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ATI RN ADULT MED SURG PROCTORED EXAM
2026/2027 | With NGN Questions | Newest
Edition | Pass Guaranteed - A+ Graded
Section 1: Cardiovascular System Disorders (Q1-12)
Q1. A nurse is assessing a client with chronic heart failure. Which finding indicates
the client is experiencing fluid volume overload?
A. Dry, nonproductive cough
B. Flat jugular veins in supine position
C. Bilateral crackles in lung bases and weight gain of 3 lb in 2 days [CORRECT]
D. Decreased heart rate and bounding peripheral pulses
Rationale: Bilateral crackles and rapid weight gain are classic signs of fluid overload
in heart failure. Dry cough and flat jugular veins are not consistent with fluid
overload; heart rate typically increases, not decreases, with compensation.
Correct Answer: C
Q2. A nurse is caring for four clients on a medical-surgical unit. Which client should
the nurse assess first?
A. A client with heart failure who reports a 2 lb weight gain over 3 days
B. A client 2 hours post-cardiac catheterization with a hematoma at the insertion site
C. A client with new-onset atrial fibrillation and a heart rate of 148 bpm who is
hypotensive [CORRECT]
D. A client requesting PRN pain medication for chronic back pain
Rationale: The client with rapid atrial fibrillation and hypotension is unstable and
requires immediate assessment due to compromised cardiac output. Weight gain,
hematoma, and pain are important but not immediately life-threatening.
Correct Answer: C
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Q3. A client admitted with chest pain is diagnosed with an ST-elevation myocardial
infarction (STEMI). Which intervention should the nurse anticipate as the priority?
A. Administering morphine sulfate 2 mg IV
B. Preparing the client for immediate percutaneous coronary intervention (PCI)
[CORRECT]
C. Initiating beta-blocker therapy orally
D. Completing a comprehensive health history
Rationale: For STEMI, reperfusion therapy via PCI within 90 minutes is the priority to
restore coronary blood flow. Morphine and beta-blockers are important but
secondary to reperfusion; comprehensive history should not delay treatment.
Correct Answer: B
Q4. A nurse is monitoring a client on a cardiac telemetry unit. Which rhythm strip
finding requires immediate intervention?
A. Sinus bradycardia at 52 bpm in a sleeping client
B. First-degree AV block with a PR interval of 0.24 seconds
C. Ventricular tachycardia with a rate of 180 bpm and loss of pulse [CORRECT]
D. Sinus arrhythmia with respiration variation
Rationale: Pulseless ventricular tachycardia is a cardiac arrest rhythm requiring
immediate defibrillation and CPR per ACLS protocol. The other rhythms are stable
and do not require emergent intervention.
Correct Answer: C
Q5. A client with heart failure is prescribed lisinopril (Zestril). Which instruction
should the nurse include in the teaching plan?
A. "Take the medication on an empty stomach for best absorption."
B. "Expect your heart rate to decrease significantly."
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C. "Report any persistent dry cough to your provider." [CORRECT]
D. "Weigh yourself once weekly and record the results."
Rationale: ACE inhibitors like lisinopril can cause a persistent dry cough due to
bradykinin accumulation; clients should report this. They do not significantly affect
heart rate, can be taken with food, and daily weights are recommended, not weekly.
Correct Answer: C
Q6. A client is prescribed digoxin 0.125 mg PO daily. Available are digoxin tablets
0.25 mg. How many tablets should the nurse administer?
A. 0.25 tablet
B. 0.5 tablet [CORRECT]
C. 1 tablet
D. 2 tablets
Rationale: 0.125 mg ÷ 0.25 mg = 0.5 tablet. Administering 1 tablet would provide
0.25 mg (double the ordered dose), which could cause digitalis toxicity.
Correct Answer: B
Q7. A client with acute myocardial infarction develops cardiogenic shock. Which
assessment finding best indicates effective treatment?
A. Urine output of 20 mL/hr
B. Mean arterial pressure (MAP) of 55 mm Hg
C. Warm, dry skin and urine output of 45 mL/hr [CORRECT]
D. Heart rate of 120 bpm with irregular rhythm
Rationale: Adequate perfusion in cardiogenic shock is indicated by MAP >65 mm Hg,
urine output >30 mL/hr, and warm dry skin. Urine output of 20 mL/hr and MAP of 55
indicate ongoing hypoperfusion.
Correct Answer: C
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Q8. A nurse is teaching a client with chronic heart failure about dietary management.
Which client statement indicates understanding?
A. "I can drink up to 3 liters of fluid daily."
B. "I should use salt substitutes containing potassium freely."
C. "I will weigh myself every morning before breakfast and call if I gain 3 lb in 2 days."
[CORRECT]
D. "I should avoid all physical activity to rest my heart."
Rationale: Daily weights and reporting a 2-3 lb gain in 2 days allows early detection
of fluid overload. Fluid is typically restricted to 2 L or less; salt substitutes can be
dangerous with ACE inhibitors; activity is encouraged as tolerated.
Correct Answer: C
Q9. Which modifiable risk factor should the nurse address first when teaching a client
newly diagnosed with coronary artery disease?
A. Family history of premature heart disease
B. Age and male gender
C. Smoking cessation [CORRECT]
D. History of osteoporosis
Rationale: Smoking is the most significant modifiable risk factor for CAD progression.
Family history, age, and gender are non-modifiable; osteoporosis is unrelated to CAD
risk.
Correct Answer: C
Q10. A client returns to the unit after a cardiac catheterization via the right femoral
artery. Which action should the nurse take?
A. Elevate the head of the bed to 45 degrees immediately
B. Maintain the client on bed rest with the leg extended for 4-6 hours [CORRECT]
C. Assess peripheral pulses every 8 hours
D. Encourage ambulation within 1 hour to prevent complications
ATI RN ADULT MED SURG PROCTORED EXAM
2026/2027 | With NGN Questions | Newest
Edition | Pass Guaranteed - A+ Graded
Section 1: Cardiovascular System Disorders (Q1-12)
Q1. A nurse is assessing a client with chronic heart failure. Which finding indicates
the client is experiencing fluid volume overload?
A. Dry, nonproductive cough
B. Flat jugular veins in supine position
C. Bilateral crackles in lung bases and weight gain of 3 lb in 2 days [CORRECT]
D. Decreased heart rate and bounding peripheral pulses
Rationale: Bilateral crackles and rapid weight gain are classic signs of fluid overload
in heart failure. Dry cough and flat jugular veins are not consistent with fluid
overload; heart rate typically increases, not decreases, with compensation.
Correct Answer: C
Q2. A nurse is caring for four clients on a medical-surgical unit. Which client should
the nurse assess first?
A. A client with heart failure who reports a 2 lb weight gain over 3 days
B. A client 2 hours post-cardiac catheterization with a hematoma at the insertion site
C. A client with new-onset atrial fibrillation and a heart rate of 148 bpm who is
hypotensive [CORRECT]
D. A client requesting PRN pain medication for chronic back pain
Rationale: The client with rapid atrial fibrillation and hypotension is unstable and
requires immediate assessment due to compromised cardiac output. Weight gain,
hematoma, and pain are important but not immediately life-threatening.
Correct Answer: C
,2
Q3. A client admitted with chest pain is diagnosed with an ST-elevation myocardial
infarction (STEMI). Which intervention should the nurse anticipate as the priority?
A. Administering morphine sulfate 2 mg IV
B. Preparing the client for immediate percutaneous coronary intervention (PCI)
[CORRECT]
C. Initiating beta-blocker therapy orally
D. Completing a comprehensive health history
Rationale: For STEMI, reperfusion therapy via PCI within 90 minutes is the priority to
restore coronary blood flow. Morphine and beta-blockers are important but
secondary to reperfusion; comprehensive history should not delay treatment.
Correct Answer: B
Q4. A nurse is monitoring a client on a cardiac telemetry unit. Which rhythm strip
finding requires immediate intervention?
A. Sinus bradycardia at 52 bpm in a sleeping client
B. First-degree AV block with a PR interval of 0.24 seconds
C. Ventricular tachycardia with a rate of 180 bpm and loss of pulse [CORRECT]
D. Sinus arrhythmia with respiration variation
Rationale: Pulseless ventricular tachycardia is a cardiac arrest rhythm requiring
immediate defibrillation and CPR per ACLS protocol. The other rhythms are stable
and do not require emergent intervention.
Correct Answer: C
Q5. A client with heart failure is prescribed lisinopril (Zestril). Which instruction
should the nurse include in the teaching plan?
A. "Take the medication on an empty stomach for best absorption."
B. "Expect your heart rate to decrease significantly."
,3
C. "Report any persistent dry cough to your provider." [CORRECT]
D. "Weigh yourself once weekly and record the results."
Rationale: ACE inhibitors like lisinopril can cause a persistent dry cough due to
bradykinin accumulation; clients should report this. They do not significantly affect
heart rate, can be taken with food, and daily weights are recommended, not weekly.
Correct Answer: C
Q6. A client is prescribed digoxin 0.125 mg PO daily. Available are digoxin tablets
0.25 mg. How many tablets should the nurse administer?
A. 0.25 tablet
B. 0.5 tablet [CORRECT]
C. 1 tablet
D. 2 tablets
Rationale: 0.125 mg ÷ 0.25 mg = 0.5 tablet. Administering 1 tablet would provide
0.25 mg (double the ordered dose), which could cause digitalis toxicity.
Correct Answer: B
Q7. A client with acute myocardial infarction develops cardiogenic shock. Which
assessment finding best indicates effective treatment?
A. Urine output of 20 mL/hr
B. Mean arterial pressure (MAP) of 55 mm Hg
C. Warm, dry skin and urine output of 45 mL/hr [CORRECT]
D. Heart rate of 120 bpm with irregular rhythm
Rationale: Adequate perfusion in cardiogenic shock is indicated by MAP >65 mm Hg,
urine output >30 mL/hr, and warm dry skin. Urine output of 20 mL/hr and MAP of 55
indicate ongoing hypoperfusion.
Correct Answer: C
, 4
Q8. A nurse is teaching a client with chronic heart failure about dietary management.
Which client statement indicates understanding?
A. "I can drink up to 3 liters of fluid daily."
B. "I should use salt substitutes containing potassium freely."
C. "I will weigh myself every morning before breakfast and call if I gain 3 lb in 2 days."
[CORRECT]
D. "I should avoid all physical activity to rest my heart."
Rationale: Daily weights and reporting a 2-3 lb gain in 2 days allows early detection
of fluid overload. Fluid is typically restricted to 2 L or less; salt substitutes can be
dangerous with ACE inhibitors; activity is encouraged as tolerated.
Correct Answer: C
Q9. Which modifiable risk factor should the nurse address first when teaching a client
newly diagnosed with coronary artery disease?
A. Family history of premature heart disease
B. Age and male gender
C. Smoking cessation [CORRECT]
D. History of osteoporosis
Rationale: Smoking is the most significant modifiable risk factor for CAD progression.
Family history, age, and gender are non-modifiable; osteoporosis is unrelated to CAD
risk.
Correct Answer: C
Q10. A client returns to the unit after a cardiac catheterization via the right femoral
artery. Which action should the nurse take?
A. Elevate the head of the bed to 45 degrees immediately
B. Maintain the client on bed rest with the leg extended for 4-6 hours [CORRECT]
C. Assess peripheral pulses every 8 hours
D. Encourage ambulation within 1 hour to prevent complications
