering prescribed nitroglycerin addresses the ischemia by dilating
coronary arteries and reducing preload. Documentation (A) is important but does not treat the
patient. Food intake (D) is irrelevant and potentially harmful during acute MI. Family notification
(C) is secondary to immediate patient stabilization.
Q2. A client with heart failure has an ejection fraction of 25% and reports waking up
breathless at night, requiring three pillows to sleep comfortably. The nurse recognizes that
adding which medication would most effectively reduce hospitalization risk?
A. Amlodipine
B. Digoxin
C. Sacubitril-valsartan
D. Hydralazine alone
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Correct Answer: C
Rationale: Sacubitril-valsartan is an ARNI (angiotensin receptor-neprilysin inhibitor) that reduces
mortality and heart failure hospitalizations in patients with reduced ejection fraction.
Amlodipine (A) does not improve outcomes in HFrEF. Digoxin (B) reduces hospitalizations but
does not improve survival. Hydralazine alone (D) is not as effective as the combination with
isosorbide dinitrate in certain populations.
Q3. A client with new-onset atrial fibrillation has a ventricular rate of 156/min and is
hemodynamically stable with blood pressure 128/78 mm Hg. The client reports
lightheadedness and palpitations. Which intervention should the nurse anticipate?
A. Immediate synchronized cardioversion
B. Administration of intravenous amiodarone
C. Administration of intravenous diltiazem
D. Insertion of a temporary pacemaker
Correct Answer: C
Rationale: In hemodynamically stable atrial fibrillation with rapid ventricular response, rate
control with a calcium channel blocker (diltiazem) or beta-blocker is indicated. Immediate
synchronized cardioversion (A) is indicated for unstable patients. Amiodarone (B) may be used
but is not typically first-line for rate control. A pacemaker (D) is not indicated for atrial
fibrillation.
Q4. A nurse is assessing a client with pericarditis. Which ECG finding is most consistent with
this diagnosis?
A. ST depression in leads V3 through V6
B. Diffuse ST elevation
C. Peaked T waves
D. Prolonged QT interval
, Page 4 of 115
Correct Answer: B
Rationale: Pericarditis is characterized by diffuse ST elevation across multiple leads due to
inflammation of the pericardium. ST depression (A) suggests myocardial ischemia or injury.
Peaked T waves (C) suggest hyperkalemia. Prolonged QT interval (D) suggests electrolyte
imbalances or medication effects.
Q5. A nurse is caring for a client receiving furosemide. Which laboratory value requires
immediate reporting?
A. Sodium 138 mEq/L
B. Potassium 2.9 mEq/L
C. Chloride 101 mEq/L
D. Calcium 9.2 mg/dL
Correct Answer: B
Rationale: Furosemide can cause hypokalemia. Severe hypokalemia increases the risk for
dysrhythmias. A potassium level of 2.9 mEq/L requires immediate reporting. Sodium 138 mEq/L
(A), chloride 101 mEq/L (C), and calcium 9.2 mg/dL (D) are within normal limits.
Q6. A nurse is teaching a client who has heart failure. Which instructions should the nurse
include? Select all that apply.
A. Weigh yourself daily
B. Restrict sodium intake
C. Report sudden weight gain
D. Drink unlimited fluids
E. Take medications as prescribed
Correct Answers: A, B, C, E
Rationale: Daily weights, sodium restriction, medication adherence, and reporting weight gain
ATI MED-SURG PROCTORED EXAM — NGN-STYLE 2026
QUESTIONS WITH VERIFIED QUESTIONS DETAILED RATIONALES
GRADED A+
ATI Med-Surg Proctored Exam — NGN-Style: Questions with Rationales
Summarized 10-Point Exam Coverage
Cardiovascular Disorders — acute myocardial infarction, heart failure, dysrhythmias,
pericarditis, hypertension, vascular disorders.
Respiratory Disorders — COPD, pneumonia, pulmonary embolism, ARDS, tracheostomy care,
chest tubes, mechanical ventilation.
Gastrointestinal Disorders — peptic ulcer disease, inflammatory bowel disease, cirrhosis,
pancreatitis, bowel obstruction, ostomies.
Renal and Urinary Disorders — acute kidney injury, chronic kidney disease, dialysis, urinary
tract infections, renal calculi, TURP.
Endocrine and Metabolic Disorders — diabetes mellitus, DKA, HHS, thyroid disorders, adrenal
disorders, SIADH, diabetes insipidus.
Neurological Disorders — stroke, seizures, traumatic brain injury, spinal cord injury, meningitis,
Guillain-Barré syndrome, myasthenia gravis.
Hematologic and Immunologic Disorders — anemia, leukemia, thrombocytopenia,
neutropenia, transfusion reactions, HIV/AIDS.
Musculoskeletal and Integumentary Disorders — fractures, total joint arthroplasty,
amputations, burns, pressure injuries, wound care.
Fluid, Electrolyte, and Acid-Base Imbalances — dehydration, fluid overload, hyperkalemia,
hypokalemia, metabolic/respiratory acidosis/alkalosis.
,Page 2 of 115
Pain Management, Safety, and Perioperative Care — pain assessment and management,
medication safety, restraint use, preoperative and postoperative nursing care, NGN clinical
judgment.
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–40)
Q1. A nurse is caring for a client with acute myocardial infarction who reports chest pain rated
8/10. Which action should the nurse take FIRST?
A. Document the pain in the client's medical record
B. Administer prescribed nitroglycerin and reassess
C. Notify the client's family members
D. Offer the client a light snack
Correct Answer: B
Rationale: Chest pain in acute myocardial infarction indicates ongoing myocardial ischemia and
is life-threatening. Administering prescribed nitroglycerin addresses the ischemia by dilating
coronary arteries and reducing preload. Documentation (A) is important but does not treat the
patient. Food intake (D) is irrelevant and potentially harmful during acute MI. Family notification
(C) is secondary to immediate patient stabilization.
Q2. A client with heart failure has an ejection fraction of 25% and reports waking up
breathless at night, requiring three pillows to sleep comfortably. The nurse recognizes that
adding which medication would most effectively reduce hospitalization risk?
A. Amlodipine
B. Digoxin
C. Sacubitril-valsartan
D. Hydralazine alone
,Page 3 of 115
Correct Answer: C
Rationale: Sacubitril-valsartan is an ARNI (angiotensin receptor-neprilysin inhibitor) that reduces
mortality and heart failure hospitalizations in patients with reduced ejection fraction.
Amlodipine (A) does not improve outcomes in HFrEF. Digoxin (B) reduces hospitalizations but
does not improve survival. Hydralazine alone (D) is not as effective as the combination with
isosorbide dinitrate in certain populations.
Q3. A client with new-onset atrial fibrillation has a ventricular rate of 156/min and is
hemodynamically stable with blood pressure 128/78 mm Hg. The client reports
lightheadedness and palpitations. Which intervention should the nurse anticipate?
A. Immediate synchronized cardioversion
B. Administration of intravenous amiodarone
C. Administration of intravenous diltiazem
D. Insertion of a temporary pacemaker
Correct Answer: C
Rationale: In hemodynamically stable atrial fibrillation with rapid ventricular response, rate
control with a calcium channel blocker (diltiazem) or beta-blocker is indicated. Immediate
synchronized cardioversion (A) is indicated for unstable patients. Amiodarone (B) may be used
but is not typically first-line for rate control. A pacemaker (D) is not indicated for atrial
fibrillation.
Q4. A nurse is assessing a client with pericarditis. Which ECG finding is most consistent with
this diagnosis?
A. ST depression in leads V3 through V6
B. Diffuse ST elevation
C. Peaked T waves
D. Prolonged QT interval
, Page 4 of 115
Correct Answer: B
Rationale: Pericarditis is characterized by diffuse ST elevation across multiple leads due to
inflammation of the pericardium. ST depression (A) suggests myocardial ischemia or injury.
Peaked T waves (C) suggest hyperkalemia. Prolonged QT interval (D) suggests electrolyte
imbalances or medication effects.
Q5. A nurse is caring for a client receiving furosemide. Which laboratory value requires
immediate reporting?
A. Sodium 138 mEq/L
B. Potassium 2.9 mEq/L
C. Chloride 101 mEq/L
D. Calcium 9.2 mg/dL
Correct Answer: B
Rationale: Furosemide can cause hypokalemia. Severe hypokalemia increases the risk for
dysrhythmias. A potassium level of 2.9 mEq/L requires immediate reporting. Sodium 138 mEq/L
(A), chloride 101 mEq/L (C), and calcium 9.2 mg/dL (D) are within normal limits.
Q6. A nurse is teaching a client who has heart failure. Which instructions should the nurse
include? Select all that apply.
A. Weigh yourself daily
B. Restrict sodium intake
C. Report sudden weight gain
D. Drink unlimited fluids
E. Take medications as prescribed
Correct Answers: A, B, C, E
Rationale: Daily weights, sodium restriction, medication adherence, and reporting weight gain
