ATI Med-Surg Proctored Exam (2026) NGN-Style Questions,
Case Scenarios & Answers Comprehensive Study
Resource | Latest Update This Year. INSTANT PDF
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SECTION 1: CARDIOVASCULAR SYSTEM
Case Scenario #1: Acute Coronary Syndrome
Scenario: A 58-year-old male arrives at the Emergency Department via ambulance with
complaints of substernal chest pressure radiating to his left arm, rated 7/10, with associated
diaphoresis and shortness of breath for the past 45 minutes. PMH: Hypertension,
hyperlipidemia, type 2 diabetes, 30-pack-year smoking history. Home medications: Lisinopril
20 mg daily, Atorvastatin 40 mg daily, Metformin 1000 mg BID.
Vital Signs: BP 152/94, HR 102 and irregular, RR 26, T 98.9°F (37.2°C), SpO2 93% on
room air.
12-lead ECG: ST-segment elevation in leads II, III, and aVF.
Labs: Troponin I pending.
,Question 1 (NGN - Extended Multiple Response):
Select all that apply. Based on the assessment findings, which interventions should the
nurse anticipate? Select all that apply.
A. Administer Aspirin 324 mg chewable
B. Administer Nitroglycerin 0.4 mg sublingual
C. Prepare for immediate PCI
D. Administer Metoprolol IV
E. Initiate oxygen therapy at 2L via nasal cannula
F. Administer Morphine 4 mg IV
G. Administer Clopidogrel 600 mg loading dose
Answer: A, B, C, D, E, F, G (All of the above)
Rationale: This patient presents with STEMI (ST-segment elevation in II, III, aVF indicates
inferior wall MI). Current guidelines recommend MONA + antiplatelet therapy + reperfusion.
Aspirin and clopidogrel provide dual antiplatelet therapy. Nitroglycerin for vasodilation and
pain. Oxygen for SpO2 <94%. Morphine for pain/anxiety. Beta-blocker unless
contraindicated. Primary PCI is the preferred reperfusion strategy if available within 90
minutes.
Question 2 (NGN - Cloze/Drop-Down):
The nurse anticipates the patient will be transported to the [] within [] minutes for definitive
treatment.
Answer: Cardiac Catheterization Lab; 90
,Rationale: Door-to-balloon time goal for STEMI is ≤90 minutes for primary PCI. Fibrinolytic
therapy is considered if PCI is not available within 120 minutes.
Question 3 (NGN - Matrix/Grid):
The nurse is monitoring for complications post-PCI. Complete the following table by
indicating whether each finding requires immediate action or continued monitoring.
Requires Immediate Continue
Finding
Action Monitoring
Chest pain 6/10 unrelieved by NTG x3 ✓
Oozing at femoral access site, small
✓
hematoma
HR 48, BP 88/56 ✓
PVCs on cardiac monitor ✓
Sudden loss of pedal pulses, cool
✓
extremity
Troponin 0.5 → 0.3 ng/mL ✓
Rationale: Chest pain unrelieved by NTG suggests re-occlusion/stent thrombosis.
Hypotension with bradycardia may indicate vasovagal reaction or bleeding. Loss of pulses
, suggests arterial occlusion. Decreasing troponin is expected. PVCs and minor oozing
require monitoring but not immediate emergency intervention.
Case Scenario #2: Heart Failure Exacerbation
Scenario: A 72-year-old female with history of HFrEF (ejection fraction 30%) presents with
progressive dyspnea, orthopnea requiring 3 pillows, 8 lb weight gain in 5 days, bilateral
lower extremity pitting edema, and crackles in bilateral lung bases. She reports non-
adherence to fluid restriction and low-sodium diet during a family reunion.
VS: BP 142/86, HR 98, RR 28, SpO2 89% on room air, T 98.2°F.
Labs: BNP 1850 pg/mL, K+ 3.3 mEq/L, Na+ 132 mEq/L, Creatinine 1.4 mg/dL (baseline
1.0).
Question 4 (NGN - Extended Multiple Response):
Select all that apply. The nurse receives orders. Which orders should the nurse question?
A. Furosemide 80 mg IV push now
B. Normal Saline at 150 mL/hour
C. Lisinopril 10 mg PO
D. Potassium 40 mEq PO
E. Strict I&O, daily weights
F. Oxygen at 2L nasal cannula titrated to SpO2 ≥92%
Answer: B, C
Case Scenarios & Answers Comprehensive Study
Resource | Latest Update This Year. INSTANT PDF
DOWNLOAD
SECTION 1: CARDIOVASCULAR SYSTEM
Case Scenario #1: Acute Coronary Syndrome
Scenario: A 58-year-old male arrives at the Emergency Department via ambulance with
complaints of substernal chest pressure radiating to his left arm, rated 7/10, with associated
diaphoresis and shortness of breath for the past 45 minutes. PMH: Hypertension,
hyperlipidemia, type 2 diabetes, 30-pack-year smoking history. Home medications: Lisinopril
20 mg daily, Atorvastatin 40 mg daily, Metformin 1000 mg BID.
Vital Signs: BP 152/94, HR 102 and irregular, RR 26, T 98.9°F (37.2°C), SpO2 93% on
room air.
12-lead ECG: ST-segment elevation in leads II, III, and aVF.
Labs: Troponin I pending.
,Question 1 (NGN - Extended Multiple Response):
Select all that apply. Based on the assessment findings, which interventions should the
nurse anticipate? Select all that apply.
A. Administer Aspirin 324 mg chewable
B. Administer Nitroglycerin 0.4 mg sublingual
C. Prepare for immediate PCI
D. Administer Metoprolol IV
E. Initiate oxygen therapy at 2L via nasal cannula
F. Administer Morphine 4 mg IV
G. Administer Clopidogrel 600 mg loading dose
Answer: A, B, C, D, E, F, G (All of the above)
Rationale: This patient presents with STEMI (ST-segment elevation in II, III, aVF indicates
inferior wall MI). Current guidelines recommend MONA + antiplatelet therapy + reperfusion.
Aspirin and clopidogrel provide dual antiplatelet therapy. Nitroglycerin for vasodilation and
pain. Oxygen for SpO2 <94%. Morphine for pain/anxiety. Beta-blocker unless
contraindicated. Primary PCI is the preferred reperfusion strategy if available within 90
minutes.
Question 2 (NGN - Cloze/Drop-Down):
The nurse anticipates the patient will be transported to the [] within [] minutes for definitive
treatment.
Answer: Cardiac Catheterization Lab; 90
,Rationale: Door-to-balloon time goal for STEMI is ≤90 minutes for primary PCI. Fibrinolytic
therapy is considered if PCI is not available within 120 minutes.
Question 3 (NGN - Matrix/Grid):
The nurse is monitoring for complications post-PCI. Complete the following table by
indicating whether each finding requires immediate action or continued monitoring.
Requires Immediate Continue
Finding
Action Monitoring
Chest pain 6/10 unrelieved by NTG x3 ✓
Oozing at femoral access site, small
✓
hematoma
HR 48, BP 88/56 ✓
PVCs on cardiac monitor ✓
Sudden loss of pedal pulses, cool
✓
extremity
Troponin 0.5 → 0.3 ng/mL ✓
Rationale: Chest pain unrelieved by NTG suggests re-occlusion/stent thrombosis.
Hypotension with bradycardia may indicate vasovagal reaction or bleeding. Loss of pulses
, suggests arterial occlusion. Decreasing troponin is expected. PVCs and minor oozing
require monitoring but not immediate emergency intervention.
Case Scenario #2: Heart Failure Exacerbation
Scenario: A 72-year-old female with history of HFrEF (ejection fraction 30%) presents with
progressive dyspnea, orthopnea requiring 3 pillows, 8 lb weight gain in 5 days, bilateral
lower extremity pitting edema, and crackles in bilateral lung bases. She reports non-
adherence to fluid restriction and low-sodium diet during a family reunion.
VS: BP 142/86, HR 98, RR 28, SpO2 89% on room air, T 98.2°F.
Labs: BNP 1850 pg/mL, K+ 3.3 mEq/L, Na+ 132 mEq/L, Creatinine 1.4 mg/dL (baseline
1.0).
Question 4 (NGN - Extended Multiple Response):
Select all that apply. The nurse receives orders. Which orders should the nurse question?
A. Furosemide 80 mg IV push now
B. Normal Saline at 150 mL/hour
C. Lisinopril 10 mg PO
D. Potassium 40 mEq PO
E. Strict I&O, daily weights
F. Oxygen at 2L nasal cannula titrated to SpO2 ≥92%
Answer: B, C
