ATI RN Adult Medical-Surgical Exam Prep 2026 | 100 NGN-
Style Questions with Answers & Rationales | Nursing Practice
Test
SECTION A: CARDIOVASCULAR
Scenario 1: A 68‑year‑old client with heart failure (HF) is admitted with worsening dyspnea,
orthopnea, and 3+ pitting edema. Current medications include lisinopril, furosemide, and
carvedilol.
1. Which assessment finding indicates the client is developing acute decompensated heart failure?
A. Jugular venous distension (JVD) while supine
B. Blood pressure 110/70 mmHg
C. Heart rate 72 bpm and regular
D. Oxygen saturation 95% on room air
Answer: A
Explanation: JVD reflects elevated central venous pressure, a key sign of right‑sided HF
exacerbation. Stable BP and O2 sat are not acute worsening.
2. The client’s morning weight is 4 kg above yesterday’s weight. What is the nurse’s priority
action?
A. Restrict oral fluids to 1 L/day
B. Administer furosemide as ordered and reassess
C. Increase the lisinopril dose
D. Place the client in Trendelenburg position
Answer: B
Explanation: Rapid weight gain indicates fluid retention. Loop diuretic (furosemide) is first‑line
to promote diuresis.
3. (NGN) The client reports a new, persistent cough. Which medication is most likely responsible?
,A. Furosemide
B. Lisinopril
C. Carvedilol
D. Digoxin
Answer: B
Explanation: ACE inhibitors (lisinopril) cause a dry, non‑productive cough due to bradykinin
accumulation.
Scenario 2: A 55‑year‑old client is 1 day post‑coronary artery bypass grafting (CABG). Telemetry
shows new atrial fibrillation with a ventricular rate of 140 bpm. Blood pressure is 90/60 mmHg.
4. What is the priority nursing action?
A. Administer amiodarone IV per protocol
B. Prepare for synchronized cardioversion
C. Check serum potassium level
D. Notify the provider and prepare for cardioversion
Answer: D
Explanation: Unstable AF with hypotension requires immediate synchronized cardioversion.
Notify provider and prepare.
5. Which laboratory value would the nurse expect to monitor closely for this client?
A. Troponin I
B. BNP
C. Creatinine kinase‑MB
D. D‑dimer
Answer: B
Explanation: BNP is elevated in HF and can also rise post‑CABG, but for AF, electrolytes and
anticoagulation are key. Among options, BNP is monitored for post‑op volume status. However,
for AF, potassium is critical. The question asks “expect to monitor” – D‑dimer for PE, CK‑MB for
MI. Best answer: BNP for HF exacerbation.
,Scenario 3: A 72‑year‑old with peripheral artery disease (PAD) reports left calf pain when walking
that resolves with rest. The left foot is cool and pale.
6. Which intervention should the nurse teach?
A. Elevate the legs above heart level
B. Apply heat to the affected leg
C. Walk to the point of pain, rest, then resume
D. Wear compression stockings during the day
Answer: C
Explanation: Supervised exercise (walk to pain, rest, repeat) improves collateral circulation.
Elevation worsens PAD; heat can cause burns; compression is for venous disease.
7. The nurse assesses a non‑healing ulcer on the left great toe. Which finding is consistent with
arterial insufficiency?
A. Punched‑out appearance with pale base
B. Brownish discoloration of surrounding skin
C. Copious serous drainage
D. Edema around the ulcer
Answer: A
Explanation: Arterial ulcers are round, deep, with pale/necrotic base. Venous ulcers have irregular
edges, brown staining, and edema.
SECTION B: RESPIRATORY
Scenario 4: A client with COPD (chronic bronchitis phenotype) has an SpO₂ of 88% on 2 L/min
nasal cannula. ABG: pH 7.32, PaCO₂ 65 mmHg, PaO₂ 60 mmHg, HCO₃ 32 mEq/L.
8. Which interpretation is correct?
A. Respiratory acidosis with metabolic compensation
, B. Metabolic acidosis with respiratory compensation
C. Respiratory alkalosis
D. Mixed metabolic alkalosis and respiratory acidosis
Answer: A
Explanation: Low pH (acidosis), high PaCO₂ (respiratory cause), high HCO₃ (compensation) →
chronic respiratory acidosis.
9. The nurse increases oxygen to 4 L/min. Thirty minutes later, the client becomes lethargic. What
is the most likely cause?
A. Oxygen toxicity
B. CO₂ narcosis
C. Pneumothorax
D. Pulmonary embolism
Answer: B
Explanation: COPD patients may lose hypoxic drive; high O₂ reduces respiratory drive, causing
CO₂ retention and narcosis.
10. Which medication is most appropriate for acute exacerbation of COPD with increased
wheezing?
A. Tiotropium (Spiriva)
B. Albuterol nebulizer
C. Fluticasone/salmeterol (Advair)
D. Oral prednisone only
Answer: B
Explanation: Short‑acting beta‑agonist (albuterol) is first‑line for acute bronchospasm.
Scenario 5: A 35‑year‑old client with asthma presents with respiratory rate 32, use of accessory
muscles, and peak expiratory flow 40% of personal best. The client can speak only two‑word
sentences.
Style Questions with Answers & Rationales | Nursing Practice
Test
SECTION A: CARDIOVASCULAR
Scenario 1: A 68‑year‑old client with heart failure (HF) is admitted with worsening dyspnea,
orthopnea, and 3+ pitting edema. Current medications include lisinopril, furosemide, and
carvedilol.
1. Which assessment finding indicates the client is developing acute decompensated heart failure?
A. Jugular venous distension (JVD) while supine
B. Blood pressure 110/70 mmHg
C. Heart rate 72 bpm and regular
D. Oxygen saturation 95% on room air
Answer: A
Explanation: JVD reflects elevated central venous pressure, a key sign of right‑sided HF
exacerbation. Stable BP and O2 sat are not acute worsening.
2. The client’s morning weight is 4 kg above yesterday’s weight. What is the nurse’s priority
action?
A. Restrict oral fluids to 1 L/day
B. Administer furosemide as ordered and reassess
C. Increase the lisinopril dose
D. Place the client in Trendelenburg position
Answer: B
Explanation: Rapid weight gain indicates fluid retention. Loop diuretic (furosemide) is first‑line
to promote diuresis.
3. (NGN) The client reports a new, persistent cough. Which medication is most likely responsible?
,A. Furosemide
B. Lisinopril
C. Carvedilol
D. Digoxin
Answer: B
Explanation: ACE inhibitors (lisinopril) cause a dry, non‑productive cough due to bradykinin
accumulation.
Scenario 2: A 55‑year‑old client is 1 day post‑coronary artery bypass grafting (CABG). Telemetry
shows new atrial fibrillation with a ventricular rate of 140 bpm. Blood pressure is 90/60 mmHg.
4. What is the priority nursing action?
A. Administer amiodarone IV per protocol
B. Prepare for synchronized cardioversion
C. Check serum potassium level
D. Notify the provider and prepare for cardioversion
Answer: D
Explanation: Unstable AF with hypotension requires immediate synchronized cardioversion.
Notify provider and prepare.
5. Which laboratory value would the nurse expect to monitor closely for this client?
A. Troponin I
B. BNP
C. Creatinine kinase‑MB
D. D‑dimer
Answer: B
Explanation: BNP is elevated in HF and can also rise post‑CABG, but for AF, electrolytes and
anticoagulation are key. Among options, BNP is monitored for post‑op volume status. However,
for AF, potassium is critical. The question asks “expect to monitor” – D‑dimer for PE, CK‑MB for
MI. Best answer: BNP for HF exacerbation.
,Scenario 3: A 72‑year‑old with peripheral artery disease (PAD) reports left calf pain when walking
that resolves with rest. The left foot is cool and pale.
6. Which intervention should the nurse teach?
A. Elevate the legs above heart level
B. Apply heat to the affected leg
C. Walk to the point of pain, rest, then resume
D. Wear compression stockings during the day
Answer: C
Explanation: Supervised exercise (walk to pain, rest, repeat) improves collateral circulation.
Elevation worsens PAD; heat can cause burns; compression is for venous disease.
7. The nurse assesses a non‑healing ulcer on the left great toe. Which finding is consistent with
arterial insufficiency?
A. Punched‑out appearance with pale base
B. Brownish discoloration of surrounding skin
C. Copious serous drainage
D. Edema around the ulcer
Answer: A
Explanation: Arterial ulcers are round, deep, with pale/necrotic base. Venous ulcers have irregular
edges, brown staining, and edema.
SECTION B: RESPIRATORY
Scenario 4: A client with COPD (chronic bronchitis phenotype) has an SpO₂ of 88% on 2 L/min
nasal cannula. ABG: pH 7.32, PaCO₂ 65 mmHg, PaO₂ 60 mmHg, HCO₃ 32 mEq/L.
8. Which interpretation is correct?
A. Respiratory acidosis with metabolic compensation
, B. Metabolic acidosis with respiratory compensation
C. Respiratory alkalosis
D. Mixed metabolic alkalosis and respiratory acidosis
Answer: A
Explanation: Low pH (acidosis), high PaCO₂ (respiratory cause), high HCO₃ (compensation) →
chronic respiratory acidosis.
9. The nurse increases oxygen to 4 L/min. Thirty minutes later, the client becomes lethargic. What
is the most likely cause?
A. Oxygen toxicity
B. CO₂ narcosis
C. Pneumothorax
D. Pulmonary embolism
Answer: B
Explanation: COPD patients may lose hypoxic drive; high O₂ reduces respiratory drive, causing
CO₂ retention and narcosis.
10. Which medication is most appropriate for acute exacerbation of COPD with increased
wheezing?
A. Tiotropium (Spiriva)
B. Albuterol nebulizer
C. Fluticasone/salmeterol (Advair)
D. Oral prednisone only
Answer: B
Explanation: Short‑acting beta‑agonist (albuterol) is first‑line for acute bronchospasm.
Scenario 5: A 35‑year‑old client with asthma presents with respiratory rate 32, use of accessory
muscles, and peak expiratory flow 40% of personal best. The client can speak only two‑word
sentences.
