NGN ATI RN ADULT MEDICAL SURGICAL PROCTORED EXAM
ATI RN Adult Medical Surgical Med Surg 2023 Proctored Exam
with NGN 100 Questions and Answers
Most tested questions reviewed by examiners panel to make
sure you score Maximum score
ATI RN Adult Medical-Surgical Med-Surg 2026 Proctored Exam
With Next Generation NCLEX (NGN) Items
Common NCLEX Traps
• "Clamp the chest tube" – This is rarely the correct first action. Place in sterile water
instead.
• "Trendelenburg position" – Outdated for shock; use modified Trendelenburg (legs up,
torso flat).
• "Take with food" for levothyroxine – Incorrect; empty stomach.
• "Stop warfarin for bruising" – Incorrect; bruising is expected.
• "Give aspirin first for stroke" – Incorrect; tPA is first if within window.
• "Active rewarming for myxedema" – Incorrect; passive rewarming only
Section 1: Cardiovascular Disorders
Question 1
A nurse is assessing a client who is 12 hours post-cardiac catheterization via the right femoral
artery. Which of the following findings requires immediate intervention?
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, NGN ATI RN ADULT MEDICAL SURGICAL PROCTORED EXAM
A. A 3 cm area of ecchymosis at the insertion site
B. The client reports pain at the site rated 3 on a 0–10 scale
C. Dorsalis pedis pulse is +2 bilaterally
D. The right foot is cool to touch with capillary refill of 6 seconds
Correct Answer: D
Rationale:
Coolness and delayed capillary refill (normal is < 3 seconds) in the affected extremity indicate
arterial insufficiency, which may be caused by thrombus formation or arterial occlusion
following catheterization. This is a vascular emergency that can lead to limb loss if not treated
immediately. Ecchymosis (bruising) is expected. Mild pain is common. A +2 dorsalis pedis pulse
is within normal limits (0 absent, +1 diminished, +2 normal, +3 bounding).
Examiner’s Remark:
This question is highly tested because vascular complications after cardiac catheterization are
a major safety concern. Students often focus on bleeding (hematoma) and overlook circulatory
compromise. Remember: pulse strength alone is insufficient—capillary refill, temperature, and
color must also be assessed. The priority is always limb perfusion.
Question 2
A nurse is caring for a client with acute decompensated heart failure. The client has 3+ pitting
edema in the lower extremities, crackles heard halfway up the lung fields, and a weight gain of
5 lbs (2.3 kg) in 24 hours. Which of the following interventions should the nurse implement
first?
A. Restrict oral fluids to 1,500 mL per day
B. Administer furosemide 40 mg IV push
C. Elevate the lower extremities on pillows
D. Apply sequential compression devices
Correct Answer: B
Rationale:
The client is displaying signs of fluid volume overload (edema, crackles, rapid weight gain).
Furosemide, a loop diuretic, rapidly reduces preload by promoting diuresis, which decreases
pulmonary congestion and improves oxygenation. This is the priority intervention to address
the immediate threat of pulmonary edema. Fluid restriction and elevation are important but
are not the first action. Sequential compression devices are for DVT prevention, not fluid
overload.
Examiner’s Remark:
This concept is tested repeatedly because heart failure exacerbation is a common admission
diagnosis. The key is recognizing that rapid weight gain (2–3 lbs in 24 hours) indicates fluid
retention before physical signs appear. Students often choose fluid restriction first,
but pharmacologic intervention (diuretics) is the priority in acute exacerbation to prevent
respiratory failure.
P a g e 2 | 49
, NGN ATI RN ADULT MEDICAL SURGICAL PROCTORED EXAM
Question 3
A nurse is administering digoxin 0.25 mg orally to a client with atrial fibrillation. Prior to
administration, the nurse obtains an apical pulse of 52 beats per minute. Which of the
following actions should the nurse take?
A. Administer the medication as prescribed
B. Hold the medication and document the finding
C. Hold the medication and notify the healthcare provider
D. Administer the medication and then notify the provider
Correct Answer: C
Rationale:
The standard hold parameter for digoxin is an apical pulse less than 60 beats per minute in
adults (or less than 50 beats per minute in some institutions). A pulse of 52 is below this
threshold, indicating potential digoxin toxicity or bradycardia that could worsen with
administration. The nurse must hold the dose and notify the provider for further instructions.
Simply documenting without notification is insufficient because the provider needs to adjust
the dose or order an ECG.
Examiner’s Remark:
This is a classic, frequently tested medication safety question. The pitfall is that students
sometimes administer the medication because "it's prescribed," but nurses have the authority
to withhold medications based on assessment parameters. Always verify the specific facility's
hold parameters, but < 60 is the NCLEX standard for digoxin.
Question 4
A client with hypertension is started on lisinopril, an ACE inhibitor. Which of the following
findings requires immediate discontinuation of the medication and emergency intervention?
A. Dry, persistent cough
B. Angioedema with swelling of the lips and tongue
C. Serum potassium level of 4.2 mEq/L
D. Orthostatic hypotension upon standing
Correct Answer: B
Rationale:
Angioedema is a life-threatening allergic reaction to ACE inhibitors characterized by swelling of
the lips, tongue, pharynx, and larynx, which can cause rapid airway compromise. This requires
immediate discontinuation of the drug and emergency management (epinephrine, airway
support). Dry cough is a common side effect but not life-threatening. Potassium 4.2 is normal.
Orthostatic hypotension is a manageable side effect.
Examiner’s Remark:
This question appears frequently because ACE inhibitors are first-line antihypertensives,
and angioedema is a critical adverse effect that students must differentiate from the more
common (but benign) dry cough. The NCLEX tests the ability to distinguish between nuisance
side effects and life-threatening complications.
P a g e 3 | 49
, NGN ATI RN ADULT MEDICAL SURGICAL PROCTORED EXAM
Question 5
A nurse is providing discharge teaching to a client who had a mechanical heart valve
replacement. Which of the following statements by the client indicates understanding of the
teaching?
A. "I will stop taking my warfarin if I notice any bruising on my arms."
B. "I will take my blood pressure daily and report readings over 140/90."
C. "I need to take antibiotics before any dental procedures."
D. "I can resume heavy lifting and yard work in 2 weeks."
Correct Answer: C
Rationale:
Clients with mechanical heart valves are at high risk for infective endocarditis. The American
Heart Association recommends prophylactic antibiotics before dental procedures that involve
manipulation of gingival tissue or the periapical region of teeth. Warfarin is lifelong therapy;
bruising is expected and does not warrant stopping the medication (which would increase
thromboembolism risk). Blood pressure monitoring is important but not specific to valve
replacement. Heavy lifting is restricted for 4–6 weeks to allow sternal healing if a sternotomy
was performed.
Examiner’s Remark:
This question tests post-operative teaching for mechanical valve replacement, a high-yield
topic. The common mistake is selecting "stop warfarin for bruising," which shows a
misunderstanding of anticoagulation therapy. The antibiotic prophylaxis requirement is a key
patient safety point tested across multiple cardiac and orthopedic conditions.
Question 6
A nurse is assessing a client with infective endocarditis. Which of the following findings is the
nurse most likely to observe?
A. Splinter hemorrhages under the fingernails
B. Bounding peripheral pulses
C. Decreased jugular venous pressure
D. Warm, dry skin
Correct Answer: A
Rationale:
Infective endocarditis is characterized by systemic embolization and vasculitis. Splinter
hemorrhages (linear red-brown streaks under nails), Osler nodes (tender subcutaneous
nodules on fingers/toes), Janeway lesions (non-tender macules on palms/soles), and petechiae
are classic peripheral manifestations. Fever, heart murmur, and night sweats are also common.
Bounding pulses and warm, dry skin are not typical; JVP is often elevated due to heart failure
from valvular damage.
Examiner’s Remark:
This question tests recognition of clinical manifestations of endocarditis. Students often
P a g e 4 | 49
ATI RN Adult Medical Surgical Med Surg 2023 Proctored Exam
with NGN 100 Questions and Answers
Most tested questions reviewed by examiners panel to make
sure you score Maximum score
ATI RN Adult Medical-Surgical Med-Surg 2026 Proctored Exam
With Next Generation NCLEX (NGN) Items
Common NCLEX Traps
• "Clamp the chest tube" – This is rarely the correct first action. Place in sterile water
instead.
• "Trendelenburg position" – Outdated for shock; use modified Trendelenburg (legs up,
torso flat).
• "Take with food" for levothyroxine – Incorrect; empty stomach.
• "Stop warfarin for bruising" – Incorrect; bruising is expected.
• "Give aspirin first for stroke" – Incorrect; tPA is first if within window.
• "Active rewarming for myxedema" – Incorrect; passive rewarming only
Section 1: Cardiovascular Disorders
Question 1
A nurse is assessing a client who is 12 hours post-cardiac catheterization via the right femoral
artery. Which of the following findings requires immediate intervention?
P a g e 1 | 49
, NGN ATI RN ADULT MEDICAL SURGICAL PROCTORED EXAM
A. A 3 cm area of ecchymosis at the insertion site
B. The client reports pain at the site rated 3 on a 0–10 scale
C. Dorsalis pedis pulse is +2 bilaterally
D. The right foot is cool to touch with capillary refill of 6 seconds
Correct Answer: D
Rationale:
Coolness and delayed capillary refill (normal is < 3 seconds) in the affected extremity indicate
arterial insufficiency, which may be caused by thrombus formation or arterial occlusion
following catheterization. This is a vascular emergency that can lead to limb loss if not treated
immediately. Ecchymosis (bruising) is expected. Mild pain is common. A +2 dorsalis pedis pulse
is within normal limits (0 absent, +1 diminished, +2 normal, +3 bounding).
Examiner’s Remark:
This question is highly tested because vascular complications after cardiac catheterization are
a major safety concern. Students often focus on bleeding (hematoma) and overlook circulatory
compromise. Remember: pulse strength alone is insufficient—capillary refill, temperature, and
color must also be assessed. The priority is always limb perfusion.
Question 2
A nurse is caring for a client with acute decompensated heart failure. The client has 3+ pitting
edema in the lower extremities, crackles heard halfway up the lung fields, and a weight gain of
5 lbs (2.3 kg) in 24 hours. Which of the following interventions should the nurse implement
first?
A. Restrict oral fluids to 1,500 mL per day
B. Administer furosemide 40 mg IV push
C. Elevate the lower extremities on pillows
D. Apply sequential compression devices
Correct Answer: B
Rationale:
The client is displaying signs of fluid volume overload (edema, crackles, rapid weight gain).
Furosemide, a loop diuretic, rapidly reduces preload by promoting diuresis, which decreases
pulmonary congestion and improves oxygenation. This is the priority intervention to address
the immediate threat of pulmonary edema. Fluid restriction and elevation are important but
are not the first action. Sequential compression devices are for DVT prevention, not fluid
overload.
Examiner’s Remark:
This concept is tested repeatedly because heart failure exacerbation is a common admission
diagnosis. The key is recognizing that rapid weight gain (2–3 lbs in 24 hours) indicates fluid
retention before physical signs appear. Students often choose fluid restriction first,
but pharmacologic intervention (diuretics) is the priority in acute exacerbation to prevent
respiratory failure.
P a g e 2 | 49
, NGN ATI RN ADULT MEDICAL SURGICAL PROCTORED EXAM
Question 3
A nurse is administering digoxin 0.25 mg orally to a client with atrial fibrillation. Prior to
administration, the nurse obtains an apical pulse of 52 beats per minute. Which of the
following actions should the nurse take?
A. Administer the medication as prescribed
B. Hold the medication and document the finding
C. Hold the medication and notify the healthcare provider
D. Administer the medication and then notify the provider
Correct Answer: C
Rationale:
The standard hold parameter for digoxin is an apical pulse less than 60 beats per minute in
adults (or less than 50 beats per minute in some institutions). A pulse of 52 is below this
threshold, indicating potential digoxin toxicity or bradycardia that could worsen with
administration. The nurse must hold the dose and notify the provider for further instructions.
Simply documenting without notification is insufficient because the provider needs to adjust
the dose or order an ECG.
Examiner’s Remark:
This is a classic, frequently tested medication safety question. The pitfall is that students
sometimes administer the medication because "it's prescribed," but nurses have the authority
to withhold medications based on assessment parameters. Always verify the specific facility's
hold parameters, but < 60 is the NCLEX standard for digoxin.
Question 4
A client with hypertension is started on lisinopril, an ACE inhibitor. Which of the following
findings requires immediate discontinuation of the medication and emergency intervention?
A. Dry, persistent cough
B. Angioedema with swelling of the lips and tongue
C. Serum potassium level of 4.2 mEq/L
D. Orthostatic hypotension upon standing
Correct Answer: B
Rationale:
Angioedema is a life-threatening allergic reaction to ACE inhibitors characterized by swelling of
the lips, tongue, pharynx, and larynx, which can cause rapid airway compromise. This requires
immediate discontinuation of the drug and emergency management (epinephrine, airway
support). Dry cough is a common side effect but not life-threatening. Potassium 4.2 is normal.
Orthostatic hypotension is a manageable side effect.
Examiner’s Remark:
This question appears frequently because ACE inhibitors are first-line antihypertensives,
and angioedema is a critical adverse effect that students must differentiate from the more
common (but benign) dry cough. The NCLEX tests the ability to distinguish between nuisance
side effects and life-threatening complications.
P a g e 3 | 49
, NGN ATI RN ADULT MEDICAL SURGICAL PROCTORED EXAM
Question 5
A nurse is providing discharge teaching to a client who had a mechanical heart valve
replacement. Which of the following statements by the client indicates understanding of the
teaching?
A. "I will stop taking my warfarin if I notice any bruising on my arms."
B. "I will take my blood pressure daily and report readings over 140/90."
C. "I need to take antibiotics before any dental procedures."
D. "I can resume heavy lifting and yard work in 2 weeks."
Correct Answer: C
Rationale:
Clients with mechanical heart valves are at high risk for infective endocarditis. The American
Heart Association recommends prophylactic antibiotics before dental procedures that involve
manipulation of gingival tissue or the periapical region of teeth. Warfarin is lifelong therapy;
bruising is expected and does not warrant stopping the medication (which would increase
thromboembolism risk). Blood pressure monitoring is important but not specific to valve
replacement. Heavy lifting is restricted for 4–6 weeks to allow sternal healing if a sternotomy
was performed.
Examiner’s Remark:
This question tests post-operative teaching for mechanical valve replacement, a high-yield
topic. The common mistake is selecting "stop warfarin for bruising," which shows a
misunderstanding of anticoagulation therapy. The antibiotic prophylaxis requirement is a key
patient safety point tested across multiple cardiac and orthopedic conditions.
Question 6
A nurse is assessing a client with infective endocarditis. Which of the following findings is the
nurse most likely to observe?
A. Splinter hemorrhages under the fingernails
B. Bounding peripheral pulses
C. Decreased jugular venous pressure
D. Warm, dry skin
Correct Answer: A
Rationale:
Infective endocarditis is characterized by systemic embolization and vasculitis. Splinter
hemorrhages (linear red-brown streaks under nails), Osler nodes (tender subcutaneous
nodules on fingers/toes), Janeway lesions (non-tender macules on palms/soles), and petechiae
are classic peripheral manifestations. Fever, heart murmur, and night sweats are also common.
Bounding pulses and warm, dry skin are not typical; JVP is often elevated due to heart failure
from valvular damage.
Examiner’s Remark:
This question tests recognition of clinical manifestations of endocarditis. Students often
P a g e 4 | 49
