ATI RN Medical-Surgical (Med-Surg) Proctored Exam | NGN Practice
Questions with Answers & Rationales | Comprehensive Study Guide
2026-2028
QUESTION 1
A nurse is caring for a client who has just returned from the PACU following a right total
knee arthroplasty. Which finding requires immediate intervention?
A) Pain level 6/10 on a 0-10 scale
B) Right foot is pale and cool with diminished pulses
C) Urinary output of 40 mL in the past hour
D) Temperature of 99.0°F (37.2°C)
ANSWER: B) Right foot is pale and cool with diminished pulses
Rationale: Pale, cool extremity with diminished pulses indicates potential vascular
compromise, which is a surgical emergency. This could indicate arterial occlusion,
compartment syndrome, or graft failure requiring immediate intervention. Pain (A) is
expected post-op but should be managed. Urinary output (C) of 40 mL/hr is adequate (30
mL/hr minimum). Temperature (D) is slightly elevated but not concerning immediately
post-op.
QUESTION 2
A client with chronic kidney disease has a serum potassium of 6.8 mEq/L. Which ECG
finding would the nurse anticipate?
,A) U waves
B) Prolonged PR interval
C) ST depression
D) Tall, peaked T waves
ANSWER: D) Tall, peaked T waves
Rationale: Hyperkalemia (K+ > 5.0 mEq/L) produces tall, peaked T waves as an early and
characteristic ECG change. U waves (A) are associated with hypokalemia. Prolonged PR (B)
can occur in both but is not the classic finding. ST depression (C) is associated with
myocardial ischemia or digitalis toxicity.
QUESTION 3
A nurse is providing discharge teaching to a client with a new colostomy. Which
statement by the client indicates a need for further teaching?
A) "I will change the appliance when it starts to leak"
B) "I can eat most foods, but I should chew them well"
C) "I will change the pouch in the morning before eating"
D) "I will avoid foods that cause gas like beans and cabbage"
ANSWER: A) "I will change the appliance when it starts to leak"
Rationale: The client should change the appliance before it leaks to prevent skin
breakdown. Changing at the first sign of leakage is reactive rather than proactive.
,Changing the pouch in the morning before eating is correct (B) because the stoma is less
active. Chewing food well and avoiding gas-forming foods are appropriate teaching
points.
QUESTION 4
A client is 24 hours post-myocardial infarction and is on strict bed rest. The nurse
assesses the client and notes crackles in the lung bases, jugular venous distention, and
peripheral edema. Which complication should the nurse suspect?
A) Cardiac tamponade
B) Pulmonary embolism
C) Heart failure
D) Ventricular aneurysm
ANSWER: C) Heart failure
Rationale: Crackles, JVD, and peripheral edema indicate fluid overload and heart failure, a
common complication post-MI due to impaired left ventricular function. Cardiac
tamponade (A) presents with muffled heart sounds and hypotension. Pulmonary embolism
(B) causes sudden dyspnea, chest pain, and hypoxia. Ventricular aneurysm (D) may
present with persistent ST elevation and arrhythmias.
QUESTION 5
A client is receiving IV heparin for treatment of a deep vein thrombosis. The nurse notes
that the aPTT is 95 seconds (normal 25-35 seconds, therapeutic 60-85 seconds). What
should the nurse do first?
, A) Stop the heparin infusion
B) Notify the provider
C) Decrease the infusion rate
D) Assess the client for signs of bleeding
ANSWER: D) Assess the client for signs of bleeding
Rationale: The priority is to assess the client for bleeding before intervening. aPTT >
therapeutic range increases bleeding risk. The nurse should assess for overt bleeding,
check vital signs, and then notify the provider for dose adjustment. Stopping infusion (A)
may be necessary but after assessment.
QUESTION 6
A client with COPD is receiving oxygen at 2 L/min via nasal cannula. The client's oxygen
saturation drops to 85% during ambulation. What should the nurse do?
A) Increase oxygen to 4 L/min and continue ambulation
B) Have the client sit down, rest, and assess oxygen saturation
C) Return the client to bed immediately
D) Decrease oxygen to 1 L/min to avoid CO₂ retention
ANSWER: B) Have the client sit down, rest, and assess oxygen saturation
Rationale: The nurse should have the client sit and rest to allow oxygen saturation to
recover. Increasing oxygen (A) may be needed, but rest is the first step. Returning to bed
Questions with Answers & Rationales | Comprehensive Study Guide
2026-2028
QUESTION 1
A nurse is caring for a client who has just returned from the PACU following a right total
knee arthroplasty. Which finding requires immediate intervention?
A) Pain level 6/10 on a 0-10 scale
B) Right foot is pale and cool with diminished pulses
C) Urinary output of 40 mL in the past hour
D) Temperature of 99.0°F (37.2°C)
ANSWER: B) Right foot is pale and cool with diminished pulses
Rationale: Pale, cool extremity with diminished pulses indicates potential vascular
compromise, which is a surgical emergency. This could indicate arterial occlusion,
compartment syndrome, or graft failure requiring immediate intervention. Pain (A) is
expected post-op but should be managed. Urinary output (C) of 40 mL/hr is adequate (30
mL/hr minimum). Temperature (D) is slightly elevated but not concerning immediately
post-op.
QUESTION 2
A client with chronic kidney disease has a serum potassium of 6.8 mEq/L. Which ECG
finding would the nurse anticipate?
,A) U waves
B) Prolonged PR interval
C) ST depression
D) Tall, peaked T waves
ANSWER: D) Tall, peaked T waves
Rationale: Hyperkalemia (K+ > 5.0 mEq/L) produces tall, peaked T waves as an early and
characteristic ECG change. U waves (A) are associated with hypokalemia. Prolonged PR (B)
can occur in both but is not the classic finding. ST depression (C) is associated with
myocardial ischemia or digitalis toxicity.
QUESTION 3
A nurse is providing discharge teaching to a client with a new colostomy. Which
statement by the client indicates a need for further teaching?
A) "I will change the appliance when it starts to leak"
B) "I can eat most foods, but I should chew them well"
C) "I will change the pouch in the morning before eating"
D) "I will avoid foods that cause gas like beans and cabbage"
ANSWER: A) "I will change the appliance when it starts to leak"
Rationale: The client should change the appliance before it leaks to prevent skin
breakdown. Changing at the first sign of leakage is reactive rather than proactive.
,Changing the pouch in the morning before eating is correct (B) because the stoma is less
active. Chewing food well and avoiding gas-forming foods are appropriate teaching
points.
QUESTION 4
A client is 24 hours post-myocardial infarction and is on strict bed rest. The nurse
assesses the client and notes crackles in the lung bases, jugular venous distention, and
peripheral edema. Which complication should the nurse suspect?
A) Cardiac tamponade
B) Pulmonary embolism
C) Heart failure
D) Ventricular aneurysm
ANSWER: C) Heart failure
Rationale: Crackles, JVD, and peripheral edema indicate fluid overload and heart failure, a
common complication post-MI due to impaired left ventricular function. Cardiac
tamponade (A) presents with muffled heart sounds and hypotension. Pulmonary embolism
(B) causes sudden dyspnea, chest pain, and hypoxia. Ventricular aneurysm (D) may
present with persistent ST elevation and arrhythmias.
QUESTION 5
A client is receiving IV heparin for treatment of a deep vein thrombosis. The nurse notes
that the aPTT is 95 seconds (normal 25-35 seconds, therapeutic 60-85 seconds). What
should the nurse do first?
, A) Stop the heparin infusion
B) Notify the provider
C) Decrease the infusion rate
D) Assess the client for signs of bleeding
ANSWER: D) Assess the client for signs of bleeding
Rationale: The priority is to assess the client for bleeding before intervening. aPTT >
therapeutic range increases bleeding risk. The nurse should assess for overt bleeding,
check vital signs, and then notify the provider for dose adjustment. Stopping infusion (A)
may be necessary but after assessment.
QUESTION 6
A client with COPD is receiving oxygen at 2 L/min via nasal cannula. The client's oxygen
saturation drops to 85% during ambulation. What should the nurse do?
A) Increase oxygen to 4 L/min and continue ambulation
B) Have the client sit down, rest, and assess oxygen saturation
C) Return the client to bed immediately
D) Decrease oxygen to 1 L/min to avoid CO₂ retention
ANSWER: B) Have the client sit down, rest, and assess oxygen saturation
Rationale: The nurse should have the client sit and rest to allow oxygen saturation to
recover. Increasing oxygen (A) may be needed, but rest is the first step. Returning to bed
