ATI Med-Surg Proctored Exam (2027) – NGN-
Style Questions, Case Scenarios & Answers
1. A nurse is caring for a client who is 6 hours post-angiogram via the
right femoral artery. Which assessment finding requires immediate
intervention?
A) Blood pressure 142/88 mm Hg
B) Heart rate 92 bpm
C) Small amount of serosanguineous drainage on the dressing
D) Loss of palpable pulse in the right foot
*D) Loss of palpable pulse in the right foot *
Rationale: Loss of pulse indicates acute arterial occlusion, a limb-threatening
emergency requiring immediate intervention. The nurse should notify the
provider immediately and prepare for possible thrombolytic therapy or
surgical intervention .
2. A client with heart failure reports a 4-pound weight gain in 3 days,
increasing dyspnea, and ankle swelling. Which medication adjustment
should the nurse anticipate?
A) Increase in beta-blocker dose
B) Increase in loop diuretic dose
C) Initiation of digoxin therapy
D) Decrease in ACE inhibitor dose
*B) Increase in loop diuretic dose *
,Rationale: Weight gain, increasing dyspnea, and edema indicate worsening
fluid overload. Loop diuretics are first-line for fluid removal in acute
decompensation. Beta-blocker increases could worsen symptoms acutely;
digoxin is not first-line, and ACE inhibitors should not be decreased during
fluid overload .
3. A client receiving a heparin infusion has an aPTT of 110 seconds
(therapeutic range 60-80 seconds). What is the priority nursing action?
A) Increase the heparin infusion rate
B) Decrease the heparin infusion rate
C) Hold the heparin infusion and notify the provider
D) Continue the infusion at the current rate
*C) Hold the heparin infusion and notify the provider *
Rationale: An aPTT of 110 seconds is significantly above therapeutic range
(1.5-2.5 times control). This indicates risk of bleeding complications. The
nurse should stop the infusion, assess for bleeding, and notify the provider .
4. A client with severe COPD is receiving oxygen at 4 L/min via nasal
cannula. The client becomes lethargic and confused. What is the most
likely cause?
A) Hyperoxygenation causing suppression of the hypoxic drive
B) Hypoxia causing confusion
C) Sedation from pain medication
D) Hypercapnia from excessive oxygen
*A) Hyperoxygenation causing suppression of the hypoxic drive *
Rationale: In severe COPD, the respiratory drive is dependent on hypoxia
rather than hypercapnia. Excessive oxygen can suppress this drive, leading to
,hypoventilation, hypercapnia, and CO2 narcosis. Confusion and lethargy are
signs of CO2 retention .
5. A client with acute respiratory distress syndrome (ARDS) is on
mechanical ventilation with low tidal volume (6 mL/kg ideal body
weight) and PEEP of 12 cm H2O. The client's PaO2 is 58 mmHg on FiO2
0.8. Which action should the nurse anticipate?
A) Increase tidal volume to 10 mL/kg
B) Increase PEEP by 2-3 cm H2O
C) Decrease FiO2 to 0.6
D) Decrease PEEP to 8 cm H2O
*B) Increase PEEP by 2-3 cm H2O *
Rationale: In ARDS, the goal is to achieve an SpO2 > 90% or PaO2 > 60
mmHg with the lowest FiO2 and PEEP to prevent oxygen toxicity. This patient
is still hypoxemic despite an FiO2 of 0.8. Increasing PEEP is the appropriate
next step to recruit alveoli and improve oxygenation .
6. A client with diabetic ketoacidosis (DKA) has a blood glucose of 450
mg/dL, pH 7.20, and HCO3 12 mEq/L. The nurse has initiated IV fluids
and insulin. Which assessment finding indicates a positive response to
treatment?
A) Blood glucose decreasing to 350 mg/dL
B) Urine output increasing to 60 mL/hr
C) Serum potassium decreasing to 3.5 mEq/L
D) All of the above
*D) All of the above *
, Rationale: All of these are positive responses to DKA treatment. Decreasing
blood glucose indicates insulin effectiveness; increasing urine output indicates
improved perfusion and hydration; potassium decreasing to 3.5 mEq/L
indicates potassium is shifting back into cells as acidosis resolves. Potassium
levels must be monitored closely .
7. A client with diabetes insipidus (DI) has a urine output of 600 mL/hr,
serum sodium 155 mEq/L, and urine specific gravity 1.002. What is the
priority nursing intervention?
A) Restrict fluids
B) Administer prescribed vasopressin
C) Administer 3% NaCl
D) Decrease IV fluids
*B) Administer prescribed vasopressin *
Rationale: This client has severe diabetes insipidus with hypernatremia and
dilute urine. Vasopressin (desmopressin/DDAVP) replaces ADH, reducing
urine output and lowering serum sodium. Fluid restriction is contraindicated;
3% NaCl would worsen hypernatremia; IV fluids should be continued to
replace losses .
8. A client with heart failure on furosemide and digoxin presents with
nausea, vomiting, blurred vision, and yellow-green halos around
lights. What is the priority action?
A) Administer an antiemetic
B) Check digoxin level
C) Increase digoxin dose
D) Administer potassium
Style Questions, Case Scenarios & Answers
1. A nurse is caring for a client who is 6 hours post-angiogram via the
right femoral artery. Which assessment finding requires immediate
intervention?
A) Blood pressure 142/88 mm Hg
B) Heart rate 92 bpm
C) Small amount of serosanguineous drainage on the dressing
D) Loss of palpable pulse in the right foot
*D) Loss of palpable pulse in the right foot *
Rationale: Loss of pulse indicates acute arterial occlusion, a limb-threatening
emergency requiring immediate intervention. The nurse should notify the
provider immediately and prepare for possible thrombolytic therapy or
surgical intervention .
2. A client with heart failure reports a 4-pound weight gain in 3 days,
increasing dyspnea, and ankle swelling. Which medication adjustment
should the nurse anticipate?
A) Increase in beta-blocker dose
B) Increase in loop diuretic dose
C) Initiation of digoxin therapy
D) Decrease in ACE inhibitor dose
*B) Increase in loop diuretic dose *
,Rationale: Weight gain, increasing dyspnea, and edema indicate worsening
fluid overload. Loop diuretics are first-line for fluid removal in acute
decompensation. Beta-blocker increases could worsen symptoms acutely;
digoxin is not first-line, and ACE inhibitors should not be decreased during
fluid overload .
3. A client receiving a heparin infusion has an aPTT of 110 seconds
(therapeutic range 60-80 seconds). What is the priority nursing action?
A) Increase the heparin infusion rate
B) Decrease the heparin infusion rate
C) Hold the heparin infusion and notify the provider
D) Continue the infusion at the current rate
*C) Hold the heparin infusion and notify the provider *
Rationale: An aPTT of 110 seconds is significantly above therapeutic range
(1.5-2.5 times control). This indicates risk of bleeding complications. The
nurse should stop the infusion, assess for bleeding, and notify the provider .
4. A client with severe COPD is receiving oxygen at 4 L/min via nasal
cannula. The client becomes lethargic and confused. What is the most
likely cause?
A) Hyperoxygenation causing suppression of the hypoxic drive
B) Hypoxia causing confusion
C) Sedation from pain medication
D) Hypercapnia from excessive oxygen
*A) Hyperoxygenation causing suppression of the hypoxic drive *
Rationale: In severe COPD, the respiratory drive is dependent on hypoxia
rather than hypercapnia. Excessive oxygen can suppress this drive, leading to
,hypoventilation, hypercapnia, and CO2 narcosis. Confusion and lethargy are
signs of CO2 retention .
5. A client with acute respiratory distress syndrome (ARDS) is on
mechanical ventilation with low tidal volume (6 mL/kg ideal body
weight) and PEEP of 12 cm H2O. The client's PaO2 is 58 mmHg on FiO2
0.8. Which action should the nurse anticipate?
A) Increase tidal volume to 10 mL/kg
B) Increase PEEP by 2-3 cm H2O
C) Decrease FiO2 to 0.6
D) Decrease PEEP to 8 cm H2O
*B) Increase PEEP by 2-3 cm H2O *
Rationale: In ARDS, the goal is to achieve an SpO2 > 90% or PaO2 > 60
mmHg with the lowest FiO2 and PEEP to prevent oxygen toxicity. This patient
is still hypoxemic despite an FiO2 of 0.8. Increasing PEEP is the appropriate
next step to recruit alveoli and improve oxygenation .
6. A client with diabetic ketoacidosis (DKA) has a blood glucose of 450
mg/dL, pH 7.20, and HCO3 12 mEq/L. The nurse has initiated IV fluids
and insulin. Which assessment finding indicates a positive response to
treatment?
A) Blood glucose decreasing to 350 mg/dL
B) Urine output increasing to 60 mL/hr
C) Serum potassium decreasing to 3.5 mEq/L
D) All of the above
*D) All of the above *
, Rationale: All of these are positive responses to DKA treatment. Decreasing
blood glucose indicates insulin effectiveness; increasing urine output indicates
improved perfusion and hydration; potassium decreasing to 3.5 mEq/L
indicates potassium is shifting back into cells as acidosis resolves. Potassium
levels must be monitored closely .
7. A client with diabetes insipidus (DI) has a urine output of 600 mL/hr,
serum sodium 155 mEq/L, and urine specific gravity 1.002. What is the
priority nursing intervention?
A) Restrict fluids
B) Administer prescribed vasopressin
C) Administer 3% NaCl
D) Decrease IV fluids
*B) Administer prescribed vasopressin *
Rationale: This client has severe diabetes insipidus with hypernatremia and
dilute urine. Vasopressin (desmopressin/DDAVP) replaces ADH, reducing
urine output and lowering serum sodium. Fluid restriction is contraindicated;
3% NaCl would worsen hypernatremia; IV fluids should be continued to
replace losses .
8. A client with heart failure on furosemide and digoxin presents with
nausea, vomiting, blurred vision, and yellow-green halos around
lights. What is the priority action?
A) Administer an antiemetic
B) Check digoxin level
C) Increase digoxin dose
D) Administer potassium
