[ATI RN Medical Surgical Proctored Actual Exam with NGN]
[180 Questions – Detailed Answers Key]
[Section 1: Standard Multiple Choice (1–150)]
Q1: A 68-year-old client with a history of chronic heart failure (CHF) presents to the
emergency department with increasing dyspnea, orthopnea, and weight gain of 4 lbs
over 2 days. Vital signs: BP 162/94 mmHg, HR 112 bpm (irregular), RR 28/min, SpO2
88% on room air. Which assessment finding requires the nurse's immediate
intervention?
A. Weight gain of 4 lbs over 2 days
B. Blood pressure of 162/94 mmHg
C. Oxygen saturation of 88% on room air [CORRECT]
D. Irregular heart rate of 112 bpm
Correct Answer: C
Rationale: While all findings are concerning in CHF, the SpO2 of 88% indicates severe
hypoxemia and represents an immediate threat to the client's physiological integrity.
According to the ABCs priority framework, airway and breathing take precedence over
circulation issues. The client requires immediate supplemental oxygen and possible
ventilatory support. The weight gain (A) indicates fluid retention but is not immediately
life-threatening. The hypertension (B) and tachycardia (D) are compensatory responses
to hypoxemia and fluid overload; these will likely improve once oxygenation is
,addressed. The irregular rhythm suggests possible atrial fibrillation, which requires
attention but not before addressing hypoxemia.
Q2: A nurse is caring for a client 24 hours post-operative following a total hip
arthroplasty. The client reports sudden onset of chest pain and shortness of breath.
Vital signs: BP 98/60 mmHg, HR 118 bpm, RR 32/min, SpO2 89% on 2L NC. Which
action should the nurse take first?
A. Administer prescribed morphine for pain
B. Apply supplemental oxygen and notify the provider [CORRECT]
C. Obtain a 12-lead ECG
D. Assess for calf pain and swelling
Correct Answer: B
Rationale: This client presents with classic signs of pulmonary embolism (PE) – sudden
chest pain, dyspnea, tachypnea, tachycardia, and hypoxemia following orthopedic
surgery (high risk for deep vein thrombosis). The nurse's first priority is to address the
life-threatening hypoxemia by applying supplemental oxygen (increasing flow rate or
switching to high-flow device) and immediately notifying the provider for emergency
intervention including possible anticoagulation and imaging. While ECG (C) and
assessment for DVT source (D) are important diagnostic steps, they do not take
precedence over oxygenation. Pain management (A) is not a priority in this emergency
situation.
,Q3: A client with type 1 diabetes mellitus is admitted with diabetic ketoacidosis (DKA).
Laboratory values reveal: glucose 485 mg/dL, pH 7.28, HCO3 16 mEq/L, potassium 3.2
mEq/L. Which intervention should the nurse implement first?
A. Begin intravenous regular insulin infusion
B. Administer intravenous potassium replacement [CORRECT]
C. Infuse 0.9% sodium chloride at 1000 mL/hr
D. Obtain arterial blood gas
Correct Answer: B
Rationale: While DKA management typically involves fluid resuscitation and insulin
therapy, this client's potassium level of 3.2 mEq/L is critically low. Insulin administration
drives potassium intracellularly, potentially causing life-threatening hypokalemia
(cardiac dysrhythmias, arrest). Current ATI and ADA guidelines emphasize correcting
potassium to >3.3 mEq/L BEFORE initiating insulin therapy. Although fluid resuscitation
(C) is important, the immediate risk of cardiac complications from hypokalemia takes
precedence. The ABG (D) has already been drawn (pH is known), and insulin (A) must
wait until potassium is corrected.
Q4: A nurse is assessing a client with acute pancreatitis. Which finding indicates a
potential complication requiring immediate provider notification?
A. Severe epigastric pain radiating to the back
B. Grey Turner's sign (flank ecchymosis) [CORRECT]
C. Elevated serum amylase and lipase
, D. Nausea and vomiting
Correct Answer: B
Rationale: Grey Turner's sign (flank ecchymosis) indicates retroperitoneal hemorrhage, a
severe complication of acute pancreatitis associated with hemorrhagic pancreatitis and
high mortality. This finding suggests severe necrotizing pancreatitis requiring
immediate intervention (possible surgery, ICU transfer). While epigastric pain (A),
elevated enzymes (C), and GI symptoms (D) are expected findings in acute pancreatitis,
they do not indicate the same level of severity as hemorrhagic complications. Cullen's
sign (periumbilical ecchymosis) is another indicator of retroperitoneal bleeding
requiring urgent attention.
Q5: A client with chronic kidney disease (CKD) stage 4 is prescribed epoetin alfa. The
nurse should monitor for which therapeutic outcome?
A. Decreased blood urea nitrogen (BUN) level
B. Increased hemoglobin and hematocrit [CORRECT]
C. Reduced serum creatinine
D. Improved glomerular filtration rate
Correct Answer: B
Rationale: Epoetin alfa is a synthetic erythropoietin used to treat anemia of chronic
kidney disease. The therapeutic goal is to stimulate erythropoiesis, thereby increasing
hemoglobin (target 11-12 g/dL) and hematocrit. The nurse should monitor these values
along with iron studies, as functional iron deficiency often accompanies CKD. Epoetin
[180 Questions – Detailed Answers Key]
[Section 1: Standard Multiple Choice (1–150)]
Q1: A 68-year-old client with a history of chronic heart failure (CHF) presents to the
emergency department with increasing dyspnea, orthopnea, and weight gain of 4 lbs
over 2 days. Vital signs: BP 162/94 mmHg, HR 112 bpm (irregular), RR 28/min, SpO2
88% on room air. Which assessment finding requires the nurse's immediate
intervention?
A. Weight gain of 4 lbs over 2 days
B. Blood pressure of 162/94 mmHg
C. Oxygen saturation of 88% on room air [CORRECT]
D. Irregular heart rate of 112 bpm
Correct Answer: C
Rationale: While all findings are concerning in CHF, the SpO2 of 88% indicates severe
hypoxemia and represents an immediate threat to the client's physiological integrity.
According to the ABCs priority framework, airway and breathing take precedence over
circulation issues. The client requires immediate supplemental oxygen and possible
ventilatory support. The weight gain (A) indicates fluid retention but is not immediately
life-threatening. The hypertension (B) and tachycardia (D) are compensatory responses
to hypoxemia and fluid overload; these will likely improve once oxygenation is
,addressed. The irregular rhythm suggests possible atrial fibrillation, which requires
attention but not before addressing hypoxemia.
Q2: A nurse is caring for a client 24 hours post-operative following a total hip
arthroplasty. The client reports sudden onset of chest pain and shortness of breath.
Vital signs: BP 98/60 mmHg, HR 118 bpm, RR 32/min, SpO2 89% on 2L NC. Which
action should the nurse take first?
A. Administer prescribed morphine for pain
B. Apply supplemental oxygen and notify the provider [CORRECT]
C. Obtain a 12-lead ECG
D. Assess for calf pain and swelling
Correct Answer: B
Rationale: This client presents with classic signs of pulmonary embolism (PE) – sudden
chest pain, dyspnea, tachypnea, tachycardia, and hypoxemia following orthopedic
surgery (high risk for deep vein thrombosis). The nurse's first priority is to address the
life-threatening hypoxemia by applying supplemental oxygen (increasing flow rate or
switching to high-flow device) and immediately notifying the provider for emergency
intervention including possible anticoagulation and imaging. While ECG (C) and
assessment for DVT source (D) are important diagnostic steps, they do not take
precedence over oxygenation. Pain management (A) is not a priority in this emergency
situation.
,Q3: A client with type 1 diabetes mellitus is admitted with diabetic ketoacidosis (DKA).
Laboratory values reveal: glucose 485 mg/dL, pH 7.28, HCO3 16 mEq/L, potassium 3.2
mEq/L. Which intervention should the nurse implement first?
A. Begin intravenous regular insulin infusion
B. Administer intravenous potassium replacement [CORRECT]
C. Infuse 0.9% sodium chloride at 1000 mL/hr
D. Obtain arterial blood gas
Correct Answer: B
Rationale: While DKA management typically involves fluid resuscitation and insulin
therapy, this client's potassium level of 3.2 mEq/L is critically low. Insulin administration
drives potassium intracellularly, potentially causing life-threatening hypokalemia
(cardiac dysrhythmias, arrest). Current ATI and ADA guidelines emphasize correcting
potassium to >3.3 mEq/L BEFORE initiating insulin therapy. Although fluid resuscitation
(C) is important, the immediate risk of cardiac complications from hypokalemia takes
precedence. The ABG (D) has already been drawn (pH is known), and insulin (A) must
wait until potassium is corrected.
Q4: A nurse is assessing a client with acute pancreatitis. Which finding indicates a
potential complication requiring immediate provider notification?
A. Severe epigastric pain radiating to the back
B. Grey Turner's sign (flank ecchymosis) [CORRECT]
C. Elevated serum amylase and lipase
, D. Nausea and vomiting
Correct Answer: B
Rationale: Grey Turner's sign (flank ecchymosis) indicates retroperitoneal hemorrhage, a
severe complication of acute pancreatitis associated with hemorrhagic pancreatitis and
high mortality. This finding suggests severe necrotizing pancreatitis requiring
immediate intervention (possible surgery, ICU transfer). While epigastric pain (A),
elevated enzymes (C), and GI symptoms (D) are expected findings in acute pancreatitis,
they do not indicate the same level of severity as hemorrhagic complications. Cullen's
sign (periumbilical ecchymosis) is another indicator of retroperitoneal bleeding
requiring urgent attention.
Q5: A client with chronic kidney disease (CKD) stage 4 is prescribed epoetin alfa. The
nurse should monitor for which therapeutic outcome?
A. Decreased blood urea nitrogen (BUN) level
B. Increased hemoglobin and hematocrit [CORRECT]
C. Reduced serum creatinine
D. Improved glomerular filtration rate
Correct Answer: B
Rationale: Epoetin alfa is a synthetic erythropoietin used to treat anemia of chronic
kidney disease. The therapeutic goal is to stimulate erythropoiesis, thereby increasing
hemoglobin (target 11-12 g/dL) and hematocrit. The nurse should monitor these values
along with iron studies, as functional iron deficiency often accompanies CKD. Epoetin
