ATI RN Fundamentals Proctored Exam
2026/2027 – NGN Questions and Answers
with Detailed Rationales
CASE STUDY 1 — POSTOPERATIVE CLIENT
Scenario:
A 68-year-old client is 4 hours postoperative following abdominal surgery. The
client is receiving IV fluids and opioid analgesia. The nurse notes increasing
abdominal pain, shallow respirations, and an oxygen saturation of 91% on room
air.
1. Recognize Cues — Multiple Response
Which findings require immediate nursing attention? Select all that apply.
A. Oxygen saturation 91%
B. Shallow respirations
C. Increasing abdominal pain
D. Temperature 37.1°C (98.8°F)
E. Heart rate 84/min
Answer: A, B, C
Rationale: Hypoxemia, shallow respirations, and increasing postoperative pain
can indicate respiratory compromise or another postoperative complication.
Normal temperature and heart rate do not require immediate intervention.
2. Analyze Cues
Which complication is the nurse most concerned about?
A. Constipation
B. Atelectasis
C. Urinary retention
D. Wound infection
,Answer: B
Rationale: Shallow postoperative respirations and decreased oxygen saturation
are classic cues for developing atelectasis. Pain and opioid use can reduce deep
breathing and coughing.
3. Generate Solutions
Which intervention should the nurse implement first?
A. Encourage incentive spirometry
B. Offer oral fluids
C. Place the client flat
D. Restrict activity
Answer: A
Rationale: Incentive spirometry promotes alveolar expansion and helps prevent
or treat atelectasis. The client should also be positioned to optimize ventilation.
4. Take Action
Which position best promotes lung expansion?
A. Supine
B. High-Fowler's
C. Trendelenburg
D. Prone
Answer: B
Rationale: High-Fowler's positioning promotes diaphragmatic expansion and
improves ventilation.
5. Evaluate Outcomes
Which finding indicates improvement?
A. Oxygen saturation 96%
B. Respiratory rate 8/min
C. Increasing crackles
D. Increasing cyanosis
,Answer: A
Rationale: An oxygen saturation of 96% indicates improved oxygenation.
Respiratory depression, worsening crackles, and cyanosis indicate deterioration.
6. Multiple Response
Which interventions help prevent postoperative atelectasis?
A. Incentive spirometry
B. Early ambulation
C. Adequate pain control
D. Prolonged bed rest
E. Coughing and deep breathing
Answer: A, B, C, E
Rationale: Lung expansion, mobility, effective pain management, coughing, and
deep breathing reduce atelectasis risk. Bed rest increases the risk.
7. Matrix
Classify each finding as Expected or Requires Follow-Up.
Finding Answer
Incisional pain rated 3/10 Expected
SpO₂ 89% Requires follow-up
RR 16/min Expected
New confusion Requires follow-up
Rationale: Mild postoperative pain and normal respiratory rate may be expected.
Significant hypoxemia and new confusion can indicate inadequate oxygenation or
another complication.
8. Priority
Which assessment should the nurse perform first?
, A. Bowel sounds
B. Respiratory status
C. Surgical dressing
D. Urine color
Answer: B
Rationale: Airway and breathing take priority. The decreased oxygen saturation
and shallow breathing require immediate assessment.
9. Multiple Response
Which findings suggest opioid-induced respiratory depression?
A. RR 8/min
B. Difficult to arouse
C. SpO₂ 88%
D. Increased alertness
E. Pinpoint pupils
Answer: A, B, C, E
Rationale: Opioids can cause respiratory depression, sedation, hypoxemia, and
miosis.
10. Action
The client's respiratory rate decreases to 7/min after IV morphine. What should
the nurse do first?
A. Administer another opioid
B. Stimulate the client and assess airway/breathing
C. Place the client flat
D. Encourage sleep
Answer: B
Rationale: Severe respiratory depression requires immediate airway and
breathing assessment. Naloxone may be prescribed/indicated after emergency
assessment and support.
11. Evaluate
2026/2027 – NGN Questions and Answers
with Detailed Rationales
CASE STUDY 1 — POSTOPERATIVE CLIENT
Scenario:
A 68-year-old client is 4 hours postoperative following abdominal surgery. The
client is receiving IV fluids and opioid analgesia. The nurse notes increasing
abdominal pain, shallow respirations, and an oxygen saturation of 91% on room
air.
1. Recognize Cues — Multiple Response
Which findings require immediate nursing attention? Select all that apply.
A. Oxygen saturation 91%
B. Shallow respirations
C. Increasing abdominal pain
D. Temperature 37.1°C (98.8°F)
E. Heart rate 84/min
Answer: A, B, C
Rationale: Hypoxemia, shallow respirations, and increasing postoperative pain
can indicate respiratory compromise or another postoperative complication.
Normal temperature and heart rate do not require immediate intervention.
2. Analyze Cues
Which complication is the nurse most concerned about?
A. Constipation
B. Atelectasis
C. Urinary retention
D. Wound infection
,Answer: B
Rationale: Shallow postoperative respirations and decreased oxygen saturation
are classic cues for developing atelectasis. Pain and opioid use can reduce deep
breathing and coughing.
3. Generate Solutions
Which intervention should the nurse implement first?
A. Encourage incentive spirometry
B. Offer oral fluids
C. Place the client flat
D. Restrict activity
Answer: A
Rationale: Incentive spirometry promotes alveolar expansion and helps prevent
or treat atelectasis. The client should also be positioned to optimize ventilation.
4. Take Action
Which position best promotes lung expansion?
A. Supine
B. High-Fowler's
C. Trendelenburg
D. Prone
Answer: B
Rationale: High-Fowler's positioning promotes diaphragmatic expansion and
improves ventilation.
5. Evaluate Outcomes
Which finding indicates improvement?
A. Oxygen saturation 96%
B. Respiratory rate 8/min
C. Increasing crackles
D. Increasing cyanosis
,Answer: A
Rationale: An oxygen saturation of 96% indicates improved oxygenation.
Respiratory depression, worsening crackles, and cyanosis indicate deterioration.
6. Multiple Response
Which interventions help prevent postoperative atelectasis?
A. Incentive spirometry
B. Early ambulation
C. Adequate pain control
D. Prolonged bed rest
E. Coughing and deep breathing
Answer: A, B, C, E
Rationale: Lung expansion, mobility, effective pain management, coughing, and
deep breathing reduce atelectasis risk. Bed rest increases the risk.
7. Matrix
Classify each finding as Expected or Requires Follow-Up.
Finding Answer
Incisional pain rated 3/10 Expected
SpO₂ 89% Requires follow-up
RR 16/min Expected
New confusion Requires follow-up
Rationale: Mild postoperative pain and normal respiratory rate may be expected.
Significant hypoxemia and new confusion can indicate inadequate oxygenation or
another complication.
8. Priority
Which assessment should the nurse perform first?
, A. Bowel sounds
B. Respiratory status
C. Surgical dressing
D. Urine color
Answer: B
Rationale: Airway and breathing take priority. The decreased oxygen saturation
and shallow breathing require immediate assessment.
9. Multiple Response
Which findings suggest opioid-induced respiratory depression?
A. RR 8/min
B. Difficult to arouse
C. SpO₂ 88%
D. Increased alertness
E. Pinpoint pupils
Answer: A, B, C, E
Rationale: Opioids can cause respiratory depression, sedation, hypoxemia, and
miosis.
10. Action
The client's respiratory rate decreases to 7/min after IV morphine. What should
the nurse do first?
A. Administer another opioid
B. Stimulate the client and assess airway/breathing
C. Place the client flat
D. Encourage sleep
Answer: B
Rationale: Severe respiratory depression requires immediate airway and
breathing assessment. Naloxone may be prescribed/indicated after emergency
assessment and support.
11. Evaluate
