ATI RN Adult Medical-Surgical NGN Proctored Exam 2025/2026 100 Questions
ATI RN Adult Medical-Surgical
Certified NGN Proctored Exam 2026
100 Questions with Answers and Rationales
Instructions: Read each question carefully. For standard multiple-choice questions,
select the single best answer. For questions marked "Select all that apply," choose all
options that apply. Each question includes the correct answer and a detailed rationale.
Use the answer sheet at the end to record your responses.
1. A
nurse is assessing a client who has heart failure and is receiving furosemide.
Which of the following findings should the nurse report to the provider
immediately?
A. Weight gain of 0.5 kg in 24 hours
B. Serum potassium level of 3.0 mEq/L
C. Presence of bibasilar crackles
D. Bounding peripheral pulses
Correct Answer B. Serum potassium level of 3.0 mEq/L
A serum potassium level of 3.0 mEq/L indicates hypokalemia, which is a critical
finding in a client receiving furosemide, a loop diuretic that causes potassium
wasting. Hypokalemia increases the risk of fatal cardiac dysrhythmias and requires
immediate intervention such as potassium supplementation. While weight gain and
crackles suggest fluid retention, and bounding pulses may indicate fluid overload,
hypokalemia poses the most immediate life-threatening risk and must be addressed
before other findings.
2. Anurse is providing discharge teaching to a client who has a new prescription
for warfarin. Which of the following statements by the client indicates an
understanding of the teaching?
Practice Exam Page 1
,ATI RN Adult Medical-Surgical NGN Proctored Exam 2025/2026 100 Questions
A. "I will eat a consistent amount of leafy green vegetables each day."
B. "I will take an aspirin daily to prevent blood clots."
C. "I will use a straight razor for shaving."
D. "I will double my dose if I miss one."
Correct Answer A. "I will eat a consistent amount of leafy green vegetables each
day."
Practice Exam Page 2
, ATI RN Adult Medical-Surgical NGN Proctored Exam 2025/2026 100 Questions
The client should maintain a consistent intake of vitamin K-rich foods, such as leafy green
vegetables, because vitamin K counteracts the effects of warfarin. Sudden changes in
dietary vitamin K intake can alter the INR and increase the risk of bleeding or thrombosis.
Taking aspirin concurrently increases bleeding risk, a straight razor poses an injury risk
due to the anticoagulant effect, and doubling a missed dose can lead to dangerous
supratherapeutic INR levels.
3. A nurse is caring for a client who had a myocardial infarction 24 hours ago.
The client reports new chest pain. Which of the following actions should the
nurse take first?
A. Administer prescribed sublingual nitroglycerin.
B. Obtain a 12-lead electrocardiogram.
C. Check the cardiac biomarker levels.
D. Auscultate heart sounds.
Correct Answer B. Obtain a 12-lead electrocardiogram.
New chest pain in a client 24 hours post-MI may indicate extension of the infarction
or another ischemic event. The first action is to obtain a 12-lead ECG to evaluate for
ST-segment changes and determine if revascularization is needed. While
nitroglycerin may relieve pain, it should be given after the ECG confirms the
diagnosis. Cardiac biomarkers take time to rise and are not immediately actionable.
Auscultation provides important data but is not the priority over electrocardiographic
assessment.
4. A nurse is reviewing the laboratory results of a client who has chronic heart
failure and is receiving digoxin. Which of the following results should the nurse
report to the provider?
A. Serum digoxin level of 1.8 ng/mL
B. Serum potassium level of 4.2 mEq/L
C. Serum sodium level of 138 mEq/L
D. Serum magnesium level of 1.8 mg/dL
Correct Answer A. Serum digoxin level of 1.8 ng/mL
The therapeutic range for digoxin is 0.5 to 2.0 ng/mL, and a level of 1.8 ng/mL is
Practice Exam Page 3
, ATI RN Adult Medical-Surgical NGN Proctored Exam 2025/2026 100 Questions
near the upper limit. However, in the context of heart failure, the preferred target
range is lower (0.5 to 0.9 ng/mL), as higher levels increase the risk of digoxin
toxicity without added benefit. Potassium of 4.2 mEq/L is normal, sodium of 138
mEq/L is within normal limits, and magnesium of 1.8 mg/dL is within the normal
range of 1.7 to 2.2 mg/dL. The digoxin level warrants provider notification for a
potential dose adjustment.
5. A nurse is preparing to administer a blood transfusion to a client. Which of
the following actions should the nurse take?
A. Prime the IV tubing with 5% dextrose in water (D5W).
B. Verify the blood product with another nurse at the bedside.
C. Administer the blood product within 6 hours of removal from the blood bank.
D. Check the client vital signs every 30 minutes for the first 2 hours.
Correct Answer B. Verify the blood product with another nurse at the bedside.
The nurse must verify the blood product with another licensed nurse at the bedside
using two unique client identifiers, the blood type and Rh factor, the unit number,
and the expiration date. This is a critical safety check to prevent transfusion
reactions. D5W should never be used to prime blood tubing because it causes red
blood cell hemolysis; 0.9% normal saline is the only appropriate solution. Blood
products must be administered within 4 hours of removal from the blood bank. Vital
signs should be checked every 5 to 15 minutes during the first 30 minutes and then
every 30 minutes until the transfusion is complete.
Practice Exam Page 4
ATI RN Adult Medical-Surgical
Certified NGN Proctored Exam 2026
100 Questions with Answers and Rationales
Instructions: Read each question carefully. For standard multiple-choice questions,
select the single best answer. For questions marked "Select all that apply," choose all
options that apply. Each question includes the correct answer and a detailed rationale.
Use the answer sheet at the end to record your responses.
1. A
nurse is assessing a client who has heart failure and is receiving furosemide.
Which of the following findings should the nurse report to the provider
immediately?
A. Weight gain of 0.5 kg in 24 hours
B. Serum potassium level of 3.0 mEq/L
C. Presence of bibasilar crackles
D. Bounding peripheral pulses
Correct Answer B. Serum potassium level of 3.0 mEq/L
A serum potassium level of 3.0 mEq/L indicates hypokalemia, which is a critical
finding in a client receiving furosemide, a loop diuretic that causes potassium
wasting. Hypokalemia increases the risk of fatal cardiac dysrhythmias and requires
immediate intervention such as potassium supplementation. While weight gain and
crackles suggest fluid retention, and bounding pulses may indicate fluid overload,
hypokalemia poses the most immediate life-threatening risk and must be addressed
before other findings.
2. Anurse is providing discharge teaching to a client who has a new prescription
for warfarin. Which of the following statements by the client indicates an
understanding of the teaching?
Practice Exam Page 1
,ATI RN Adult Medical-Surgical NGN Proctored Exam 2025/2026 100 Questions
A. "I will eat a consistent amount of leafy green vegetables each day."
B. "I will take an aspirin daily to prevent blood clots."
C. "I will use a straight razor for shaving."
D. "I will double my dose if I miss one."
Correct Answer A. "I will eat a consistent amount of leafy green vegetables each
day."
Practice Exam Page 2
, ATI RN Adult Medical-Surgical NGN Proctored Exam 2025/2026 100 Questions
The client should maintain a consistent intake of vitamin K-rich foods, such as leafy green
vegetables, because vitamin K counteracts the effects of warfarin. Sudden changes in
dietary vitamin K intake can alter the INR and increase the risk of bleeding or thrombosis.
Taking aspirin concurrently increases bleeding risk, a straight razor poses an injury risk
due to the anticoagulant effect, and doubling a missed dose can lead to dangerous
supratherapeutic INR levels.
3. A nurse is caring for a client who had a myocardial infarction 24 hours ago.
The client reports new chest pain. Which of the following actions should the
nurse take first?
A. Administer prescribed sublingual nitroglycerin.
B. Obtain a 12-lead electrocardiogram.
C. Check the cardiac biomarker levels.
D. Auscultate heart sounds.
Correct Answer B. Obtain a 12-lead electrocardiogram.
New chest pain in a client 24 hours post-MI may indicate extension of the infarction
or another ischemic event. The first action is to obtain a 12-lead ECG to evaluate for
ST-segment changes and determine if revascularization is needed. While
nitroglycerin may relieve pain, it should be given after the ECG confirms the
diagnosis. Cardiac biomarkers take time to rise and are not immediately actionable.
Auscultation provides important data but is not the priority over electrocardiographic
assessment.
4. A nurse is reviewing the laboratory results of a client who has chronic heart
failure and is receiving digoxin. Which of the following results should the nurse
report to the provider?
A. Serum digoxin level of 1.8 ng/mL
B. Serum potassium level of 4.2 mEq/L
C. Serum sodium level of 138 mEq/L
D. Serum magnesium level of 1.8 mg/dL
Correct Answer A. Serum digoxin level of 1.8 ng/mL
The therapeutic range for digoxin is 0.5 to 2.0 ng/mL, and a level of 1.8 ng/mL is
Practice Exam Page 3
, ATI RN Adult Medical-Surgical NGN Proctored Exam 2025/2026 100 Questions
near the upper limit. However, in the context of heart failure, the preferred target
range is lower (0.5 to 0.9 ng/mL), as higher levels increase the risk of digoxin
toxicity without added benefit. Potassium of 4.2 mEq/L is normal, sodium of 138
mEq/L is within normal limits, and magnesium of 1.8 mg/dL is within the normal
range of 1.7 to 2.2 mg/dL. The digoxin level warrants provider notification for a
potential dose adjustment.
5. A nurse is preparing to administer a blood transfusion to a client. Which of
the following actions should the nurse take?
A. Prime the IV tubing with 5% dextrose in water (D5W).
B. Verify the blood product with another nurse at the bedside.
C. Administer the blood product within 6 hours of removal from the blood bank.
D. Check the client vital signs every 30 minutes for the first 2 hours.
Correct Answer B. Verify the blood product with another nurse at the bedside.
The nurse must verify the blood product with another licensed nurse at the bedside
using two unique client identifiers, the blood type and Rh factor, the unit number,
and the expiration date. This is a critical safety check to prevent transfusion
reactions. D5W should never be used to prime blood tubing because it causes red
blood cell hemolysis; 0.9% normal saline is the only appropriate solution. Blood
products must be administered within 4 hours of removal from the blood bank. Vital
signs should be checked every 5 to 15 minutes during the first 30 minutes and then
every 30 minutes until the transfusion is complete.
Practice Exam Page 4
