ATI RN ADULT MEDICAL-SURGICAL NURSING –
COMPREHENSIVE NGN-STYLE STUDY QUESTIONS
AND ANSWERS | 2026/2027 LATEST UPDATE
SECTION 1: FOUNDATIONS, ASSESSMENT, INFECTION CONTROL, AND PERIOPERATIVE CARE
Questions 1–10
1. Which assessment finding requires the nurse to intervene first when receiving a client
on a medical-surgical unit?
A) Temperature of 37.4°C (99.3°F)
B) Respiratory rate of 30/min with oxygen saturation of 86%
C) Pain rating of 7/10 after surgery
D) Blood pressure of 142/86 mm Hg
Correct Answer: B) Respiratory rate of 30/min with oxygen saturation of 86%
Rationale: Hypoxemia and tachypnea indicate impaired oxygenation and take priority under
the airway-breathing-circulation framework. The pain score requires treatment but does not
immediately threaten oxygenation. The temperature and blood pressure are less urgent in
this context. The nurse should promptly assess respiratory status and initiate appropriate
oxygenation measures.
2. A sterile package is being opened for a procedure. Which flap should the nurse unfold
first?
A) The flap closest to the nurse
B) The right lateral flap
C) The left lateral flap
D) The flap farthest from the nurse
Correct Answer: D) The flap farthest from the nurse
Rationale: Opening the farthest flap first prevents the nurse's hands or arms from passing
over the sterile field. The lateral flaps are opened next, followed by the flap nearest the
nurse. This sequence helps maintain sterility and reduces the risk of contaminating the field.
3. Which action is most effective for preventing transmission of microorganisms between
clients?
A) Performing hand hygiene before and after client contact
B) Wearing gloves for every client interaction
C) Keeping the client's door closed
D) Administering prophylactic antibiotics
Correct Answer: A) Performing hand hygiene before and after client contact
,Rationale: Hand hygiene is the primary method for reducing transmission of microorganisms
in healthcare settings. Gloves do not replace hand hygiene and can become contaminated
during care. Door closure and antibiotics have specific indications but do not provide the
broad infection-prevention benefit of appropriate hand hygiene.
4. A client is scheduled for a procedure requiring moderate sedation. Which information is
most important for the nurse to verify before the procedure?
A) The client's preferred meal
B) The client's usual bedtime
C) The client's allergy history
D) The client's daily exercise routine
Correct Answer: C) The client's allergy history
Rationale: Allergy information is essential before administering medications or contrast
agents because an exposure can cause a serious hypersensitivity reaction. Routine
preferences and lifestyle information are less immediately relevant. The nurse should also
verify informed consent, medication history, fasting status, and baseline assessment findings
as appropriate.
5. Which finding most strongly suggests a postoperative wound infection?
A) Mild incisional discomfort
B) Small amount of serosanguineous drainage
C) Slight bruising surrounding the incision
D) Purulent drainage with increasing erythema
Correct Answer: D) Purulent drainage with increasing erythema
Rationale: Purulent drainage and increasing redness are classic findings associated with
localized wound infection. Some discomfort and limited serosanguineous drainage can occur
during normal healing. Bruising may also occur after surgery. Increasing warmth, swelling,
pain, fever, and purulent drainage warrant further assessment and intervention.
6. A nurse is preparing to administer medication through an enteral feeding tube. Which
action is appropriate?
A) Mix all medications together before administration
B) Verify tube placement according to facility policy
C) Add medications directly to the enteral formula
D) Crush every medication before administration
Correct Answer: B) Verify tube placement according to facility policy
Rationale: Tube placement must be verified using the institution's approved method before
medication administration. Medications should generally be administered separately and
flushed appropriately. Some medications must not be crushed, and medications should not
,routinely be mixed directly into enteral formula because of compatibility and dosing
concerns.
7. A client develops chills, hypotension, and dyspnea shortly after a blood transfusion
begins. What should the nurse do first?
A) Stop the transfusion
B) Increase the infusion rate
C) Document the findings after the transfusion
D) Administer the next scheduled medication
Correct Answer: A) Stop the transfusion
Rationale: Acute symptoms during transfusion can indicate a potentially life-threatening
transfusion reaction. The transfusion should be stopped immediately, while maintaining IV
access according to protocol with appropriate compatible solution. The nurse should then
notify the provider and blood bank and follow institutional transfusion-reaction procedures.
8. Which intervention is appropriate for a client receiving contact precautions?
A) Use an N95 respirator for every interaction
B) Place the client in a positive-pressure room
C) Wear gown and gloves according to precautions and anticipated contact
D) Keep the client in a negative-pressure room
Correct Answer: C) Wear gown and gloves according to precautions and anticipated
contact
Rationale: Contact precautions are intended to prevent transmission through direct or
indirect contact. Appropriate personal protective equipment includes gloves and, when
indicated by anticipated contact with the client or environment, a gown. Negative-pressure
rooms are associated with airborne precautions, whereas positive pressure is used for
selected protective environments.
9. Which postoperative finding should the nurse report immediately?
A) Pain rated 5/10
B) Urine output of 35 mL/hr
C) Small amount of incisional drainage
D) Sudden unilateral calf swelling and pain
Correct Answer: D) Sudden unilateral calf swelling and pain
Rationale: Sudden unilateral calf swelling and pain can indicate deep-vein thrombosis. A
thrombus can embolize and cause pulmonary embolism, creating a potentially life-
threatening complication. The nurse should promptly assess the client and notify the
appropriate clinician rather than massaging the extremity.
, 10. Which statement demonstrates correct understanding of incentive spirometry?
A) “I should exhale forcefully into the device.”
B) “I should use it only when I feel short of breath.”
C) “I should inhale slowly and deeply through the mouthpiece.”
D) “I should lie flat while using it.”
Correct Answer: C) “I should inhale slowly and deeply through the mouthpiece.”
Rationale: Incentive spirometry promotes sustained deep inspiration and helps prevent
postoperative atelectasis. The client should generally sit upright, seal the lips around the
mouthpiece, and inhale slowly and deeply. It is used regularly as prescribed rather than only
when dyspnea occurs.
SECTION 2: FLUID, ELECTROLYTE, AND ACID–BASE BALANCE
Questions 11–20
11. Which finding is most consistent with fluid volume deficit?
A) Bounding peripheral pulses
B) Orthostatic hypotension
C) Jugular venous distention
D) Bilateral crackles
Correct Answer: B) Orthostatic hypotension
Rationale: Fluid volume deficit decreases circulating volume and can cause orthostatic
hypotension, tachycardia, dry mucous membranes, and concentrated urine. Bounding pulses,
jugular venous distention, and crackles are more consistent with fluid volume excess. Urine
output and daily weight are also important indicators of changing fluid status.
12. A client has a serum potassium level of 6.7 mEq/L. Which finding requires immediate
attention?
A) Muscle weakness
B) Abdominal discomfort
C) Peaked T waves on the ECG
D) Increased thirst
Correct Answer: C) Peaked T waves on the ECG
Rationale: Severe hyperkalemia can cause dangerous cardiac conduction abnormalities.
Peaked T waves are an early ECG manifestation and indicate increased risk for dysrhythmia.
Muscle weakness can occur but the ECG change represents an immediate cardiovascular
threat requiring rapid intervention and cardiac monitoring.
COMPREHENSIVE NGN-STYLE STUDY QUESTIONS
AND ANSWERS | 2026/2027 LATEST UPDATE
SECTION 1: FOUNDATIONS, ASSESSMENT, INFECTION CONTROL, AND PERIOPERATIVE CARE
Questions 1–10
1. Which assessment finding requires the nurse to intervene first when receiving a client
on a medical-surgical unit?
A) Temperature of 37.4°C (99.3°F)
B) Respiratory rate of 30/min with oxygen saturation of 86%
C) Pain rating of 7/10 after surgery
D) Blood pressure of 142/86 mm Hg
Correct Answer: B) Respiratory rate of 30/min with oxygen saturation of 86%
Rationale: Hypoxemia and tachypnea indicate impaired oxygenation and take priority under
the airway-breathing-circulation framework. The pain score requires treatment but does not
immediately threaten oxygenation. The temperature and blood pressure are less urgent in
this context. The nurse should promptly assess respiratory status and initiate appropriate
oxygenation measures.
2. A sterile package is being opened for a procedure. Which flap should the nurse unfold
first?
A) The flap closest to the nurse
B) The right lateral flap
C) The left lateral flap
D) The flap farthest from the nurse
Correct Answer: D) The flap farthest from the nurse
Rationale: Opening the farthest flap first prevents the nurse's hands or arms from passing
over the sterile field. The lateral flaps are opened next, followed by the flap nearest the
nurse. This sequence helps maintain sterility and reduces the risk of contaminating the field.
3. Which action is most effective for preventing transmission of microorganisms between
clients?
A) Performing hand hygiene before and after client contact
B) Wearing gloves for every client interaction
C) Keeping the client's door closed
D) Administering prophylactic antibiotics
Correct Answer: A) Performing hand hygiene before and after client contact
,Rationale: Hand hygiene is the primary method for reducing transmission of microorganisms
in healthcare settings. Gloves do not replace hand hygiene and can become contaminated
during care. Door closure and antibiotics have specific indications but do not provide the
broad infection-prevention benefit of appropriate hand hygiene.
4. A client is scheduled for a procedure requiring moderate sedation. Which information is
most important for the nurse to verify before the procedure?
A) The client's preferred meal
B) The client's usual bedtime
C) The client's allergy history
D) The client's daily exercise routine
Correct Answer: C) The client's allergy history
Rationale: Allergy information is essential before administering medications or contrast
agents because an exposure can cause a serious hypersensitivity reaction. Routine
preferences and lifestyle information are less immediately relevant. The nurse should also
verify informed consent, medication history, fasting status, and baseline assessment findings
as appropriate.
5. Which finding most strongly suggests a postoperative wound infection?
A) Mild incisional discomfort
B) Small amount of serosanguineous drainage
C) Slight bruising surrounding the incision
D) Purulent drainage with increasing erythema
Correct Answer: D) Purulent drainage with increasing erythema
Rationale: Purulent drainage and increasing redness are classic findings associated with
localized wound infection. Some discomfort and limited serosanguineous drainage can occur
during normal healing. Bruising may also occur after surgery. Increasing warmth, swelling,
pain, fever, and purulent drainage warrant further assessment and intervention.
6. A nurse is preparing to administer medication through an enteral feeding tube. Which
action is appropriate?
A) Mix all medications together before administration
B) Verify tube placement according to facility policy
C) Add medications directly to the enteral formula
D) Crush every medication before administration
Correct Answer: B) Verify tube placement according to facility policy
Rationale: Tube placement must be verified using the institution's approved method before
medication administration. Medications should generally be administered separately and
flushed appropriately. Some medications must not be crushed, and medications should not
,routinely be mixed directly into enteral formula because of compatibility and dosing
concerns.
7. A client develops chills, hypotension, and dyspnea shortly after a blood transfusion
begins. What should the nurse do first?
A) Stop the transfusion
B) Increase the infusion rate
C) Document the findings after the transfusion
D) Administer the next scheduled medication
Correct Answer: A) Stop the transfusion
Rationale: Acute symptoms during transfusion can indicate a potentially life-threatening
transfusion reaction. The transfusion should be stopped immediately, while maintaining IV
access according to protocol with appropriate compatible solution. The nurse should then
notify the provider and blood bank and follow institutional transfusion-reaction procedures.
8. Which intervention is appropriate for a client receiving contact precautions?
A) Use an N95 respirator for every interaction
B) Place the client in a positive-pressure room
C) Wear gown and gloves according to precautions and anticipated contact
D) Keep the client in a negative-pressure room
Correct Answer: C) Wear gown and gloves according to precautions and anticipated
contact
Rationale: Contact precautions are intended to prevent transmission through direct or
indirect contact. Appropriate personal protective equipment includes gloves and, when
indicated by anticipated contact with the client or environment, a gown. Negative-pressure
rooms are associated with airborne precautions, whereas positive pressure is used for
selected protective environments.
9. Which postoperative finding should the nurse report immediately?
A) Pain rated 5/10
B) Urine output of 35 mL/hr
C) Small amount of incisional drainage
D) Sudden unilateral calf swelling and pain
Correct Answer: D) Sudden unilateral calf swelling and pain
Rationale: Sudden unilateral calf swelling and pain can indicate deep-vein thrombosis. A
thrombus can embolize and cause pulmonary embolism, creating a potentially life-
threatening complication. The nurse should promptly assess the client and notify the
appropriate clinician rather than massaging the extremity.
, 10. Which statement demonstrates correct understanding of incentive spirometry?
A) “I should exhale forcefully into the device.”
B) “I should use it only when I feel short of breath.”
C) “I should inhale slowly and deeply through the mouthpiece.”
D) “I should lie flat while using it.”
Correct Answer: C) “I should inhale slowly and deeply through the mouthpiece.”
Rationale: Incentive spirometry promotes sustained deep inspiration and helps prevent
postoperative atelectasis. The client should generally sit upright, seal the lips around the
mouthpiece, and inhale slowly and deeply. It is used regularly as prescribed rather than only
when dyspnea occurs.
SECTION 2: FLUID, ELECTROLYTE, AND ACID–BASE BALANCE
Questions 11–20
11. Which finding is most consistent with fluid volume deficit?
A) Bounding peripheral pulses
B) Orthostatic hypotension
C) Jugular venous distention
D) Bilateral crackles
Correct Answer: B) Orthostatic hypotension
Rationale: Fluid volume deficit decreases circulating volume and can cause orthostatic
hypotension, tachycardia, dry mucous membranes, and concentrated urine. Bounding pulses,
jugular venous distention, and crackles are more consistent with fluid volume excess. Urine
output and daily weight are also important indicators of changing fluid status.
12. A client has a serum potassium level of 6.7 mEq/L. Which finding requires immediate
attention?
A) Muscle weakness
B) Abdominal discomfort
C) Peaked T waves on the ECG
D) Increased thirst
Correct Answer: C) Peaked T waves on the ECG
Rationale: Severe hyperkalemia can cause dangerous cardiac conduction abnormalities.
Peaked T waves are an early ECG manifestation and indicate increased risk for dysrhythmia.
Muscle weakness can occur but the ECG change represents an immediate cardiovascular
threat requiring rapid intervention and cardiac monitoring.
