ATI RN Adult Medical-Surgical NGN
Proctored Exam 2026/2027 | Med-Surg
Practice Questions, Answers & Exam Prep
ATI RN ADULT MEDICAL-SURGICAL NGN PROCTORED EXAM 2026/2027
Med-Surg Practice Questions, Answers & Exam Prep
DOCUMENT OVERVIEW
• This comprehensive exam contains 200 rigorously developed practice questions
covering all major Adult Medical-Surgical nursing domains, including cardiovascular,
respiratory, gastrointestinal, endocrine, renal, neurological, and musculoskeletal
systems
• Study this material by reviewing each question thoroughly, attempting answers
before checking rationales, and focusing on understanding the clinical reasoning
behind each correct answer to build competency for the NGN exam format
QUESTIONS AND ANSWERS
QUESTION 1
A 68-year-old client presents to the emergency department with acute coronary
syndrome. Which of the following actions should the nurse implement FIRST?
A) Administer oxygen via nasal cannula at 2-4 L/min
B) Establish intravenous access and initiate cardiac monitoring
C) Obtain a 12-lead electrocardiogram
D) Administer aspirin 325 mg orally
E) Notify the physician immediately
,>>> CORRECT ANSWER: B) Establish intravenous access and initiate cardiac
monitoring
RATIONALE: Establishing IV access and initiating cardiac monitoring takes
immediate priority in acute coronary syndrome because it allows for direct
medication administration and continuous assessment of the client's cardiac
rhythm and hemodynamic status. While obtaining an ECG and administering
oxygen are also important interventions, securing IV access and monitoring are
critical first steps that enable all subsequent interventions. Aspirin administration is
important but should follow after IV access is established. Notifying the physician is
appropriate but should not delay these foundational nursing interventions.
QUESTION 2
A client with heart failure is prescribed digoxin. The nurse reviews the client's lab
values and notes a potassium level of 2.8 mEq/L. Which action should the nurse
take?
A) Administer the digoxin as scheduled
B) Hold the digoxin and notify the healthcare provider
C) Administer potassium supplementation without notifying the provider
D) Request an EKG before administering the digoxin
E) Administer the digoxin after giving potassium
>>> CORRECT ANSWER: B) Hold the digoxin and notify the healthcare provider
RATIONALE: Hypokalemia (potassium level <3.5 mEq/L) increases the risk of
digoxin toxicity due to enhanced binding of digoxin to the Na-K-ATPase pump when
potassium is depleted. A potassium level of 2.8 mEq/L is critically low and places
the client at significant risk for digoxin-related arrhythmias and toxicity. The nurse
must hold the digoxin and notify the healthcare provider to allow for appropriate
potassium replacement before digoxin administration. Administering digoxin
,without correcting the electrolyte imbalance puts the client at serious risk for
toxicity-related complications.
QUESTION 3
A 55-year-old client with chronic obstructive pulmonary disease (COPD) is
experiencing an acute exacerbation. Which finding indicates the client is
experiencing hypoxemia?
A) Respiratory rate of 18 breaths/minute
B) Oxygen saturation via pulse oximetry of 91%
C) PaCO2 of 45 mmHg
D) pH of 7.40
E) HCO3 of 24 mEq/L
>>> CORRECT ANSWER: B) Oxygen saturation via pulse oximetry of 91%
RATIONALE: An oxygen saturation of 91% indicates hypoxemia in a client with
COPD. Normal oxygen saturation is 95-100%, and levels below 92% indicate
inadequate oxygenation of the blood. In acute exacerbations of COPD, maintaining
oxygen saturation above 92% is typically the goal. A respiratory rate of 18 is within
normal range (12-20), a PaCO2 of 45 is only slightly elevated, a pH of 7.40 is normal,
and an HCO3 of 24 is normal. The low oxygen saturation is the critical indicator of
hypoxemia requiring intervention.
QUESTION 4
A client admitted with pneumonia has an order for empiric antibiotic therapy.
Which nursing consideration is MOST important when administering the initial
dose?
, A) Document the client's allergy history thoroughly
B) Administer the antibiotic at the exact time ordered regardless of meal intake
C) Assess the client for signs of anaphylaxis after administration
D) Obtain a sputum culture before administering the antibiotic
E) Verify that a lactation assessment has been completed
>>> CORRECT ANSWER: D) Obtain a sputum culture before administering the
antibiotic
RATIONALE: Obtaining a sputum culture BEFORE administering the first dose of
antibiotic is critical to allow for proper identification of the causative organism and
sensitivity testing. Once antibiotics are administered, culture results become
unreliable as the antibiotic begins killing the organism, making identification and
sensitivity testing less accurate or impossible. While assessing for allergies and
signs of anaphylaxis are important nursing responsibilities, obtaining the culture
before the first antibiotic dose is the priority to ensure appropriate organism
identification and treatment guidance. Meal intake does not typically affect empiric
antibiotic administration timing.
QUESTION 5
A 72-year-old client with acute myocardial infarction is receiving thrombolytic
therapy. Which adverse effect should prompt the nurse to stop the infusion and
notify the provider immediately?
A) Elevated troponin levels
B) Intermittent chest pain lasting less than 5 minutes
C) Uncontrolled bleeding from the IV site
D) Mild bradycardia (HR 55 beats/minute)
E) Slight elevation in blood pressure
Proctored Exam 2026/2027 | Med-Surg
Practice Questions, Answers & Exam Prep
ATI RN ADULT MEDICAL-SURGICAL NGN PROCTORED EXAM 2026/2027
Med-Surg Practice Questions, Answers & Exam Prep
DOCUMENT OVERVIEW
• This comprehensive exam contains 200 rigorously developed practice questions
covering all major Adult Medical-Surgical nursing domains, including cardiovascular,
respiratory, gastrointestinal, endocrine, renal, neurological, and musculoskeletal
systems
• Study this material by reviewing each question thoroughly, attempting answers
before checking rationales, and focusing on understanding the clinical reasoning
behind each correct answer to build competency for the NGN exam format
QUESTIONS AND ANSWERS
QUESTION 1
A 68-year-old client presents to the emergency department with acute coronary
syndrome. Which of the following actions should the nurse implement FIRST?
A) Administer oxygen via nasal cannula at 2-4 L/min
B) Establish intravenous access and initiate cardiac monitoring
C) Obtain a 12-lead electrocardiogram
D) Administer aspirin 325 mg orally
E) Notify the physician immediately
,>>> CORRECT ANSWER: B) Establish intravenous access and initiate cardiac
monitoring
RATIONALE: Establishing IV access and initiating cardiac monitoring takes
immediate priority in acute coronary syndrome because it allows for direct
medication administration and continuous assessment of the client's cardiac
rhythm and hemodynamic status. While obtaining an ECG and administering
oxygen are also important interventions, securing IV access and monitoring are
critical first steps that enable all subsequent interventions. Aspirin administration is
important but should follow after IV access is established. Notifying the physician is
appropriate but should not delay these foundational nursing interventions.
QUESTION 2
A client with heart failure is prescribed digoxin. The nurse reviews the client's lab
values and notes a potassium level of 2.8 mEq/L. Which action should the nurse
take?
A) Administer the digoxin as scheduled
B) Hold the digoxin and notify the healthcare provider
C) Administer potassium supplementation without notifying the provider
D) Request an EKG before administering the digoxin
E) Administer the digoxin after giving potassium
>>> CORRECT ANSWER: B) Hold the digoxin and notify the healthcare provider
RATIONALE: Hypokalemia (potassium level <3.5 mEq/L) increases the risk of
digoxin toxicity due to enhanced binding of digoxin to the Na-K-ATPase pump when
potassium is depleted. A potassium level of 2.8 mEq/L is critically low and places
the client at significant risk for digoxin-related arrhythmias and toxicity. The nurse
must hold the digoxin and notify the healthcare provider to allow for appropriate
potassium replacement before digoxin administration. Administering digoxin
,without correcting the electrolyte imbalance puts the client at serious risk for
toxicity-related complications.
QUESTION 3
A 55-year-old client with chronic obstructive pulmonary disease (COPD) is
experiencing an acute exacerbation. Which finding indicates the client is
experiencing hypoxemia?
A) Respiratory rate of 18 breaths/minute
B) Oxygen saturation via pulse oximetry of 91%
C) PaCO2 of 45 mmHg
D) pH of 7.40
E) HCO3 of 24 mEq/L
>>> CORRECT ANSWER: B) Oxygen saturation via pulse oximetry of 91%
RATIONALE: An oxygen saturation of 91% indicates hypoxemia in a client with
COPD. Normal oxygen saturation is 95-100%, and levels below 92% indicate
inadequate oxygenation of the blood. In acute exacerbations of COPD, maintaining
oxygen saturation above 92% is typically the goal. A respiratory rate of 18 is within
normal range (12-20), a PaCO2 of 45 is only slightly elevated, a pH of 7.40 is normal,
and an HCO3 of 24 is normal. The low oxygen saturation is the critical indicator of
hypoxemia requiring intervention.
QUESTION 4
A client admitted with pneumonia has an order for empiric antibiotic therapy.
Which nursing consideration is MOST important when administering the initial
dose?
, A) Document the client's allergy history thoroughly
B) Administer the antibiotic at the exact time ordered regardless of meal intake
C) Assess the client for signs of anaphylaxis after administration
D) Obtain a sputum culture before administering the antibiotic
E) Verify that a lactation assessment has been completed
>>> CORRECT ANSWER: D) Obtain a sputum culture before administering the
antibiotic
RATIONALE: Obtaining a sputum culture BEFORE administering the first dose of
antibiotic is critical to allow for proper identification of the causative organism and
sensitivity testing. Once antibiotics are administered, culture results become
unreliable as the antibiotic begins killing the organism, making identification and
sensitivity testing less accurate or impossible. While assessing for allergies and
signs of anaphylaxis are important nursing responsibilities, obtaining the culture
before the first antibiotic dose is the priority to ensure appropriate organism
identification and treatment guidance. Meal intake does not typically affect empiric
antibiotic administration timing.
QUESTION 5
A 72-year-old client with acute myocardial infarction is receiving thrombolytic
therapy. Which adverse effect should prompt the nurse to stop the infusion and
notify the provider immediately?
A) Elevated troponin levels
B) Intermittent chest pain lasting less than 5 minutes
C) Uncontrolled bleeding from the IV site
D) Mild bradycardia (HR 55 beats/minute)
E) Slight elevation in blood pressure
