ATI RN Adult Medical-Surgical (NGN) – ATI Adult
Medical-Surgical Proctored Exam Study Guide,
Original NGN-Style Practice Questions & Answers,
Comprehensive Med-Surg Review, Cardiovascular,
Respiratory, Neurological, Gastrointestinal, Renal,
Endocrine, Metabolic, Musculoskeletal, Immune &
Infectious Disorders, Perioperative Care,
Pharmacology, Laboratory Values, Prioritization,
Patient Safety & Clinical Judgment
Question 1: A nurse is caring for a client who is 24 hours post-op following an
open reduction and internal fixation of the right femur. Which assessment
finding is the priority for the nurse to report to the healthcare provider?
A. Pain rated 6 on a 0-10 scale at the surgical site
B. Serosanguineous drainage on the dressing
C. Pulse oximetry reading of 89% on room air
D. Urinary output of 40 mL over the last hour
CORRECT ANSWER: C. Pulse oximetry reading of 89% on room air
Rationale: A pulse oximetry reading of 89% indicates hypoxemia, which is a critical
finding. This could be an early sign of a pulmonary embolism, a life-threatening
complication following orthopedic surgery. Airway, breathing, and circulation (ABC) is
the priority framework, making this the most urgent finding to report.
Question 2: A nurse is providing teaching to a client with heart failure who has
a new prescription for furosemide. Which statement by the client indicates a
need for further teaching?
A. "I will take this medication in the morning to avoid waking up at night."
B. "I should weigh myself daily and report a gain of 2 pounds in one day."
C. "I can continue to use salt substitutes freely to season my food."
D. "I will rise slowly from a sitting position to prevent dizziness."
CORRECT ANSWER: C. "I can continue to use salt substitutes freely to season
my food."
Rationale: Salt substitutes are high in potassium. Furosemide is a loop diuretic that can
cause hypokalemia, but many clients with heart failure also take potassium-sparing
diuretics or ACE inhibitors. Using salt substitutes can lead to life-threatening
hyperkalemia. The client should be taught to avoid them or use them only with provider
approval.
Question 3: A nurse is assessing a client with chronic obstructive pulmonary
disease (COPD) who is receiving oxygen at 2 L/min via nasal cannula. Which
finding indicates the client is experiencing oxygen toxicity?
,A. Increased appetite
B. A dry, non-productive cough
C. Bradycardia
D. Somnolence
CORRECT ANSWER: B. A dry, non-productive cough
Rationale: Oxygen toxicity is a complication of high concentrations of oxygen or
prolonged therapy. Early signs include a dry, non-productive cough, substernal chest
pain, and paresthesias. Later signs include dyspnea and crackles. The nurse should
monitor the client and adjust the oxygen delivery as prescribed to maintain saturation
between 88-92% for clients with COPD.
Question 4: A nurse is caring for a client with acute pancreatitis. Which
laboratory value is most indicative of this condition?
A. Elevated serum amylase
B. Decreased serum glucose
C. Elevated serum calcium
D. Decreased serum bilirubin
CORRECT ANSWER: A. Elevated serum amylase
Rationale: Serum amylase and lipase are the primary diagnostic markers for acute
pancreatitis. Amylase levels typically rise within 6-12 hours of onset and remain elevated
for 3-5 days. Lipase is more specific and remains elevated longer. Serum calcium may
decrease due to saponification (fat necrosis), and glucose may increase due to impaired
insulin release.
Question 5: A nurse is preparing to administer a blood transfusion to a client.
Which action should the nurse take first?
A. Verify the client's identity using two identifiers
B. Obtain the client's vital signs
C. Prime the intravenous tubing with 0.9% normal saline
D. Check the client's blood type and cross-match results
CORRECT ANSWER: D. Check the client's blood type and cross-match results
Rationale: Before initiating a blood transfusion, the nurse must verify that the blood
product is compatible with the client. This involves checking the blood type, Rh factor,
and cross-match results against the client's record. While verifying identity and vital
signs are important, checking compatibility is the priority to prevent a life-threatening
hemolytic reaction.
Question 6: A client with cirrhosis is prescribed lactulose. Which assessment
finding indicates the medication is having the desired therapeutic effect?
A. Serum ammonia level decreases from 180 mcg/dL to 80 mcg/dL
B. Serum bilirubin level decreases from 3.0 mg/dL to 1.5 mg/dL
,C. The client reports a decrease in abdominal girth
D. The client's stool is soft and formed
CORRECT ANSWER: A. Serum ammonia level decreases from 180 mcg/dL to
80 mcg/dL
Rationale: Lactulose is administered to clients with hepatic encephalopathy to reduce
serum ammonia levels. It works by acidifying the colon, which traps ammonia and
promotes its excretion in the stool. A decrease in serum ammonia levels indicates
therapeutic effectiveness. The normal range for ammonia is 15-45 mcg/dL.
Question 7: A nurse is assessing a client who is 2 days post-operative following
a total hip arthroplasty. Which finding requires immediate intervention?
A. The client's affected leg is externally rotated
B. The client reports pain of 4 on a 0-10 scale
C. The client's hemoglobin is 10.5 g/dL
D. The client's incision has scant serous drainage
CORRECT ANSWER: A. The client's affected leg is externally rotated
Rationale: External rotation of the affected leg following a total hip arthroplasty may
indicate dislocation of the prosthesis. This is a surgical emergency. The nurse should
avoid moving the leg and notify the healthcare provider immediately. The client should
maintain hip precautions, including no flexion beyond 90 degrees, no adduction, and no
internal rotation.
Question 8: A nurse is providing dietary teaching to a client with a new
diagnosis of celiac disease. Which food item is safe for the client to consume?
A. Rye bread toast
B. Barley soup
C. Corn tortilla chips
D. Wheat pasta salad
CORRECT ANSWER: C. Corn tortilla chips
Rationale: Celiac disease requires a strict gluten-free diet. Clients must avoid wheat,
rye, and barley. Corn, rice, and potatoes are gluten-free and safe to consume. Corn
tortilla chips are made from corn and are safe. The client should be instructed to read
food labels carefully for hidden sources of gluten.
Question 9: A nurse is monitoring a client receiving a continuous heparin
infusion for a pulmonary embolism. Which laboratory value is most important
to monitor for therapeutic effectiveness?
A. Activated partial thromboplastin time (aPTT)
B. Prothrombin time (PT)
C. International normalized ratio (INR)
D. Platelet count
, CORRECT ANSWER: A. Activated partial thromboplastin time (aPTT)
Rationale: Heparin affects the intrinsic pathway of the coagulation cascade. The aPTT
is the primary laboratory test used to monitor heparin therapy. The therapeutic goal is to
maintain the aPTT at 1.5 to 2.5 times the normal control value. PT and INR are used to
monitor warfarin therapy, and platelet count is monitored to detect heparin-induced
thrombocytopenia (HIT).
Question 10: A client with diabetes mellitus type 2 is prescribed metformin.
Which side effect should the nurse include in the client's teaching?
A. Weight gain
B. Hypoglycemia
C. Lactic acidosis
D. Tachycardia
CORRECT ANSWER: C. Lactic acidosis
Rationale: Metformin can cause lactic acidosis, a rare but serious side effect, especially
in clients with renal impairment, liver disease, or heart failure. The nurse should teach
the client to report symptoms such as muscle pain, difficulty breathing, dizziness, and
unusual tiredness. Metformin does not typically cause hypoglycemia or weight gain.
Question 11: A nurse is caring for a client with a chest tube following a
pneumothorax. Which finding indicates that the chest tube system is
functioning correctly?
A. Continuous bubbling in the water seal chamber
B. Tidaling (fluctuation) in the water seal chamber with respirations
C. Vigorous bubbling in the suction control chamber
D. Absence of drainage in the collection chamber
CORRECT ANSWER: B. Tidaling (fluctuation) in the water seal chamber with
respirations
Rationale: Tidaling (fluctuation) in the water seal chamber is a normal finding and
indicates that the chest tube is patent and the system is functioning correctly.
Continuous bubbling in the water seal chamber indicates an air leak. The suction control
chamber should have gentle bubbling, not vigorous, and the collection chamber should
have drainage that is documented.
Question 12: A client with acute kidney injury has a potassium level of 6.5
mEq/L. Which intervention should the nurse anticipate?
A. Administration of sodium polystyrene sulfonate
B. Administration of potassium chloride
C. Restriction of oral fluids
D. Administration of furosemide
CORRECT ANSWER: A. Administration of sodium polystyrene sulfonate
Medical-Surgical Proctored Exam Study Guide,
Original NGN-Style Practice Questions & Answers,
Comprehensive Med-Surg Review, Cardiovascular,
Respiratory, Neurological, Gastrointestinal, Renal,
Endocrine, Metabolic, Musculoskeletal, Immune &
Infectious Disorders, Perioperative Care,
Pharmacology, Laboratory Values, Prioritization,
Patient Safety & Clinical Judgment
Question 1: A nurse is caring for a client who is 24 hours post-op following an
open reduction and internal fixation of the right femur. Which assessment
finding is the priority for the nurse to report to the healthcare provider?
A. Pain rated 6 on a 0-10 scale at the surgical site
B. Serosanguineous drainage on the dressing
C. Pulse oximetry reading of 89% on room air
D. Urinary output of 40 mL over the last hour
CORRECT ANSWER: C. Pulse oximetry reading of 89% on room air
Rationale: A pulse oximetry reading of 89% indicates hypoxemia, which is a critical
finding. This could be an early sign of a pulmonary embolism, a life-threatening
complication following orthopedic surgery. Airway, breathing, and circulation (ABC) is
the priority framework, making this the most urgent finding to report.
Question 2: A nurse is providing teaching to a client with heart failure who has
a new prescription for furosemide. Which statement by the client indicates a
need for further teaching?
A. "I will take this medication in the morning to avoid waking up at night."
B. "I should weigh myself daily and report a gain of 2 pounds in one day."
C. "I can continue to use salt substitutes freely to season my food."
D. "I will rise slowly from a sitting position to prevent dizziness."
CORRECT ANSWER: C. "I can continue to use salt substitutes freely to season
my food."
Rationale: Salt substitutes are high in potassium. Furosemide is a loop diuretic that can
cause hypokalemia, but many clients with heart failure also take potassium-sparing
diuretics or ACE inhibitors. Using salt substitutes can lead to life-threatening
hyperkalemia. The client should be taught to avoid them or use them only with provider
approval.
Question 3: A nurse is assessing a client with chronic obstructive pulmonary
disease (COPD) who is receiving oxygen at 2 L/min via nasal cannula. Which
finding indicates the client is experiencing oxygen toxicity?
,A. Increased appetite
B. A dry, non-productive cough
C. Bradycardia
D. Somnolence
CORRECT ANSWER: B. A dry, non-productive cough
Rationale: Oxygen toxicity is a complication of high concentrations of oxygen or
prolonged therapy. Early signs include a dry, non-productive cough, substernal chest
pain, and paresthesias. Later signs include dyspnea and crackles. The nurse should
monitor the client and adjust the oxygen delivery as prescribed to maintain saturation
between 88-92% for clients with COPD.
Question 4: A nurse is caring for a client with acute pancreatitis. Which
laboratory value is most indicative of this condition?
A. Elevated serum amylase
B. Decreased serum glucose
C. Elevated serum calcium
D. Decreased serum bilirubin
CORRECT ANSWER: A. Elevated serum amylase
Rationale: Serum amylase and lipase are the primary diagnostic markers for acute
pancreatitis. Amylase levels typically rise within 6-12 hours of onset and remain elevated
for 3-5 days. Lipase is more specific and remains elevated longer. Serum calcium may
decrease due to saponification (fat necrosis), and glucose may increase due to impaired
insulin release.
Question 5: A nurse is preparing to administer a blood transfusion to a client.
Which action should the nurse take first?
A. Verify the client's identity using two identifiers
B. Obtain the client's vital signs
C. Prime the intravenous tubing with 0.9% normal saline
D. Check the client's blood type and cross-match results
CORRECT ANSWER: D. Check the client's blood type and cross-match results
Rationale: Before initiating a blood transfusion, the nurse must verify that the blood
product is compatible with the client. This involves checking the blood type, Rh factor,
and cross-match results against the client's record. While verifying identity and vital
signs are important, checking compatibility is the priority to prevent a life-threatening
hemolytic reaction.
Question 6: A client with cirrhosis is prescribed lactulose. Which assessment
finding indicates the medication is having the desired therapeutic effect?
A. Serum ammonia level decreases from 180 mcg/dL to 80 mcg/dL
B. Serum bilirubin level decreases from 3.0 mg/dL to 1.5 mg/dL
,C. The client reports a decrease in abdominal girth
D. The client's stool is soft and formed
CORRECT ANSWER: A. Serum ammonia level decreases from 180 mcg/dL to
80 mcg/dL
Rationale: Lactulose is administered to clients with hepatic encephalopathy to reduce
serum ammonia levels. It works by acidifying the colon, which traps ammonia and
promotes its excretion in the stool. A decrease in serum ammonia levels indicates
therapeutic effectiveness. The normal range for ammonia is 15-45 mcg/dL.
Question 7: A nurse is assessing a client who is 2 days post-operative following
a total hip arthroplasty. Which finding requires immediate intervention?
A. The client's affected leg is externally rotated
B. The client reports pain of 4 on a 0-10 scale
C. The client's hemoglobin is 10.5 g/dL
D. The client's incision has scant serous drainage
CORRECT ANSWER: A. The client's affected leg is externally rotated
Rationale: External rotation of the affected leg following a total hip arthroplasty may
indicate dislocation of the prosthesis. This is a surgical emergency. The nurse should
avoid moving the leg and notify the healthcare provider immediately. The client should
maintain hip precautions, including no flexion beyond 90 degrees, no adduction, and no
internal rotation.
Question 8: A nurse is providing dietary teaching to a client with a new
diagnosis of celiac disease. Which food item is safe for the client to consume?
A. Rye bread toast
B. Barley soup
C. Corn tortilla chips
D. Wheat pasta salad
CORRECT ANSWER: C. Corn tortilla chips
Rationale: Celiac disease requires a strict gluten-free diet. Clients must avoid wheat,
rye, and barley. Corn, rice, and potatoes are gluten-free and safe to consume. Corn
tortilla chips are made from corn and are safe. The client should be instructed to read
food labels carefully for hidden sources of gluten.
Question 9: A nurse is monitoring a client receiving a continuous heparin
infusion for a pulmonary embolism. Which laboratory value is most important
to monitor for therapeutic effectiveness?
A. Activated partial thromboplastin time (aPTT)
B. Prothrombin time (PT)
C. International normalized ratio (INR)
D. Platelet count
, CORRECT ANSWER: A. Activated partial thromboplastin time (aPTT)
Rationale: Heparin affects the intrinsic pathway of the coagulation cascade. The aPTT
is the primary laboratory test used to monitor heparin therapy. The therapeutic goal is to
maintain the aPTT at 1.5 to 2.5 times the normal control value. PT and INR are used to
monitor warfarin therapy, and platelet count is monitored to detect heparin-induced
thrombocytopenia (HIT).
Question 10: A client with diabetes mellitus type 2 is prescribed metformin.
Which side effect should the nurse include in the client's teaching?
A. Weight gain
B. Hypoglycemia
C. Lactic acidosis
D. Tachycardia
CORRECT ANSWER: C. Lactic acidosis
Rationale: Metformin can cause lactic acidosis, a rare but serious side effect, especially
in clients with renal impairment, liver disease, or heart failure. The nurse should teach
the client to report symptoms such as muscle pain, difficulty breathing, dizziness, and
unusual tiredness. Metformin does not typically cause hypoglycemia or weight gain.
Question 11: A nurse is caring for a client with a chest tube following a
pneumothorax. Which finding indicates that the chest tube system is
functioning correctly?
A. Continuous bubbling in the water seal chamber
B. Tidaling (fluctuation) in the water seal chamber with respirations
C. Vigorous bubbling in the suction control chamber
D. Absence of drainage in the collection chamber
CORRECT ANSWER: B. Tidaling (fluctuation) in the water seal chamber with
respirations
Rationale: Tidaling (fluctuation) in the water seal chamber is a normal finding and
indicates that the chest tube is patent and the system is functioning correctly.
Continuous bubbling in the water seal chamber indicates an air leak. The suction control
chamber should have gentle bubbling, not vigorous, and the collection chamber should
have drainage that is documented.
Question 12: A client with acute kidney injury has a potassium level of 6.5
mEq/L. Which intervention should the nurse anticipate?
A. Administration of sodium polystyrene sulfonate
B. Administration of potassium chloride
C. Restriction of oral fluids
D. Administration of furosemide
CORRECT ANSWER: A. Administration of sodium polystyrene sulfonate
