2026 ATI RN Adult Medical Surgical (Med-
Surg) NGN Latest Exam: 150 High-Yield,
Scenario-Based Multiple-Choice Questions
Covering Cardiovascular, Respiratory,
Renal, Endocrine, Neurologic, and
Musculoskeletal Systems with Detailed
Answer Rationales
Table of Contents
1. Cardiovascular & Hematologic Disorders (Questions 1–25)
2. Respiratory Disorders (Questions 26–50)
3. Gastrointestinal & Hepatic Disorders (Questions 51–75)
4. Renal & Genitourinary Disorders (Questions 76–100)
5. Endocrine & Metabolic Disorders (Questions 101–120)
6. Neurologic & Musculoskeletal Disorders (Questions 121–150)
Section 1: Cardiovascular & Hematologic Disorders (Questions 1–25)
🟢 1. A client with acute decompensated heart failure is prescribed IV furosemide. Which assessment
finding indicates the therapy is effective?
A. Urine output of 100 mL/hr
B. Blood pressure of 88/50 mm Hg
C. Crackles auscultated halfway up the posterior lung fields
🔴 D. Decrease in the client's weight by 1 kg (2.2 lb) after 24 hours
Rationale: A decrease in weight is the most reliable indicator of fluid loss and effective diuresis. Options
A, B, and C indicate potential complications (hypotension) or a lack of therapeutic effect (continued
crackles).
🟢 2. A nurse is caring for a client who has just returned from a cardiac catheterization via the femoral
artery. Which action is the priority?
🔴 A. Assess the insertion site for bleeding and hematoma formation.
,B. Maintain the client in a supine position with the head elevated.
C. Encourage the client to flex the affected leg to promote circulation.
D. Administer the prescribed oral anticoagulant.
Rationale: The priority following a femoral artery puncture is to monitor for bleeding and hematoma,
the most common complications. The leg should be kept straight, not flexed.
🟢 3. A client with a new diagnosis of atrial fibrillation has a heart rate of 150/min and is symptomatic.
Which class of medication does the nurse anticipate administering first for rate control?
A. Anticoagulant (e.g., heparin)
B. Angiotensin-converting enzyme (ACE) inhibitor
C. Calcium channel blocker (e.g., diltiazem)
🔴 D. Beta-adrenergic blocker (e.g., metoprolol)
Rationale: Beta-blockers and calcium channel blockers are first-line agents for rate control in atrial
fibrillation. Beta-blockers are often preferred due to their rapid onset of action.
🟢 4. A nurse is teaching a client about a new prescription for warfarin. Which statement by the client
indicates a need for further teaching?
A. "I will use a soft toothbrush and an electric razor."
B. "I need to keep my intake of vitamin K foods consistent."
🔴 C. "I should take aspirin for any minor aches or pains."
D. "I will report any unusual bleeding or bruising to my provider."
Rationale: Aspirin and other NSAIDs increase the risk of bleeding when taken with warfarin. The client
should use acetaminophen for mild pain unless otherwise directed.
🟢 5. A client is admitted with a suspected myocardial infarction (MI). The provider prescribes
morphine sulfate. What is the primary purpose of administering morphine in this situation?
A. To decrease the heart rate
B. To prevent platelet aggregation
🔴 C. To reduce pain and decrease myocardial oxygen demand
D. To increase blood pressure and cardiac output
Rationale: Morphine reduces pain, anxiety, and preload/afterload, which collectively decreases
myocardial oxygen demand, the primary goal in acute MI management.
🟢 6. A client has a new permanent pacemaker inserted. Which instruction should the nurse include in
the discharge teaching?
🔴 A. "Avoid lifting your arm on the affected side above your shoulder for several weeks."
B. "You can resume contact sports as soon as the incision heals."
C. "It is safe to go through airport security without any special precautions."
D. "You should expect a clicking sound from the pacemaker generator."
Rationale: Arm movement restriction prevents dislodgement of the newly placed leads. Contact sports
should be avoided, and airport security may require a special ID card.
🟢 7. A client is admitted with an acute exacerbation of heart failure. The provider orders a 2-gram
sodium diet. Which food selection by the client indicates understanding?
A. Canned vegetable soup
B. A deli meat sandwich
, 🔴 C. Fresh fruit salad with grilled chicken
D. A frozen dinner entrée
Rationale: Fresh foods are naturally low in sodium. Processed and canned foods are typically high in
sodium.
🟢 8. A nurse is assessing a client who is receiving a blood transfusion. The client develops fever, chills,
and low back pain. What is the nurse's first action?
🔴 A. Stop the transfusion immediately.
B. Administer the prescribed antipyretic.
C. Slow the transfusion rate.
D. Obtain a urine specimen.
Rationale: These are signs of an acute hemolytic transfusion reaction. The first action is always to stop
the transfusion immediately to prevent further reaction.
🟢 9. A client with DVT is started on a heparin infusion. The nurse should monitor for which adverse
effect?
A. Hyperkalemia
B. Hypertension
C. Thrombocytopenia
🔴 D. Bleeding
Rationale: The primary adverse effect of heparin is bleeding (hemorrhage). Heparin-induced
thrombocytopenia (HIT) is a serious but less common complication.
🟢 10. A client is scheduled for an exercise stress test. Which instruction should the nurse provide?
A. "You should eat a heavy meal 2 hours before the test."
B. "You should take your beta-blocker as prescribed on the morning of the test."
🔴 C. "Wear comfortable clothing and shoes suitable for walking."
D. "Avoid caffeine for 24 hours after the test."
Rationale: Comfortable clothing is essential for the treadmill portion. Beta-blockers are typically held
before the test as they can blunt the heart rate response.
🟢 11. A nurse is caring for a client who has a new diagnosis of infective endocarditis. Which
assessment finding is a major criterion for this diagnosis?
A. Fever
B. Splenomegaly
🔴 C. New murmur
D. Janeway lesions
Rationale: A new or changing murmur is a major Duke criterion. Fever and Janeway lesions are minor
criteria.
🟢 12. A client with severe aortic stenosis is at risk for which complication?
A. Pulmonary embolism
🔴 B. Syncope
C. Hypertension
D. Bradycardia
Rationale: Aortic stenosis can lead to decreased cardiac output and syncope, especially during exertion.
Surg) NGN Latest Exam: 150 High-Yield,
Scenario-Based Multiple-Choice Questions
Covering Cardiovascular, Respiratory,
Renal, Endocrine, Neurologic, and
Musculoskeletal Systems with Detailed
Answer Rationales
Table of Contents
1. Cardiovascular & Hematologic Disorders (Questions 1–25)
2. Respiratory Disorders (Questions 26–50)
3. Gastrointestinal & Hepatic Disorders (Questions 51–75)
4. Renal & Genitourinary Disorders (Questions 76–100)
5. Endocrine & Metabolic Disorders (Questions 101–120)
6. Neurologic & Musculoskeletal Disorders (Questions 121–150)
Section 1: Cardiovascular & Hematologic Disorders (Questions 1–25)
🟢 1. A client with acute decompensated heart failure is prescribed IV furosemide. Which assessment
finding indicates the therapy is effective?
A. Urine output of 100 mL/hr
B. Blood pressure of 88/50 mm Hg
C. Crackles auscultated halfway up the posterior lung fields
🔴 D. Decrease in the client's weight by 1 kg (2.2 lb) after 24 hours
Rationale: A decrease in weight is the most reliable indicator of fluid loss and effective diuresis. Options
A, B, and C indicate potential complications (hypotension) or a lack of therapeutic effect (continued
crackles).
🟢 2. A nurse is caring for a client who has just returned from a cardiac catheterization via the femoral
artery. Which action is the priority?
🔴 A. Assess the insertion site for bleeding and hematoma formation.
,B. Maintain the client in a supine position with the head elevated.
C. Encourage the client to flex the affected leg to promote circulation.
D. Administer the prescribed oral anticoagulant.
Rationale: The priority following a femoral artery puncture is to monitor for bleeding and hematoma,
the most common complications. The leg should be kept straight, not flexed.
🟢 3. A client with a new diagnosis of atrial fibrillation has a heart rate of 150/min and is symptomatic.
Which class of medication does the nurse anticipate administering first for rate control?
A. Anticoagulant (e.g., heparin)
B. Angiotensin-converting enzyme (ACE) inhibitor
C. Calcium channel blocker (e.g., diltiazem)
🔴 D. Beta-adrenergic blocker (e.g., metoprolol)
Rationale: Beta-blockers and calcium channel blockers are first-line agents for rate control in atrial
fibrillation. Beta-blockers are often preferred due to their rapid onset of action.
🟢 4. A nurse is teaching a client about a new prescription for warfarin. Which statement by the client
indicates a need for further teaching?
A. "I will use a soft toothbrush and an electric razor."
B. "I need to keep my intake of vitamin K foods consistent."
🔴 C. "I should take aspirin for any minor aches or pains."
D. "I will report any unusual bleeding or bruising to my provider."
Rationale: Aspirin and other NSAIDs increase the risk of bleeding when taken with warfarin. The client
should use acetaminophen for mild pain unless otherwise directed.
🟢 5. A client is admitted with a suspected myocardial infarction (MI). The provider prescribes
morphine sulfate. What is the primary purpose of administering morphine in this situation?
A. To decrease the heart rate
B. To prevent platelet aggregation
🔴 C. To reduce pain and decrease myocardial oxygen demand
D. To increase blood pressure and cardiac output
Rationale: Morphine reduces pain, anxiety, and preload/afterload, which collectively decreases
myocardial oxygen demand, the primary goal in acute MI management.
🟢 6. A client has a new permanent pacemaker inserted. Which instruction should the nurse include in
the discharge teaching?
🔴 A. "Avoid lifting your arm on the affected side above your shoulder for several weeks."
B. "You can resume contact sports as soon as the incision heals."
C. "It is safe to go through airport security without any special precautions."
D. "You should expect a clicking sound from the pacemaker generator."
Rationale: Arm movement restriction prevents dislodgement of the newly placed leads. Contact sports
should be avoided, and airport security may require a special ID card.
🟢 7. A client is admitted with an acute exacerbation of heart failure. The provider orders a 2-gram
sodium diet. Which food selection by the client indicates understanding?
A. Canned vegetable soup
B. A deli meat sandwich
, 🔴 C. Fresh fruit salad with grilled chicken
D. A frozen dinner entrée
Rationale: Fresh foods are naturally low in sodium. Processed and canned foods are typically high in
sodium.
🟢 8. A nurse is assessing a client who is receiving a blood transfusion. The client develops fever, chills,
and low back pain. What is the nurse's first action?
🔴 A. Stop the transfusion immediately.
B. Administer the prescribed antipyretic.
C. Slow the transfusion rate.
D. Obtain a urine specimen.
Rationale: These are signs of an acute hemolytic transfusion reaction. The first action is always to stop
the transfusion immediately to prevent further reaction.
🟢 9. A client with DVT is started on a heparin infusion. The nurse should monitor for which adverse
effect?
A. Hyperkalemia
B. Hypertension
C. Thrombocytopenia
🔴 D. Bleeding
Rationale: The primary adverse effect of heparin is bleeding (hemorrhage). Heparin-induced
thrombocytopenia (HIT) is a serious but less common complication.
🟢 10. A client is scheduled for an exercise stress test. Which instruction should the nurse provide?
A. "You should eat a heavy meal 2 hours before the test."
B. "You should take your beta-blocker as prescribed on the morning of the test."
🔴 C. "Wear comfortable clothing and shoes suitable for walking."
D. "Avoid caffeine for 24 hours after the test."
Rationale: Comfortable clothing is essential for the treadmill portion. Beta-blockers are typically held
before the test as they can blunt the heart rate response.
🟢 11. A nurse is caring for a client who has a new diagnosis of infective endocarditis. Which
assessment finding is a major criterion for this diagnosis?
A. Fever
B. Splenomegaly
🔴 C. New murmur
D. Janeway lesions
Rationale: A new or changing murmur is a major Duke criterion. Fever and Janeway lesions are minor
criteria.
🟢 12. A client with severe aortic stenosis is at risk for which complication?
A. Pulmonary embolism
🔴 B. Syncope
C. Hypertension
D. Bradycardia
Rationale: Aortic stenosis can lead to decreased cardiac output and syncope, especially during exertion.
