ATI RN ADULT MED SURG PROCTORED EXAM
Next Generation NCLEX (NGN) Master Comprehensive Study Guide & Item Analysis
VERIFIED NCLEX STANDARD NGN CLINICAL JUDGMENT DETAILED RATIONALES
90+ 100% NGN
EXAM QUESTIONS COVERED VERIFIED CORRECT ANSWERS CASE STUDIES & HOTSPOTS INCLUDED
SECTION 1: NEXT GENERATION NCLEX (NGN) CASE STUDIES & BOWTIE
MODELS
Question 1: NGN Clinical Case — Older Adult Behavioral & Cognitive Assessment
A nurse is caring for an older adult client accompanied by their adult child. Highlight findings that require immediate
nurse follow-up.
NURSES' NOTES & FINDINGS:
0945: Adult child reports cognitive/physical decline, memory loss, appetite loss, and self-care deficit. Child states: "I
found the title to the car today, signed over to me." Client makes poor eye contact, monotone voice, lack of facial
expression. Sleeping 7 hr/night. Reports not wanting to eat; weight loss of 8 lb in past month. HR 68/min.
1030: Client found sitting in waiting room, head in hands: "Why don't you just leave me? I am of no use."
Correct Findings to Highlight / Immediate Follow-Up:
• Car title signed over to adult child (Giving away prized personal possessions — acute warning sign
of impending suicide).
• Poor eye contact, monotone voice, lack of facial expression (Flat affect, severe major depression).
• Not wanting to eat / 8 lb weight loss in past month (Significant anorexia/unintentional weight loss
secondary to severe depression).
• Statement: "Why don't you just leave me? I am of no use." (Direct expression of worthlessness,
hopelessness, and potential suicidal ideation).
Rationale: Older adults are at high risk for suicide, especially when presenting with sudden major life changes, giving
away personal belongings, anorexia with rapid weight loss, flat affect, and verbalizing statements of worthlessness.
Immediate safety assessment and 1-on-1 suicide precautions are required.
Question 2: Safe Medication Timing — Vancomycin IV Administration
A nurse is preparing to administer vancomycin IV to an adult client. The client asks if the medication can be given 2
hours earlier. Which statement should the nurse make?
Correct Answer:
"I can start the medication 30 minutes earlier."
Rationale: Standard medication administration guidelines allow a window of 30 minutes before or after the scheduled
time for time-critical medications like vancomycin to maintain therapeutic trough and peak serum levels and prevent
toxicity or undertreatment.
ATI RN Adult Med Surg Proctored Exam NGN — Complete Study Guide Page 1 of 16
, Question 3: Organ Donation Screening — Living Kidney Donor Contraindications
A nurse is caring for a client with end-stage kidney disease (ESKD). The client's adult child asks about becoming a
living donor. Which condition in the child's medical history is a contraindication?
Correct Answer:
Hypertension
Rationale: Hypertension increases the donor's long-term risk of developing renal failure after living donation. Living
donors must have intact renal function and no pre-existing systemic vascular disease or hypertension that compromises
solitary kidney function post-donation.
Question 4: NGN Clinical Diagram — Postoperative Deep Vein Thrombosis (DVT) Management
A 75-year-old client is 2 days post-op following a hysterectomy. The client presents with unilateral right lower
extremity swelling, warmth, and pain below the knee (pain scale 2/10). Client refused SCDs earlier due to
discomfort. Complete the clinical decision model.
Correct Clinical Decision Structure:
• Most Likely Condition: Deep Vein Thrombosis (DVT)
• 2 Actions to Take:
1. Request a prescription for a duplex venous ultrasound / Doppler flow study.
2. Elevate the affected extremity and maintain bed rest (avoid massaged leg).
• 2 Parameters to Monitor:
1. D-dimer and platelet count / Coagulation profile (aPTT / PT / INR).
2. Signs of bleeding after anticoagulant initiation (e.g., hematuria, melena, ecchymosis).
Rationale: Unilateral extremity edema, warmth, and localized pain post-surgery strongly indicate DVT. Venous Doppler
confirms diagnosis. Anticoagulation is started; monitoring coagulation parameters and bleeding is mandatory. Massage
is strictly contraindicated to prevent pulmonary embolism.
Question 5: Client Teaching — Preoperative Learning in Older Adults
A nurse is providing preoperative teaching to an older adult client scheduled for surgery. Which action should the
nurse take to promote learning?
Correct Answer:
Connect new information with the client's past experiences.
Rationale: Adult learning principles (andragogy) state that older adults retain new information best when linked to prior
life experiences. Written materials should use 14-point font or larger, avoid abstract concepts, and normal conversational
tones should be used unless hearing impairment is documented.
Question 6: Nursing Ethics & Advocacy — Suspected Elder Abuse Assessment
A nurse is admitting an older adult client who has pressure ulcers on the coccyx and abrasions around both wrists.
Which action should the nurse take to address suspected elder abuse?
Correct Answer:
Privately interview the client about the injuries.
Rationale: When elder abuse or neglect is suspected, the initial action is to interview the client privately without family or
caregivers present to avoid intimidation and allow honest disclosure before mandatory reporting procedures are initiated.
ATI RN Adult Med Surg Proctored Exam NGN — Complete Study Guide Page 2 of 16
, SECTION 2: ENDOCRINE, METABOLIC & GASTROINTESTINAL SYSTEMS
Question 7: Cushing's Syndrome Clinical Manifestations
A nurse is assessing a client who has Cushing's syndrome. Which finding should the nurse expect?
Correct Answer:
Osteoporosis (along with moon face, buffalo hump, purple striae, muscle wasting, hyperglycemia, and
hypernatremia).
Question 8: Basal Cell Carcinoma Assessment
A nurse is inspecting the skin of a client with basal cell carcinoma. Which lesion characteristic should the nurse
identify?
Correct Answer:
A pearly, waxy nodule with central crater or rolled borders.
Question 9: Chvostek's Sign Assessment for Hypocalcemia
In which facial area should the nurse tap to detect Chvostek's sign?
Correct Answer:
Tap the client's cheek just in front of the ear and below the zygomatic arch (facial nerve).
Rationale: Tapping the facial nerve causes facial muscle twitching in hypocalcemia due to neuromuscular excitability.
Question 10: Diuretic Overuse & Hyponatremia Lab Finding
A client overusing prescribed diuretics presents with a sodium level of 127 mEq/L. Which lab finding is expected?
Correct Answer:
Low urine specific gravity (dilute urine excretion).
Question 11: Type 1 Diabetes Mellitus New Diagnosis Manifestation
A nurse is caring for a client newly diagnosed with type 1 diabetes. Which finding indicates type 1 DM?
Correct Answer:
Ketones in the urine (ketonuria secondary to fat breakdown for energy in insulin absence).
Question 12: Type 1 Diabetes Mellitus Health Promotion & Exercise
A client with type 1 diabetes is learning about exercise management. Which statement shows understanding?
Correct Answer:
"I will check my blood sugar level before exercising."
ATI RN Adult Med Surg Proctored Exam NGN — Complete Study Guide Page 3 of 16
Next Generation NCLEX (NGN) Master Comprehensive Study Guide & Item Analysis
VERIFIED NCLEX STANDARD NGN CLINICAL JUDGMENT DETAILED RATIONALES
90+ 100% NGN
EXAM QUESTIONS COVERED VERIFIED CORRECT ANSWERS CASE STUDIES & HOTSPOTS INCLUDED
SECTION 1: NEXT GENERATION NCLEX (NGN) CASE STUDIES & BOWTIE
MODELS
Question 1: NGN Clinical Case — Older Adult Behavioral & Cognitive Assessment
A nurse is caring for an older adult client accompanied by their adult child. Highlight findings that require immediate
nurse follow-up.
NURSES' NOTES & FINDINGS:
0945: Adult child reports cognitive/physical decline, memory loss, appetite loss, and self-care deficit. Child states: "I
found the title to the car today, signed over to me." Client makes poor eye contact, monotone voice, lack of facial
expression. Sleeping 7 hr/night. Reports not wanting to eat; weight loss of 8 lb in past month. HR 68/min.
1030: Client found sitting in waiting room, head in hands: "Why don't you just leave me? I am of no use."
Correct Findings to Highlight / Immediate Follow-Up:
• Car title signed over to adult child (Giving away prized personal possessions — acute warning sign
of impending suicide).
• Poor eye contact, monotone voice, lack of facial expression (Flat affect, severe major depression).
• Not wanting to eat / 8 lb weight loss in past month (Significant anorexia/unintentional weight loss
secondary to severe depression).
• Statement: "Why don't you just leave me? I am of no use." (Direct expression of worthlessness,
hopelessness, and potential suicidal ideation).
Rationale: Older adults are at high risk for suicide, especially when presenting with sudden major life changes, giving
away personal belongings, anorexia with rapid weight loss, flat affect, and verbalizing statements of worthlessness.
Immediate safety assessment and 1-on-1 suicide precautions are required.
Question 2: Safe Medication Timing — Vancomycin IV Administration
A nurse is preparing to administer vancomycin IV to an adult client. The client asks if the medication can be given 2
hours earlier. Which statement should the nurse make?
Correct Answer:
"I can start the medication 30 minutes earlier."
Rationale: Standard medication administration guidelines allow a window of 30 minutes before or after the scheduled
time for time-critical medications like vancomycin to maintain therapeutic trough and peak serum levels and prevent
toxicity or undertreatment.
ATI RN Adult Med Surg Proctored Exam NGN — Complete Study Guide Page 1 of 16
, Question 3: Organ Donation Screening — Living Kidney Donor Contraindications
A nurse is caring for a client with end-stage kidney disease (ESKD). The client's adult child asks about becoming a
living donor. Which condition in the child's medical history is a contraindication?
Correct Answer:
Hypertension
Rationale: Hypertension increases the donor's long-term risk of developing renal failure after living donation. Living
donors must have intact renal function and no pre-existing systemic vascular disease or hypertension that compromises
solitary kidney function post-donation.
Question 4: NGN Clinical Diagram — Postoperative Deep Vein Thrombosis (DVT) Management
A 75-year-old client is 2 days post-op following a hysterectomy. The client presents with unilateral right lower
extremity swelling, warmth, and pain below the knee (pain scale 2/10). Client refused SCDs earlier due to
discomfort. Complete the clinical decision model.
Correct Clinical Decision Structure:
• Most Likely Condition: Deep Vein Thrombosis (DVT)
• 2 Actions to Take:
1. Request a prescription for a duplex venous ultrasound / Doppler flow study.
2. Elevate the affected extremity and maintain bed rest (avoid massaged leg).
• 2 Parameters to Monitor:
1. D-dimer and platelet count / Coagulation profile (aPTT / PT / INR).
2. Signs of bleeding after anticoagulant initiation (e.g., hematuria, melena, ecchymosis).
Rationale: Unilateral extremity edema, warmth, and localized pain post-surgery strongly indicate DVT. Venous Doppler
confirms diagnosis. Anticoagulation is started; monitoring coagulation parameters and bleeding is mandatory. Massage
is strictly contraindicated to prevent pulmonary embolism.
Question 5: Client Teaching — Preoperative Learning in Older Adults
A nurse is providing preoperative teaching to an older adult client scheduled for surgery. Which action should the
nurse take to promote learning?
Correct Answer:
Connect new information with the client's past experiences.
Rationale: Adult learning principles (andragogy) state that older adults retain new information best when linked to prior
life experiences. Written materials should use 14-point font or larger, avoid abstract concepts, and normal conversational
tones should be used unless hearing impairment is documented.
Question 6: Nursing Ethics & Advocacy — Suspected Elder Abuse Assessment
A nurse is admitting an older adult client who has pressure ulcers on the coccyx and abrasions around both wrists.
Which action should the nurse take to address suspected elder abuse?
Correct Answer:
Privately interview the client about the injuries.
Rationale: When elder abuse or neglect is suspected, the initial action is to interview the client privately without family or
caregivers present to avoid intimidation and allow honest disclosure before mandatory reporting procedures are initiated.
ATI RN Adult Med Surg Proctored Exam NGN — Complete Study Guide Page 2 of 16
, SECTION 2: ENDOCRINE, METABOLIC & GASTROINTESTINAL SYSTEMS
Question 7: Cushing's Syndrome Clinical Manifestations
A nurse is assessing a client who has Cushing's syndrome. Which finding should the nurse expect?
Correct Answer:
Osteoporosis (along with moon face, buffalo hump, purple striae, muscle wasting, hyperglycemia, and
hypernatremia).
Question 8: Basal Cell Carcinoma Assessment
A nurse is inspecting the skin of a client with basal cell carcinoma. Which lesion characteristic should the nurse
identify?
Correct Answer:
A pearly, waxy nodule with central crater or rolled borders.
Question 9: Chvostek's Sign Assessment for Hypocalcemia
In which facial area should the nurse tap to detect Chvostek's sign?
Correct Answer:
Tap the client's cheek just in front of the ear and below the zygomatic arch (facial nerve).
Rationale: Tapping the facial nerve causes facial muscle twitching in hypocalcemia due to neuromuscular excitability.
Question 10: Diuretic Overuse & Hyponatremia Lab Finding
A client overusing prescribed diuretics presents with a sodium level of 127 mEq/L. Which lab finding is expected?
Correct Answer:
Low urine specific gravity (dilute urine excretion).
Question 11: Type 1 Diabetes Mellitus New Diagnosis Manifestation
A nurse is caring for a client newly diagnosed with type 1 diabetes. Which finding indicates type 1 DM?
Correct Answer:
Ketones in the urine (ketonuria secondary to fat breakdown for energy in insulin absence).
Question 12: Type 1 Diabetes Mellitus Health Promotion & Exercise
A client with type 1 diabetes is learning about exercise management. Which statement shows understanding?
Correct Answer:
"I will check my blood sugar level before exercising."
ATI RN Adult Med Surg Proctored Exam NGN — Complete Study Guide Page 3 of 16
