ATI PN MEDICAL SURGICAL CMS PROCTORED ACTUAL
EXAM 2026/2027 | NGN Next Gen NCLEX Format | Clinical
Judgment Measurement Model | Complete Q&A with Detailed
Answer Key | 100% Verified | ATI CMS Blueprint | Pass
Guaranteed - A+ Graded
[Section 1: NGN Unfolding Case Study #1 - Cardiovascular & Hematologic Disorders
(HF, DVT, Anemia) (Q/Tasks 1-32)]
Case Study Context: M.J. is a 74-year-old male admitted with acute decompensated
heart failure (HFrEF, EF 35%). He reports dyspnea at rest, orthopnea, and a 8-lb weight
gain over 5 days. Vital signs: BP 162/94, HR 118, RR 28, SpO2 89% on room air. Physical
assessment reveals +4 pitting edema bilateral lower extremities, JVD distended at 45°,
S3 gallop, and crackles 2/3 bilateral lung bases.
Q1. The nurse auscultates an S3 gallop and bilateral crackles. These findings indicate
which pathophysiological process?
A. Left ventricular systolic dysfunction with pulmonary venous congestion
B. Right ventricular infarction with hepatic congestion
C. Aortic stenosis with decreased cardiac output
D. Mitral regurgitation with forward flow obstruction
A. Left ventricular systolic dysfunction with pulmonary venous congestion [CORRECT]
Rationale: S3 gallop reflects rapid ventricular filling due to systolic dysfunction, and
crackles indicate fluid transudation into alveoli from elevated pulmonary capillary
pressure; right ventricular infarction would show JVD and clear lungs, while valvular
lesions are not the primary pathology here. CJMM Layer: Analyze Cues
Correct Answer: A
,Q2. M.J.’s SpO2 is 89% on room air. Which cue requires the most immediate
intervention?
A. 8-lb weight gain over 5 days
B. SpO2 89%
C. S3 gallop
D. JVD at 45°
B. SpO2 89% [CORRECT]
Rationale: SpO2 below 90% indicates hypoxemia and threatens airway/breathing
(ABCs), requiring immediate oxygen therapy; weight gain, S3, and JVD are serious but
do not represent an immediate oxygenation crisis. CJMM Layer: Prioritize Hypotheses
Correct Answer: B
Q3. The nurse is developing a plan of care. Which hypothesis should be prioritized as
the most urgent?
A. Risk for impaired skin integrity related to peripheral edema
B. Acute decompensated heart failure with pulmonary congestion
C. Activity intolerance related to chronic fatigue
D. Nonadherence to sodium-restricted diet
B. Acute decompensated heart failure with pulmonary congestion [CORRECT]
Rationale: The acute presentation with hypoxemia, crackles, and orthopnea represents a
life-threatening deterioration requiring immediate intervention; risk for skin breakdown
and activity intolerance are important but not urgent. CJMM Layer: Prioritize
Hypotheses
Correct Answer: B
Q4. Which intervention is most appropriate to include in the initial plan of care for M.J.?
A. Administer furosemide 40 mg IV push and monitor urine output hourly
B. Initiate daily walking protocol on the unit
C. Provide a regular diet with no restrictions
D. Schedule an outpatient cardiology appointment
,A. Administer furosemide 40 mg IV push and monitor urine output hourly [CORRECT]
Rationale: IV loop diuretics are first-line for acute decompensated HF to reduce
pulmonary congestion; ambulation, unrestricted diet, and outpatient scheduling are
inappropriate for acute decompensation. CJMM Layer: Generate Solutions
Correct Answer: A
Q5. The nurse is implementing care. Which action should the nurse take first?
A. Apply oxygen via nasal cannula at 2 L/min and titrate to SpO2 >90%
B. Insert a urinary catheter
C. Obtain a 12-lead EKG
D. Administer lisinopril PO
A. Apply oxygen via nasal cannula at 2 L/min and titrate to SpO2 >90% [CORRECT]
Rationale: Oxygenation takes priority per ABCs before other interventions;
catheterization, EKG, and ACE inhibitors are important but follow stabilization of
breathing. CJMM Layer: Take Action
Correct Answer: A
Q6. Twenty-four hours after initiating diuretic therapy, which outcome indicates effective
intervention?
A. Weight increased by 2 lbs
B. Crackles cleared and SpO2 94% on 2 L NC
C. HR increased to 130 bpm
D. JVD remains distended at 45°
B. Crackles cleared and SpO2 94% on 2 L NC [CORRECT]
Rationale: Resolution of crackles and improved oxygenation indicate successful
diuresis and decreased pulmonary congestion; weight gain, tachycardia, and persistent
JVD indicate worsening or inadequate response. CJMM Layer: Evaluate Outcomes
Correct Answer: B
, Q7. M.J. is prescribed sacubitril/valsartan (Entresto). The nurse should monitor for
which adverse effect?
A. Hyperkalemia and hypotension
B. Hyperglycemia and weight gain
C. Bradycardia and bronchospasm
D. Thrombocytopenia and hepatotoxicity
A. Hyperkalemia and hypotension [CORRECT]
Rationale: Sacubitril/valsartan, an ARNI, causes vasodilation and can elevate
potassium; it does not typically cause hyperglycemia, bradycardia, or hematologic
toxicity. CJMM Layer: Generate Solutions
Correct Answer: A
Q8. M.J. is on bed rest. Which intervention is the priority to prevent deep vein
thrombosis?
A. Apply thigh-high compression stockings and encourage ankle pumps q1h
B. Massage both calves to promote circulation
C. Keep legs in dependent position to reduce edema
D. Administer prophylactic heparin only if platelets are >500,000
A. Apply thigh-high compression stockings and encourage ankle pumps q1h [CORRECT]
Rationale: Mechanical prophylaxis and active ankle movement promote venous return;
calf massage is contraindicated due to risk of dislodging a clot, dependent positioning
worsens stasis, and platelet threshold is not the criterion for DVT prophylaxis. CJMM
Layer: Take Action
Correct Answer: A
Q9. M.J. has a history of iron deficiency anemia with Hgb 9.2 g/dL. Which dietary
teaching is appropriate?
A. Increase intake of red meat, leafy greens, and vitamin C with meals
B. Consume dairy products with each meal to enhance absorption
EXAM 2026/2027 | NGN Next Gen NCLEX Format | Clinical
Judgment Measurement Model | Complete Q&A with Detailed
Answer Key | 100% Verified | ATI CMS Blueprint | Pass
Guaranteed - A+ Graded
[Section 1: NGN Unfolding Case Study #1 - Cardiovascular & Hematologic Disorders
(HF, DVT, Anemia) (Q/Tasks 1-32)]
Case Study Context: M.J. is a 74-year-old male admitted with acute decompensated
heart failure (HFrEF, EF 35%). He reports dyspnea at rest, orthopnea, and a 8-lb weight
gain over 5 days. Vital signs: BP 162/94, HR 118, RR 28, SpO2 89% on room air. Physical
assessment reveals +4 pitting edema bilateral lower extremities, JVD distended at 45°,
S3 gallop, and crackles 2/3 bilateral lung bases.
Q1. The nurse auscultates an S3 gallop and bilateral crackles. These findings indicate
which pathophysiological process?
A. Left ventricular systolic dysfunction with pulmonary venous congestion
B. Right ventricular infarction with hepatic congestion
C. Aortic stenosis with decreased cardiac output
D. Mitral regurgitation with forward flow obstruction
A. Left ventricular systolic dysfunction with pulmonary venous congestion [CORRECT]
Rationale: S3 gallop reflects rapid ventricular filling due to systolic dysfunction, and
crackles indicate fluid transudation into alveoli from elevated pulmonary capillary
pressure; right ventricular infarction would show JVD and clear lungs, while valvular
lesions are not the primary pathology here. CJMM Layer: Analyze Cues
Correct Answer: A
,Q2. M.J.’s SpO2 is 89% on room air. Which cue requires the most immediate
intervention?
A. 8-lb weight gain over 5 days
B. SpO2 89%
C. S3 gallop
D. JVD at 45°
B. SpO2 89% [CORRECT]
Rationale: SpO2 below 90% indicates hypoxemia and threatens airway/breathing
(ABCs), requiring immediate oxygen therapy; weight gain, S3, and JVD are serious but
do not represent an immediate oxygenation crisis. CJMM Layer: Prioritize Hypotheses
Correct Answer: B
Q3. The nurse is developing a plan of care. Which hypothesis should be prioritized as
the most urgent?
A. Risk for impaired skin integrity related to peripheral edema
B. Acute decompensated heart failure with pulmonary congestion
C. Activity intolerance related to chronic fatigue
D. Nonadherence to sodium-restricted diet
B. Acute decompensated heart failure with pulmonary congestion [CORRECT]
Rationale: The acute presentation with hypoxemia, crackles, and orthopnea represents a
life-threatening deterioration requiring immediate intervention; risk for skin breakdown
and activity intolerance are important but not urgent. CJMM Layer: Prioritize
Hypotheses
Correct Answer: B
Q4. Which intervention is most appropriate to include in the initial plan of care for M.J.?
A. Administer furosemide 40 mg IV push and monitor urine output hourly
B. Initiate daily walking protocol on the unit
C. Provide a regular diet with no restrictions
D. Schedule an outpatient cardiology appointment
,A. Administer furosemide 40 mg IV push and monitor urine output hourly [CORRECT]
Rationale: IV loop diuretics are first-line for acute decompensated HF to reduce
pulmonary congestion; ambulation, unrestricted diet, and outpatient scheduling are
inappropriate for acute decompensation. CJMM Layer: Generate Solutions
Correct Answer: A
Q5. The nurse is implementing care. Which action should the nurse take first?
A. Apply oxygen via nasal cannula at 2 L/min and titrate to SpO2 >90%
B. Insert a urinary catheter
C. Obtain a 12-lead EKG
D. Administer lisinopril PO
A. Apply oxygen via nasal cannula at 2 L/min and titrate to SpO2 >90% [CORRECT]
Rationale: Oxygenation takes priority per ABCs before other interventions;
catheterization, EKG, and ACE inhibitors are important but follow stabilization of
breathing. CJMM Layer: Take Action
Correct Answer: A
Q6. Twenty-four hours after initiating diuretic therapy, which outcome indicates effective
intervention?
A. Weight increased by 2 lbs
B. Crackles cleared and SpO2 94% on 2 L NC
C. HR increased to 130 bpm
D. JVD remains distended at 45°
B. Crackles cleared and SpO2 94% on 2 L NC [CORRECT]
Rationale: Resolution of crackles and improved oxygenation indicate successful
diuresis and decreased pulmonary congestion; weight gain, tachycardia, and persistent
JVD indicate worsening or inadequate response. CJMM Layer: Evaluate Outcomes
Correct Answer: B
, Q7. M.J. is prescribed sacubitril/valsartan (Entresto). The nurse should monitor for
which adverse effect?
A. Hyperkalemia and hypotension
B. Hyperglycemia and weight gain
C. Bradycardia and bronchospasm
D. Thrombocytopenia and hepatotoxicity
A. Hyperkalemia and hypotension [CORRECT]
Rationale: Sacubitril/valsartan, an ARNI, causes vasodilation and can elevate
potassium; it does not typically cause hyperglycemia, bradycardia, or hematologic
toxicity. CJMM Layer: Generate Solutions
Correct Answer: A
Q8. M.J. is on bed rest. Which intervention is the priority to prevent deep vein
thrombosis?
A. Apply thigh-high compression stockings and encourage ankle pumps q1h
B. Massage both calves to promote circulation
C. Keep legs in dependent position to reduce edema
D. Administer prophylactic heparin only if platelets are >500,000
A. Apply thigh-high compression stockings and encourage ankle pumps q1h [CORRECT]
Rationale: Mechanical prophylaxis and active ankle movement promote venous return;
calf massage is contraindicated due to risk of dislodging a clot, dependent positioning
worsens stasis, and platelet threshold is not the criterion for DVT prophylaxis. CJMM
Layer: Take Action
Correct Answer: A
Q9. M.J. has a history of iron deficiency anemia with Hgb 9.2 g/dL. Which dietary
teaching is appropriate?
A. Increase intake of red meat, leafy greens, and vitamin C with meals
B. Consume dairy products with each meal to enhance absorption
