ATI RN MEDICAL SURGICAL 2023/2024
PROCTORED EXAM | LATEST | 100 QUESTION AND ANSWERS
❤️ Question 4: NGN Case Study - Myocardial Infarction
A client presents with chest pain radiating to the left arm, diaphoresis, and nausea. The
ECG shows ST-segment elevation in leads II, III, and aVF. Which intervention should the
nurse anticipate first?
A) Administer sublingual nitroglycerin
B) Prepare for percutaneous coronary intervention (PCI)
C) Administer IV morphine sulfate
D) Obtain cardiac enzymes
Answer: B) Prepare for percutaneous coronary intervention (PCI)
Rationale: ST-elevation MI (STEMI) is a medical emergency. The priority is rapid
reperfusion, with PCI being the gold standard if available within 90 minutes of arrival.
While nitroglycerin, morphine, and enzymes are all important, PCI is the definitive
treatment.
🧠 Question 5: NGN Case Study - Stroke Assessment
A client is brought to the emergency department with sudden onset of right-sided
weakness, facial droop, and slurred speech. The client's symptoms began 1 hour ago.
Which action should the nurse take first?
A) Obtain a CT scan of the head
B) Start an IV line
C) Perform a bedside swallow screening
D) Administer aspirin
,Answer: A) Obtain a CT scan of the head
Rationale: For a client with suspected acute ischemic stroke, a non-contrast CT scan
must be obtained immediately to differentiate between ischemic and hemorrhagic
stroke. This determines whether thrombolytics (tPA) can be administered. The time
frame is critical (within 3-4.5 hours of symptom onset).
🩸 Question 6: Multiple-Select NGN - Transfusion Reaction
A client is receiving a blood transfusion and suddenly reports chills, lower back pain, and
nausea. What are the nurse's priority actions? (Select all that apply.)
A) Stop the blood transfusion
B) Maintain IV access with normal saline
C) Notify the blood bank
D) Administer diphenhydramine
E) Document the reaction
Answer: A, B, C, D, E
Rationale: A transfusion reaction is an emergency. The nurse should stop the
transfusion, maintain IV access with normal saline (using new tubing), notify the provider
and blood bank, administer antihistamines as prescribed, and document all findings and
actions.
🫀 Question 7: NGN Case Study - Cardiac Tamponade
A client who had cardiac surgery 2 days ago develops muffled heart sounds, jugular
venous distension, and hypotension. Which condition should the nurse suspect?
A) Cardiac tamponade
B) Pulmonary embolism
C) Myocardial infarction
D) Aortic dissection
,Answer: A) Cardiac tamponade
Rationale: The classic triad of cardiac tamponade is Beck's triad: muffled heart sounds,
JVD, and hypotension. This occurs due to fluid accumulation in the pericardial sac
compressing the heart. It is a medical emergency requiring pericardiocentesis.
💉 Question 8: NGN Case Study - Insulin Administration
A client with type 1 diabetes has a blood glucose of 320 mg/dL and moderate ketones
in the urine. The provider orders regular insulin IV. Which action should the nurse take?
A) Administer insulin subcutaneously
B) Use an insulin infusion pump
C) Administer insulin IV push
D) Prepare a continuous IV insulin infusion
Answer: D) Prepare a continuous IV insulin infusion
Rationale: In diabetic ketoacidosis (DKA), regular insulin is given as a continuous IV
infusion for rapid and controlled lowering of blood glucose. IV bolus may also be given
initially, but the infusion is the standard maintenance therapy. Subcutaneous
administration is not appropriate in DKA due to poor tissue perfusion.
🫁 Question 9: Multiple-Select NGN - Pneumonia Interventions
A client is admitted with pneumonia. Which interventions should the nurse include in
the plan of care? (Select all that apply.)
A) Encourage deep breathing and coughing
B) Administer antibiotics as prescribed
C) Restrict oral fluids
D) Monitor oxygen saturation
E) Provide antipyretics for fever
, Answer: A, B, D, E
Rationale: Pneumonia management includes antibiotics, deep breathing/coughing to
clear secretions, monitoring oxygenation, and antipyretics for fever. Fluids should be
encouraged to thin secretions, not restricted.
🧬 Question 10: NGN Case Study - Hyponatremia
A client has a serum sodium of 125 mEq/L. Which neurologic manifestation should the
nurse expect?
A) Hyperreflexia
B) Confusion
C) Seizures
D) Muscle rigidity
E) Headache
Answer: B) Confusion
Rationale: Hyponatremia (Na+ <135 mEq/L) causes cerebral edema and neurologic
symptoms including confusion, headache, nausea, and seizures. Confusion is an early
sign. In severe cases, seizures and coma can occur. The hallmark symptom is altered
mental status.
🦴 Question 11: NGN Case Study - Osteomyelitis
A client is diagnosed with acute osteomyelitis of the right tibia. Which intervention is the
priority?
A) Immobilize the affected leg
B) Apply heat to the area
C) Perform passive range-of-motion exercises
D) Ambulate with assistance
PROCTORED EXAM | LATEST | 100 QUESTION AND ANSWERS
❤️ Question 4: NGN Case Study - Myocardial Infarction
A client presents with chest pain radiating to the left arm, diaphoresis, and nausea. The
ECG shows ST-segment elevation in leads II, III, and aVF. Which intervention should the
nurse anticipate first?
A) Administer sublingual nitroglycerin
B) Prepare for percutaneous coronary intervention (PCI)
C) Administer IV morphine sulfate
D) Obtain cardiac enzymes
Answer: B) Prepare for percutaneous coronary intervention (PCI)
Rationale: ST-elevation MI (STEMI) is a medical emergency. The priority is rapid
reperfusion, with PCI being the gold standard if available within 90 minutes of arrival.
While nitroglycerin, morphine, and enzymes are all important, PCI is the definitive
treatment.
🧠 Question 5: NGN Case Study - Stroke Assessment
A client is brought to the emergency department with sudden onset of right-sided
weakness, facial droop, and slurred speech. The client's symptoms began 1 hour ago.
Which action should the nurse take first?
A) Obtain a CT scan of the head
B) Start an IV line
C) Perform a bedside swallow screening
D) Administer aspirin
,Answer: A) Obtain a CT scan of the head
Rationale: For a client with suspected acute ischemic stroke, a non-contrast CT scan
must be obtained immediately to differentiate between ischemic and hemorrhagic
stroke. This determines whether thrombolytics (tPA) can be administered. The time
frame is critical (within 3-4.5 hours of symptom onset).
🩸 Question 6: Multiple-Select NGN - Transfusion Reaction
A client is receiving a blood transfusion and suddenly reports chills, lower back pain, and
nausea. What are the nurse's priority actions? (Select all that apply.)
A) Stop the blood transfusion
B) Maintain IV access with normal saline
C) Notify the blood bank
D) Administer diphenhydramine
E) Document the reaction
Answer: A, B, C, D, E
Rationale: A transfusion reaction is an emergency. The nurse should stop the
transfusion, maintain IV access with normal saline (using new tubing), notify the provider
and blood bank, administer antihistamines as prescribed, and document all findings and
actions.
🫀 Question 7: NGN Case Study - Cardiac Tamponade
A client who had cardiac surgery 2 days ago develops muffled heart sounds, jugular
venous distension, and hypotension. Which condition should the nurse suspect?
A) Cardiac tamponade
B) Pulmonary embolism
C) Myocardial infarction
D) Aortic dissection
,Answer: A) Cardiac tamponade
Rationale: The classic triad of cardiac tamponade is Beck's triad: muffled heart sounds,
JVD, and hypotension. This occurs due to fluid accumulation in the pericardial sac
compressing the heart. It is a medical emergency requiring pericardiocentesis.
💉 Question 8: NGN Case Study - Insulin Administration
A client with type 1 diabetes has a blood glucose of 320 mg/dL and moderate ketones
in the urine. The provider orders regular insulin IV. Which action should the nurse take?
A) Administer insulin subcutaneously
B) Use an insulin infusion pump
C) Administer insulin IV push
D) Prepare a continuous IV insulin infusion
Answer: D) Prepare a continuous IV insulin infusion
Rationale: In diabetic ketoacidosis (DKA), regular insulin is given as a continuous IV
infusion for rapid and controlled lowering of blood glucose. IV bolus may also be given
initially, but the infusion is the standard maintenance therapy. Subcutaneous
administration is not appropriate in DKA due to poor tissue perfusion.
🫁 Question 9: Multiple-Select NGN - Pneumonia Interventions
A client is admitted with pneumonia. Which interventions should the nurse include in
the plan of care? (Select all that apply.)
A) Encourage deep breathing and coughing
B) Administer antibiotics as prescribed
C) Restrict oral fluids
D) Monitor oxygen saturation
E) Provide antipyretics for fever
, Answer: A, B, D, E
Rationale: Pneumonia management includes antibiotics, deep breathing/coughing to
clear secretions, monitoring oxygenation, and antipyretics for fever. Fluids should be
encouraged to thin secretions, not restricted.
🧬 Question 10: NGN Case Study - Hyponatremia
A client has a serum sodium of 125 mEq/L. Which neurologic manifestation should the
nurse expect?
A) Hyperreflexia
B) Confusion
C) Seizures
D) Muscle rigidity
E) Headache
Answer: B) Confusion
Rationale: Hyponatremia (Na+ <135 mEq/L) causes cerebral edema and neurologic
symptoms including confusion, headache, nausea, and seizures. Confusion is an early
sign. In severe cases, seizures and coma can occur. The hallmark symptom is altered
mental status.
🦴 Question 11: NGN Case Study - Osteomyelitis
A client is diagnosed with acute osteomyelitis of the right tibia. Which intervention is the
priority?
A) Immobilize the affected leg
B) Apply heat to the area
C) Perform passive range-of-motion exercises
D) Ambulate with assistance
