ATI RN Adult Medical Surgical 2023
Proctored Exam with NGN 90
Questions and Answers-2026 Version.
update
This Exam contains:
Guarantee passing score
180 questions and Ansẉers
format set of multiple-choice
Expert-Verified Explanation
Verified ẉith trusted textbooks
,───────────────────────────────────────────────────────
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. 1: A nurse is caring for a client who requires protective isolation following a
hematopoietic stem cell transplant. Which of the following interventions should
the nurse implement to protect the client from infection?
A) Make sure the client’s room has positive-pressure airflow.
B) Make sure dietary plates and utensils are disposable.
C) Wear an N95 respirator when providing direct client care.
D) Monitor the client’s temperature once every 6 hr.
Correct answerA) Make sure the client’s room has positive-pressure airflow.
Expert-Explanation A client undergoing a hematopoietic stem cell transplant is
severely immunocompromised (neutropenic) and is at the highest risk for
opportunistic infections. Positive-pressure airflow rooms (or laminar airflow) are
designed to push air out of the room, preventing airborne pathogens from
entering. This is the standard for protective (neutropenic) isolation. Disposable
utensils are often used but are secondary to airflow management. An N95
respirator is for airborne precautions to protect staff from clients (e.g., TB), not
the other way around. Temperature monitoring is vital, but every 6 hours is too
infrequent for this high-risk client; usually, it is done every 1-4 hours. The
priority intervention based on the hierarchy of infection control is engineering
controls (airflow). For the NCLEX/ATI, always prioritize what physically prevents
the organism from reaching the patient. Positive pressure keeps "good" air in;
negative pressure keeps "bad" air out (used for TB or COVID). This client needs
protection from the outside environment, hence positive pressure.
. 2: A nurse is assessing a client who is 4 hours postoperative following an
open reduction internal fixation (ORIF) of the right ankle. Which of the following
assessment findings should the nurse report to the provider?
A) Extremity cool upon palpation.
B) Serosanguineous drainage on the dressing.
C) Capillary refill of 2 seconds.
D) Client report of discomfort when moving toes.
Correct answerA) Extremity cool upon palpation.
Expert-Explanation Following orthopedic surgery, specifically an ORIF, the
cardinal rule is to monitor for Compartment Syndrome or vascular compromise.
The "6 P's" include pain, pallor, pulselessness, paresthesia, poikilothermia
,(coolness), and paralysis. A cool extremity suggests decreased arterial blood
flow to the limb, which could indicate a vascular injury during surgery, a
developing hematoma compressing arteries, or severe edema cutting off
circulation. This is a medical emergency requiring immediate intervention (such
as a fasciotomy) to prevent tissue necrosis and loss of limb. Serosanguineous
drainage (pink-tinged fluid) is normal in the first 24 hours. Capillary refill of 2
seconds is normal. Discomfort when moving toes is expected after bone
surgery. However, if the pain is out of proportion to the injury and not relieved
by opioids, that is also a sign of compartment syndrome, but coolness indicates
actual ischemic changes, which is a later and more critical sign.
. 3: A nurse is reviewing the medical record of a client who has nephrotic
syndrome. Which of the following findings should the nurse expect?
A) Hyperalbuminemia.
B) Proteinuria.
C) Decreased serum lipid levels.
D) Decreased coagulation.
Correct answerB) Proteinuria.
Expert-Explanation Nephrotic syndrome is characterized by damage to the
glomeruli (the filtering units of the kidney). This damage causes the kidneys to
leak large amounts of protein (specifically albumin) from the blood into the
urine. The hallmark signs are proteinuria (specifically >3.5 g/24h),
hypoalbuminemia (low blood protein, not high), edema, and hyperlipidemia
(high cholesterol/triglycerides). The liver tries to compensate for the lost
protein by making more lipoproteins, leading to high serum lipid levels.
Regarding coagulation, clients with nephrotic syndrome lose antithrombin III (a
natural anticoagulant) in the urine, making them hypercoagulable (increased
risk of clots, not decreased). Therefore, the nurse should expect to see
significant protein on urine dipstick or 24-hour urine collection. Understanding
the pathophysiology of the glomerular basement membrane damage explains
why "proteinuria" is the only correct answer here.
. 4: A nurse is providing teaching for a client who is taking isoniazid (INH) for
tuberculosis. Which of the following statements by the client indicates an
understanding of the teaching?
A) "I plan to take this medication for 1 week."
B) "I should take an antacid with each dose of this medication."
C) "This medication may cause my blood pressure to increase."
, D) "I will have my liver function tested while I am taking this medication."
Correct answerD) "I will have my liver function tested while I am taking this
medication."
Expert-Explanation Isoniazid (INH) is hepatotoxic (toxic to the liver). Clients
must be monitored for signs of hepatitis (nausea, vomiting, dark urine,
jaundice) and have regular liver function tests (LFTs) to ensure the medication
isn't causing liver damage. Tuberculosis treatment lasts for 6 to 9 months
minimum, not 1 week. Antacids interfere with the absorption of INH; they
should be taken 1 hour before or 2 hours after the medication. INH does not
typically cause hypertension; it can cause peripheral neuropathy
(numbness/tingling) which is prevented by taking vitamin B6 (pyridoxine).
Client education for TB medications always revolves around adherence (directly
observed therapy) and monitoring for specific toxicity: INH = liver and
neuropathy, Rifampin = orange secretions, Ethambutol = vision changes.
. 5: A patient is admitted with an acute exacerbation of heart failure and is
receiving IV furosemide. After two doses, the nurse notes muscle weakness,
irregular heart rhythm, and serum potassium of 2.8 mEq/L. What is the nurse's
priority action?
A) Notify the provider and anticipate potassium replacement.
B) Encourage the patient to eat high-potassium foods.
C) Continue furosemide as prescribed.
D) Monitor intake and output closely.
Correct answerA) Notify the provider and anticipate potassium replacement.
Expert-Explanation Furosemide (Lasix) is a loop diuretic that causes the
excretion of potassium. A potassium level of 2.8 mEq/L is severely low (normal
~3.5-5.0). Hypokalemia leads to muscle weakness, cramping, and most
dangerously, cardiac dysrhythmias (irregular rhythm). The priority is to correct
the life-threatening electrolyte imbalance immediately. Dietary potassium (like
bananas or potatoes) is good for maintenance but will not raise a level of 2.8
fast enough to prevent cardiac arrest. Continuing furosemide will worsen the
hypokalemia. While monitoring I&O is important for heart failure, it does not
address the acute electrolyte crisis. The nurse should stop the furosemide (or
hold it), notify the provider, and prepare for IV or high-dose oral potassium
replacement. This . emphasizes the "Electrolytes" priority framework. A
potassium of 2.8 is a critical value requiring immediate intervention.
Proctored Exam with NGN 90
Questions and Answers-2026 Version.
update
This Exam contains:
Guarantee passing score
180 questions and Ansẉers
format set of multiple-choice
Expert-Verified Explanation
Verified ẉith trusted textbooks
,───────────────────────────────────────────────────────
─
. 1: A nurse is caring for a client who requires protective isolation following a
hematopoietic stem cell transplant. Which of the following interventions should
the nurse implement to protect the client from infection?
A) Make sure the client’s room has positive-pressure airflow.
B) Make sure dietary plates and utensils are disposable.
C) Wear an N95 respirator when providing direct client care.
D) Monitor the client’s temperature once every 6 hr.
Correct answerA) Make sure the client’s room has positive-pressure airflow.
Expert-Explanation A client undergoing a hematopoietic stem cell transplant is
severely immunocompromised (neutropenic) and is at the highest risk for
opportunistic infections. Positive-pressure airflow rooms (or laminar airflow) are
designed to push air out of the room, preventing airborne pathogens from
entering. This is the standard for protective (neutropenic) isolation. Disposable
utensils are often used but are secondary to airflow management. An N95
respirator is for airborne precautions to protect staff from clients (e.g., TB), not
the other way around. Temperature monitoring is vital, but every 6 hours is too
infrequent for this high-risk client; usually, it is done every 1-4 hours. The
priority intervention based on the hierarchy of infection control is engineering
controls (airflow). For the NCLEX/ATI, always prioritize what physically prevents
the organism from reaching the patient. Positive pressure keeps "good" air in;
negative pressure keeps "bad" air out (used for TB or COVID). This client needs
protection from the outside environment, hence positive pressure.
. 2: A nurse is assessing a client who is 4 hours postoperative following an
open reduction internal fixation (ORIF) of the right ankle. Which of the following
assessment findings should the nurse report to the provider?
A) Extremity cool upon palpation.
B) Serosanguineous drainage on the dressing.
C) Capillary refill of 2 seconds.
D) Client report of discomfort when moving toes.
Correct answerA) Extremity cool upon palpation.
Expert-Explanation Following orthopedic surgery, specifically an ORIF, the
cardinal rule is to monitor for Compartment Syndrome or vascular compromise.
The "6 P's" include pain, pallor, pulselessness, paresthesia, poikilothermia
,(coolness), and paralysis. A cool extremity suggests decreased arterial blood
flow to the limb, which could indicate a vascular injury during surgery, a
developing hematoma compressing arteries, or severe edema cutting off
circulation. This is a medical emergency requiring immediate intervention (such
as a fasciotomy) to prevent tissue necrosis and loss of limb. Serosanguineous
drainage (pink-tinged fluid) is normal in the first 24 hours. Capillary refill of 2
seconds is normal. Discomfort when moving toes is expected after bone
surgery. However, if the pain is out of proportion to the injury and not relieved
by opioids, that is also a sign of compartment syndrome, but coolness indicates
actual ischemic changes, which is a later and more critical sign.
. 3: A nurse is reviewing the medical record of a client who has nephrotic
syndrome. Which of the following findings should the nurse expect?
A) Hyperalbuminemia.
B) Proteinuria.
C) Decreased serum lipid levels.
D) Decreased coagulation.
Correct answerB) Proteinuria.
Expert-Explanation Nephrotic syndrome is characterized by damage to the
glomeruli (the filtering units of the kidney). This damage causes the kidneys to
leak large amounts of protein (specifically albumin) from the blood into the
urine. The hallmark signs are proteinuria (specifically >3.5 g/24h),
hypoalbuminemia (low blood protein, not high), edema, and hyperlipidemia
(high cholesterol/triglycerides). The liver tries to compensate for the lost
protein by making more lipoproteins, leading to high serum lipid levels.
Regarding coagulation, clients with nephrotic syndrome lose antithrombin III (a
natural anticoagulant) in the urine, making them hypercoagulable (increased
risk of clots, not decreased). Therefore, the nurse should expect to see
significant protein on urine dipstick or 24-hour urine collection. Understanding
the pathophysiology of the glomerular basement membrane damage explains
why "proteinuria" is the only correct answer here.
. 4: A nurse is providing teaching for a client who is taking isoniazid (INH) for
tuberculosis. Which of the following statements by the client indicates an
understanding of the teaching?
A) "I plan to take this medication for 1 week."
B) "I should take an antacid with each dose of this medication."
C) "This medication may cause my blood pressure to increase."
, D) "I will have my liver function tested while I am taking this medication."
Correct answerD) "I will have my liver function tested while I am taking this
medication."
Expert-Explanation Isoniazid (INH) is hepatotoxic (toxic to the liver). Clients
must be monitored for signs of hepatitis (nausea, vomiting, dark urine,
jaundice) and have regular liver function tests (LFTs) to ensure the medication
isn't causing liver damage. Tuberculosis treatment lasts for 6 to 9 months
minimum, not 1 week. Antacids interfere with the absorption of INH; they
should be taken 1 hour before or 2 hours after the medication. INH does not
typically cause hypertension; it can cause peripheral neuropathy
(numbness/tingling) which is prevented by taking vitamin B6 (pyridoxine).
Client education for TB medications always revolves around adherence (directly
observed therapy) and monitoring for specific toxicity: INH = liver and
neuropathy, Rifampin = orange secretions, Ethambutol = vision changes.
. 5: A patient is admitted with an acute exacerbation of heart failure and is
receiving IV furosemide. After two doses, the nurse notes muscle weakness,
irregular heart rhythm, and serum potassium of 2.8 mEq/L. What is the nurse's
priority action?
A) Notify the provider and anticipate potassium replacement.
B) Encourage the patient to eat high-potassium foods.
C) Continue furosemide as prescribed.
D) Monitor intake and output closely.
Correct answerA) Notify the provider and anticipate potassium replacement.
Expert-Explanation Furosemide (Lasix) is a loop diuretic that causes the
excretion of potassium. A potassium level of 2.8 mEq/L is severely low (normal
~3.5-5.0). Hypokalemia leads to muscle weakness, cramping, and most
dangerously, cardiac dysrhythmias (irregular rhythm). The priority is to correct
the life-threatening electrolyte imbalance immediately. Dietary potassium (like
bananas or potatoes) is good for maintenance but will not raise a level of 2.8
fast enough to prevent cardiac arrest. Continuing furosemide will worsen the
hypokalemia. While monitoring I&O is important for heart failure, it does not
address the acute electrolyte crisis. The nurse should stop the furosemide (or
hold it), notify the provider, and prepare for IV or high-dose oral potassium
replacement. This . emphasizes the "Electrolytes" priority framework. A
potassium of 2.8 is a critical value requiring immediate intervention.
