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ATI RN MED SURG PROCTORED RETAKE EXAM
(Version 1, 2, & 3) (NGN-Style Questions & Case
Scenario) Actual Qs & Ans to Pass the Exam
Case Study 1 – Postoperative Patient with Pain Management
Scenario: A client is 12 hours postoperative following a colon resection. The client
has a morphine PCA pump. The nurse notes the client is drowsy and has a
respiratory rate of 8 breaths/min.
1. What is the nurse’s priority action?
A) Encourage deep breathing and coughing
B) Administer naloxone immediately
C) Notify the provider and prepare to reduce PCA dose
D) Increase oxygen flow rate
Correct Answer: C) Notify the provider and prepare to reduce PCA dose.
Rationale: Respiratory depression (RR <10) with sedation requires dose
adjustment and close monitoring before naloxone administration. Naloxone is
reserved for severe, life-threatening respiratory depression.
2. The client’s respiratory rate improves after the PCA dose is reduced. Which
finding indicates the client is tolerating the new dose?
A) Pain score 5/10
B) Respiratory rate 12 breaths/min
C) Oxygen saturation 88%
D) Sedation score 4 (very drowsy)
Correct Answer: B) Respiratory rate 12 breaths/min.
Rationale: An RR of 12 is within normal range (12–20). Adequate oxygenation
(SpO₂ ≥90%) and manageable pain are also important, but the priority is safe
respiration.
3. (Select all that apply) Which adverse effects should the nurse monitor for in a
client receiving heparin?
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A) Bleeding gums
B) Bruising
C) Hypertension
D) Thrombocytopenia
E) Hyperkalemia
Correct Answers: A, B, D. Heparin can cause bleeding (bleeding gums, bruising)
and heparin-induced thrombocytopenia (HIT). It does not typically cause
hypertension or hyperkalemia.
Case Study 2 – Digoxin Toxicity
Scenario: A client on digoxin reports nausea, vomiting, and yellow halos in vision.
Heart rate is 48 bpm.
4. What is the nurse’s priority action?
A) Administer digoxin as ordered
B) Hold digoxin and notify the provider
C) Give antiemetics
D) Encourage fluids
Correct Answer: B) Hold digoxin and notify the provider.
Rationale: These are classic signs of digoxin toxicity (nausea, vomiting, visual
disturbances, bradycardia). Digoxin should be withheld immediately.
5. (Matrix) Which statements about digoxin are correct?
A) Digoxin is a cardiac glycoside that increases contractility.
B) Therapeutic digoxin level is 0.5–0.8 ng/mL for heart failure.
C) Hypokalemia increases the risk of digoxin toxicity.
D) Digoxin should be given with a full glass of milk.
Correct Answers: A, B, C.
Rationale: Digoxin increases contractility; the therapeutic range for heart failure
is 0.5–0.8 ng/mL; hypokalemia predisposes to toxicity. Milk does not affect
absorption but is not required.
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Case Study 3 – Furosemide & Electrolyte Imbalance
Scenario: A client receiving furosemide complains of muscle weakness and
cramps.
6. Which laboratory value requires immediate attention?
A) Sodium 140 mEq/L
B) Potassium 2.8 mEq/L
C) Calcium 9.2 mg/dL
D) Magnesium 2.0 mEq/L
Correct Answer: B) Potassium 2.8 mEq/L.
Rationale: Furosemide is a loop diuretic that causes potassium loss. Hypokalemia
(K <3.5) can cause muscle cramps and cardiac arrhythmias.
7. (Multiple-response) Which adverse effects are associated with loop diuretics?
A) Hypokalemia
B) Ototoxicity
C) Hyperglycemia
D) Hypotension
E) Hypercalcemia
Correct Answers: A, B, C, D. Loop diuretics cause hypokalemia, ototoxicity
(especially with rapid IV administration), hyperglycemia, and hypotension.
Hypercalcemia is not a typical adverse effect; thiazides can cause hypercalcemia.
Case Study 4 – Enoxaparin & Thrombocytopenia
Scenario: A client on enoxaparin has a platelet count of 80,000/mm³.
8. What should the nurse do?
A) Continue medication and monitor platelets
B) Hold medication and notify provider
C) Increase dose per protocol
D) Administer vitamin K
Correct Answer: B) Hold medication and notify provider.
Rationale: Thrombocytopenia may indicate heparin-induced thrombocytopenia
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(HIT), which requires immediate discontinuation of all heparin products (including
enoxaparin).
9. (Drag-and-drop) Order the steps for administering subcutaneous enoxaparin
correctly:
A) Clean injection site with alcohol
B) Pinch skin and insert needle at 90°
C) Inject medication slowly without aspiration
D) Remove needle and apply gentle pressure
E) Dispose of needle in sharps container
Correct Order: A → B → C → D → E.
Rationale: Proper technique prevents tissue damage and ensures medication
absorption. Aspiration is not required for subcutaneous heparin/enoxaparin.
Case Study 5 – ACE Inhibitors
Scenario: A client newly started on lisinopril asks about possible side effects.
10. (Select all that apply) Which are common side effects of lisinopril?
A) Persistent dry cough
B) Hyperkalemia
C) Angioedema
D) Bradycardia
E) Hypotension
Correct Answers: A, B, C, E. ACE inhibitors commonly cause cough, hyperkalemia,
angioedema, and hypotension. Bradycardia is not typical.
11. The client reports a dry cough that is bothersome. What should the nurse
recommend?
A) Take the medication with food
B) Switch to an ARB (angiotensin receptor blocker)
C) Increase fluid intake
D) Discontinue the medication immediately
Correct Answer: B) Switch to an ARB.
Rationale: The dry cough is a well-known side effect of ACE inhibitors due to
ATI RN MED SURG PROCTORED RETAKE EXAM
(Version 1, 2, & 3) (NGN-Style Questions & Case
Scenario) Actual Qs & Ans to Pass the Exam
Case Study 1 – Postoperative Patient with Pain Management
Scenario: A client is 12 hours postoperative following a colon resection. The client
has a morphine PCA pump. The nurse notes the client is drowsy and has a
respiratory rate of 8 breaths/min.
1. What is the nurse’s priority action?
A) Encourage deep breathing and coughing
B) Administer naloxone immediately
C) Notify the provider and prepare to reduce PCA dose
D) Increase oxygen flow rate
Correct Answer: C) Notify the provider and prepare to reduce PCA dose.
Rationale: Respiratory depression (RR <10) with sedation requires dose
adjustment and close monitoring before naloxone administration. Naloxone is
reserved for severe, life-threatening respiratory depression.
2. The client’s respiratory rate improves after the PCA dose is reduced. Which
finding indicates the client is tolerating the new dose?
A) Pain score 5/10
B) Respiratory rate 12 breaths/min
C) Oxygen saturation 88%
D) Sedation score 4 (very drowsy)
Correct Answer: B) Respiratory rate 12 breaths/min.
Rationale: An RR of 12 is within normal range (12–20). Adequate oxygenation
(SpO₂ ≥90%) and manageable pain are also important, but the priority is safe
respiration.
3. (Select all that apply) Which adverse effects should the nurse monitor for in a
client receiving heparin?
,2
A) Bleeding gums
B) Bruising
C) Hypertension
D) Thrombocytopenia
E) Hyperkalemia
Correct Answers: A, B, D. Heparin can cause bleeding (bleeding gums, bruising)
and heparin-induced thrombocytopenia (HIT). It does not typically cause
hypertension or hyperkalemia.
Case Study 2 – Digoxin Toxicity
Scenario: A client on digoxin reports nausea, vomiting, and yellow halos in vision.
Heart rate is 48 bpm.
4. What is the nurse’s priority action?
A) Administer digoxin as ordered
B) Hold digoxin and notify the provider
C) Give antiemetics
D) Encourage fluids
Correct Answer: B) Hold digoxin and notify the provider.
Rationale: These are classic signs of digoxin toxicity (nausea, vomiting, visual
disturbances, bradycardia). Digoxin should be withheld immediately.
5. (Matrix) Which statements about digoxin are correct?
A) Digoxin is a cardiac glycoside that increases contractility.
B) Therapeutic digoxin level is 0.5–0.8 ng/mL for heart failure.
C) Hypokalemia increases the risk of digoxin toxicity.
D) Digoxin should be given with a full glass of milk.
Correct Answers: A, B, C.
Rationale: Digoxin increases contractility; the therapeutic range for heart failure
is 0.5–0.8 ng/mL; hypokalemia predisposes to toxicity. Milk does not affect
absorption but is not required.
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Case Study 3 – Furosemide & Electrolyte Imbalance
Scenario: A client receiving furosemide complains of muscle weakness and
cramps.
6. Which laboratory value requires immediate attention?
A) Sodium 140 mEq/L
B) Potassium 2.8 mEq/L
C) Calcium 9.2 mg/dL
D) Magnesium 2.0 mEq/L
Correct Answer: B) Potassium 2.8 mEq/L.
Rationale: Furosemide is a loop diuretic that causes potassium loss. Hypokalemia
(K <3.5) can cause muscle cramps and cardiac arrhythmias.
7. (Multiple-response) Which adverse effects are associated with loop diuretics?
A) Hypokalemia
B) Ototoxicity
C) Hyperglycemia
D) Hypotension
E) Hypercalcemia
Correct Answers: A, B, C, D. Loop diuretics cause hypokalemia, ototoxicity
(especially with rapid IV administration), hyperglycemia, and hypotension.
Hypercalcemia is not a typical adverse effect; thiazides can cause hypercalcemia.
Case Study 4 – Enoxaparin & Thrombocytopenia
Scenario: A client on enoxaparin has a platelet count of 80,000/mm³.
8. What should the nurse do?
A) Continue medication and monitor platelets
B) Hold medication and notify provider
C) Increase dose per protocol
D) Administer vitamin K
Correct Answer: B) Hold medication and notify provider.
Rationale: Thrombocytopenia may indicate heparin-induced thrombocytopenia
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(HIT), which requires immediate discontinuation of all heparin products (including
enoxaparin).
9. (Drag-and-drop) Order the steps for administering subcutaneous enoxaparin
correctly:
A) Clean injection site with alcohol
B) Pinch skin and insert needle at 90°
C) Inject medication slowly without aspiration
D) Remove needle and apply gentle pressure
E) Dispose of needle in sharps container
Correct Order: A → B → C → D → E.
Rationale: Proper technique prevents tissue damage and ensures medication
absorption. Aspiration is not required for subcutaneous heparin/enoxaparin.
Case Study 5 – ACE Inhibitors
Scenario: A client newly started on lisinopril asks about possible side effects.
10. (Select all that apply) Which are common side effects of lisinopril?
A) Persistent dry cough
B) Hyperkalemia
C) Angioedema
D) Bradycardia
E) Hypotension
Correct Answers: A, B, C, E. ACE inhibitors commonly cause cough, hyperkalemia,
angioedema, and hypotension. Bradycardia is not typical.
11. The client reports a dry cough that is bothersome. What should the nurse
recommend?
A) Take the medication with food
B) Switch to an ARB (angiotensin receptor blocker)
C) Increase fluid intake
D) Discontinue the medication immediately
Correct Answer: B) Switch to an ARB.
Rationale: The dry cough is a well-known side effect of ACE inhibitors due to
