ATI RN ADULT MEDICAL SURGICAL MED-SURG
NGN ADVANCED PRACTICE EXAM PREP
QUESTIONS AND ANSWERS BANK QUESTIONS
WITH EXPLANATIONS
This high-yield Next Generation NCLEX (NGN) practice
collection contains advanced adult medical-surgical
multiple-choice questions, featuring immediate answers and
comprehensive, bolded justifications. It is meticulously
aligned with current nursing concepts, prioritizing clinical
judgment frameworks like ABCs, fluid and electrolyte
balancing, and acute postoperative emergency management.
Ideal for nursing students seeking top-tier study resources,
this comprehensive test bank guarantees deeper conceptual
clarity and enhanced board exam readiness.
Question 1
A nurse is caring for a client who is 24 hours postoperative
following a total thyroidectomy. Which of the following findings is
the priority for the nurse to report to the provider?
• A) Mild hoarseness when speaking
• B) Laryngeal stridor or crowing respirations
• C) Pain rating of 6 out of 10 at the incision site
• D) Calcium level of 8.8 mg/dL
,Answer: B
Rationale: Laryngeal stridor indicates an acute airway
obstruction, which can occur after thyroid surgery due to edema,
nerve damage, or tetany from hypocalcemia. This is a life-
threatening emergency that requires immediate intervention. Mild
hoarseness is expected due to endotracheal intubation. A calcium
level of 8.8 mg/dL is slightly low but not as critically urgent as a
compromised airway.
Question 2
A nurse is assessing a client who has advanced cirrhosis. Which
of the following clinical manifestations should the nurse expect to
find?
• A) Increased skin turgor
• B) Splenomegaly and ascites
• C) Decreased prothrombin time (PT)
• D) Hyperglycemia
Answer: B
Rationale: Portal hypertension caused by cirrhosis leads to fluid
backup into the spleen (splenomegaly) and fluid accumulation in
the peritoneal cavity (ascites). The liver synthesized clotting
factors, so cirrhosis causes an increased, prolonged PT, not a
decreased one. Skin turgor is typically poor, and clients are prone
to hypoglycemia due to impaired glycogen storage.
Question 3
,A nurse is planning care for a client who is experiencing an acute
exacerbation of ulcerative colitis. Which of the following dietary
recommendations is appropriate?
• A) High-fiber diet with raw vegetables
• B) Low-residue, high-protein diet
• C) Increased consumption of caffeinated beverages
• D) Whole-grain breads and cereals
Answer: B
Rationale: During an acute flare-up of ulcerative colitis, the bowel
needs to rest. A low-residue (low-fiber) diet reduces stool bulk and
irritation to the colon mucosa. High protein is necessary to
promote tissue healing and counteract protein loss from
inflammatory exudates. Caffeine and high-fiber foods exacerbate
diarrhea and cramping.
Question 4
A nurse is monitoring a client who is receiving a blood transfusion.
Within 15 minutes of the start of the infusion, the client reports
chills, low back pain, and anxiety. Which of the following actions
should the nurse take first?
• A) Administer diphenhydramine intravenously
• B) Slow the infusion rate down to a keep-vein-open rate
• C) Stop the blood transfusion immediately
• D) Obtain a urine specimen to check for hemoglobinuria
, Answer: C
Rationale: The client is exhibiting classic signs of an acute
hemolytic transfusion reaction (chills, low back pain, anxiety,
fever). The priority nursing action is to immediately stop the
infusion to prevent further administration of incompatible blood.
Maintaining the IV line with normal saline using new tubing is the
next step, followed by notifying the provider.
Question 5
A nurse is caring for a client admitted with Diabetic Ketoacidosis
(DKA). Which of the following laboratory values should the nurse
anticipate?
• A) Serum pH 7.48, PaCO2 38 mm Hg, HCO3 28 mEq/L
• B) Serum pH 7.28, PaCO2 30 mm Hg, HCO3 14 mEq/L
• C) Blood glucose 180 mg/dL, negative ketones
• D) Serum potassium 2.8 mEq/L
Answer: B
Rationale: Diabetic Ketoacidosis is characterized by metabolic
acidosis. A pH below 7.35 and an HCO3 below 22 mEq/L match
this state. The PaCO2 drops below normal (35-45 mm Hg) as a
compensatory mechanism (Kussmaul respirations) to blow off
carbon dioxide. Blood glucose in DKA is typically significantly
higher (greater than 250 mg/dL), and ketones are strongly
present.
Question 6
NGN ADVANCED PRACTICE EXAM PREP
QUESTIONS AND ANSWERS BANK QUESTIONS
WITH EXPLANATIONS
This high-yield Next Generation NCLEX (NGN) practice
collection contains advanced adult medical-surgical
multiple-choice questions, featuring immediate answers and
comprehensive, bolded justifications. It is meticulously
aligned with current nursing concepts, prioritizing clinical
judgment frameworks like ABCs, fluid and electrolyte
balancing, and acute postoperative emergency management.
Ideal for nursing students seeking top-tier study resources,
this comprehensive test bank guarantees deeper conceptual
clarity and enhanced board exam readiness.
Question 1
A nurse is caring for a client who is 24 hours postoperative
following a total thyroidectomy. Which of the following findings is
the priority for the nurse to report to the provider?
• A) Mild hoarseness when speaking
• B) Laryngeal stridor or crowing respirations
• C) Pain rating of 6 out of 10 at the incision site
• D) Calcium level of 8.8 mg/dL
,Answer: B
Rationale: Laryngeal stridor indicates an acute airway
obstruction, which can occur after thyroid surgery due to edema,
nerve damage, or tetany from hypocalcemia. This is a life-
threatening emergency that requires immediate intervention. Mild
hoarseness is expected due to endotracheal intubation. A calcium
level of 8.8 mg/dL is slightly low but not as critically urgent as a
compromised airway.
Question 2
A nurse is assessing a client who has advanced cirrhosis. Which
of the following clinical manifestations should the nurse expect to
find?
• A) Increased skin turgor
• B) Splenomegaly and ascites
• C) Decreased prothrombin time (PT)
• D) Hyperglycemia
Answer: B
Rationale: Portal hypertension caused by cirrhosis leads to fluid
backup into the spleen (splenomegaly) and fluid accumulation in
the peritoneal cavity (ascites). The liver synthesized clotting
factors, so cirrhosis causes an increased, prolonged PT, not a
decreased one. Skin turgor is typically poor, and clients are prone
to hypoglycemia due to impaired glycogen storage.
Question 3
,A nurse is planning care for a client who is experiencing an acute
exacerbation of ulcerative colitis. Which of the following dietary
recommendations is appropriate?
• A) High-fiber diet with raw vegetables
• B) Low-residue, high-protein diet
• C) Increased consumption of caffeinated beverages
• D) Whole-grain breads and cereals
Answer: B
Rationale: During an acute flare-up of ulcerative colitis, the bowel
needs to rest. A low-residue (low-fiber) diet reduces stool bulk and
irritation to the colon mucosa. High protein is necessary to
promote tissue healing and counteract protein loss from
inflammatory exudates. Caffeine and high-fiber foods exacerbate
diarrhea and cramping.
Question 4
A nurse is monitoring a client who is receiving a blood transfusion.
Within 15 minutes of the start of the infusion, the client reports
chills, low back pain, and anxiety. Which of the following actions
should the nurse take first?
• A) Administer diphenhydramine intravenously
• B) Slow the infusion rate down to a keep-vein-open rate
• C) Stop the blood transfusion immediately
• D) Obtain a urine specimen to check for hemoglobinuria
, Answer: C
Rationale: The client is exhibiting classic signs of an acute
hemolytic transfusion reaction (chills, low back pain, anxiety,
fever). The priority nursing action is to immediately stop the
infusion to prevent further administration of incompatible blood.
Maintaining the IV line with normal saline using new tubing is the
next step, followed by notifying the provider.
Question 5
A nurse is caring for a client admitted with Diabetic Ketoacidosis
(DKA). Which of the following laboratory values should the nurse
anticipate?
• A) Serum pH 7.48, PaCO2 38 mm Hg, HCO3 28 mEq/L
• B) Serum pH 7.28, PaCO2 30 mm Hg, HCO3 14 mEq/L
• C) Blood glucose 180 mg/dL, negative ketones
• D) Serum potassium 2.8 mEq/L
Answer: B
Rationale: Diabetic Ketoacidosis is characterized by metabolic
acidosis. A pH below 7.35 and an HCO3 below 22 mEq/L match
this state. The PaCO2 drops below normal (35-45 mm Hg) as a
compensatory mechanism (Kussmaul respirations) to blow off
carbon dioxide. Blood glucose in DKA is typically significantly
higher (greater than 250 mg/dL), and ketones are strongly
present.
Question 6
