Study Guide NGN ATI Med-Surg Exam 2024
NGN ATI Med-Surg Proctored Exam 2024
Study Guide
Comprehensive Preparation for Nursing Students
Date: June 18, 2025
Introduction
This study guide prepares nursing students for the 2024 Next Generation NCLEX (NGN) ATI
Medical-Surgical Proctored Exam. It includes 100 sample questions (traditional multiple-choice
and NGN case studies with select-all-that-apply, drag-and-drop, and prioritization formats), cov-
ering cardiovascular, respiratory, gastrointestinal, neurological, endocrine, renal, and patient
safety topics. Each question provides a verified answer with a step-by-step rationale to enhance
clinical judgment. Study tips, curated resources, a practice strategy, and common pitfalls to
avoid ensure a robust preparation framework aligned with the NCSBN Clinical Judgment Mea-
surement Model.
1 Key Topics to Review
• Cardiovascular Disorders: Heart failure, myocardial infarction, hypertension, dysrhyth-
mias.
• Respiratory Disorders: COPD, pneumonia, pulmonary embolism, chest tubes.
• Gastrointestinal Disorders: Peptic ulcer disease, liver cirrhosis, pancreatitis.
• Neurological Disorders: Stroke, seizures, traumatic brain injury.
• Endocrine Disorders: Diabetes mellitus, thyroid disorders, diabetes insipidus.
• Renal and Urinary Disorders: Chronic kidney disease, urinary tract infections.
• Patient Safety: Infection control, medication administration, fall prevention.
• NGN Case Studies: Prioritization, delegation, clinical judgment, collaboration.
2 Sample Questions and Answers
2.1 Traditional Multiple-Choice Questions
1. A nurse is caring for a client with heart failure reporting shortness of breath. Which
laboratory value should be prioritized?
A. Sodium 138 mEq/L
B. Potassium 5.8 mEq/L
C. Calcium 9 mg/dL
D. Magnesium 2 mEq/L
Correct Answer: B. Potassium 5.8 mEq/L
Rationale: Hyperkalemia (>5.0 mEq/L) risks dysrhythmias in heart failure. Step-by-
step: Sodium (A) 135–145 mEq/L, calcium (C) 8.5–10.5 mg/dL, magnesium (D) 1.5–2.5
mEq/L are normal.
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,Study Guide NGN ATI Med-Surg Exam 2024
2. A nurse provides discharge teaching for a client on warfarin. Which statement in-
dicates understanding?
A. “I can eat unlimited spinach.”
B. “I’ll report bleeding immediately.”
C. “INR monitoring isn’t needed.”
D. “Ibuprofen is safe for pain.”
Correct Answer: B. “I’ll report bleeding immediately.”
Rationale: Warfarin increases bleeding risk; report bruising or blood in urine. Step-by-
step: Spinach (A) reduces efficacy, INR (C) is required, ibuprofen (D) increases bleeding.
3. A nurse assesses a client with a chest tube for hemothorax. Which finding should be
reported?
A. Intermittent suction chamber bubbling
B. 100 mL dark red drainage/hour
C. Continuous water seal chamber bubbling
D. Gentle water seal fluctuation
Correct Answer: C. Continuous water seal chamber bubbling
Rationale: Continuous bubbling indicates an air leak. Step-by-step: Suction bubbling
(A) and fluctuations (D) are normal; drainage (B) is acceptable.
4. A nurse cares for a client post-TURP with bladder irrigation. Which finding should
be reported?
A. Output equals irrigant
B. Bladder spasms
C. Viscous output with clots
D. Urge to urinate
Correct Answer: C. Viscous output with clots
Rationale: Clots suggest arterial bleeding, an emergency. Step-by-step: Equal output (A),
spasms (B), and urge (D) are expected.
5. A nurse administers lactated Ringer’s at 200 mL/hr with 10 drops/mL tubing. How
many drops/min? (Round to nearest whole number.)
A. 10
B. 22
C. 33
D. 44
Correct Answer: C. 33
Rationale: (200 × 10) ÷ 60 = 33.33, rounded to 33.
6. A nurse cares for a client with diabetes insipidus. Which medication is appropriate?
A. Furosemide
B. Desmopressin
C. Lisinopril
D. Metformin
Correct Answer: B. Desmopressin
Rationale: Desmopressin reduces urine output. Step-by-step: Furosemide (A) is a di-
uretic, lisinopril (C) an ACE inhibitor, metformin (D) for diabetes mellitus.
7. A nurse reviews CSF for bacterial meningitis. Which finding is expected?
A. Elevated glucose
B. Elevated protein
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, Study Guide NGN ATI Med-Surg Exam 2024
C. RBCs in CSF
D. Decreased WBCs
Correct Answer: B. Elevated protein
Rationale: Meningitis causes high protein, low glucose, high WBCs. RBCs (C) suggest
bleeding.
8. A nurse teaches a client on ranitidine for peptic ulcer. Which instruction is correct?
A. “Take at bedtime to prevent ulcers.”
B. “Take on an empty stomach.”
C. “Expect a metallic taste.”
D. “Avoid antacids within 1 hour.”
Correct Answer: B. “Take on an empty stomach.”
Rationale: Ranitidine is effective on an empty stomach. Antacids (D) are compatible,
metallic taste (C) is uncommon.
9. A nurse monitors a blood transfusion client with bounding pulses, hypertension, and
JVD. Which medication is anticipated?
A. Diphenhydramine
B. Furosemide
C. Epinephrine
D. Acetaminophen
Correct Answer: B. Furosemide
Rationale: Fluid overload requires furosemide. Diphenhydramine (A) for allergies, epinephrine
(C) for anaphylaxis, acetaminophen (D) for fever.
10. A nurse cares for a client 12 hours post-colon resection. Which finding should be
reported?
A. Abdominal distension
B. Bowel sounds
C. Flatus
D. Soft abdomen
Correct Answer: A. Abdominal distension
Rationale: Distension suggests ileus or obstruction. Bowel sounds (B), flatus (C), and
soft abdomen (D) are normal.
11. A nurse assesses a client with COPD. Which finding indicates worsening condition?
A. SpO2 90%
B. Barrel chest
C. Use of accessory muscles
D. Pursed-lip breathing
Correct Answer: C. Use of accessory muscles
Rationale: Accessory muscle use indicates respiratory distress. Barrel chest (B) and
pursed-lip breathing (D) are chronic; SpO2 90% (A) is borderline.
12. A nurse administers insulin lispro. When should the meal be served?
A. Immediately
B. 30 minutes later
C. 1 hour later
D. 2 hours later
Correct Answer: A. Immediately
Rationale: Lispro peaks in 15–30 minutes, requiring immediate food intake.
Page 3
NGN ATI Med-Surg Proctored Exam 2024
Study Guide
Comprehensive Preparation for Nursing Students
Date: June 18, 2025
Introduction
This study guide prepares nursing students for the 2024 Next Generation NCLEX (NGN) ATI
Medical-Surgical Proctored Exam. It includes 100 sample questions (traditional multiple-choice
and NGN case studies with select-all-that-apply, drag-and-drop, and prioritization formats), cov-
ering cardiovascular, respiratory, gastrointestinal, neurological, endocrine, renal, and patient
safety topics. Each question provides a verified answer with a step-by-step rationale to enhance
clinical judgment. Study tips, curated resources, a practice strategy, and common pitfalls to
avoid ensure a robust preparation framework aligned with the NCSBN Clinical Judgment Mea-
surement Model.
1 Key Topics to Review
• Cardiovascular Disorders: Heart failure, myocardial infarction, hypertension, dysrhyth-
mias.
• Respiratory Disorders: COPD, pneumonia, pulmonary embolism, chest tubes.
• Gastrointestinal Disorders: Peptic ulcer disease, liver cirrhosis, pancreatitis.
• Neurological Disorders: Stroke, seizures, traumatic brain injury.
• Endocrine Disorders: Diabetes mellitus, thyroid disorders, diabetes insipidus.
• Renal and Urinary Disorders: Chronic kidney disease, urinary tract infections.
• Patient Safety: Infection control, medication administration, fall prevention.
• NGN Case Studies: Prioritization, delegation, clinical judgment, collaboration.
2 Sample Questions and Answers
2.1 Traditional Multiple-Choice Questions
1. A nurse is caring for a client with heart failure reporting shortness of breath. Which
laboratory value should be prioritized?
A. Sodium 138 mEq/L
B. Potassium 5.8 mEq/L
C. Calcium 9 mg/dL
D. Magnesium 2 mEq/L
Correct Answer: B. Potassium 5.8 mEq/L
Rationale: Hyperkalemia (>5.0 mEq/L) risks dysrhythmias in heart failure. Step-by-
step: Sodium (A) 135–145 mEq/L, calcium (C) 8.5–10.5 mg/dL, magnesium (D) 1.5–2.5
mEq/L are normal.
Page 1
,Study Guide NGN ATI Med-Surg Exam 2024
2. A nurse provides discharge teaching for a client on warfarin. Which statement in-
dicates understanding?
A. “I can eat unlimited spinach.”
B. “I’ll report bleeding immediately.”
C. “INR monitoring isn’t needed.”
D. “Ibuprofen is safe for pain.”
Correct Answer: B. “I’ll report bleeding immediately.”
Rationale: Warfarin increases bleeding risk; report bruising or blood in urine. Step-by-
step: Spinach (A) reduces efficacy, INR (C) is required, ibuprofen (D) increases bleeding.
3. A nurse assesses a client with a chest tube for hemothorax. Which finding should be
reported?
A. Intermittent suction chamber bubbling
B. 100 mL dark red drainage/hour
C. Continuous water seal chamber bubbling
D. Gentle water seal fluctuation
Correct Answer: C. Continuous water seal chamber bubbling
Rationale: Continuous bubbling indicates an air leak. Step-by-step: Suction bubbling
(A) and fluctuations (D) are normal; drainage (B) is acceptable.
4. A nurse cares for a client post-TURP with bladder irrigation. Which finding should
be reported?
A. Output equals irrigant
B. Bladder spasms
C. Viscous output with clots
D. Urge to urinate
Correct Answer: C. Viscous output with clots
Rationale: Clots suggest arterial bleeding, an emergency. Step-by-step: Equal output (A),
spasms (B), and urge (D) are expected.
5. A nurse administers lactated Ringer’s at 200 mL/hr with 10 drops/mL tubing. How
many drops/min? (Round to nearest whole number.)
A. 10
B. 22
C. 33
D. 44
Correct Answer: C. 33
Rationale: (200 × 10) ÷ 60 = 33.33, rounded to 33.
6. A nurse cares for a client with diabetes insipidus. Which medication is appropriate?
A. Furosemide
B. Desmopressin
C. Lisinopril
D. Metformin
Correct Answer: B. Desmopressin
Rationale: Desmopressin reduces urine output. Step-by-step: Furosemide (A) is a di-
uretic, lisinopril (C) an ACE inhibitor, metformin (D) for diabetes mellitus.
7. A nurse reviews CSF for bacterial meningitis. Which finding is expected?
A. Elevated glucose
B. Elevated protein
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, Study Guide NGN ATI Med-Surg Exam 2024
C. RBCs in CSF
D. Decreased WBCs
Correct Answer: B. Elevated protein
Rationale: Meningitis causes high protein, low glucose, high WBCs. RBCs (C) suggest
bleeding.
8. A nurse teaches a client on ranitidine for peptic ulcer. Which instruction is correct?
A. “Take at bedtime to prevent ulcers.”
B. “Take on an empty stomach.”
C. “Expect a metallic taste.”
D. “Avoid antacids within 1 hour.”
Correct Answer: B. “Take on an empty stomach.”
Rationale: Ranitidine is effective on an empty stomach. Antacids (D) are compatible,
metallic taste (C) is uncommon.
9. A nurse monitors a blood transfusion client with bounding pulses, hypertension, and
JVD. Which medication is anticipated?
A. Diphenhydramine
B. Furosemide
C. Epinephrine
D. Acetaminophen
Correct Answer: B. Furosemide
Rationale: Fluid overload requires furosemide. Diphenhydramine (A) for allergies, epinephrine
(C) for anaphylaxis, acetaminophen (D) for fever.
10. A nurse cares for a client 12 hours post-colon resection. Which finding should be
reported?
A. Abdominal distension
B. Bowel sounds
C. Flatus
D. Soft abdomen
Correct Answer: A. Abdominal distension
Rationale: Distension suggests ileus or obstruction. Bowel sounds (B), flatus (C), and
soft abdomen (D) are normal.
11. A nurse assesses a client with COPD. Which finding indicates worsening condition?
A. SpO2 90%
B. Barrel chest
C. Use of accessory muscles
D. Pursed-lip breathing
Correct Answer: C. Use of accessory muscles
Rationale: Accessory muscle use indicates respiratory distress. Barrel chest (B) and
pursed-lip breathing (D) are chronic; SpO2 90% (A) is borderline.
12. A nurse administers insulin lispro. When should the meal be served?
A. Immediately
B. 30 minutes later
C. 1 hour later
D. 2 hours later
Correct Answer: A. Immediately
Rationale: Lispro peaks in 15–30 minutes, requiring immediate food intake.
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