ATI Med-Surg Proctored Actual Exam 2025 (V1 & V2)
200 NGN Questions with Detailed Rationales. 100% Verified Answers. 2025/2026
1.
A client with chronic heart failure is admitted with 3+ pitting edema in the legs, crackles in both
lower lung fields, and dyspnea at rest. The nurse notes a serum sodium of 128 mEq/L.
Which provider prescription should the nurse implement first?
A. Administer furosemide 40 mg IV push
B. Place the client on a fluid restriction
C. Draw blood for a BNP level
C
D. Monitor daily weight
Correct answer: A. Administer furosemide 40 mg IV push
LE
Rationale: This client is experiencing fluid volume overload with hyponatremia due to dilutional
effect. Immediate diuresis is required to reduce pulmonary edema and improve oxygenation.
Fluid restriction and weight monitoring are important but secondary. BNP level helps in
ST
diagnosis but is not the first life-saving step.
2.
BE
A client who is 4 hours postoperative following abdominal surgery suddenly develops shortness
of breath and sharp chest pain. The nurse notes SpO₂ 84% on room air and tachycardia 132 bpm.
Which is the nurse’s priority intervention?
A. Encourage the use of an incentive spirometer
B. Apply oxygen via non-rebreather mask
C. Notify the healthcare provider immediately
D. Prepare for IV morphine administration
Correct answer: B. Apply oxygen via non-rebreather mask
Rationale: Sudden dyspnea and chest pain postoperatively suggests pulmonary embolism.
Oxygen therapy is the immediate priority to prevent hypoxemia while preparing for further
,interventions such as anticoagulation. Pain relief and provider notification follow after oxygen is
applied.
3.
A client with chronic kidney disease (CKD) reports numbness, tingling, and muscle cramps. Lab
results show K⁺ 6.3 mEq/L and ECG with peaked T waves.
Which medication should the nurse anticipate administering first?
A. Sodium polystyrene sulfonate (Kayexalate)
B. IV calcium gluconate
C. Regular insulin IV with 50% dextrose
D. Furosemide IV
Correct answer: B. IV calcium gluconate
C
Rationale: Severe hyperkalemia with ECG changes can cause ventricular arrhythmias or cardiac
LE
arrest. IV calcium stabilizes myocardial cells immediately, reducing the risk of fatal arrhythmias.
Insulin and Kayexalate lower serum potassium but act slower.
ST
4.
A client with pneumonia is receiving IV vancomycin. The nurse notices redness and flushing of
the neck, chest, and face during the infusion.
BE
What is the nurse’s best initial action?
A. Stop the infusion immediately and call the provider
B. Slow the infusion rate and monitor closely
C. Administer diphenhydramine IV push
D. Flush the IV with normal saline
Correct answer: B. Slow the infusion rate and monitor closely
Rationale: This is likely Red Man Syndrome, a histamine reaction caused by rapid vancomycin
infusion, not a true allergy. Slowing the rate usually resolves symptoms. If symptoms worsen or
respiratory compromise occurs, then the infusion is stopped and the provider notified.
5.
,A client with cholelithiasis develops sudden severe right upper quadrant pain radiating to the
back, nausea, and vomiting after a high-fat meal.
Which diagnostic test will best confirm the suspected complication?
A. Abdominal ultrasound
B. CT scan of the abdomen
C. Serum amylase and lipase
D. ERCP (Endoscopic retrograde cholangiopancreatography)
Correct answer: A. Abdominal ultrasound
Rationale: RUQ pain after fatty meals suggests acute cholecystitis or gallstone obstruction.
Ultrasound is the first-line, noninvasive test to detect gallstones and duct dilation. Amylase/lipase
help assess pancreatitis, and ERCP is both diagnostic and therapeutic but more invasive.
C
6.
LE
A client with type 1 diabetes is found diaphoretic, shaky, and confused. Blood glucose is
52 mg/dL.
Which action should the nurse take first?
ST
A. Give 4 oz orange juice
B. Administer 1 mg glucagon IM
C. Notify the provider
BE
D. Recheck blood glucose in 15 minutes
Correct answer: A. Give 4 oz orange juice
Rationale: The client is symptomatic with mild hypoglycemia and is alert enough to swallow.
Providing fast-acting carbohydrate orally (juice) is the first action. Rechecking should follow 15
minutes after intervention. Glucagon is reserved for unconscious clients or inability to swallow.
7.
A client with heart failure is taking furosemide. This morning’s labs show K⁺ of 3.0 mEq/L, and
the ECG reveals flattened T waves.
Which action should the nurse prioritize?
A. Administer prescribed digoxin
, B. Offer banana slices
C. Arrange for potassium replacement
D. Restrict potassium intake
Correct answer: C. Arrange for potassium replacement
Rationale: Loop diuretics can cause hypokalemia, increasing risk for cardiac arrhythmias.
Serum K⁺ level of 3.0 along with ECG changes signals urgent need for repletion, before starting
medications like digoxin.
8.
A client on IV ceftriaxone for pneumonia reports ringing in the ears (tinnitus) and labs show
creatinine of 2.1 mg/dL.
What is the nurse’s next step?
C
A. Document and continue the infusion
B. Stop the infusion and notify provider
C. Offer antipyretics
LE
D. Slow the infusion rate
ST
Correct answer: B. Stop the infusion and notify provider
Rationale: Ototoxicity and nephrotoxicity are serious adverse effects of ceftriaxone. Tinnitus
and rising creatinine require immediate reevaluation of therapy to prevent permanent damage.
BE
9.
A client with liver cirrhosis and ascites is SOB and at rest.
Which intervention offers immediate respiratory relief?
A. Encourage ambulation
B. High Fowler’s position
C. Abdomen warm compress application
D. 500 mL fluid bolus
Correct answer: B. High Fowler’s position
Rationale: Supine positioning worsens diaphragmatic compression by ascitic fluid. Elevating
the upper body facilitates lung expansion and improves oxygenation.
200 NGN Questions with Detailed Rationales. 100% Verified Answers. 2025/2026
1.
A client with chronic heart failure is admitted with 3+ pitting edema in the legs, crackles in both
lower lung fields, and dyspnea at rest. The nurse notes a serum sodium of 128 mEq/L.
Which provider prescription should the nurse implement first?
A. Administer furosemide 40 mg IV push
B. Place the client on a fluid restriction
C. Draw blood for a BNP level
C
D. Monitor daily weight
Correct answer: A. Administer furosemide 40 mg IV push
LE
Rationale: This client is experiencing fluid volume overload with hyponatremia due to dilutional
effect. Immediate diuresis is required to reduce pulmonary edema and improve oxygenation.
Fluid restriction and weight monitoring are important but secondary. BNP level helps in
ST
diagnosis but is not the first life-saving step.
2.
BE
A client who is 4 hours postoperative following abdominal surgery suddenly develops shortness
of breath and sharp chest pain. The nurse notes SpO₂ 84% on room air and tachycardia 132 bpm.
Which is the nurse’s priority intervention?
A. Encourage the use of an incentive spirometer
B. Apply oxygen via non-rebreather mask
C. Notify the healthcare provider immediately
D. Prepare for IV morphine administration
Correct answer: B. Apply oxygen via non-rebreather mask
Rationale: Sudden dyspnea and chest pain postoperatively suggests pulmonary embolism.
Oxygen therapy is the immediate priority to prevent hypoxemia while preparing for further
,interventions such as anticoagulation. Pain relief and provider notification follow after oxygen is
applied.
3.
A client with chronic kidney disease (CKD) reports numbness, tingling, and muscle cramps. Lab
results show K⁺ 6.3 mEq/L and ECG with peaked T waves.
Which medication should the nurse anticipate administering first?
A. Sodium polystyrene sulfonate (Kayexalate)
B. IV calcium gluconate
C. Regular insulin IV with 50% dextrose
D. Furosemide IV
Correct answer: B. IV calcium gluconate
C
Rationale: Severe hyperkalemia with ECG changes can cause ventricular arrhythmias or cardiac
LE
arrest. IV calcium stabilizes myocardial cells immediately, reducing the risk of fatal arrhythmias.
Insulin and Kayexalate lower serum potassium but act slower.
ST
4.
A client with pneumonia is receiving IV vancomycin. The nurse notices redness and flushing of
the neck, chest, and face during the infusion.
BE
What is the nurse’s best initial action?
A. Stop the infusion immediately and call the provider
B. Slow the infusion rate and monitor closely
C. Administer diphenhydramine IV push
D. Flush the IV with normal saline
Correct answer: B. Slow the infusion rate and monitor closely
Rationale: This is likely Red Man Syndrome, a histamine reaction caused by rapid vancomycin
infusion, not a true allergy. Slowing the rate usually resolves symptoms. If symptoms worsen or
respiratory compromise occurs, then the infusion is stopped and the provider notified.
5.
,A client with cholelithiasis develops sudden severe right upper quadrant pain radiating to the
back, nausea, and vomiting after a high-fat meal.
Which diagnostic test will best confirm the suspected complication?
A. Abdominal ultrasound
B. CT scan of the abdomen
C. Serum amylase and lipase
D. ERCP (Endoscopic retrograde cholangiopancreatography)
Correct answer: A. Abdominal ultrasound
Rationale: RUQ pain after fatty meals suggests acute cholecystitis or gallstone obstruction.
Ultrasound is the first-line, noninvasive test to detect gallstones and duct dilation. Amylase/lipase
help assess pancreatitis, and ERCP is both diagnostic and therapeutic but more invasive.
C
6.
LE
A client with type 1 diabetes is found diaphoretic, shaky, and confused. Blood glucose is
52 mg/dL.
Which action should the nurse take first?
ST
A. Give 4 oz orange juice
B. Administer 1 mg glucagon IM
C. Notify the provider
BE
D. Recheck blood glucose in 15 minutes
Correct answer: A. Give 4 oz orange juice
Rationale: The client is symptomatic with mild hypoglycemia and is alert enough to swallow.
Providing fast-acting carbohydrate orally (juice) is the first action. Rechecking should follow 15
minutes after intervention. Glucagon is reserved for unconscious clients or inability to swallow.
7.
A client with heart failure is taking furosemide. This morning’s labs show K⁺ of 3.0 mEq/L, and
the ECG reveals flattened T waves.
Which action should the nurse prioritize?
A. Administer prescribed digoxin
, B. Offer banana slices
C. Arrange for potassium replacement
D. Restrict potassium intake
Correct answer: C. Arrange for potassium replacement
Rationale: Loop diuretics can cause hypokalemia, increasing risk for cardiac arrhythmias.
Serum K⁺ level of 3.0 along with ECG changes signals urgent need for repletion, before starting
medications like digoxin.
8.
A client on IV ceftriaxone for pneumonia reports ringing in the ears (tinnitus) and labs show
creatinine of 2.1 mg/dL.
What is the nurse’s next step?
C
A. Document and continue the infusion
B. Stop the infusion and notify provider
C. Offer antipyretics
LE
D. Slow the infusion rate
ST
Correct answer: B. Stop the infusion and notify provider
Rationale: Ototoxicity and nephrotoxicity are serious adverse effects of ceftriaxone. Tinnitus
and rising creatinine require immediate reevaluation of therapy to prevent permanent damage.
BE
9.
A client with liver cirrhosis and ascites is SOB and at rest.
Which intervention offers immediate respiratory relief?
A. Encourage ambulation
B. High Fowler’s position
C. Abdomen warm compress application
D. 500 mL fluid bolus
Correct answer: B. High Fowler’s position
Rationale: Supine positioning worsens diaphragmatic compression by ascitic fluid. Elevating
the upper body facilitates lung expansion and improves oxygenation.
