ATI RN Medical-Surgical Proctored Exam 2026/2027 —
Comprehensive 150-Question NGN Practice Test with Correct
Answers & Detailed Rationales
1. A client with heart failure reports increasing shortness of breath and has bilateral
crackles. Which action should the nurse take first?
A. Encourage oral fluids
B. Place the client in high-Fowler's position
C. Encourage ambulation
D. Administer a sedative
Answer: B. Place the client in high-Fowler's position
Rationale: High-Fowler's positioning improves lung expansion and decreases venous return,
which can reduce pulmonary congestion and improve oxygenation.
2. A client with acute pulmonary edema has severe dyspnea and an oxygen saturation of
82%. Which intervention has priority?
A. Place the client supine
B. Apply oxygen as prescribed
C. Encourage oral fluids
D. Obtain a daily weight
Answer: B. Apply oxygen as prescribed
Rationale: Severe hypoxemia is an immediate priority. Oxygen therapy supports adequate tissue
oxygenation while additional treatment is initiated.
3. A client taking furosemide reports muscle weakness and palpitations. Which laboratory
value should the nurse assess first?
A. Potassium
B. Hemoglobin
C. Platelets
D. Calcium
Answer: A. Potassium
,Rationale: Furosemide can cause potassium loss. Hypokalemia can produce muscle weakness
and potentially dangerous cardiac dysrhythmias.
4. A client taking digoxin has an apical pulse of 52/min and reports nausea and yellow-
green visual changes. What should the nurse do?
A. Administer the medication
B. Hold the medication and notify the provider
C. Give an additional dose
D. Encourage increased sodium intake
Answer: B. Hold the medication and notify the provider
Rationale: Bradycardia, nausea, and visual disturbances are manifestations of possible digoxin
toxicity.
5. A client taking warfarin has an INR of 5.2. Which action should the nurse anticipate?
A. Administer the scheduled dose
B. Hold the medication and notify the provider
C. Encourage increased activity
D. Administer aspirin
Answer: B. Hold the medication and notify the provider
Rationale: An excessively elevated INR increases bleeding risk. The medication should be held
and the provider notified for further management.
6. A client receiving heparin develops bleeding from the gums and has a significantly
elevated aPTT. Which action is appropriate?
A. Continue the infusion
B. Stop the infusion and notify the provider
C. Administer aspirin
D. Encourage ambulation
Answer: B. Stop the infusion and notify the provider
Rationale: Excessive anticoagulation with active bleeding requires immediate intervention.
,7. A client with COPD is receiving oxygen. Which prescription should the nurse question?
A. Low-flow oxygen with monitoring
B. Oxygen titrated according to prescribed target saturation
C. Continuous pulse oximetry
D. Uncontrolled high-concentration oxygen without monitoring
Answer: D. Uncontrolled high-concentration oxygen without monitoring
Rationale: Oxygen should be carefully titrated in clients with COPD according to the prescribed
target and clinical condition.
8. A client with COPD is experiencing dyspnea. Which breathing technique should the
nurse teach?
A. Pursed-lip breathing
B. Rapid shallow breathing
C. Breath holding
D. Mouth breathing only
Answer: A. Pursed-lip breathing
Rationale: Pursed-lip breathing helps maintain airway pressure during exhalation and can
decrease air trapping and dyspnea.
9. A client with asthma develops wheezing and difficulty breathing. Which medication
should the nurse expect to administer for rapid relief?
A. Albuterol
B. Montelukast
C. Fluticasone
D. Prednisone only
Answer: A. Albuterol
Rationale: Albuterol is a short-acting beta2 agonist that produces rapid bronchodilation during
acute bronchospasm.
, 10. A client with pneumonia has a temperature of 39.2°C (102.6°F), respiratory rate of
30/min, and oxygen saturation of 86%. Which finding requires priority intervention?
A. Fever
B. Hypoxemia
C. Productive cough
D. Fatigue
Answer: B. Hypoxemia
Rationale: Oxygenation is the immediate priority. An oxygen saturation of 86% indicates
significant impaired oxygenation.
11. A client with a chest tube suddenly has continuous bubbling in the water-seal chamber.
What should the nurse do first?
A. Clamp the chest tube
B. Assess the system for an air leak
C. Remove the chest tube
D. Place the client flat
Answer: B. Assess the system for an air leak
Rationale: Continuous bubbling in the water-seal chamber can indicate an air leak. The nurse
should assess connections and the tubing system.
12. A client with a chest tube is accidentally disconnected from the drainage system. What
should the nurse do?
A. Place the end of the tube in sterile water
B. Clamp the tube for several hours
C. Remove the tube
D. Leave the tube open to air
Answer: A. Place the end of the tube in sterile water
Rationale: Placing the tube end in sterile water temporarily recreates a water seal and helps
prevent air from entering the pleural space.
Comprehensive 150-Question NGN Practice Test with Correct
Answers & Detailed Rationales
1. A client with heart failure reports increasing shortness of breath and has bilateral
crackles. Which action should the nurse take first?
A. Encourage oral fluids
B. Place the client in high-Fowler's position
C. Encourage ambulation
D. Administer a sedative
Answer: B. Place the client in high-Fowler's position
Rationale: High-Fowler's positioning improves lung expansion and decreases venous return,
which can reduce pulmonary congestion and improve oxygenation.
2. A client with acute pulmonary edema has severe dyspnea and an oxygen saturation of
82%. Which intervention has priority?
A. Place the client supine
B. Apply oxygen as prescribed
C. Encourage oral fluids
D. Obtain a daily weight
Answer: B. Apply oxygen as prescribed
Rationale: Severe hypoxemia is an immediate priority. Oxygen therapy supports adequate tissue
oxygenation while additional treatment is initiated.
3. A client taking furosemide reports muscle weakness and palpitations. Which laboratory
value should the nurse assess first?
A. Potassium
B. Hemoglobin
C. Platelets
D. Calcium
Answer: A. Potassium
,Rationale: Furosemide can cause potassium loss. Hypokalemia can produce muscle weakness
and potentially dangerous cardiac dysrhythmias.
4. A client taking digoxin has an apical pulse of 52/min and reports nausea and yellow-
green visual changes. What should the nurse do?
A. Administer the medication
B. Hold the medication and notify the provider
C. Give an additional dose
D. Encourage increased sodium intake
Answer: B. Hold the medication and notify the provider
Rationale: Bradycardia, nausea, and visual disturbances are manifestations of possible digoxin
toxicity.
5. A client taking warfarin has an INR of 5.2. Which action should the nurse anticipate?
A. Administer the scheduled dose
B. Hold the medication and notify the provider
C. Encourage increased activity
D. Administer aspirin
Answer: B. Hold the medication and notify the provider
Rationale: An excessively elevated INR increases bleeding risk. The medication should be held
and the provider notified for further management.
6. A client receiving heparin develops bleeding from the gums and has a significantly
elevated aPTT. Which action is appropriate?
A. Continue the infusion
B. Stop the infusion and notify the provider
C. Administer aspirin
D. Encourage ambulation
Answer: B. Stop the infusion and notify the provider
Rationale: Excessive anticoagulation with active bleeding requires immediate intervention.
,7. A client with COPD is receiving oxygen. Which prescription should the nurse question?
A. Low-flow oxygen with monitoring
B. Oxygen titrated according to prescribed target saturation
C. Continuous pulse oximetry
D. Uncontrolled high-concentration oxygen without monitoring
Answer: D. Uncontrolled high-concentration oxygen without monitoring
Rationale: Oxygen should be carefully titrated in clients with COPD according to the prescribed
target and clinical condition.
8. A client with COPD is experiencing dyspnea. Which breathing technique should the
nurse teach?
A. Pursed-lip breathing
B. Rapid shallow breathing
C. Breath holding
D. Mouth breathing only
Answer: A. Pursed-lip breathing
Rationale: Pursed-lip breathing helps maintain airway pressure during exhalation and can
decrease air trapping and dyspnea.
9. A client with asthma develops wheezing and difficulty breathing. Which medication
should the nurse expect to administer for rapid relief?
A. Albuterol
B. Montelukast
C. Fluticasone
D. Prednisone only
Answer: A. Albuterol
Rationale: Albuterol is a short-acting beta2 agonist that produces rapid bronchodilation during
acute bronchospasm.
, 10. A client with pneumonia has a temperature of 39.2°C (102.6°F), respiratory rate of
30/min, and oxygen saturation of 86%. Which finding requires priority intervention?
A. Fever
B. Hypoxemia
C. Productive cough
D. Fatigue
Answer: B. Hypoxemia
Rationale: Oxygenation is the immediate priority. An oxygen saturation of 86% indicates
significant impaired oxygenation.
11. A client with a chest tube suddenly has continuous bubbling in the water-seal chamber.
What should the nurse do first?
A. Clamp the chest tube
B. Assess the system for an air leak
C. Remove the chest tube
D. Place the client flat
Answer: B. Assess the system for an air leak
Rationale: Continuous bubbling in the water-seal chamber can indicate an air leak. The nurse
should assess connections and the tubing system.
12. A client with a chest tube is accidentally disconnected from the drainage system. What
should the nurse do?
A. Place the end of the tube in sterile water
B. Clamp the tube for several hours
C. Remove the tube
D. Leave the tube open to air
Answer: A. Place the end of the tube in sterile water
Rationale: Placing the tube end in sterile water temporarily recreates a water seal and helps
prevent air from entering the pleural space.
