NGN ATI Med-Surg Proctored Exam (Next Generation NCLEX)
– 150 Questions with Answers & Detailed Rationales |
Comprehensive Practice Test 2026
SECTION COVERED:
Section 1: Cardiovascular Disorders (Questions 1-20)
Section 2: Respiratory Disorders (Questions 21-40)
Section 3: Gastrointestinal Disorders (Questions 41-60)
Section 4: Endocrine Disorders (Questions 61-80)
Section 5: Renal and Urinary Disorders (Questions 81-100)
Section 6: Neurological Disorders (Questions 101-120)
Section 7: Musculoskeletal and Integumentary Disorders (Questions 121-140)
Section 8: Hematologic and Oncologic Disorders (Questions 141-150)
,Section 1: Cardiovascular Disorders (Questions 1-20)
1. A nurse is assessing a client with pericarditis. Which finding is the priority to report to the
provider?
a) Friction rub auscultated at the left sternal border
b) Client reports sharp chest pain that worsens with inspiration
c) Muffled heart sounds and a drop in systolic BP of 15 mmHg during inspiration
d) ST-segment elevation on the ECG
Answer: c) Muffled heart sounds and a drop in systolic BP of 15 mmHg during inspiration
Rationale: Muffled heart sounds, hypotension, and jugular venous distension (Beck’s triad)
indicate cardiac tamponade, a life-threatening complication of pericarditis. Pulsus paradoxus (a
drop in systolic BP >10 mmHg during inspiration) is an associated sign. This is a medical
emergency requiring immediate pericardiocentesis.
2. A client with heart failure is prescribed furosemide (Lasix) 40 mg IV. Which laboratory value
requires the nurse to hold the medication and contact the provider?
a) Potassium 3.8 mEq/L
b) Sodium 135 mEq/L
c) Potassium 3.1 mEq/L
d) Magnesium 2.0 mg/dL
Answer: c) Potassium 3.1 mEq/L
Rationale: Furosemide is a loop diuretic that causes potassium wasting. A potassium level of 3.1
mEq/L is below the normal range (3.5-5.0 mEq/L) and increases the risk for cardiac
dysrhythmias. The nurse should hold the medication and notify the provider for a potential
potassium supplement or alternative medication.
3. (SATA) A nurse is providing discharge teaching for a client after a myocardial infarction (MI).
Which statements by the client indicate understanding?
Select all that apply.
a) "I will avoid drinking grapefruit juice while taking atorvastatin."
b) "I should stop taking my aspirin if I notice any bruising."
c) "I will take nitroglycerin every 5 minutes until the chest pain stops, even if it makes my head
pound."
d) "I need to monitor my weight daily and report a gain of more than 2 lbs in 24 hours."
e) "I can resume sexual activity when I can climb two flights of stairs without chest pain."
Answer: a, d, e
Rationale:
a) Correct: Grapefruit juice inhibits the metabolism of atorvastatin, increasing the risk of toxicity
,and rhabdomyolysis.
b) Incorrect: Aspirin is a critical antiplatelet medication post-MI. Bruising is a common side
effect; the client should report excessive bruising but not stop the medication abruptly, as this
could precipitate a thrombotic event.
c) Incorrect: Nitroglycerin should be taken up to 3 doses, 5 minutes apart. If pain persists after 3
doses, the client must call 911. A pounding headache is a common side effect but does not
indicate a need to exceed the dosing limit.
d) Correct: Daily weight is the best indicator of fluid retention. A gain of 2-3 lbs in a day or 5 lbs
in a week should be reported.
e) Correct: This is the standard criteria for safe resumption of sexual activity post-MI.
4. A nurse is caring for a client with a new diagnosis of deep vein thrombosis (DVT). The client
is prescribed heparin infusion. Which laboratory test is used to monitor therapeutic
effectiveness?
a) Prothrombin time (PT)
b) International normalized ratio (INR)
c) Activated partial thromboplastin time (aPTT)
d) Platelet count
Answer: c) Activated partial thromboplastin time (aPTT)
Rationale: Heparin therapy is monitored by aPTT. The therapeutic goal is typically 1.5 to 2.5
times the control value. PT/INR is used to monitor warfarin (Coumadin). Platelets are monitored
to watch for heparin-induced thrombocytopenia (HIT), but aPTT monitors therapeutic effect.
5. A client is 12 hours post-abdominal aortic aneurysm (AAA) repair. The nurse notes a sudden
decrease in urinary output to 20 mL over 2 hours. Which action should the nurse take first?
a) Increase the IV fluid rate.
b) Assess the client’s blood pressure and heart rate.
c) Notify the surgeon immediately.
d) Flush the indwelling urinary catheter.
Answer: b) Assess the client’s blood pressure and heart rate.
Rationale: Following AAA repair, a sudden decrease in urine output may indicate hypovolemia
(due to hemorrhage) or renal artery thrombosis. The nurse must first assess for signs of shock
(hypotension, tachycardia) to determine the urgency of the situation. This follows the
assessment step of the nursing process. After assessment, the nurse should notify the provider.
6. (Matrix) A nurse is assessing four clients. Which client is at highest risk for developing
infective endocarditis?
, Client Condition
A Mitral valve prolapse with no regurgitation
B Mechanical aortic valve
C History of rheumatic fever 30 years ago
D Coronary artery disease with stent
Answer: B (Mechanical aortic valve)
Rationale: Clients with prosthetic heart valves are at the highest risk for infective endocarditis
because the artificial surface provides a site for bacterial colonization. They require prophylactic
antibiotics before invasive dental procedures. While rheumatic fever history and mitral valve
prolapse with regurgitation also carry risk, prosthetic valves are the highest.
7. A nurse is administering digoxin (Lanoxin) to a client with heart failure. Which finding
requires immediate action?
a) Apical pulse of 62 beats per minute
b) Report of blurred vision with yellow halos around lights
c) Serum digoxin level of 1.2 ng/mL
d) Nausea and anorexia
Answer: b) Report of blurred vision with yellow halos around lights
Rationale: Visual disturbances (blurred vision, yellow-green halos) are classic signs of digoxin
toxicity. This is a priority finding. A digoxin level of 1.2 ng/mL is therapeutic (0.8-2.0 ng/mL). A
pulse of 62 is acceptable if it is >60 bpm for adults (though some protocols hold for <60).
Nausea and anorexia can be early signs of toxicity but are less specific than visual changes.
8. (SATA) A nurse is caring for a client following a cardiac catheterization via the femoral
artery. Which actions should be included in the post-procedure plan of care?
Select all that apply.
a) Keep the affected leg straight.
b) Apply a sandbag over the insertion site for pressure.
c) Assess the distal pulses in the affected extremity.
d) Encourage the client to flex the hip to promote comfort.
e) Monitor the insertion site for hematoma.
– 150 Questions with Answers & Detailed Rationales |
Comprehensive Practice Test 2026
SECTION COVERED:
Section 1: Cardiovascular Disorders (Questions 1-20)
Section 2: Respiratory Disorders (Questions 21-40)
Section 3: Gastrointestinal Disorders (Questions 41-60)
Section 4: Endocrine Disorders (Questions 61-80)
Section 5: Renal and Urinary Disorders (Questions 81-100)
Section 6: Neurological Disorders (Questions 101-120)
Section 7: Musculoskeletal and Integumentary Disorders (Questions 121-140)
Section 8: Hematologic and Oncologic Disorders (Questions 141-150)
,Section 1: Cardiovascular Disorders (Questions 1-20)
1. A nurse is assessing a client with pericarditis. Which finding is the priority to report to the
provider?
a) Friction rub auscultated at the left sternal border
b) Client reports sharp chest pain that worsens with inspiration
c) Muffled heart sounds and a drop in systolic BP of 15 mmHg during inspiration
d) ST-segment elevation on the ECG
Answer: c) Muffled heart sounds and a drop in systolic BP of 15 mmHg during inspiration
Rationale: Muffled heart sounds, hypotension, and jugular venous distension (Beck’s triad)
indicate cardiac tamponade, a life-threatening complication of pericarditis. Pulsus paradoxus (a
drop in systolic BP >10 mmHg during inspiration) is an associated sign. This is a medical
emergency requiring immediate pericardiocentesis.
2. A client with heart failure is prescribed furosemide (Lasix) 40 mg IV. Which laboratory value
requires the nurse to hold the medication and contact the provider?
a) Potassium 3.8 mEq/L
b) Sodium 135 mEq/L
c) Potassium 3.1 mEq/L
d) Magnesium 2.0 mg/dL
Answer: c) Potassium 3.1 mEq/L
Rationale: Furosemide is a loop diuretic that causes potassium wasting. A potassium level of 3.1
mEq/L is below the normal range (3.5-5.0 mEq/L) and increases the risk for cardiac
dysrhythmias. The nurse should hold the medication and notify the provider for a potential
potassium supplement or alternative medication.
3. (SATA) A nurse is providing discharge teaching for a client after a myocardial infarction (MI).
Which statements by the client indicate understanding?
Select all that apply.
a) "I will avoid drinking grapefruit juice while taking atorvastatin."
b) "I should stop taking my aspirin if I notice any bruising."
c) "I will take nitroglycerin every 5 minutes until the chest pain stops, even if it makes my head
pound."
d) "I need to monitor my weight daily and report a gain of more than 2 lbs in 24 hours."
e) "I can resume sexual activity when I can climb two flights of stairs without chest pain."
Answer: a, d, e
Rationale:
a) Correct: Grapefruit juice inhibits the metabolism of atorvastatin, increasing the risk of toxicity
,and rhabdomyolysis.
b) Incorrect: Aspirin is a critical antiplatelet medication post-MI. Bruising is a common side
effect; the client should report excessive bruising but not stop the medication abruptly, as this
could precipitate a thrombotic event.
c) Incorrect: Nitroglycerin should be taken up to 3 doses, 5 minutes apart. If pain persists after 3
doses, the client must call 911. A pounding headache is a common side effect but does not
indicate a need to exceed the dosing limit.
d) Correct: Daily weight is the best indicator of fluid retention. A gain of 2-3 lbs in a day or 5 lbs
in a week should be reported.
e) Correct: This is the standard criteria for safe resumption of sexual activity post-MI.
4. A nurse is caring for a client with a new diagnosis of deep vein thrombosis (DVT). The client
is prescribed heparin infusion. Which laboratory test is used to monitor therapeutic
effectiveness?
a) Prothrombin time (PT)
b) International normalized ratio (INR)
c) Activated partial thromboplastin time (aPTT)
d) Platelet count
Answer: c) Activated partial thromboplastin time (aPTT)
Rationale: Heparin therapy is monitored by aPTT. The therapeutic goal is typically 1.5 to 2.5
times the control value. PT/INR is used to monitor warfarin (Coumadin). Platelets are monitored
to watch for heparin-induced thrombocytopenia (HIT), but aPTT monitors therapeutic effect.
5. A client is 12 hours post-abdominal aortic aneurysm (AAA) repair. The nurse notes a sudden
decrease in urinary output to 20 mL over 2 hours. Which action should the nurse take first?
a) Increase the IV fluid rate.
b) Assess the client’s blood pressure and heart rate.
c) Notify the surgeon immediately.
d) Flush the indwelling urinary catheter.
Answer: b) Assess the client’s blood pressure and heart rate.
Rationale: Following AAA repair, a sudden decrease in urine output may indicate hypovolemia
(due to hemorrhage) or renal artery thrombosis. The nurse must first assess for signs of shock
(hypotension, tachycardia) to determine the urgency of the situation. This follows the
assessment step of the nursing process. After assessment, the nurse should notify the provider.
6. (Matrix) A nurse is assessing four clients. Which client is at highest risk for developing
infective endocarditis?
, Client Condition
A Mitral valve prolapse with no regurgitation
B Mechanical aortic valve
C History of rheumatic fever 30 years ago
D Coronary artery disease with stent
Answer: B (Mechanical aortic valve)
Rationale: Clients with prosthetic heart valves are at the highest risk for infective endocarditis
because the artificial surface provides a site for bacterial colonization. They require prophylactic
antibiotics before invasive dental procedures. While rheumatic fever history and mitral valve
prolapse with regurgitation also carry risk, prosthetic valves are the highest.
7. A nurse is administering digoxin (Lanoxin) to a client with heart failure. Which finding
requires immediate action?
a) Apical pulse of 62 beats per minute
b) Report of blurred vision with yellow halos around lights
c) Serum digoxin level of 1.2 ng/mL
d) Nausea and anorexia
Answer: b) Report of blurred vision with yellow halos around lights
Rationale: Visual disturbances (blurred vision, yellow-green halos) are classic signs of digoxin
toxicity. This is a priority finding. A digoxin level of 1.2 ng/mL is therapeutic (0.8-2.0 ng/mL). A
pulse of 62 is acceptable if it is >60 bpm for adults (though some protocols hold for <60).
Nausea and anorexia can be early signs of toxicity but are less specific than visual changes.
8. (SATA) A nurse is caring for a client following a cardiac catheterization via the femoral
artery. Which actions should be included in the post-procedure plan of care?
Select all that apply.
a) Keep the affected leg straight.
b) Apply a sandbag over the insertion site for pressure.
c) Assess the distal pulses in the affected extremity.
d) Encourage the client to flex the hip to promote comfort.
e) Monitor the insertion site for hematoma.
