ATI PN MEDICAL SURGICAL EXAM 2026 | Latest Updated
with NGN Questions | Proctored Assessment | Practical
Nursing | Pass Guaranteed - A+ Graded
Section 1: Respiratory & Cardiovascular Disorders (Questions 1-
18)
Q1. A client with chronic obstructive pulmonary disease (COPD) is admitted with an
acute exacerbation. Arterial blood gas results show pH 7.32, PaCO₂ 58 mmHg, PaO₂
62 mmHg, and HCO₃⁻ 30 mEq/L. Which acid-base imbalance is present?
A. Respiratory alkalosis with metabolic compensation
B. Respiratory acidosis with metabolic compensation
C. Metabolic acidosis with respiratory compensation
D. Metabolic alkalosis with respiratory compensation
Rationale: The pH of 7.32 indicates acidosis. The elevated PaCO₂ (58 mmHg)
confirms a respiratory cause, while the elevated HCO₃⁻ (30 mEq/L) demonstrates
metabolic compensation (kidneys retaining bicarbonate). Option A is incorrect
because the pH is acidic, not alkaline. Option C is incorrect because the primary
disturbance is respiratory (elevated CO₂), not metabolic. Option D is incorrect
because this is not a metabolic alkalosis pattern.
Correct Answer: B
Q2. A client with heart failure is prescribed furosemide (Lasix) 40 mg IV daily. The
practical nurse should monitor for which adverse effect that requires immediate
reporting?
A. Dry mouth
B. Hypokalemia with muscle weakness and cardiac dysrhythmias
,C. Mild ankle edema
D. Increased appetite
Rationale: Furosemide is a loop diuretic that causes potassium wasting, leading to
hypokalemia. Severe hypokalemia causes muscle weakness, fatigue, and life-
threatening cardiac dysrhythmias (U waves, flattened T waves, ventricular
tachycardia). Option A is a mild anticholinergic effect not requiring immediate action.
Option C indicates worsening heart failure, not a furosemide adverse effect. Option D
is unrelated to loop diuretics.
Correct Answer: B
Q3. A client with a pulmonary embolism (PE) is receiving heparin therapy. The
practical nurse notes the client's aPTT is 95 seconds (therapeutic range 60-80
seconds). Which action should the nurse take FIRST?
A. Continue the current heparin infusion rate and recheck in 4 hours
B. Stop the heparin infusion immediately and notify the primary health care provider
C. Administer the next scheduled dose of warfarin (Coumadin) early
D. Increase the heparin infusion rate to achieve a higher therapeutic level
Rationale: An aPTT of 95 seconds exceeds the therapeutic range, indicating
supratherapeutic anticoagulation with increased bleeding risk. The nurse must stop
the infusion immediately and notify the provider. Option A would increase bleeding
risk. Option C is inappropriate—warfarin is not adjusted based on aPTT. Option D
would further increase the aPTT and bleeding risk.
Correct Answer: B
Q4. A client with asthma is using a metered-dose inhaler (MDI) with a bronchodilator
and corticosteroid. Which instruction should the practical nurse provide regarding
the sequence of inhaler use?
,A. Use the corticosteroid first, wait 5 minutes, then use the bronchodilator
B. Use the bronchodilator first, wait 5 minutes, then use the corticosteroid
C. Use both inhalers simultaneously for maximum effect
D. Use only the bronchodilator during an acute attack and the corticosteroid for
maintenance only
Rationale: The bronchodilator should be used first to open the airways, allowing
better penetration of the corticosteroid when administered 5 minutes later. Option A
reverses the correct sequence, reducing corticosteroid effectiveness. Option C is
unsafe and reduces medication distribution. Option D incorrectly limits corticosteroid
use—corticosteroids are essential for inflammation control during acute
exacerbations.
Correct Answer: B
Q5. A client with left-sided heart failure develops acute pulmonary edema. Which
position should the practical nurse place the client in immediately?
A. Supine with legs elevated to promote venous return
B. High Fowler's position with legs dangling over the side of the bed
C. Trendelenburg position to increase cerebral perfusion
D. Prone position to improve ventilation-perfusion matching
Rationale: High Fowler's position with legs dangling reduces venous return (preload)
to the heart, decreases pulmonary congestion, and facilitates lung expansion. Option
A increases preload and worsens pulmonary edema. Option C increases intrathoracic
blood volume and worsens respiratory distress. Option D is contraindicated in acute
respiratory distress.
Correct Answer: B
Q6. A client with tuberculosis (TB) is started on rifampin (Rifadin), isoniazid (INH),
pyrazinamide, and ethambutol. The practical nurse should teach the client to expect
which harmless but alarming side effect of rifampin?
, A. Red-orange discoloration of urine, sweat, tears, and contact lenses
B. Permanent blue-gray skin discoloration
C. Black, tarry stools
D. Yellowing of the sclerae indicating hepatotoxicity
Rationale: Rifampin causes harmless red-orange discoloration of body fluids and
contact lenses, which alarms clients but requires no intervention. Option B is not
associated with rifampin. Option C indicates GI bleeding and requires immediate
evaluation. Option D indicates hepatotoxicity, a serious adverse effect requiring
provider notification, not a harmless effect.
Correct Answer: A
Q7. A client with coronary artery disease (CAD) is prescribed nitroglycerin sublingual
tablets for angina. The practical nurse should instruct the client to take which action
if chest pain persists after the first dose?
A. Take up to 2 additional tablets at 5-minute intervals, then call 911 if pain persists
B. Take all remaining tablets at once for maximum vasodilation
C. Wait 30 minutes before taking another dose to avoid hypotension
D. Switch to aspirin only and discontinue nitroglycerin
Rationale: The correct protocol is up to 3 doses total (1 initial + 2 additional) at 5-
minute intervals; if pain persists after 3 doses, the client must call 911 for possible MI.
Option B risks severe hypotension and cardiovascular collapse. Option C delays
critical intervention during a potential MI. Option D abandons effective vasodilation
when it is most needed.
Correct Answer: A
Q8. A client with deep vein thrombosis (DVT) is on bed rest with the affected leg
elevated. Which finding should the practical nurse report immediately as a sign of
potential pulmonary embolism?
with NGN Questions | Proctored Assessment | Practical
Nursing | Pass Guaranteed - A+ Graded
Section 1: Respiratory & Cardiovascular Disorders (Questions 1-
18)
Q1. A client with chronic obstructive pulmonary disease (COPD) is admitted with an
acute exacerbation. Arterial blood gas results show pH 7.32, PaCO₂ 58 mmHg, PaO₂
62 mmHg, and HCO₃⁻ 30 mEq/L. Which acid-base imbalance is present?
A. Respiratory alkalosis with metabolic compensation
B. Respiratory acidosis with metabolic compensation
C. Metabolic acidosis with respiratory compensation
D. Metabolic alkalosis with respiratory compensation
Rationale: The pH of 7.32 indicates acidosis. The elevated PaCO₂ (58 mmHg)
confirms a respiratory cause, while the elevated HCO₃⁻ (30 mEq/L) demonstrates
metabolic compensation (kidneys retaining bicarbonate). Option A is incorrect
because the pH is acidic, not alkaline. Option C is incorrect because the primary
disturbance is respiratory (elevated CO₂), not metabolic. Option D is incorrect
because this is not a metabolic alkalosis pattern.
Correct Answer: B
Q2. A client with heart failure is prescribed furosemide (Lasix) 40 mg IV daily. The
practical nurse should monitor for which adverse effect that requires immediate
reporting?
A. Dry mouth
B. Hypokalemia with muscle weakness and cardiac dysrhythmias
,C. Mild ankle edema
D. Increased appetite
Rationale: Furosemide is a loop diuretic that causes potassium wasting, leading to
hypokalemia. Severe hypokalemia causes muscle weakness, fatigue, and life-
threatening cardiac dysrhythmias (U waves, flattened T waves, ventricular
tachycardia). Option A is a mild anticholinergic effect not requiring immediate action.
Option C indicates worsening heart failure, not a furosemide adverse effect. Option D
is unrelated to loop diuretics.
Correct Answer: B
Q3. A client with a pulmonary embolism (PE) is receiving heparin therapy. The
practical nurse notes the client's aPTT is 95 seconds (therapeutic range 60-80
seconds). Which action should the nurse take FIRST?
A. Continue the current heparin infusion rate and recheck in 4 hours
B. Stop the heparin infusion immediately and notify the primary health care provider
C. Administer the next scheduled dose of warfarin (Coumadin) early
D. Increase the heparin infusion rate to achieve a higher therapeutic level
Rationale: An aPTT of 95 seconds exceeds the therapeutic range, indicating
supratherapeutic anticoagulation with increased bleeding risk. The nurse must stop
the infusion immediately and notify the provider. Option A would increase bleeding
risk. Option C is inappropriate—warfarin is not adjusted based on aPTT. Option D
would further increase the aPTT and bleeding risk.
Correct Answer: B
Q4. A client with asthma is using a metered-dose inhaler (MDI) with a bronchodilator
and corticosteroid. Which instruction should the practical nurse provide regarding
the sequence of inhaler use?
,A. Use the corticosteroid first, wait 5 minutes, then use the bronchodilator
B. Use the bronchodilator first, wait 5 minutes, then use the corticosteroid
C. Use both inhalers simultaneously for maximum effect
D. Use only the bronchodilator during an acute attack and the corticosteroid for
maintenance only
Rationale: The bronchodilator should be used first to open the airways, allowing
better penetration of the corticosteroid when administered 5 minutes later. Option A
reverses the correct sequence, reducing corticosteroid effectiveness. Option C is
unsafe and reduces medication distribution. Option D incorrectly limits corticosteroid
use—corticosteroids are essential for inflammation control during acute
exacerbations.
Correct Answer: B
Q5. A client with left-sided heart failure develops acute pulmonary edema. Which
position should the practical nurse place the client in immediately?
A. Supine with legs elevated to promote venous return
B. High Fowler's position with legs dangling over the side of the bed
C. Trendelenburg position to increase cerebral perfusion
D. Prone position to improve ventilation-perfusion matching
Rationale: High Fowler's position with legs dangling reduces venous return (preload)
to the heart, decreases pulmonary congestion, and facilitates lung expansion. Option
A increases preload and worsens pulmonary edema. Option C increases intrathoracic
blood volume and worsens respiratory distress. Option D is contraindicated in acute
respiratory distress.
Correct Answer: B
Q6. A client with tuberculosis (TB) is started on rifampin (Rifadin), isoniazid (INH),
pyrazinamide, and ethambutol. The practical nurse should teach the client to expect
which harmless but alarming side effect of rifampin?
, A. Red-orange discoloration of urine, sweat, tears, and contact lenses
B. Permanent blue-gray skin discoloration
C. Black, tarry stools
D. Yellowing of the sclerae indicating hepatotoxicity
Rationale: Rifampin causes harmless red-orange discoloration of body fluids and
contact lenses, which alarms clients but requires no intervention. Option B is not
associated with rifampin. Option C indicates GI bleeding and requires immediate
evaluation. Option D indicates hepatotoxicity, a serious adverse effect requiring
provider notification, not a harmless effect.
Correct Answer: A
Q7. A client with coronary artery disease (CAD) is prescribed nitroglycerin sublingual
tablets for angina. The practical nurse should instruct the client to take which action
if chest pain persists after the first dose?
A. Take up to 2 additional tablets at 5-minute intervals, then call 911 if pain persists
B. Take all remaining tablets at once for maximum vasodilation
C. Wait 30 minutes before taking another dose to avoid hypotension
D. Switch to aspirin only and discontinue nitroglycerin
Rationale: The correct protocol is up to 3 doses total (1 initial + 2 additional) at 5-
minute intervals; if pain persists after 3 doses, the client must call 911 for possible MI.
Option B risks severe hypotension and cardiovascular collapse. Option C delays
critical intervention during a potential MI. Option D abandons effective vasodilation
when it is most needed.
Correct Answer: A
Q8. A client with deep vein thrombosis (DVT) is on bed rest with the affected leg
elevated. Which finding should the practical nurse report immediately as a sign of
potential pulmonary embolism?
