Approved ATI RN Adult Medical Surgical
2023 Actual & Retake Proctored Exam with
NGN 100 Clear Questions to Pass Level 3 RN
ATI Adult Med-Surg 2023–2025 Proctored
Exam with NGN
1. A nurse is caring for a client with COPD who has an arterial blood gas
(ABG) result of pH 7.30, PaCO2 58, HCO3 24. Which of the following should
the nurse anticipate?
A. Administer sodium bicarbonate
B. Prepare for mechanical ventilation
C. Increase oxygen flow rate to 6 L/min
D. Administer IV fluids rapidly
Rationale: The ABG shows respiratory acidosis (pH < 7.35, PaCO2 > 45). In
COPD, the primary drive to breathe is hypoxemia (not CO2). Administering
high-flow oxygen can eliminate the hypoxic drive, causing respiratory arrest.
The appropriate action is to prepare for non-invasive positive pressure
ventilation (BiPAP) or mechanical ventilation if the patient is fatigued.
Sodium bicarbonate is not indicated for respiratory acidosis; it is used for
metabolic acidosis. IV fluids do not correct ventilation issues.
2. A nurse is assessing a client 6 hours post-thoracentesis. Which finding
indicates a complication?
A. Serous drainage on the dressing
B. Pain at the insertion site rated 3/10
,C. Tracheal deviation to the unaffected side
D. Slight decrease in respiratory rate
Rationale: Tracheal deviation to the unaffected side indicates a tension
pneumothorax, a life-threatening complication of thoracentesis. The
trachea is pushed away from the affected side due to pressure buildup.
Serous drainage and mild pain are expected. A decrease in respiratory rate
is not a sign of pneumothorax; tachypnea and dyspnea are.
3. A client with a chest tube has continuous bubbling in the water seal
chamber. What is the nurse's priority action?
A. Clamp the chest tube near the insertion site
B. Check the system for an air leak
C. Increase the suction pressure
D. Document the finding as normal
Rationale: Continuous bubbling in the water seal chamber indicates an air
leak (either in the patient or the system). The nurse should assess the
system for leaks (tightening connections). Clamping is contraindicated as
it can lead to tension pneumothorax. Suction pressure is regulated by the
amount of suction, not by bubbling in the water seal (which should be
intermittent/tidaling). Continuous bubbling is not normal.
4. A nurse is teaching a client about using an incentive spirometer. Which
instruction is correct?
A. Exhale forcefully into the mouthpiece
B. Inhale quickly and deeply
C. Hold the breath for 2 to 3 seconds after inhalation
D. Use the device every 8 hours
Rationale: The goal of incentive spirometry is to prevent atelectasis. The
client should inhale slowly and deeply to open alveoli, then hold their breath
for 2-3 seconds to allow oxygen exchange. Exhaling forcefully is wrong
(you exhale normally). Inhaling quickly does not open alveoli effectively. It
should be used every 1-2 hours while awake, not every 8 hours.
,5. A client is admitted with a pulmonary embolism. Which lab value is most
indicative of this condition?
A. Elevated D-dimer
B. Elevated BNP
C. Decreased PT/INR
D. Increased hemoglobin
Rationale: D-dimer is a fibrin degradation product. It is elevated in the
presence of a thrombus (clot) and is sensitive for PE/DVT, though not
specific. BNP indicates heart failure. PT/INR would be elevated if the
patient is on anticoagulants, not decreased. Hemoglobin is generally
normal unless chronic bleeding.
6. A nurse is caring for a client with status asthmaticus. Which assessment
finding indicates impending respiratory failure?
A. Productive cough with green sputum
B. Expiratory wheezing audible without a stethoscope
C. Absence of wheezing with decreased breath sounds
D. Heart rate of 100/min
Rationale: The "silent chest" (absence of wheezing with poor air movement)
is a sign of severe bronchospasm and impending respiratory failure. It
indicates that air flow is so diminished that wheezing cannot be heard.
Loud wheezing indicates airflow, although obstructed. Tachycardia is
expected; "silent chest" is the red flag.
7. A client requires 2 L/min of oxygen via nasal cannula. The nurse
recognizes this delivery method provides approximately what FiO2?
A. 24%
B. 28%
C. 35%
D. 44%
, Rationale: Nasal cannula delivers 24% to 44% FiO2 depending on flow rate
(1L = 24%, 2L = 28%, 3L = 32%, 4L = 36%, 5L = 40%, 6L = 44%). The formula
is approx 4% increase per liter.
8. A nurse is assessing a client with tuberculosis. Which manifestation is
expected?
A. Weight gain
B. Night sweats and hemoptysis
C. High fever with bradycardia
D. Productive cough with clear sputum
Rationale: Classic TB symptoms include night sweats, fever, weight loss,
and hemoptysis (bloody sputum). Bradycardia is not associated;
tachycardia is. Weight loss is common, not gain. Sputum is often purulent
or blood-tinged, not clear.
9. A client is being discharged with home oxygen. Which safety teaching is
essential?
A. "Store oxygen tanks horizontally."
B. "You may use petroleum-based lotions on your face."
C. "Post 'No Smoking' signs in the home."
D. "Keep oxygen near the stove for warmth."
Rationale: Oxygen supports combustion. Smoking is the number one
contraindication. Petroleum products (Vaseline) should be avoided
because they are flammable and can ignite near oxygen. Tanks should be
stored upright and away from heat sources.
10. A client is diagnosed with pneumonia. Which finding indicates the need
for immediate intubation?
A. Fever of 102°F
B. Oxygen saturation 88% on 15 L non-rebreather
C. Coarse crackles in lung bases
D. White blood cell count 15,000
2023 Actual & Retake Proctored Exam with
NGN 100 Clear Questions to Pass Level 3 RN
ATI Adult Med-Surg 2023–2025 Proctored
Exam with NGN
1. A nurse is caring for a client with COPD who has an arterial blood gas
(ABG) result of pH 7.30, PaCO2 58, HCO3 24. Which of the following should
the nurse anticipate?
A. Administer sodium bicarbonate
B. Prepare for mechanical ventilation
C. Increase oxygen flow rate to 6 L/min
D. Administer IV fluids rapidly
Rationale: The ABG shows respiratory acidosis (pH < 7.35, PaCO2 > 45). In
COPD, the primary drive to breathe is hypoxemia (not CO2). Administering
high-flow oxygen can eliminate the hypoxic drive, causing respiratory arrest.
The appropriate action is to prepare for non-invasive positive pressure
ventilation (BiPAP) or mechanical ventilation if the patient is fatigued.
Sodium bicarbonate is not indicated for respiratory acidosis; it is used for
metabolic acidosis. IV fluids do not correct ventilation issues.
2. A nurse is assessing a client 6 hours post-thoracentesis. Which finding
indicates a complication?
A. Serous drainage on the dressing
B. Pain at the insertion site rated 3/10
,C. Tracheal deviation to the unaffected side
D. Slight decrease in respiratory rate
Rationale: Tracheal deviation to the unaffected side indicates a tension
pneumothorax, a life-threatening complication of thoracentesis. The
trachea is pushed away from the affected side due to pressure buildup.
Serous drainage and mild pain are expected. A decrease in respiratory rate
is not a sign of pneumothorax; tachypnea and dyspnea are.
3. A client with a chest tube has continuous bubbling in the water seal
chamber. What is the nurse's priority action?
A. Clamp the chest tube near the insertion site
B. Check the system for an air leak
C. Increase the suction pressure
D. Document the finding as normal
Rationale: Continuous bubbling in the water seal chamber indicates an air
leak (either in the patient or the system). The nurse should assess the
system for leaks (tightening connections). Clamping is contraindicated as
it can lead to tension pneumothorax. Suction pressure is regulated by the
amount of suction, not by bubbling in the water seal (which should be
intermittent/tidaling). Continuous bubbling is not normal.
4. A nurse is teaching a client about using an incentive spirometer. Which
instruction is correct?
A. Exhale forcefully into the mouthpiece
B. Inhale quickly and deeply
C. Hold the breath for 2 to 3 seconds after inhalation
D. Use the device every 8 hours
Rationale: The goal of incentive spirometry is to prevent atelectasis. The
client should inhale slowly and deeply to open alveoli, then hold their breath
for 2-3 seconds to allow oxygen exchange. Exhaling forcefully is wrong
(you exhale normally). Inhaling quickly does not open alveoli effectively. It
should be used every 1-2 hours while awake, not every 8 hours.
,5. A client is admitted with a pulmonary embolism. Which lab value is most
indicative of this condition?
A. Elevated D-dimer
B. Elevated BNP
C. Decreased PT/INR
D. Increased hemoglobin
Rationale: D-dimer is a fibrin degradation product. It is elevated in the
presence of a thrombus (clot) and is sensitive for PE/DVT, though not
specific. BNP indicates heart failure. PT/INR would be elevated if the
patient is on anticoagulants, not decreased. Hemoglobin is generally
normal unless chronic bleeding.
6. A nurse is caring for a client with status asthmaticus. Which assessment
finding indicates impending respiratory failure?
A. Productive cough with green sputum
B. Expiratory wheezing audible without a stethoscope
C. Absence of wheezing with decreased breath sounds
D. Heart rate of 100/min
Rationale: The "silent chest" (absence of wheezing with poor air movement)
is a sign of severe bronchospasm and impending respiratory failure. It
indicates that air flow is so diminished that wheezing cannot be heard.
Loud wheezing indicates airflow, although obstructed. Tachycardia is
expected; "silent chest" is the red flag.
7. A client requires 2 L/min of oxygen via nasal cannula. The nurse
recognizes this delivery method provides approximately what FiO2?
A. 24%
B. 28%
C. 35%
D. 44%
, Rationale: Nasal cannula delivers 24% to 44% FiO2 depending on flow rate
(1L = 24%, 2L = 28%, 3L = 32%, 4L = 36%, 5L = 40%, 6L = 44%). The formula
is approx 4% increase per liter.
8. A nurse is assessing a client with tuberculosis. Which manifestation is
expected?
A. Weight gain
B. Night sweats and hemoptysis
C. High fever with bradycardia
D. Productive cough with clear sputum
Rationale: Classic TB symptoms include night sweats, fever, weight loss,
and hemoptysis (bloody sputum). Bradycardia is not associated;
tachycardia is. Weight loss is common, not gain. Sputum is often purulent
or blood-tinged, not clear.
9. A client is being discharged with home oxygen. Which safety teaching is
essential?
A. "Store oxygen tanks horizontally."
B. "You may use petroleum-based lotions on your face."
C. "Post 'No Smoking' signs in the home."
D. "Keep oxygen near the stove for warmth."
Rationale: Oxygen supports combustion. Smoking is the number one
contraindication. Petroleum products (Vaseline) should be avoided
because they are flammable and can ignite near oxygen. Tanks should be
stored upright and away from heat sources.
10. A client is diagnosed with pneumonia. Which finding indicates the need
for immediate intubation?
A. Fever of 102°F
B. Oxygen saturation 88% on 15 L non-rebreather
C. Coarse crackles in lung bases
D. White blood cell count 15,000
