ATI PN ADULT MEDICAL-SURGICAL 2026
PROCTORED EXAM
Comprehensive 100-Question Practice Exam & LPN Nursing Assessment Study
Guide
EXAM INSTRUCTIONS & CLINICAL GUIDELINES:
• This complete 100-question practice exam reflects the updated 2026 ATI PN Adult Medical-Surgical
test plan.
• Focus areas include: Cardiovascular, Respiratory, Neurological, Gastrointestinal, Endocrine,
Renal/Urinary, Musculoskeletal, Hematological/Immune, Integumentary, and
Perioperative/Pharmacological management.
• Each question includes the correct answer and a detailed clinical rationale emphasizing the
Practical Nurse (LPN) scope of practice, priority assessments, and nursing interventions.
Question 1: A practical nurse (PN) is caring for a client with left-sided heart failure. Which
of the following findings should the PN expect during the assessment?
A. Jugular vein distension
B. Dependent peripheral edema
C. Crackles in lung bases
D. Hepatomegaly
Answer & Rationale: Correct Answer: C. Left-sided heart failure results in pulmonary congestion due
to the heart's inability to pump blood effectively into the systemic circulation, leading to fluid
accumulation in the alveoli (crackles, dyspnea, cough). Jugular vein distension, peripheral edema,
and hepatomegaly are classic signs of right-sided heart failure.
Question 2: A client with a new prescription for digoxin 0.25 mg PO daily has a pulse rate
of 52/min. Which of the following actions should the PN take?
A. Administer the medication as prescribed.
B. Withhold the medication and notify the charge nurse/provider.
C. Administer the medication and recheck the pulse in 1 hour.
D. Crush the medication and mix with applesauce.
Answer & Rationale: Correct Answer: B. Digoxin slows the heart rate and increases myocardial
contractility. If the apical pulse is less than 60/min in an adult, the PN must withhold the dose and
notify the provider to prevent severe bradycardia or digitalis toxicity.
Question 3: A PN is reinforcing discharge teaching for a client who has atherosclerosis
and a new prescription for atorvastatin. Which of the following statements by the client
indicates an understanding of the teaching?
, A. 'I will stop taking this medication if my cholesterol levels return to normal.'
B. 'I should report severe muscle pain or tenderness to my doctor immediately.'
C. 'I can take this medication with grapefruit juice every morning.'
D. 'This medication will cure my atherosclerosis.'
Answer & Rationale: Correct Answer: B. Statins like atorvastatin can cause myopathy and
rhabdomyolysis; clients must report unexplained muscle pain or tenderness immediately. Grapefruit
juice inhibits statin metabolism and increases toxicity risk. Statins manage rather than cure
atherosclerosis.
Question 4: A PN is caring for a client who is admitted with suspected acute myocardial
infarction (MI). Which of the following laboratory tests is the most specific cardiac
marker to monitor?
A. Creatine kinase-MB (CK-MB)
B. Myoglobin
C. Troponin T
D. C-reactive protein
Answer & Rationale: Correct Answer: C. Cardiac-specific troponin T and troponin I are the gold
standard and most specific biomarkers for myocardial injury, remaining elevated for 1 to 3 weeks.
Myoglobin rises early but lacks cardiac specificity.
Question 5: A client is receiving a continuous intravenous infusion of heparin for deep
vein thrombosis (DVT). Which of the following laboratory values should the PN monitor
to evaluate the effectiveness of the therapy?
A. Prothrombin time (PT)
B. International Normalized Ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Platelet count
Answer & Rationale: Correct Answer: C. Heparin therapy is monitored using aPTT, targeting 1.5 to
2 times the normal control value. PT and INR are used to monitor warfarin (Coumadin) therapy.
Question 6: A PN is assessing a client who has peripheral arterial disease (PAD). Which
of the following clinical manifestations should the PN expect?
A. Lower extremity edema
B. Brownish discoloration of the lower legs
C. Intermittent claudication
D. Warm, palpable pulses
Answer & Rationale: Correct Answer: C. Intermittent claudication (ischemic muscle pain brought on
by exertion and relieved by rest) is a hallmark symptom of PAD due to decreased arterial blood
supply. Edema and brownish pigmentation are characteristic of chronic venous insufficiency.
Question 7: A client is admitted with a diagnosis of essential hypertension, with a blood
pressure reading of 160/98 mm Hg. Which of the following lifestyle modifications should
the PN prioritize in client education?
, A. Increasing daily dietary protein intake
B. Sodium restriction and weight management
C. Engaging in high-intensity anaerobic weightlifting daily
D. Complete elimination of all dietary fats
Answer & Rationale: Correct Answer: B. Sodium restriction and maintaining a healthy body weight
are cornerstone lifestyle interventions for managing hypertension. Extreme protein adjustments or
high-intensity anaerobic strain are not primary recommendations.
Question 8: A PN is caring for a client who has a temporary transvenous pacemaker
inserted. Which of the following findings indicates pacemaker capture?
A. Pacer spikes followed immediately by QRS complexes on the monitor
B. A heart rate consistently below 50/min
C. Absence of P waves on the telemetry strip
D. Continuous fluttering of the atrial chambers
Answer & Rationale: Correct Answer: A. Pacemaker capture is demonstrated on the
electrocardiogram (ECG) by a pacemaker spike followed immediately by the appropriate depolarized
waveform (P wave for atrial, QRS complex for ventricular capture).
Question 9: A PN is reinforcing teaching for a client with a new prescription for
nitroglycerin sublingual tablets for angina pectoris. Which instruction should the PN
include?
A. 'Swallow the tablet whole with a full glass of water.'
B. 'Store the tablets in a clear plastic pill box in your bathroom.'
C. 'Take one tablet every 5 minutes for up to three doses, and call 911 if pain persists after the
first dose.'
D. 'Avoid taking phosphodiesterase inhibitors like sildenafil while using nitroglycerin.'
Answer & Rationale: Correct Answer: D. Concurrent use of nitrates and phosphodiesterase type 5
inhibitors (e.g., sildenafil) causes profound, life-threatening hypotension. Nitroglycerin sublingual must
dissolve under the tongue, be stored in dark glass containers, and emergency services called if pain
is unrelieved after the first tablet depending on protocol (or after 3 doses, but safety guidelines
emphasize calling 911 if unrelieved by first dose/if pain worsens).
Question 10: A PN is assessing a client who had a cardiac catheterization via the right
femoral approach 2 hours ago. Which of the following assessments is priority?
A. Auscultating bowel sounds in all four quadrants
B. Palpating the right pedal pulse and checking color and temperature
C. Assessing the client's visual acuity
D. Encouraging high-fiber dietary intake
Answer & Rationale: Correct Answer: B. Monitoring the distal pulses (dorsalis pedis and posterior
tibial), capillary refill, color, and temperature of the affected extremity is crucial to detect early arterial
occlusion or hemorrhage following femoral cardiac catheterization.
Question 11: A client with infective endocarditis is prescribed a 6-week course of IV
antibiotic therapy. Which of the following complications should the PN monitor for?
PROCTORED EXAM
Comprehensive 100-Question Practice Exam & LPN Nursing Assessment Study
Guide
EXAM INSTRUCTIONS & CLINICAL GUIDELINES:
• This complete 100-question practice exam reflects the updated 2026 ATI PN Adult Medical-Surgical
test plan.
• Focus areas include: Cardiovascular, Respiratory, Neurological, Gastrointestinal, Endocrine,
Renal/Urinary, Musculoskeletal, Hematological/Immune, Integumentary, and
Perioperative/Pharmacological management.
• Each question includes the correct answer and a detailed clinical rationale emphasizing the
Practical Nurse (LPN) scope of practice, priority assessments, and nursing interventions.
Question 1: A practical nurse (PN) is caring for a client with left-sided heart failure. Which
of the following findings should the PN expect during the assessment?
A. Jugular vein distension
B. Dependent peripheral edema
C. Crackles in lung bases
D. Hepatomegaly
Answer & Rationale: Correct Answer: C. Left-sided heart failure results in pulmonary congestion due
to the heart's inability to pump blood effectively into the systemic circulation, leading to fluid
accumulation in the alveoli (crackles, dyspnea, cough). Jugular vein distension, peripheral edema,
and hepatomegaly are classic signs of right-sided heart failure.
Question 2: A client with a new prescription for digoxin 0.25 mg PO daily has a pulse rate
of 52/min. Which of the following actions should the PN take?
A. Administer the medication as prescribed.
B. Withhold the medication and notify the charge nurse/provider.
C. Administer the medication and recheck the pulse in 1 hour.
D. Crush the medication and mix with applesauce.
Answer & Rationale: Correct Answer: B. Digoxin slows the heart rate and increases myocardial
contractility. If the apical pulse is less than 60/min in an adult, the PN must withhold the dose and
notify the provider to prevent severe bradycardia or digitalis toxicity.
Question 3: A PN is reinforcing discharge teaching for a client who has atherosclerosis
and a new prescription for atorvastatin. Which of the following statements by the client
indicates an understanding of the teaching?
, A. 'I will stop taking this medication if my cholesterol levels return to normal.'
B. 'I should report severe muscle pain or tenderness to my doctor immediately.'
C. 'I can take this medication with grapefruit juice every morning.'
D. 'This medication will cure my atherosclerosis.'
Answer & Rationale: Correct Answer: B. Statins like atorvastatin can cause myopathy and
rhabdomyolysis; clients must report unexplained muscle pain or tenderness immediately. Grapefruit
juice inhibits statin metabolism and increases toxicity risk. Statins manage rather than cure
atherosclerosis.
Question 4: A PN is caring for a client who is admitted with suspected acute myocardial
infarction (MI). Which of the following laboratory tests is the most specific cardiac
marker to monitor?
A. Creatine kinase-MB (CK-MB)
B. Myoglobin
C. Troponin T
D. C-reactive protein
Answer & Rationale: Correct Answer: C. Cardiac-specific troponin T and troponin I are the gold
standard and most specific biomarkers for myocardial injury, remaining elevated for 1 to 3 weeks.
Myoglobin rises early but lacks cardiac specificity.
Question 5: A client is receiving a continuous intravenous infusion of heparin for deep
vein thrombosis (DVT). Which of the following laboratory values should the PN monitor
to evaluate the effectiveness of the therapy?
A. Prothrombin time (PT)
B. International Normalized Ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Platelet count
Answer & Rationale: Correct Answer: C. Heparin therapy is monitored using aPTT, targeting 1.5 to
2 times the normal control value. PT and INR are used to monitor warfarin (Coumadin) therapy.
Question 6: A PN is assessing a client who has peripheral arterial disease (PAD). Which
of the following clinical manifestations should the PN expect?
A. Lower extremity edema
B. Brownish discoloration of the lower legs
C. Intermittent claudication
D. Warm, palpable pulses
Answer & Rationale: Correct Answer: C. Intermittent claudication (ischemic muscle pain brought on
by exertion and relieved by rest) is a hallmark symptom of PAD due to decreased arterial blood
supply. Edema and brownish pigmentation are characteristic of chronic venous insufficiency.
Question 7: A client is admitted with a diagnosis of essential hypertension, with a blood
pressure reading of 160/98 mm Hg. Which of the following lifestyle modifications should
the PN prioritize in client education?
, A. Increasing daily dietary protein intake
B. Sodium restriction and weight management
C. Engaging in high-intensity anaerobic weightlifting daily
D. Complete elimination of all dietary fats
Answer & Rationale: Correct Answer: B. Sodium restriction and maintaining a healthy body weight
are cornerstone lifestyle interventions for managing hypertension. Extreme protein adjustments or
high-intensity anaerobic strain are not primary recommendations.
Question 8: A PN is caring for a client who has a temporary transvenous pacemaker
inserted. Which of the following findings indicates pacemaker capture?
A. Pacer spikes followed immediately by QRS complexes on the monitor
B. A heart rate consistently below 50/min
C. Absence of P waves on the telemetry strip
D. Continuous fluttering of the atrial chambers
Answer & Rationale: Correct Answer: A. Pacemaker capture is demonstrated on the
electrocardiogram (ECG) by a pacemaker spike followed immediately by the appropriate depolarized
waveform (P wave for atrial, QRS complex for ventricular capture).
Question 9: A PN is reinforcing teaching for a client with a new prescription for
nitroglycerin sublingual tablets for angina pectoris. Which instruction should the PN
include?
A. 'Swallow the tablet whole with a full glass of water.'
B. 'Store the tablets in a clear plastic pill box in your bathroom.'
C. 'Take one tablet every 5 minutes for up to three doses, and call 911 if pain persists after the
first dose.'
D. 'Avoid taking phosphodiesterase inhibitors like sildenafil while using nitroglycerin.'
Answer & Rationale: Correct Answer: D. Concurrent use of nitrates and phosphodiesterase type 5
inhibitors (e.g., sildenafil) causes profound, life-threatening hypotension. Nitroglycerin sublingual must
dissolve under the tongue, be stored in dark glass containers, and emergency services called if pain
is unrelieved after the first tablet depending on protocol (or after 3 doses, but safety guidelines
emphasize calling 911 if unrelieved by first dose/if pain worsens).
Question 10: A PN is assessing a client who had a cardiac catheterization via the right
femoral approach 2 hours ago. Which of the following assessments is priority?
A. Auscultating bowel sounds in all four quadrants
B. Palpating the right pedal pulse and checking color and temperature
C. Assessing the client's visual acuity
D. Encouraging high-fiber dietary intake
Answer & Rationale: Correct Answer: B. Monitoring the distal pulses (dorsalis pedis and posterior
tibial), capillary refill, color, and temperature of the affected extremity is crucial to detect early arterial
occlusion or hemorrhage following femoral cardiac catheterization.
Question 11: A client with infective endocarditis is prescribed a 6-week course of IV
antibiotic therapy. Which of the following complications should the PN monitor for?
