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ATI RN ADULT MEDICAL SURGICAL PRACTICE
EXAM 2026 UPDATE NEXT GENERATION NCLEX
(NGN) STYLE – 200+ QUESTIONS WITH
RATIONALES
Section 1: Cardiovascular Disorders (Questions 1-25)
### Standard Multiple Choice
**1. A nurse is assessing a client who is 12 hours postoperative
following a cardiac catheterization via the right femoral artery. Which of
the following findings requires immediate intervention?**
- A) Blood pressure 128/74 mm Hg
- B) Heart rate 86/min
- C) A small amount of bloody drainage on the dressing
- D) A palpable, hard lump at the catheter insertion site
**Answer: D) A palpable, hard lump at the catheter insertion site**
*Rationale:* A palpable, hard lump (hematoma) at the insertion site
indicates active bleeding into the tissue, which can lead to compromised
circulation to the limb and significant blood loss. The nurse should
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immediately apply firm pressure proximal to the site, assess distal
pulses, and notify the provider. Small amounts of drainage are expected.
---
**2. A client with acute decompensated heart failure has an ejection
fraction of 25% and presents with severe dyspnea and crackles in all
lung fields. Which medication does the nurse expect to administer
first?**
- A) Digoxin
- B) Furosemide IV
- C) Carvedilol
- D) Spironolactone
**Answer: B) Furosemide IV**
*Rationale:* IV furosemide rapidly reduces preload, relieving
pulmonary edema. Beta-blockers (carvedilol) are for chronic HF
management, not acute decompensation. Digoxin and spironolactone are
not first-line for acute pulmonary edema.
---
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**3. A client with atrial fibrillation is prescribed warfarin. Which INR
value indicates a therapeutic range for this client?**
- A) 1.5
- B) 2.5
- C) 3.8
- D) 4.5
**Answer: B) 2.5**
*Rationale:* Target INR for atrial fibrillation is 2-3. An INR of 1.5 is
subtherapeutic and increases stroke risk. An INR >4 increases bleeding
risk.
---
**4. A client with an acute STEMI reports chest pain unrelieved by three
sublingual nitroglycerin tablets. Which medication should the nurse
prepare to administer?**
- A) Morphine sulfate
- B) Aspirin
- C) Metoprolol
- D) Heparin
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**Answer: A) Morphine sulfate**
*Rationale:* Morphine reduces pain and preload, decreasing myocardial
oxygen demand. Aspirin should already have been given on arrival.
Heparin and metoprolol do not provide acute pain relief.
---
**5. A nurse is providing discharge teaching to a client who has a new
prescription for sublingual nitroglycerin. Which client statement
indicates understanding of the teaching?**
- A) "I can keep my medications for 1 year before replacing it."
- B) "I should lie down when I take this medication."
- C) "I should discontinue this medication if I develop a headache."
- D) "I can take up to five tablets in 15 minutes before seeking medical
attention."
**Answer: B) "I should lie down when I take this medication."**
*Rationale:* Nitroglycerin causes vasodilation and can lead to
hypotension and dizziness. Lying down helps prevent injury from falls.
Headache is an expected side effect and not a reason to discontinue.
Nitroglycerin should be replaced every 6 months. The correct dosing is
one tablet every 5 minutes for up to 3 doses; if pain persists, seek
emergency care.
ATI RN ADULT MEDICAL SURGICAL PRACTICE
EXAM 2026 UPDATE NEXT GENERATION NCLEX
(NGN) STYLE – 200+ QUESTIONS WITH
RATIONALES
Section 1: Cardiovascular Disorders (Questions 1-25)
### Standard Multiple Choice
**1. A nurse is assessing a client who is 12 hours postoperative
following a cardiac catheterization via the right femoral artery. Which of
the following findings requires immediate intervention?**
- A) Blood pressure 128/74 mm Hg
- B) Heart rate 86/min
- C) A small amount of bloody drainage on the dressing
- D) A palpable, hard lump at the catheter insertion site
**Answer: D) A palpable, hard lump at the catheter insertion site**
*Rationale:* A palpable, hard lump (hematoma) at the insertion site
indicates active bleeding into the tissue, which can lead to compromised
circulation to the limb and significant blood loss. The nurse should
,2|Page
immediately apply firm pressure proximal to the site, assess distal
pulses, and notify the provider. Small amounts of drainage are expected.
---
**2. A client with acute decompensated heart failure has an ejection
fraction of 25% and presents with severe dyspnea and crackles in all
lung fields. Which medication does the nurse expect to administer
first?**
- A) Digoxin
- B) Furosemide IV
- C) Carvedilol
- D) Spironolactone
**Answer: B) Furosemide IV**
*Rationale:* IV furosemide rapidly reduces preload, relieving
pulmonary edema. Beta-blockers (carvedilol) are for chronic HF
management, not acute decompensation. Digoxin and spironolactone are
not first-line for acute pulmonary edema.
---
,3|Page
**3. A client with atrial fibrillation is prescribed warfarin. Which INR
value indicates a therapeutic range for this client?**
- A) 1.5
- B) 2.5
- C) 3.8
- D) 4.5
**Answer: B) 2.5**
*Rationale:* Target INR for atrial fibrillation is 2-3. An INR of 1.5 is
subtherapeutic and increases stroke risk. An INR >4 increases bleeding
risk.
---
**4. A client with an acute STEMI reports chest pain unrelieved by three
sublingual nitroglycerin tablets. Which medication should the nurse
prepare to administer?**
- A) Morphine sulfate
- B) Aspirin
- C) Metoprolol
- D) Heparin
, 4|Page
**Answer: A) Morphine sulfate**
*Rationale:* Morphine reduces pain and preload, decreasing myocardial
oxygen demand. Aspirin should already have been given on arrival.
Heparin and metoprolol do not provide acute pain relief.
---
**5. A nurse is providing discharge teaching to a client who has a new
prescription for sublingual nitroglycerin. Which client statement
indicates understanding of the teaching?**
- A) "I can keep my medications for 1 year before replacing it."
- B) "I should lie down when I take this medication."
- C) "I should discontinue this medication if I develop a headache."
- D) "I can take up to five tablets in 15 minutes before seeking medical
attention."
**Answer: B) "I should lie down when I take this medication."**
*Rationale:* Nitroglycerin causes vasodilation and can lead to
hypotension and dizziness. Lying down helps prevent injury from falls.
Headache is an expected side effect and not a reason to discontinue.
Nitroglycerin should be replaced every 6 months. The correct dosing is
one tablet every 5 minutes for up to 3 doses; if pain persists, seek
emergency care.
