ATI PN NURSING
PN Adult Medical-Surgical Nursing
Edition 12.0 - Verified Questions and Correct Answers
Official Practice Exam · 2026/2027 Academic Year
Practical Nursing · Adult Medical-Surgical Certification Review
Questions Minutes Passing Score Recertification
100 120 80% Annual
Table of Contents
SECTION 1: Cardiovascular & Hematologic Disorders (18 Questions)
SECTION 2: Respiratory Disorders (17 Questions)
SECTION 3: Gastrointestinal & Nutritional Disorders (17 Questions)
SECTION 4: Neurological & Sensory Disorders (17 Questions)
SECTION 5: Endocrine, Renal & Urinary Disorders (16 Questions)
SECTION 6: Musculoskeletal, Integumentary & Immune Disorders (15 Questions)
Instructions
This practice exam is designed to simulate the actual PN Adult Medical-Surgical Nursing Edition 12.0 certification examination.
Each question presents a realistic clinical scenario followed by four answer choices. Select the best answer for each question.
The correct answer and a detailed rationale are provided after each question for study purposes. A passing score of 80% or
higher (80 out of 100 correct) is required. Review all rationales carefully to strengthen your understanding of adult
medical-surgical nursing concepts, clinical judgment, and evidence-based practice.
Good luck on your PN Adult Medical-Surgical Nursing examination!
,PN Med-Surg Nursing - 2026/2027 | Passing Score: 80% | Page 2
SECTION 1: Cardiovascular & Hematologic Disorders (18 Questions) · 2026/2027
Q1 Question 1 of 100
A 67-year-old male patient is admitted to the telemetry unit with complaints of substernal chest pain radiating to
his left arm that began 45 minutes ago while shoveling snow. The 12-lead ECG shows ST-segment elevation in
leads II, III, and aVF. The nurse recognizes this pattern indicates an acute myocardial infarction in which
location?
B. Inferior wall of the left ventricle
A. Anterior wall of the left ventricle
C. Lateral wall of the left ventricle
D. Right ventricle
Correct Answer: A
Rationale:
ST-segment elevation in leads II, III, and aVF is the classic ECG pattern for an inferior wall myocardial infarction, which
results from occlusion of the right coronary artery. Anterior wall MI would show ST elevation in V1 through V4, while
lateral wall MI involves leads I, aVL, V5, and V6. Recognizing the location helps anticipate complications such as
bradycardia and hypotension common with inferior MI.
Q2 Question 2 of 100
A 72-year-old female with a history of atrial fibrillation is prescribed warfarin (Coumadin) for stroke prevention.
During a routine clinic visit, her INR is 4.8. The patient reports experiencing gum bleeding when brushing her
teeth. What is the priority nursing action?
B. Hold the next dose of warfarin and notify the provider immediately for dose adjustment
A. Instruct the patient to continue the current dose and return in one week for a repeat INR
C. Administer vitamin K intravenously as an emergency reversal agent
D. Advise the patient to use a soft-bristle toothbrush and monitor for additional bleeding
Correct Answer: A
Rationale:
An INR of 4.8 is significantly above the therapeutic range of 2.0 to 3.0 for atrial fibrillation, and the patient is already
exhibiting signs of bleeding. The priority action is to hold the next warfarin dose and notify the provider for dose
adjustment. While vitamin K may be needed for severe bleeding, intravenous administration is reserved for
life-threatening hemorrhage, not for an elevated INR with minor gum bleeding. Simply monitoring or continuing the
current dose would be unsafe.
,PN Med-Surg Nursing - 2026/2027 | Passing Score: 80% | Page 3
Q3 Question 3 of 100
A 58-year-old male with hypertension and type 2 diabetes presents to the emergency department with sudden
onset of severe, tearing chest pain that radiates to his back between the shoulder blades. His blood pressure is
180/110 mmHg in the right arm and 140/85 mmHg in the left arm. What condition should the nurse suspect?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Tension pneumothorax
Correct Answer: C
Rationale:
The classic presentation of an aortic dissection includes sudden, severe tearing or ripping chest pain that radiates to
the back, along with a significant blood pressure differential between the arms (greater than 20 mmHg), which
indicates involvement of the subclavian artery. While acute MI also causes chest pain, it is typically described as
pressure or squeezing rather than tearing. Pulmonary embolism usually presents with dyspnea and pleuritic pain, and
tension pneumothorax causes absent breath sounds on the affected side.
Q4 Question 4 of 100
A 65-year-old female is admitted with a diagnosis of heart failure (NYHA Class III). She reports dyspnea with
less-than-ordinary activity, orthopnea requiring three pillows, and peripheral edema in both ankles. Which
assessment finding would the nurse expect when auscultating her lungs?
A. Clear lung sounds bilaterally
B. Wheezing in the upper lobes
C. Crackles in the bilateral bases
D. Stridor over the trachea
Correct Answer: C
Rationale:
Crackles (rales) in the bilateral bases are the hallmark auscultatory finding in left-sided heart failure due to pulmonary
congestion from fluid backing up into the lungs. Orthopnea and dyspnea on exertion are consistent with this pulmonary
fluid accumulation. Wheezing suggests bronchospasm or asthma, stridor indicates upper airway obstruction, and clear
lung sounds would not be expected in a patient with symptomatic heart failure and orthopnea.
, PN Med-Surg Nursing - 2026/2027 | Passing Score: 80% | Page 4
Q5 Question 5 of 100
A 49-year-old male is admitted with deep vein thrombosis (DVT) in his right leg and is started on a continuous
heparin infusion. Six hours after the infusion begins, the lab reports an aPTT of 95 seconds. The therapeutic
range for heparin is 60 to 80 seconds. What action should the nurse take?
A. Increase the heparin infusion rate to achieve a higher aPTT
B. Continue the current infusion rate and recheck the aPTT in 6 hours
C. Stop the infusion temporarily and notify the provider for a rate adjustment
D. Administer protamine sulfate immediately to reverse the heparin
Correct Answer: C
Rationale:
An aPTT of 95 seconds is above the therapeutic range of 60 to 80 seconds, indicating the patient is at increased risk
for bleeding. The correct action is to stop the infusion temporarily (per protocol) and notify the provider, who will likely
order a rate reduction. Protamine sulfate is the reversal agent for heparin but is reserved for significant bleeding, not
just an elevated aPTT. Increasing the rate would further elevate the aPTT and increase bleeding risk.
Q6 Question 6 of 100
A 73-year-old male with a history of coronary artery disease undergoes a percutaneous coronary intervention
(PCI) with stent placement. The provider prescribes dual antiplatelet therapy with aspirin and clopidogrel
(Plavix). The patient asks why he needs both medications. What is the best explanation?
A. Aspirin prevents platelet aggregation while clopidogrel prevents clot formation through a
different pathway, providing complementary protection against stent thrombosis
B. Clopidogrel reduces cholesterol levels while aspirin prevents platelet aggregation
C. Both medications thin the blood in the same way but the combination allows lower doses of each
D. Aspirin is only needed for pain relief after the procedure, while clopidogrel protects the stent
Correct Answer: A
Rationale:
Dual antiplatelet therapy after PCI with stent placement uses two medications that work through different mechanisms:
aspirin inhibits thromboxane A2 synthesis to prevent platelet aggregation, while clopidogrel blocks the P2Y12 ADP
receptor on platelets to inhibit activation through a separate pathway. This complementary approach significantly
reduces the risk of stent thrombosis compared to either agent alone. Clopidogrel does not affect cholesterol, and both
drugs target platelets, not blood thinning in the anticoagulant sense.
PN Adult Medical-Surgical Nursing
Edition 12.0 - Verified Questions and Correct Answers
Official Practice Exam · 2026/2027 Academic Year
Practical Nursing · Adult Medical-Surgical Certification Review
Questions Minutes Passing Score Recertification
100 120 80% Annual
Table of Contents
SECTION 1: Cardiovascular & Hematologic Disorders (18 Questions)
SECTION 2: Respiratory Disorders (17 Questions)
SECTION 3: Gastrointestinal & Nutritional Disorders (17 Questions)
SECTION 4: Neurological & Sensory Disorders (17 Questions)
SECTION 5: Endocrine, Renal & Urinary Disorders (16 Questions)
SECTION 6: Musculoskeletal, Integumentary & Immune Disorders (15 Questions)
Instructions
This practice exam is designed to simulate the actual PN Adult Medical-Surgical Nursing Edition 12.0 certification examination.
Each question presents a realistic clinical scenario followed by four answer choices. Select the best answer for each question.
The correct answer and a detailed rationale are provided after each question for study purposes. A passing score of 80% or
higher (80 out of 100 correct) is required. Review all rationales carefully to strengthen your understanding of adult
medical-surgical nursing concepts, clinical judgment, and evidence-based practice.
Good luck on your PN Adult Medical-Surgical Nursing examination!
,PN Med-Surg Nursing - 2026/2027 | Passing Score: 80% | Page 2
SECTION 1: Cardiovascular & Hematologic Disorders (18 Questions) · 2026/2027
Q1 Question 1 of 100
A 67-year-old male patient is admitted to the telemetry unit with complaints of substernal chest pain radiating to
his left arm that began 45 minutes ago while shoveling snow. The 12-lead ECG shows ST-segment elevation in
leads II, III, and aVF. The nurse recognizes this pattern indicates an acute myocardial infarction in which
location?
B. Inferior wall of the left ventricle
A. Anterior wall of the left ventricle
C. Lateral wall of the left ventricle
D. Right ventricle
Correct Answer: A
Rationale:
ST-segment elevation in leads II, III, and aVF is the classic ECG pattern for an inferior wall myocardial infarction, which
results from occlusion of the right coronary artery. Anterior wall MI would show ST elevation in V1 through V4, while
lateral wall MI involves leads I, aVL, V5, and V6. Recognizing the location helps anticipate complications such as
bradycardia and hypotension common with inferior MI.
Q2 Question 2 of 100
A 72-year-old female with a history of atrial fibrillation is prescribed warfarin (Coumadin) for stroke prevention.
During a routine clinic visit, her INR is 4.8. The patient reports experiencing gum bleeding when brushing her
teeth. What is the priority nursing action?
B. Hold the next dose of warfarin and notify the provider immediately for dose adjustment
A. Instruct the patient to continue the current dose and return in one week for a repeat INR
C. Administer vitamin K intravenously as an emergency reversal agent
D. Advise the patient to use a soft-bristle toothbrush and monitor for additional bleeding
Correct Answer: A
Rationale:
An INR of 4.8 is significantly above the therapeutic range of 2.0 to 3.0 for atrial fibrillation, and the patient is already
exhibiting signs of bleeding. The priority action is to hold the next warfarin dose and notify the provider for dose
adjustment. While vitamin K may be needed for severe bleeding, intravenous administration is reserved for
life-threatening hemorrhage, not for an elevated INR with minor gum bleeding. Simply monitoring or continuing the
current dose would be unsafe.
,PN Med-Surg Nursing - 2026/2027 | Passing Score: 80% | Page 3
Q3 Question 3 of 100
A 58-year-old male with hypertension and type 2 diabetes presents to the emergency department with sudden
onset of severe, tearing chest pain that radiates to his back between the shoulder blades. His blood pressure is
180/110 mmHg in the right arm and 140/85 mmHg in the left arm. What condition should the nurse suspect?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Tension pneumothorax
Correct Answer: C
Rationale:
The classic presentation of an aortic dissection includes sudden, severe tearing or ripping chest pain that radiates to
the back, along with a significant blood pressure differential between the arms (greater than 20 mmHg), which
indicates involvement of the subclavian artery. While acute MI also causes chest pain, it is typically described as
pressure or squeezing rather than tearing. Pulmonary embolism usually presents with dyspnea and pleuritic pain, and
tension pneumothorax causes absent breath sounds on the affected side.
Q4 Question 4 of 100
A 65-year-old female is admitted with a diagnosis of heart failure (NYHA Class III). She reports dyspnea with
less-than-ordinary activity, orthopnea requiring three pillows, and peripheral edema in both ankles. Which
assessment finding would the nurse expect when auscultating her lungs?
A. Clear lung sounds bilaterally
B. Wheezing in the upper lobes
C. Crackles in the bilateral bases
D. Stridor over the trachea
Correct Answer: C
Rationale:
Crackles (rales) in the bilateral bases are the hallmark auscultatory finding in left-sided heart failure due to pulmonary
congestion from fluid backing up into the lungs. Orthopnea and dyspnea on exertion are consistent with this pulmonary
fluid accumulation. Wheezing suggests bronchospasm or asthma, stridor indicates upper airway obstruction, and clear
lung sounds would not be expected in a patient with symptomatic heart failure and orthopnea.
, PN Med-Surg Nursing - 2026/2027 | Passing Score: 80% | Page 4
Q5 Question 5 of 100
A 49-year-old male is admitted with deep vein thrombosis (DVT) in his right leg and is started on a continuous
heparin infusion. Six hours after the infusion begins, the lab reports an aPTT of 95 seconds. The therapeutic
range for heparin is 60 to 80 seconds. What action should the nurse take?
A. Increase the heparin infusion rate to achieve a higher aPTT
B. Continue the current infusion rate and recheck the aPTT in 6 hours
C. Stop the infusion temporarily and notify the provider for a rate adjustment
D. Administer protamine sulfate immediately to reverse the heparin
Correct Answer: C
Rationale:
An aPTT of 95 seconds is above the therapeutic range of 60 to 80 seconds, indicating the patient is at increased risk
for bleeding. The correct action is to stop the infusion temporarily (per protocol) and notify the provider, who will likely
order a rate reduction. Protamine sulfate is the reversal agent for heparin but is reserved for significant bleeding, not
just an elevated aPTT. Increasing the rate would further elevate the aPTT and increase bleeding risk.
Q6 Question 6 of 100
A 73-year-old male with a history of coronary artery disease undergoes a percutaneous coronary intervention
(PCI) with stent placement. The provider prescribes dual antiplatelet therapy with aspirin and clopidogrel
(Plavix). The patient asks why he needs both medications. What is the best explanation?
A. Aspirin prevents platelet aggregation while clopidogrel prevents clot formation through a
different pathway, providing complementary protection against stent thrombosis
B. Clopidogrel reduces cholesterol levels while aspirin prevents platelet aggregation
C. Both medications thin the blood in the same way but the combination allows lower doses of each
D. Aspirin is only needed for pain relief after the procedure, while clopidogrel protects the stent
Correct Answer: A
Rationale:
Dual antiplatelet therapy after PCI with stent placement uses two medications that work through different mechanisms:
aspirin inhibits thromboxane A2 synthesis to prevent platelet aggregation, while clopidogrel blocks the P2Y12 ADP
receptor on platelets to inhibit activation through a separate pathway. This complementary approach significantly
reduces the risk of stent thrombosis compared to either agent alone. Clopidogrel does not affect cholesterol, and both
drugs target platelets, not blood thinning in the anticoagulant sense.
