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, Gastrointestinal & Hepatic, Renal &
Genitourinary, Endocrine & Metabolic,
Neurological, Musculoskeletal, Immune & Infectious
Disorders, Perioperative Care, Pharmacology,
Laboratory Values, Prioritization, Patient Safety &
Clinical Judgment
Question 1: A client with chronic kidney disease is scheduled for hemodialysis.
Which assessment finding should the nurse report to the provider
immediately?
A. Blood pressure of 145/90 mmHg
B. Serum potassium level of 6.2 mEq/L
C. Weight gain of 1 kg since the last session
D. Mild cramping in the lower extremities
CORRECT ANSWER: B. Serum potassium level of 6.2 mEq/L
Rationale: A serum potassium level of 6.2 mEq/L is critically elevated and places the
client at high risk for life-threatening cardiac dysrhythmias. This level requires
immediate intervention, such as emergent dialysis. The other findings are abnormal but
are expected or manageable in a client with chronic kidney disease and do not pose an
immediate life-threatening risk.
Question 2: The nurse is caring for a client who is 24 hours post-operative
following a total hip arthroplasty. Which action should the nurse prioritize to
prevent dislocation of the new joint?
A. Maintain the client in a low Fowler's position
B. Keep a pillow between the client's legs when turning
C. Encourage the client to perform straight leg raises
D. Place the client in a prone position for 15 minutes each hour
CORRECT ANSWER: B. Keep a pillow between the client's legs when turning
Rationale: Keeping an abduction pillow or a pillow between the client's legs prevents
adduction and internal rotation of the hip, which are the primary positions that can
cause dislocation of a new hip prosthesis. This is a standard postoperative precaution
that must be strictly maintained.
Question 3: A client with heart failure is prescribed digoxin and furosemide.
Which laboratory finding places the client at the greatest risk for digoxin
toxicity?
,A. Serum sodium of 135 mEq/L
B. Serum calcium of 9.2 mg/dL
C. Serum magnesium of 1.8 mEq/L
D. Serum potassium of 3.1 mEq/L
CORRECT ANSWER: D. Serum potassium of 3.1 mEq/L
Rationale: Hypokalemia (serum potassium < 3.5 mEq/L), which can be caused by the
potassium-wasting diuretic furosemide, increases the risk of digoxin toxicity by
enhancing the binding of digoxin to cardiac cells. A potassium level of 3.1 mEq/L is
significantly low and requires immediate attention.
Question 4: The nurse is teaching a client with type 1 diabetes mellitus about
sick-day rules. Which statement by the client indicates a need for further
teaching?
A. "I will check my blood glucose every 2 to 4 hours."
B. "I should continue to take my insulin even if I am not eating."
C. "I will drink sugar-free liquids to stay hydrated."
D. "I will call my provider if I have vomiting for more than 12 hours."
CORRECT ANSWER: C. "I will drink sugar-free liquids to stay hydrated."
Rationale: During illness, the client with type 1 diabetes should consume carbohydrate-
containing fluids (e.g., juice, sports drinks) to prevent hypoglycemia and provide energy.
Drinking only sugar-free liquids can lead to hypoglycemia, especially if insulin is being
taken. The other statements reflect correct sick-day management.
Question 5: The nurse is assessing a client with a chest tube connected to a
water-seal drainage system. Which observation indicates that the system is
functioning correctly?
A. Continuous bubbling in the water-seal chamber
B. Fluctuation of the fluid level in the water-seal chamber with inspiration and expiration
C. Intermittent bubbling in the suction control chamber
D. No fluctuation in the water-seal chamber during deep breathing
CORRECT ANSWER: B. Fluctuation of the fluid level in the water-seal chamber
with inspiration and expiration
Rationale: Fluctuation (tidaling) in the water-seal chamber indicates that the chest tube
is patent and that the negative pressure in the pleural space is being maintained.
Continuous bubbling in the water-seal chamber indicates an air leak, while absence of
tidaling suggests a blockage or full lung re-expansion.
Question 6: A client with cirrhosis is noted to have asterixis. The nurse
understands that this finding is most indicative of which complication?
A. Portal hypertension
B. Hepatic encephalopathy
,C. Esophageal varices
D. Hepatorenal syndrome
CORRECT ANSWER: B. Hepatic encephalopathy
Rationale: Asterixis, also known as liver flap, is a motor disturbance characterized by
involuntary flapping movements of the hands. It is a classic neurological sign associated
with hepatic encephalopathy, a complication of cirrhosis caused by the accumulation of
ammonia and other toxins in the blood.
Question 7: The nurse is preparing to administer a blood transfusion to a
client. What is the most important nursing action prior to infusing the blood
product?
A. Prime the IV tubing with 0.9% normal saline.
B. Obtain the client's vital signs.
C. Check the blood bag for clots.
D. Verify the client's identity and blood compatibility with another nurse.
CORRECT ANSWER: D. Verify the client's identity and blood compatibility with
another nurse.
Rationale: The most critical step in preventing a transfusion error is the two-nurse
verification process. The nurse must verify the client's identity, the blood product, and
the compatibility with another licensed nurse. While the other actions are important,
verification is the priority for patient safety.
Question 8: A client with chronic obstructive pulmonary disease (COPD) is
receiving oxygen via nasal cannula at 2 L/min. The nurse should monitor the
client for which potential complication?
A. Carbon dioxide narcosis
B. Oxygen toxicity
C. Nasal mucosal drying
D. Pneumothorax
CORRECT ANSWER: A. Carbon dioxide narcosis
Rationale: Clients with COPD often have a hypoxic drive to breathe. Administering
high-flow oxygen can suppress this drive, leading to hypoventilation and an increase in
carbon dioxide levels, which can progress to carbon dioxide narcosis and respiratory
failure. 2 L/min is generally considered safe, but the client's respiratory status should be
closely monitored.
Question 9: A client is admitted with a diagnosis of acute pancreatitis. Which
laboratory finding is most consistent with this diagnosis?
A. Elevated serum amylase and lipase
B. Elevated serum bilirubin and alkaline phosphatase
, C. Decreased serum calcium and magnesium
D. Elevated serum glucose and ketones
CORRECT ANSWER: A. Elevated serum amylase and lipase
Rationale: In acute pancreatitis, the pancreas releases large amounts of amylase and
lipase into the bloodstream. These are the primary diagnostic markers for acute
pancreatitis, with lipase being more specific. The other findings may be present in other
conditions or as secondary complications of pancreatitis.
Question 10: The nurse is caring for a client with a nasogastric (NG) tube
attached to low intermittent suction. Which assessment finding should the
nurse anticipate in this client?
A. Metabolic alkalosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Respiratory acidosis
CORRECT ANSWER: A. Metabolic alkalosis
Rationale: Nasogastric suctioning removes gastric acid (hydrochloric acid) from the
stomach. Loss of this acid leads to a relative increase in bicarbonate, resulting in
metabolic alkalosis. The other acid-base imbalances are not typically associated with
this type of fluid loss.
Question 11: A client who had a myocardial infarction 24 hours ago is
prescribed aspirin. What is the primary purpose of this medication?
A. To relieve chest pain
B. To prevent further platelet aggregation
C. To reduce blood pressure
D. To decrease cardiac workload
CORRECT ANSWER: B. To prevent further platelet aggregation
Rationale: The purpose of aspirin in acute coronary syndrome is to inhibit platelet
aggregation. This action prevents the formation of new clots and prevents the existing
clot from enlarging, thereby reducing mortality and the risk of recurrent infarction.
Question 12: The nurse is assessing a client with a suspected pulmonary
embolism. Which finding is a classic manifestation of this condition?
A. Bradycardia and hypotension
B. Sudden pleuritic chest pain and dyspnea
C. Productive cough with purulent sputum
D. Hyper-resonance over the affected lung field
CORRECT ANSWER: B. Sudden pleuritic chest pain and dyspnea
Medical-Surgical Proctored Exam Study Guide,
Original NGN-Style Practice Questions & Answers,
Comprehensive Med-Surg Review, Cardiovascular,
Respiratory, Gastrointestinal & Hepatic, Renal &
Genitourinary, Endocrine & Metabolic,
Neurological, Musculoskeletal, Immune & Infectious
Disorders, Perioperative Care, Pharmacology,
Laboratory Values, Prioritization, Patient Safety &
Clinical Judgment
Question 1: A client with chronic kidney disease is scheduled for hemodialysis.
Which assessment finding should the nurse report to the provider
immediately?
A. Blood pressure of 145/90 mmHg
B. Serum potassium level of 6.2 mEq/L
C. Weight gain of 1 kg since the last session
D. Mild cramping in the lower extremities
CORRECT ANSWER: B. Serum potassium level of 6.2 mEq/L
Rationale: A serum potassium level of 6.2 mEq/L is critically elevated and places the
client at high risk for life-threatening cardiac dysrhythmias. This level requires
immediate intervention, such as emergent dialysis. The other findings are abnormal but
are expected or manageable in a client with chronic kidney disease and do not pose an
immediate life-threatening risk.
Question 2: The nurse is caring for a client who is 24 hours post-operative
following a total hip arthroplasty. Which action should the nurse prioritize to
prevent dislocation of the new joint?
A. Maintain the client in a low Fowler's position
B. Keep a pillow between the client's legs when turning
C. Encourage the client to perform straight leg raises
D. Place the client in a prone position for 15 minutes each hour
CORRECT ANSWER: B. Keep a pillow between the client's legs when turning
Rationale: Keeping an abduction pillow or a pillow between the client's legs prevents
adduction and internal rotation of the hip, which are the primary positions that can
cause dislocation of a new hip prosthesis. This is a standard postoperative precaution
that must be strictly maintained.
Question 3: A client with heart failure is prescribed digoxin and furosemide.
Which laboratory finding places the client at the greatest risk for digoxin
toxicity?
,A. Serum sodium of 135 mEq/L
B. Serum calcium of 9.2 mg/dL
C. Serum magnesium of 1.8 mEq/L
D. Serum potassium of 3.1 mEq/L
CORRECT ANSWER: D. Serum potassium of 3.1 mEq/L
Rationale: Hypokalemia (serum potassium < 3.5 mEq/L), which can be caused by the
potassium-wasting diuretic furosemide, increases the risk of digoxin toxicity by
enhancing the binding of digoxin to cardiac cells. A potassium level of 3.1 mEq/L is
significantly low and requires immediate attention.
Question 4: The nurse is teaching a client with type 1 diabetes mellitus about
sick-day rules. Which statement by the client indicates a need for further
teaching?
A. "I will check my blood glucose every 2 to 4 hours."
B. "I should continue to take my insulin even if I am not eating."
C. "I will drink sugar-free liquids to stay hydrated."
D. "I will call my provider if I have vomiting for more than 12 hours."
CORRECT ANSWER: C. "I will drink sugar-free liquids to stay hydrated."
Rationale: During illness, the client with type 1 diabetes should consume carbohydrate-
containing fluids (e.g., juice, sports drinks) to prevent hypoglycemia and provide energy.
Drinking only sugar-free liquids can lead to hypoglycemia, especially if insulin is being
taken. The other statements reflect correct sick-day management.
Question 5: The nurse is assessing a client with a chest tube connected to a
water-seal drainage system. Which observation indicates that the system is
functioning correctly?
A. Continuous bubbling in the water-seal chamber
B. Fluctuation of the fluid level in the water-seal chamber with inspiration and expiration
C. Intermittent bubbling in the suction control chamber
D. No fluctuation in the water-seal chamber during deep breathing
CORRECT ANSWER: B. Fluctuation of the fluid level in the water-seal chamber
with inspiration and expiration
Rationale: Fluctuation (tidaling) in the water-seal chamber indicates that the chest tube
is patent and that the negative pressure in the pleural space is being maintained.
Continuous bubbling in the water-seal chamber indicates an air leak, while absence of
tidaling suggests a blockage or full lung re-expansion.
Question 6: A client with cirrhosis is noted to have asterixis. The nurse
understands that this finding is most indicative of which complication?
A. Portal hypertension
B. Hepatic encephalopathy
,C. Esophageal varices
D. Hepatorenal syndrome
CORRECT ANSWER: B. Hepatic encephalopathy
Rationale: Asterixis, also known as liver flap, is a motor disturbance characterized by
involuntary flapping movements of the hands. It is a classic neurological sign associated
with hepatic encephalopathy, a complication of cirrhosis caused by the accumulation of
ammonia and other toxins in the blood.
Question 7: The nurse is preparing to administer a blood transfusion to a
client. What is the most important nursing action prior to infusing the blood
product?
A. Prime the IV tubing with 0.9% normal saline.
B. Obtain the client's vital signs.
C. Check the blood bag for clots.
D. Verify the client's identity and blood compatibility with another nurse.
CORRECT ANSWER: D. Verify the client's identity and blood compatibility with
another nurse.
Rationale: The most critical step in preventing a transfusion error is the two-nurse
verification process. The nurse must verify the client's identity, the blood product, and
the compatibility with another licensed nurse. While the other actions are important,
verification is the priority for patient safety.
Question 8: A client with chronic obstructive pulmonary disease (COPD) is
receiving oxygen via nasal cannula at 2 L/min. The nurse should monitor the
client for which potential complication?
A. Carbon dioxide narcosis
B. Oxygen toxicity
C. Nasal mucosal drying
D. Pneumothorax
CORRECT ANSWER: A. Carbon dioxide narcosis
Rationale: Clients with COPD often have a hypoxic drive to breathe. Administering
high-flow oxygen can suppress this drive, leading to hypoventilation and an increase in
carbon dioxide levels, which can progress to carbon dioxide narcosis and respiratory
failure. 2 L/min is generally considered safe, but the client's respiratory status should be
closely monitored.
Question 9: A client is admitted with a diagnosis of acute pancreatitis. Which
laboratory finding is most consistent with this diagnosis?
A. Elevated serum amylase and lipase
B. Elevated serum bilirubin and alkaline phosphatase
, C. Decreased serum calcium and magnesium
D. Elevated serum glucose and ketones
CORRECT ANSWER: A. Elevated serum amylase and lipase
Rationale: In acute pancreatitis, the pancreas releases large amounts of amylase and
lipase into the bloodstream. These are the primary diagnostic markers for acute
pancreatitis, with lipase being more specific. The other findings may be present in other
conditions or as secondary complications of pancreatitis.
Question 10: The nurse is caring for a client with a nasogastric (NG) tube
attached to low intermittent suction. Which assessment finding should the
nurse anticipate in this client?
A. Metabolic alkalosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Respiratory acidosis
CORRECT ANSWER: A. Metabolic alkalosis
Rationale: Nasogastric suctioning removes gastric acid (hydrochloric acid) from the
stomach. Loss of this acid leads to a relative increase in bicarbonate, resulting in
metabolic alkalosis. The other acid-base imbalances are not typically associated with
this type of fluid loss.
Question 11: A client who had a myocardial infarction 24 hours ago is
prescribed aspirin. What is the primary purpose of this medication?
A. To relieve chest pain
B. To prevent further platelet aggregation
C. To reduce blood pressure
D. To decrease cardiac workload
CORRECT ANSWER: B. To prevent further platelet aggregation
Rationale: The purpose of aspirin in acute coronary syndrome is to inhibit platelet
aggregation. This action prevents the formation of new clots and prevents the existing
clot from enlarging, thereby reducing mortality and the risk of recurrent infarction.
Question 12: The nurse is assessing a client with a suspected pulmonary
embolism. Which finding is a classic manifestation of this condition?
A. Bradycardia and hypotension
B. Sudden pleuritic chest pain and dyspnea
C. Productive cough with purulent sputum
D. Hyper-resonance over the affected lung field
CORRECT ANSWER: B. Sudden pleuritic chest pain and dyspnea
