ATI RN Medical-Surgical (Med-Surg) Proctored Exam | NGN Practice
Questions with Answers & Rationales | Comprehensive Study Guide
Question 1
A nurse is reviewing the provider’s prescriptions for a client who has a serum potassium
level of 6.2 mEq/L. Which of the following medications should the nurse expect to
administer?
A. Potassium chloride IV infusion
B. Sodium polystyrene sulfonate
C. Spironolactone
D. Furosemide continuous infusion
Answer: B. Sodium polystyrene sulfonate
Rationale: A serum potassium level of 6.2 mEq/L indicates severe hyperkalemia.
Sodium polystyrene sulfonate is an ion-exchange resin that binds potassium in the
gastrointestinal tract and excretes it through feces. Potassium chloride would worsen
hyperkalemia, spironolactone is a potassium-sparing diuretic that would increase levels,
and while furosemide is a loop diuretic that excretes potassium, a continuous infusion is
not the primary immediate medication used compared to binding resins or
insulin/glucose protocols.
Question 2
A nurse is providing discharge teaching to a client who has a new prescription for
warfarin. Which of the following instructions should the nurse include?
A. Increase consumption of dark green leafy vegetables.
B. Use a firm-bristled toothbrush to maintain oral hygiene.
C. Report any black, tarry stools to the provider immediately.
D. Take aspirin for mild headaches or body aches.
Answer: C. Report any black, tarry stools to the provider immediately.
Rationale: Warfarin is an anticoagulant that increases the risk of bleeding. Black, tarry
stools indicate gastrointestinal bleeding and must be reported immediately. Clients
should maintain a consistent intake of vitamin K (found in dark green leafy vegetables)
rather than increasing it, as vitamin K is the antidote and can decrease warfarin's
effectiveness. Clients should use soft-bristled toothbrushes and avoid aspirin due to
increased bleeding risks.
Question 3
,A nurse is caring for a client who is in the compensatory stage of shock. Which of the
following clinical manifestations should the nurse expect?
A. Bradycardia
B. Hypotension
C. Cold, clammy skin
D. Decreased respiratory rate
Answer: C. Cold, clammy skin
Rationale: In the compensatory stage of shock, the sympathetic nervous system is
stimulated, resulting in vasoconstriction to shunt blood to vital organs (heart and brain).
This shunting causes the skin to become cool, clammy, and pale. The heart rate and
respiratory rate increase during this stage to maintain cardiac output and oxygenation.
Blood pressure is often maintained within normal limits due to compensatory
mechanisms.
Question 4
A nurse is assessing a client who has a history of left-sided heart failure. Which of the
following findings should the nurse expect?
A. Jugular venous distention
B. Dependent pitting edema
C. Pulmonary crackles
D. Hepatosplenomegaly
Answer: C. Pulmonary crackles
Rationale: Left-sided heart failure leads to pulmonary congestion due to the back-up of
blood from the left ventricle into the pulmonary vasculature. This results in respiratory
manifestations such as dyspnea, orthopnea, cough, and crackles. Jugular venous
distention, dependent edema, and hepatosplenomegaly are characteristic signs of right-
sided heart failure caused by systemic venous congestion.
Question 5
A nurse is preparing to care for a client who has a suspected diagnosis of bacterial
meningitis. Which of the following infection control precautions should the nurse
implement?
A. Airborne precautions
B. Droplet precautions
C. Contact precautions
D. Protective isolation
Answer: B. Droplet precautions
Rationale: Bacterial meningitis (caused by organisms like Neisseria meningitidis) is
transmitted via large-particle droplets from the respiratory tract. Droplet precautions
,require a private room and the use of a surgical mask by staff when within 3 feet of the
client. Airborne precautions are used for smaller droplets like tuberculosis or varicella.
Question 6
A nurse is reviewing lab results for a client with acute pancreatitis. Which of the
following laboratory values should the nurse expect to be elevated?
A. Serum calcium
B. Serum amylase
C. Serum potassium
D. White blood cell count decrease
Answer: B. Serum amylase
Rationale: Acute pancreatitis causes inflammation and auto-digestion of the pancreas,
leading to the release of pancreatic enzymes into the bloodstream. Serum amylase and
lipase levels rise significantly within 24 hours of symptom onset. Serum calcium levels
typically decrease (hypocalcemia) due to fat necrosis binding calcium.
Question 7
A nurse is teaching a client who has a new diagnosis of chronic kidney disease (CKD)
about dietary restrictions. Which of the following modifications should the nurse
emphasize?
A. Increase dietary phosphorus intake.
B. Limit protein intake to prevent uremia.
C. Use salt substitutes to lower sodium levels.
D. Increase fluid intake to 3 liters per day.
Answer: B. Limit protein intake to prevent uremia.
Rationale: In CKD, the kidneys cannot efficiently excrete urea and other nitrogenous
waste products of protein metabolism, leading to uremia. Limiting protein intake helps
slow the progression of kidney disease. Phosphorus must be restricted, not increased.
Salt substitutes often contain potassium chloride and should be avoided due to the risk
of hyperkalemia. Fluids are typically restricted based on urine output.
Question 8
A nurse is monitoring a client who is receiving mechanical ventilation. The low-pressure
alarm on the ventilator begins to sound. Which of the following issues should the nurse
suspect?
A. The client is biting the endotracheal tube.
B. Excess secretions are present in the airway.
C. A disconnection has occurred in the ventilator circuit.
D. The client is fighting the ventilator.
Answer: C. A disconnection has occurred in the ventilator circuit.
, Rationale: Low-pressure alarms are triggered by a drop in airway pressure, which most
commonly indicates a circuit disconnection, an air leak in the cuff, or a total
displacement of the tube. High-pressure alarms are triggered by increased resistance,
such as biting the tube, secretions, coughing, or bronchospasms.
Question 9
A nurse is caring for a client who has a cast applied to the right lower extremity 4 hours
ago. The client reports severe, escalating pain that is unrelieved by the prescribed
opioid medication. Which of the following actions should the nurse take first?
A. Administer an additional dose of pain medication.
B. Elevate the extremity above the level of the heart.
C. Apply an ice pack to the external cast surface.
D. Assess the pedal pulse and capillary refill of the affected extremity.
Answer: D. Assess the pedal pulse and capillary refill of the affected extremity.
Rationale: Severe, escalating pain that is unresponsive to opioids following a fracture or
cast application is a primary indicator of compartment syndrome. The nurse must
immediately assess neurovascular status (pulses, capillary refill, paresthesia, pallor) to
detect ischemia. Elevating the limb above the heart is contraindicated in suspected
compartment syndrome as it further decreases arterial perfusion.
Question 10
A nurse is preparing to administer a regular insulin sliding scale dose to a client before
breakfast. The client's blood glucose is 280 mg/dL. When should the nurse administer
this insulin?
A. 30 minutes before the meal arrives.
B. Immediately after the client finishes eating.
C. 2 hours after the breakfast meal.
D. Concurrently with a long-acting insulin in the same syringe.
Answer: A. 30 minutes before the meal arrives.
Rationale: Regular insulin is a short-acting insulin with an onset of action of 30 to 60
minutes. To match its peak action with postprandial blood glucose spikes, it must be
administered approximately 30 minutes before eating. Regular insulin should not be
given after meals for routine sliding scales and should not be mixed with long-acting
insulins like glargine.
Question 11
A nurse is assessing a client who has peripheral arterial disease (PAD). Which of the
following clinical manifestations should the nurse expect?
A. Pitting edema around the ankles
B. Intermittent claudication during ambulation
Questions with Answers & Rationales | Comprehensive Study Guide
Question 1
A nurse is reviewing the provider’s prescriptions for a client who has a serum potassium
level of 6.2 mEq/L. Which of the following medications should the nurse expect to
administer?
A. Potassium chloride IV infusion
B. Sodium polystyrene sulfonate
C. Spironolactone
D. Furosemide continuous infusion
Answer: B. Sodium polystyrene sulfonate
Rationale: A serum potassium level of 6.2 mEq/L indicates severe hyperkalemia.
Sodium polystyrene sulfonate is an ion-exchange resin that binds potassium in the
gastrointestinal tract and excretes it through feces. Potassium chloride would worsen
hyperkalemia, spironolactone is a potassium-sparing diuretic that would increase levels,
and while furosemide is a loop diuretic that excretes potassium, a continuous infusion is
not the primary immediate medication used compared to binding resins or
insulin/glucose protocols.
Question 2
A nurse is providing discharge teaching to a client who has a new prescription for
warfarin. Which of the following instructions should the nurse include?
A. Increase consumption of dark green leafy vegetables.
B. Use a firm-bristled toothbrush to maintain oral hygiene.
C. Report any black, tarry stools to the provider immediately.
D. Take aspirin for mild headaches or body aches.
Answer: C. Report any black, tarry stools to the provider immediately.
Rationale: Warfarin is an anticoagulant that increases the risk of bleeding. Black, tarry
stools indicate gastrointestinal bleeding and must be reported immediately. Clients
should maintain a consistent intake of vitamin K (found in dark green leafy vegetables)
rather than increasing it, as vitamin K is the antidote and can decrease warfarin's
effectiveness. Clients should use soft-bristled toothbrushes and avoid aspirin due to
increased bleeding risks.
Question 3
,A nurse is caring for a client who is in the compensatory stage of shock. Which of the
following clinical manifestations should the nurse expect?
A. Bradycardia
B. Hypotension
C. Cold, clammy skin
D. Decreased respiratory rate
Answer: C. Cold, clammy skin
Rationale: In the compensatory stage of shock, the sympathetic nervous system is
stimulated, resulting in vasoconstriction to shunt blood to vital organs (heart and brain).
This shunting causes the skin to become cool, clammy, and pale. The heart rate and
respiratory rate increase during this stage to maintain cardiac output and oxygenation.
Blood pressure is often maintained within normal limits due to compensatory
mechanisms.
Question 4
A nurse is assessing a client who has a history of left-sided heart failure. Which of the
following findings should the nurse expect?
A. Jugular venous distention
B. Dependent pitting edema
C. Pulmonary crackles
D. Hepatosplenomegaly
Answer: C. Pulmonary crackles
Rationale: Left-sided heart failure leads to pulmonary congestion due to the back-up of
blood from the left ventricle into the pulmonary vasculature. This results in respiratory
manifestations such as dyspnea, orthopnea, cough, and crackles. Jugular venous
distention, dependent edema, and hepatosplenomegaly are characteristic signs of right-
sided heart failure caused by systemic venous congestion.
Question 5
A nurse is preparing to care for a client who has a suspected diagnosis of bacterial
meningitis. Which of the following infection control precautions should the nurse
implement?
A. Airborne precautions
B. Droplet precautions
C. Contact precautions
D. Protective isolation
Answer: B. Droplet precautions
Rationale: Bacterial meningitis (caused by organisms like Neisseria meningitidis) is
transmitted via large-particle droplets from the respiratory tract. Droplet precautions
,require a private room and the use of a surgical mask by staff when within 3 feet of the
client. Airborne precautions are used for smaller droplets like tuberculosis or varicella.
Question 6
A nurse is reviewing lab results for a client with acute pancreatitis. Which of the
following laboratory values should the nurse expect to be elevated?
A. Serum calcium
B. Serum amylase
C. Serum potassium
D. White blood cell count decrease
Answer: B. Serum amylase
Rationale: Acute pancreatitis causes inflammation and auto-digestion of the pancreas,
leading to the release of pancreatic enzymes into the bloodstream. Serum amylase and
lipase levels rise significantly within 24 hours of symptom onset. Serum calcium levels
typically decrease (hypocalcemia) due to fat necrosis binding calcium.
Question 7
A nurse is teaching a client who has a new diagnosis of chronic kidney disease (CKD)
about dietary restrictions. Which of the following modifications should the nurse
emphasize?
A. Increase dietary phosphorus intake.
B. Limit protein intake to prevent uremia.
C. Use salt substitutes to lower sodium levels.
D. Increase fluid intake to 3 liters per day.
Answer: B. Limit protein intake to prevent uremia.
Rationale: In CKD, the kidneys cannot efficiently excrete urea and other nitrogenous
waste products of protein metabolism, leading to uremia. Limiting protein intake helps
slow the progression of kidney disease. Phosphorus must be restricted, not increased.
Salt substitutes often contain potassium chloride and should be avoided due to the risk
of hyperkalemia. Fluids are typically restricted based on urine output.
Question 8
A nurse is monitoring a client who is receiving mechanical ventilation. The low-pressure
alarm on the ventilator begins to sound. Which of the following issues should the nurse
suspect?
A. The client is biting the endotracheal tube.
B. Excess secretions are present in the airway.
C. A disconnection has occurred in the ventilator circuit.
D. The client is fighting the ventilator.
Answer: C. A disconnection has occurred in the ventilator circuit.
, Rationale: Low-pressure alarms are triggered by a drop in airway pressure, which most
commonly indicates a circuit disconnection, an air leak in the cuff, or a total
displacement of the tube. High-pressure alarms are triggered by increased resistance,
such as biting the tube, secretions, coughing, or bronchospasms.
Question 9
A nurse is caring for a client who has a cast applied to the right lower extremity 4 hours
ago. The client reports severe, escalating pain that is unrelieved by the prescribed
opioid medication. Which of the following actions should the nurse take first?
A. Administer an additional dose of pain medication.
B. Elevate the extremity above the level of the heart.
C. Apply an ice pack to the external cast surface.
D. Assess the pedal pulse and capillary refill of the affected extremity.
Answer: D. Assess the pedal pulse and capillary refill of the affected extremity.
Rationale: Severe, escalating pain that is unresponsive to opioids following a fracture or
cast application is a primary indicator of compartment syndrome. The nurse must
immediately assess neurovascular status (pulses, capillary refill, paresthesia, pallor) to
detect ischemia. Elevating the limb above the heart is contraindicated in suspected
compartment syndrome as it further decreases arterial perfusion.
Question 10
A nurse is preparing to administer a regular insulin sliding scale dose to a client before
breakfast. The client's blood glucose is 280 mg/dL. When should the nurse administer
this insulin?
A. 30 minutes before the meal arrives.
B. Immediately after the client finishes eating.
C. 2 hours after the breakfast meal.
D. Concurrently with a long-acting insulin in the same syringe.
Answer: A. 30 minutes before the meal arrives.
Rationale: Regular insulin is a short-acting insulin with an onset of action of 30 to 60
minutes. To match its peak action with postprandial blood glucose spikes, it must be
administered approximately 30 minutes before eating. Regular insulin should not be
given after meals for routine sliding scales and should not be mixed with long-acting
insulins like glargine.
Question 11
A nurse is assessing a client who has peripheral arterial disease (PAD). Which of the
following clinical manifestations should the nurse expect?
A. Pitting edema around the ankles
B. Intermittent claudication during ambulation
