ATI RN ADULT MEDICAL-SURGICAL PROCTORED EXAM
NGN 2026/2027 | 250 Q&A | 100% Correct Answers |
Latest Version | Pass Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR & PERIPHERAL VASCULAR
DISORDERS (Q1-30)
Q1. A client is admitted with acute myocardial infarction (MI) and develops
cardiogenic shock 6 hours post-admission. Which finding requires the most
immediate intervention by the nurse?
A. Blood pressure 88/52 mmHg
B. Urine output 25 mL/hr
C. Crackles in bilateral lung bases
D. Cool, clammy skin with capillary refill 4 seconds
Correct Answer: A
Rationale: While all findings indicate cardiogenic shock, a systolic BP below 90
mmHg represents profound hypotension requiring immediate vasopressor support
and potential intra-aortic balloon pump consideration. Urine output of 25 mL/hr (B),
while low, is not yet anuric; crackles (C) indicate pulmonary edema but are expected
in cardiogenic shock; cool clammy skin (D) is a compensatory response but less
immediately life-threatening than profound hypotension compromising coronary
and cerebral perfusion.
Q2. A client with heart failure is prescribed sacubitril/valsartan (Entresto). Which
assessment finding would cause the nurse to withhold the dose and notify the
provider?
,A. Serum potassium 4.8 mEq/L
B. Blood pressure 92/58 mmHg
C. Heart rate 68 bpm
D. Serum sodium 138 mEq/L
Correct Answer: B
Rationale: Sacubitril/valsartan is contraindicated with systolic BP below 90 mmHg
due to risk of profound hypotension, syncope, and renal hypoperfusion. Serum
potassium 4.8 (A) is within normal limits; heart rate 68 (C) is acceptable; sodium 138
(D) is normal. The nurse must hold the dose and notify the provider for hypotension
management.
Q3. A client with atrial fibrillation is receiving heparin infusion at 1,200 units/hr.
The aPTT is 98 seconds (control 30-40 seconds). Which action should the nurse
take?
A. Continue the infusion at the current rate
B. Decrease the infusion rate and recheck aPTT in 4 hours
C. Stop the infusion immediately and administer protamine sulfate
D. Increase the infusion rate to achieve therapeutic anticoagulation
Correct Answer: B
Rationale: An aPTT of 98 seconds represents supratherapeutic anticoagulation
(therapeutic range typically 1.5-2.5 times control, or 45-100 seconds at most
institutions). The nurse should decrease the rate and recheck. Continuing current rate
(A) risks bleeding; protamine sulfate (C) is for heparin overdose with active bleeding,
not elevated aPTT alone; increasing rate (D) would worsen supratherapeutic levels.
,Q4. A client post-cardiac arrest is receiving targeted temperature management
(TTM) at 33°C (91.4°F). Which nursing intervention is the priority?
A. Administer warmed IV fluids to prevent hypothermia
B. Monitor for shivering and administer sedation/neuromuscular blockade as
prescribed
C. Encourage oral intake to maintain hydration
D. Apply warming blankets to maintain comfort
Correct Answer: B
Rationale: Shivering during TTM increases metabolic demand, oxygen consumption,
and intracranial pressure, counteracting the neuroprotective benefits. Shivering must
be prevented with sedation and paralytics as prescribed. Warmed fluids (A) and
warming blankets (D) counteract TTM; oral intake (C) is contraindicated in the
unconscious or sedated post-arrest client.
Q5. A client with a left ventricular assist device (LVAD) reports dizziness and the
alarm is sounding. The nurse notes the power source is disconnected. What is the
FIRST action?
A. Call the LVAD coordinator immediately
B. Reconnect the power source and assess device function
C. Begin CPR
D. Administer supplemental oxygen
Correct Answer: B
Rationale: The FIRST action is to reconnect the power source, as LVADs are life-
sustaining and power loss is immediately critical. After reconnection, assess function
and then notify the coordinator (A). CPR (C) is not indicated unless cardiac arrest
occurs; oxygen (D) is supportive but not the priority over restoring power.
, Q6. A client with infective endocarditis is prescribed gentamicin 1.7 mg/kg IV
every 8 hours. The client weighs 70 kg. What is the total daily dose?
A. 119 mg/day
B. 238 mg/day
C. 357 mg/day
D. 476 mg/day
Correct Answer: C
Rationale: 1.7 mg/kg × 70 kg = 119 mg per dose. Three doses per day (q8h) = 119 ×
3 = 357 mg/day. Option A is the single dose, B is two doses, and D is an incorrect
calculation.
Q7. A client with aortic stenosis is scheduled for transcatheter aortic valve
replacement (TAVR). Which pre-procedure teaching point is most important?
A. "You will be able to resume all normal activities immediately after the procedure."
B. "You will need lifelong anticoagulation with warfarin after the procedure."
C. "You may experience temporary heart block requiring a pacemaker."
D. "The procedure requires open-heart surgery with sternotomy."
Correct Answer: C
Rationale: TAVR carries risk of conduction system injury causing heart block,
potentially requiring permanent pacemaker placement. This is a critical informed
consent element. Immediate normal activities (A) is incorrect; lifelong warfarin (B) is
not standard for all TAVR patients; TAVR is transcatheter, not open-heart (D).
Q8. A client with peripheral arterial disease (PAD) has an ankle-brachial index
(ABI) of 0.62. Which nursing intervention is appropriate?
A. Apply heating pad to the affected extremity for pain relief
NGN 2026/2027 | 250 Q&A | 100% Correct Answers |
Latest Version | Pass Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR & PERIPHERAL VASCULAR
DISORDERS (Q1-30)
Q1. A client is admitted with acute myocardial infarction (MI) and develops
cardiogenic shock 6 hours post-admission. Which finding requires the most
immediate intervention by the nurse?
A. Blood pressure 88/52 mmHg
B. Urine output 25 mL/hr
C. Crackles in bilateral lung bases
D. Cool, clammy skin with capillary refill 4 seconds
Correct Answer: A
Rationale: While all findings indicate cardiogenic shock, a systolic BP below 90
mmHg represents profound hypotension requiring immediate vasopressor support
and potential intra-aortic balloon pump consideration. Urine output of 25 mL/hr (B),
while low, is not yet anuric; crackles (C) indicate pulmonary edema but are expected
in cardiogenic shock; cool clammy skin (D) is a compensatory response but less
immediately life-threatening than profound hypotension compromising coronary
and cerebral perfusion.
Q2. A client with heart failure is prescribed sacubitril/valsartan (Entresto). Which
assessment finding would cause the nurse to withhold the dose and notify the
provider?
,A. Serum potassium 4.8 mEq/L
B. Blood pressure 92/58 mmHg
C. Heart rate 68 bpm
D. Serum sodium 138 mEq/L
Correct Answer: B
Rationale: Sacubitril/valsartan is contraindicated with systolic BP below 90 mmHg
due to risk of profound hypotension, syncope, and renal hypoperfusion. Serum
potassium 4.8 (A) is within normal limits; heart rate 68 (C) is acceptable; sodium 138
(D) is normal. The nurse must hold the dose and notify the provider for hypotension
management.
Q3. A client with atrial fibrillation is receiving heparin infusion at 1,200 units/hr.
The aPTT is 98 seconds (control 30-40 seconds). Which action should the nurse
take?
A. Continue the infusion at the current rate
B. Decrease the infusion rate and recheck aPTT in 4 hours
C. Stop the infusion immediately and administer protamine sulfate
D. Increase the infusion rate to achieve therapeutic anticoagulation
Correct Answer: B
Rationale: An aPTT of 98 seconds represents supratherapeutic anticoagulation
(therapeutic range typically 1.5-2.5 times control, or 45-100 seconds at most
institutions). The nurse should decrease the rate and recheck. Continuing current rate
(A) risks bleeding; protamine sulfate (C) is for heparin overdose with active bleeding,
not elevated aPTT alone; increasing rate (D) would worsen supratherapeutic levels.
,Q4. A client post-cardiac arrest is receiving targeted temperature management
(TTM) at 33°C (91.4°F). Which nursing intervention is the priority?
A. Administer warmed IV fluids to prevent hypothermia
B. Monitor for shivering and administer sedation/neuromuscular blockade as
prescribed
C. Encourage oral intake to maintain hydration
D. Apply warming blankets to maintain comfort
Correct Answer: B
Rationale: Shivering during TTM increases metabolic demand, oxygen consumption,
and intracranial pressure, counteracting the neuroprotective benefits. Shivering must
be prevented with sedation and paralytics as prescribed. Warmed fluids (A) and
warming blankets (D) counteract TTM; oral intake (C) is contraindicated in the
unconscious or sedated post-arrest client.
Q5. A client with a left ventricular assist device (LVAD) reports dizziness and the
alarm is sounding. The nurse notes the power source is disconnected. What is the
FIRST action?
A. Call the LVAD coordinator immediately
B. Reconnect the power source and assess device function
C. Begin CPR
D. Administer supplemental oxygen
Correct Answer: B
Rationale: The FIRST action is to reconnect the power source, as LVADs are life-
sustaining and power loss is immediately critical. After reconnection, assess function
and then notify the coordinator (A). CPR (C) is not indicated unless cardiac arrest
occurs; oxygen (D) is supportive but not the priority over restoring power.
, Q6. A client with infective endocarditis is prescribed gentamicin 1.7 mg/kg IV
every 8 hours. The client weighs 70 kg. What is the total daily dose?
A. 119 mg/day
B. 238 mg/day
C. 357 mg/day
D. 476 mg/day
Correct Answer: C
Rationale: 1.7 mg/kg × 70 kg = 119 mg per dose. Three doses per day (q8h) = 119 ×
3 = 357 mg/day. Option A is the single dose, B is two doses, and D is an incorrect
calculation.
Q7. A client with aortic stenosis is scheduled for transcatheter aortic valve
replacement (TAVR). Which pre-procedure teaching point is most important?
A. "You will be able to resume all normal activities immediately after the procedure."
B. "You will need lifelong anticoagulation with warfarin after the procedure."
C. "You may experience temporary heart block requiring a pacemaker."
D. "The procedure requires open-heart surgery with sternotomy."
Correct Answer: C
Rationale: TAVR carries risk of conduction system injury causing heart block,
potentially requiring permanent pacemaker placement. This is a critical informed
consent element. Immediate normal activities (A) is incorrect; lifelong warfarin (B) is
not standard for all TAVR patients; TAVR is transcatheter, not open-heart (D).
Q8. A client with peripheral arterial disease (PAD) has an ankle-brachial index
(ABI) of 0.62. Which nursing intervention is appropriate?
A. Apply heating pad to the affected extremity for pain relief
